WorldWideScience

Sample records for joint conservative care

  1. Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions.

    Science.gov (United States)

    Chakraverty, Robin; Dias, Richard

    2004-12-01

    The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

  2. Joint Venture Modes of Water Conservancy and Hydroelectric Engineering

    Directory of Open Access Journals (Sweden)

    Zhiding Chen

    2013-07-01

    Full Text Available With the long construction period, the giant scope and complex technology, water conservancy and hydroelectric engineering construction has large investment. In the fully competitive water conservancy and hydropower project construction contracting market, it is almost impossible for a company to contract with a water conservancy and hydropower project independently. Therefore, water conservancy and hydropower project construction can be contracted by several construction companies together, to play each company's strengths, lower offer, improve project quality, shorten the construction period and win the competition. In this paper, we started from the definition of Joint Venture, summed up the forms of Joint Venture in water conservancy and hydropower engineering, proposed that the JV modes can be divided into domestic and international union, tight mode, half-tight mode, loose mode, incorporation and consortium. Furthermore, we analyzed the advantages and disadvantages of Joint Venture. Put forward that the JV can relieve the owner from interfacial administrative work, reduce risk of engineering, and raise the success rate of engineering contract, improve the correctness of price and increase the opportunity of project contracting, Learn from other members, enhance technology and management and make full use of idle resources

  3. CT of the temporomandibular joint: The conservative approach

    International Nuclear Information System (INIS)

    Jend, H.H.; Jend-Rossmann, I.; Heller, M.

    1986-01-01

    Until recently, CT investigation of temporomandibular joint (TMJ) disorders has been regarded as a sophisticated procedure. A method of investigation was developed that allows easy evaluation of axial scans. The method was evaluated in a series of 65 joints with arthrographically diagnosed internal derangements. In anterior disk displacement CT findings led to an identical diagnosis in 56 of 65 joints (sensitivity, 86%). In clinically asymptomatic joints investigated for other reasons, only one of 12 showed signs of internal derangement on CT (specificity, 92%). This conservative approach to CT evaluation of internal derangement seems to be as accurate as more sophisticated methods. It is easy to perform, requires no additional manpower or computer time, and has a very good reproducibility

  4. [Conservative therapy of cartilage defects of the upper ankle joint].

    Science.gov (United States)

    Smolenski, U C; Best, N; Bocker, B

    2008-03-01

    Cartilage defects of the upper ankle joint reflect the problem that great force is transmitted and balanced out over a relatively small surface area. As a pathophysiological factor, cartilage-bone contusions play a significant role in the development of cartilage defects of the upper ankle joint. Physiotherapeutic procedures belong to the standard procedures of conservative therapy. The use and selection of the type of therapy is based on empirical considerations and experience and investigations on effectiveness of particular therapies are relatively rare. At present a symptom-oriented therapy of cartilage defects of the upper ankle joint seems to be the most sensible approach. It can be assumed that it makes sense that the symptomatic treatment of cartilage defects or initial stages of arthritis also includes the subsequent symptoms of pain, irritated condition and limited function. This leads to starting points for physiotherapy with respect to pain therapy, optimisation of pressure relationships, avoidance of pressure points, improvement of diffusion and pressure release. In addition to the differential physiotherapeutic findings, the determination of a curative, preventive or rehabilitative procedure is especially important. In physical therapy special importance is placed on a scheduled serial application corresponding to the findings, employing the necessary methods, such as physiotherapy, sport therapy, medical mechanics, manual therapy, massage, electrotherapy and warmth therapy. From this the findings-related therapy is proposed as a practical therapy concept: locomotive apparatus pain therapy, optimisation of pressure relationships, improvement of diffusion and decongestion therapy. Therapy options have been selected base on the current literature and are summarised in tabular form. The art of symptomatic therapy of cartilage defects of the upper ankle joint does not lie in the multitude of sometimes speculative procedures, but in the targeted selection

  5. Bird Habitat Conservation at Various Scales in the Atlantic Coast Joint Venture

    Science.gov (United States)

    Andrew Milliken; Craig Watson; Chuck Hayes

    2005-01-01

    The Atlantic Coast Joint Venture is a partnership focused on the conservation of habitats for migratory birds within the Atlantic Flyway/Atlantic Coast Region from Maine south to Puerto Rico. In order to be effective in planning and implementing conservation in this large and diverse area, the joint venture must work at multiple spatial scales, from the largest ?...

  6. Comprehensive Care For Joint Replacement Model - Provider Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Comprehensive Care for Joint Replacement Model - provider data. This data set includes provider data for two quality measures tracked during an episode of care:...

  7. Help Desk Answers: Surgery vs conservative management for AC joint repair: How do the 2 compare?

    Science.gov (United States)

    Matchin, Bruce; Yee, Bruce; Mott, Timothy

    2016-04-01

    When not considering the grade of acromioclavicular (AC) joint dislocation, both conservative and surgical management lead to positive outcomes, although surgically managed patients require more time out of work.

  8. Conservation caring: measuring the influence of zoo visitors' connection to wildlife on pro-conservation behaviors.

    Science.gov (United States)

    Skibins, Jeffrey C; Powell, Robert B

    2013-01-01

    Zoos in the 21st century are striving to make effective contributions to conservation. Although zoos are extremely popular and host over 600 million visitors worldwide, one challenge zoos face is how to effectively engage visitors and raise awareness and action for conservation. To this end, zoos commonly rely on charismatic megafauna, which have been shown to elicit a connection with zoo visitors. However, little is known about how to measure a connection to a species or how this connection may influence conservation behaviors. This study had two sequential objectives. The first was to develop a scale to measure visitors' connection to a species (Conservation Caring). The second was to investigate the relationship of Conservation Caring to pro-conservation behaviors, following a zoo experience. Pre- (n = 411) and post-visit (n = 452) responses were collected from three sites in order to assess the reliability and validity of a scale to measure Conservation Caring. Structural equation modeling was used to explore the relationship between Conservation Caring and pro-conservation behaviors. Conservation Caring was deemed a valid and reliable scale and was a strong predictor of species oriented behaviors (β = 0.62), for example, "adopting" an animal, but a weak predictor for biodiversity oriented behaviors (β = 0.07), for example, supporting sustainability policies. Results support the role zoos can play in fostering a connection to wildlife and stimulating pro-conservation behaviors. Additionally, visitors connected to a wide array of animals. On the basis of these results, zoos may recruit a wider assemblage of species as potential flagships. © 2013 Wiley Periodicals, Inc.

  9. [Case control study of fractures-dislocations of ankle joint with conservative and operative treatment].

    Science.gov (United States)

    Zhang, Song-Tu; Lin, Yi-Rong; Chen, Lian-Yuan

    2010-10-01

    To compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment. From September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups. All patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

  10. Development of Non-Conservative Joints in Beam Networks for Vibration Energy Flow Analysis

    Directory of Open Access Journals (Sweden)

    Jee-Hun Song

    2007-01-01

    Full Text Available Our work aims to find a general solution for the vibrational energy flow through a plane network of beams on the basis of an energy flow analysis. A joint between two semi-infinite beams are modeled by three sets of springs and dashpots. Thus, the results can incorporate the case of complaint and non-conservative in all the three degrees of freedom. In the cases of finite coupled structures connected at a certain angle, the derived non-conservative joints and developed wave energy equation were applied. The joint properties, the frequency, the coupling angle, and the internal loss factor were changed to evaluate the proposed methods for predicting medium-to-high frequency vibrational energy and intensity distributions.

  11. Taking care of your new hip joint

    Science.gov (United States)

    Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... After you have hip replacement surgery, you will need to be careful how you move your hip, especially for the first few months ...

  12. Taking care of your new knee joint

    Science.gov (United States)

    Knee arthroplasty - precautions; Knee replacement - precautions ... After you have knee replacement surgery , you will need to be careful about how you move your knee, especially for the first few ...

  13. Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.

    Science.gov (United States)

    Ionna, Franco; Amantea, Massimiliano; Mastrangelo, Filiberto; Ballini, Andrea; Maglione, Maria Grazia; Aversa, Corrado; De Cecio, Rossella; Russo, Daniela; Marrelli, Massimo; Tatullo, Marco

    2016-07-01

    Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

  14. Reducing Length of Stay in Total Joint Arthroplasty Care.

    Science.gov (United States)

    Walters, Megan; Chambers, Monique C; Sayeed, Zain; Anoushiravani, Afshin A; El-Othmani, Mouhanad M; Saleh, Khaled J

    2016-10-01

    As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Joint optimization scheduling for water conservancy projects in complex river networks

    Directory of Open Access Journals (Sweden)

    Qin Liu

    2017-01-01

    Full Text Available In this study, we simulated water flow in a water conservancy project consisting of various hydraulic structures, such as sluices, pumping stations, hydropower stations, ship locks, and culverts, and developed a multi-period and multi-variable joint optimization scheduling model for flood control, drainage, and irrigation. In this model, the number of sluice holes, pump units, and hydropower station units to be opened were used as decision variables, and different optimization objectives and constraints were considered. This model was solved with improved genetic algorithms and verified using the Huaian Water Conservancy Project as an example. The results show that the use of the joint optimization scheduling led to a 10% increase in the power generation capacity and a 15% reduction in the total energy consumption. The change in the water level was reduced by 0.25 m upstream of the Yundong Sluice, and by 50% downstream of pumping stations No. 1, No. 2, and No. 4. It is clear that the joint optimization scheduling proposed in this study can effectively improve power generation capacity of the project, minimize operating costs and energy consumption, and enable more stable operation of various hydraulic structures. The results may provide references for the management of water conservancy projects in complex river networks.

  16. Identifying care actions to conserve dignity in end-of-life care.

    Science.gov (United States)

    Brown, Hilary; Johnston, Bridget; Ostlund, Ulrika

    2011-05-01

    Community nurses have a central role in the provision of palliative and end-of-life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity.

  17. Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

    NARCIS (Netherlands)

    Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

    2005-01-01

    Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

  18. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    Science.gov (United States)

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  19. CT morphology and function of the condylar joints after conservative functional treatment of condylar fractures

    International Nuclear Information System (INIS)

    Eberhardt, K.; Sahm, G.

    1990-01-01

    In 8 adult and 13 adolescent individuals who had undergone conservative treatment for condylar fractures 4.2 and 4.5 years earlier, respectively computed tomography was performed. In addition, joint mobility was examined clinically in 18 of these patients. The results of the radiological examination allow discrimination between high-grade and low-grade remodeling and excessive bone formation. With one exception, high-grade remodeling was invariably observed after childhood fractures. In the adult patients new bone formation was rarely observed. Correlation between the mrophologic appearance and joint mobility was detectable only in cases of severely limited function. In the presence of less severe functional lesions, the size of the insertion area of the lateral pterygoid muscle might indicate the degree of functional rehabilitation. The radiological procedure is discussed. (orig.) [de

  20. Conservative treatment of congenital false joint of shin in newborns and infants

    Directory of Open Access Journals (Sweden)

    O. V. Shchokin

    2017-04-01

    Full Text Available Congenital false joint of shin occurs in 1 case per 28 000 - 190 000 live births, but it is hard-to-treat and disabling disease. Objective: Improving treatment outcomes, reducing the number of surgical interventions for the treatment of congenital false joint of shin. Materials and Methods. The method is carried out using staged plaster casts with the gradual correction of deformities. When axis of the leg approximates to the normal one, axial load is added. First, it is done by tapping on the heel. When the child was 7-8 months old he was put on the legs and taught to walk. The plaster bandage is replaced by "Scotch cast" and "soft cast" bandage. The treatment lasted up to reaching of clinical effect – correction of shin deformation and absence of pathological mobility. Clinical effect must be confirmed by roentgenography which must demonstrate filling of false joint zone with bone tissue and restoration of intramedullary canal. During all the period of treating alternate courses of electrophoresis with calcium chloride, medical mud extracts and magnetic therapy are conducted. In the period from 1995 till 2015 in the Regional Zaporizhzhia Children Clinical Hospital 4 children (6 shins aged from 1 to 7 months with false joint of shin were treated using proposed method. Results and discussion. All 4 children (6 shins treated in clinic with proposed conservative method showed filling of false joint zone with bone tissue, restoration of intramedullary canal and significant extension of axis of the shin. The load on the leg in early terms results in compression of bone fragments (as in compression-distraction osteosynthesis, magnetic therapy, electrophoresis with calcium chloride and medical mud extracts promote active functioning of the muscles that improves regional blood supply and improves osteogenesis. Conclusions. Using the proposed method of treatment of congenital false joint of shins in newborns and infants can allow avoiding surgical

  1. Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series.

    Science.gov (United States)

    Vanaclocha, Vicente; Herrera, Juan Manuel; Sáiz-Sapena, Nieves; Rivera-Paz, Marlon; Verdú-López, Francisco

    2018-01-01

    Sacroiliac joint (SIJ) pain is an under-recognized condition. Substantial information supports the safety and effectiveness of SIJ fusion (SIJF). Long-term follow-up after SIJF has not been reported. To determine responses to conservative management (CM), SIJ denervation, and SIJF in patients with SIJ pain unresponsive to CM. Retrospective study with long-term (up to 6 yr) follow-up of 137 patients with SIJ pain seen in an outpatient neurosurgery clinic who received either CM (n = 63), sacroiliac denervation (n = 47), or minimally invasive SIJF (n = 27). At each routine clinic visit, patients completed pain scores and Oswestry Disability Index. Additional data were extracted from medical charts. Patients treated with continued CM had no long-term improvement in pain (mean worsening of 1 point) or disability (mean Oswestry Disability Index worsened by 4-6 points), increased their use of opioids, and had poor long-term work status. SIJF patients had large improvements in SIJ pain (mean 6 points), large improvements in disability (mean 25 points), a decrease in opioid use, and good final work status. Sacroiliac denervation patients had intermediate responses (0-1 and 1-2 points, respectively). In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent long-term clinical responses, with low opioid use and better work status compared to other treatments. Copyright © 2017 by the Congress of Neurological Surgeons

  2. Post-acute care disparities in total joint arthroplasty.

    Science.gov (United States)

    Lan, Roy H; Kamath, Atul F

    2017-09-01

    Understanding the socioeconomic factors that influence hospitalization and post-discharge metrics after joint replacement is important for identifying key areas of improvement in the delivery of orthopaedic care. An institutional administrative data set of 2869 patients from an academic arthroplasty referral center was analyzed to quantify the relationship between socioeconomic factors and post-acute rehabilitation care received, length of stay, and cost of care. The study used International Classification of Disease, ninth edition coding in order to identify cohorts of patients who received joint arthroplasty of the knee and hip between January 2007 and May 2015. The study found that females (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.74-2.46), minorities (OR, 2.11; 95% CI, 1.78-2.51), and non-private insurance holders (OR, 1.56; 95% CI, 1.26-1.94) were more likely to be assigned to institutional care after discharge. The study also found that minorities (OR, 1.45; 95% CI, 1.24-1.70) and non-private insurance holders (OR, 1.43; 95% CI, 1.16-1.77) are more likely to exhibit longer length of stay. Mean charges were higher for males when compared to females ($80,010 vs $74,855; P total costs ($19,910 vs $18,613; P  = .001). Socioeconomic factors such as gender, race, and insurance status should be further explored with respect to healthcare policies seeking to influence quality of care and health outcomes.

  3. Dignity-conserving care actions in palliative care: an integrative review of Swedish research.

    Science.gov (United States)

    Harstäde, Carina Werkander; Blomberg, Karin; Benzein, Eva; Östlund, Ulrika

    2018-03-01

    Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons' dignity is a crucial challenge for professional nurses. The 'Dignity Care Intervention' addresses the multidimensionality of dignity by identifying patients' dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity. An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms 'dignity' and 'palliative care'. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov's model of dignity. Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses' perceptiveness towards the patients was a core approach. The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve

  4. An evaluation of charity care for tax-exempt hospitals engaging in joint ventures.

    Science.gov (United States)

    Smith, Pamela C

    2006-01-01

    The study examines whether the level of charity care and financial stability contribute to a nonprofit hospital's motivation for partnering with a for-profit hospital through a joint venture. The Internal Revenue Service (IRS) has heightened its scrutiny of joint ventures within the health care sector. Considering recent calls to investigate the merit of the tax-exempt status of hospitals engaged in joint ventures, this research will assist policy makers in the evaluation of nonprofit hospitals. Constituents will continue to question whether joint ventures contribute to a reduced focus on charitable activities. Results indicate that the propensity to engage in a joint venture significantly increases with increased levels of charity care. Furthermore, nonprofit hospitals with lower profitability are more likely to engage in joint ventures. These results are useful to policy makers when evaluating the level of charity care provided by hospitals seeking alternative strategic alliances. Considering many critics allege hospitals are reducing the provision of charity care to the community, it is imperative for management to be conscious of the impact of joint ventures on the provision of charity care.

  5. Clinic, hospital try to fulfill vision of coordinated care with joint venture company.

    Science.gov (United States)

    2000-09-01

    Coordinated Care Services Inc., a joint venture of Carle Foundation and Carle Clinic Association in Urbana, IL, shares its initial successes and ongoing challenges after one year of operation. The biggest barrier to further improvements remains insufficient information management capability.

  6. Conservation

    NARCIS (Netherlands)

    Noteboom, H.P.

    1985-01-01

    The IUCN/WWF Plants Conservation Programme 1984 — 1985. World Wildlife Fund chose plants to be the subject of their fund-raising campaign in the period 1984 — 1985. The objectives were to: 1. Use information techniques to achieve the conservation objectives of the Plants Programme – to save plants;

  7. Conservation.

    Science.gov (United States)

    National Audubon Society, New York, NY.

    This set of teaching aids consists of seven Audubon Nature Bulletins, providing the teacher and student with informational reading on various topics in conservation. The bulletins have these titles: Plants as Makers of Soil, Water Pollution Control, The Ground Water Table, Conservation--To Keep This Earth Habitable, Our Threatened Air Supply,…

  8. Health care joint ventures between tax-exempt organizations and for-profit entities.

    Science.gov (United States)

    Sanders, Michael I

    2005-01-01

    Health care exempt organizations have many options regarding their structure and affiliations with for-profit entities. As long as any joint ventures are carefully structured and the nonprofit retains control over the exempt health care activities, the Internal Revenue Service should not question the structure. However, as outlined above, if the for-profit entity effectively gains control over the activities of the venture, the structure is not likely to be upheld by the IRS or the courts, and either the exempt status of the nonprofit will be denied or revoked, or health care income will be subject to the unrelated business income tax. In summary, the health care industry has been severely impacted by many economic forces, including uncertainty in the area of joint ventures between nonprofits and for-profit health care systems. The uncertainty as to whether the joint venture would negatively impact the nonprofit's tax-exempt status undoubtedly caused many nonprofits to form for-profit subsidiaries and otherwise expanded operations in a for-profit marketplace. Fortunately, with the guidance that is currently available in the form of Revenue Ruling 98-15, Redlands, St. David's, and now Revenue Ruling 2004-51, health care institutions can move forward with properly structured joint ventures with greater confidence that the joint venture will not endanger the tax-exempt status of the nonprofit.

  9. Intra-household work timing: the effect on joint activities and the demand for child care

    NARCIS (Netherlands)

    van Klaveren, C.; Maassen van den Brink, H.; van Praag, B.

    2011-01-01

    This study examines whether couples time their work hours and how this work timing influences child care demand and the time that spouses jointly spend on leisure, household chores, and child care. By using an innovative matching strategy, this study identifies the timing of work hours that cannot

  10. Health Care Reform: Impact on Total Joint Replacement.

    Science.gov (United States)

    Chambers, Monique C; El-Othmani, Mouhanad M; Saleh, Khaled J

    2016-10-01

    The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis.

    Science.gov (United States)

    Fantini Pagani, Cynthia H; Willwacher, Steffen; Benker, Rita; Brüggemann, Gert-Peter

    2014-12-01

    Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Controlled laboratory study, repeated measurements. In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle-foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2013.

  12. Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

    Science.gov (United States)

    McLawhorn, Alexander S; Buller, Leonard T

    2017-09-01

    The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

  13. A joint research protocol for music therapy in dementia care

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf

    2011-01-01

    Agitation is a major challenge within institutions of care for the elderly. The effect of music therapy on agitation and quality of live is investigated in a practice-relevant research combined with a Randomized Controlled Trial and multicentre research. The research protocol is developed...... in dialogue with practicing music therapists....

  14. Utilization of Total Joint Arthroplasty in Physician-Owned Specialty Hospitals vs Acute Care Facilities.

    Science.gov (United States)

    Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad

    2017-07-01

    The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Joint principles: Integrating behavioral health care into the patient-centered medical home.

    Science.gov (United States)

    2014-06-01

    The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we aspire. However, there is an element running implicitly through these joint principles that is difficult to achieve yet indispensable to the success of the entire PCMH concept. The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH. Therefore we offer a complementary set of joint principles that recognizes the centrality of behavioral health care as part of the PCMH. This document follows the order and language of the original joint principles while emphasizing what needs to be addressed to insure incorporation of the essential behavioral elements. It is intended to supplement and not replace the original Joint Principles document, which still stands.

  16. FY 1999 report on basic survey project for joint implementations, etc. Feasibility study on energy conservation at Norsi Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    This project is to link in the future to COP3 (Third Session of the Conference of the Parties to the United Nations Framework Convention on Climate Change) joint implementations, etc. Taken up in this survey are a topping unit, vacuum distillation unit, catalytic reforming unit, and a middle cut desulfurization unit. The purpose of the refurbishment is to conserve energy. It is estimated that 48000 TOE/year of energy will be saved and that there will be a 1.2-million tons-CO2/year reduction in greenhouse gas emissions. It is predicted that an amount equivalent to 1.3% of Russia's 1997 oil consumption will be saved across Russia and that there will be a greenhouse gas reduction equivalent to 8.8% of what Japan plans to reduce. The main problem to solve before execution of this project is in the raising of funds. Although Russia hopes that Japan will invest in the project, such at the present stage will be a high-risk venture now that the Russian economic situation and the details (CO2 emission trading, etc.) of its joint implementation framework are not yet definite. The reasonable way for Japan to follow will be to support Russia as a buyer using credits with Russia acting as the principle party. (NEDO)

  17. FY 1999 report on basic survey project for joint implementations, etc. Feasibility study on energy conservation at Norsi Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    This project is to link in the future to COP3 (Third Session of the Conference of the Parties to the United Nations Framework Convention on Climate Change) joint implementations, etc. Taken up in this survey are a topping unit, vacuum distillation unit, catalytic reforming unit, and a middle cut desulfurization unit. The purpose of the refurbishment is to conserve energy. It is estimated that 48000 TOE/year of energy will be saved and that there will be a 1.2-million tons-CO2/year reduction in greenhouse gas emissions. It is predicted that an amount equivalent to 1.3% of Russia's 1997 oil consumption will be saved across Russia and that there will be a greenhouse gas reduction equivalent to 8.8% of what Japan plans to reduce. The main problem to solve before execution of this project is in the raising of funds. Although Russia hopes that Japan will invest in the project, such at the present stage will be a high-risk venture now that the Russian economic situation and the details (CO2 emission trading, etc.) of its joint implementation framework are not yet definite. The reasonable way for Japan to follow will be to support Russia as a buyer using credits with Russia acting as the principle party. (NEDO)

  18. Basic survey for joint implementation, etc. Basic feasibility study on energy conservation at Tadeusz Sendzimir Steelworks

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of reducing greenhouse effect gas emissions, a feasibility study was conducted on the energy conservation at Huta Sendzimir Steelworks in Poland. The study was made on quantity-energy consuming facilities such as blast furnace, sintering plant and steelmaking plant, power plant, by-producing gas, purchased power, etc. Moreover, as to the energy consuming system, surveys were made on the exhaust heat recovery equipment already introduced and energy saving equipment for pig iron/steel making. As a result, it was found out that Huta Sendzimir Steelworks has an ability and experiences for implementation of the energy conservation project with no problems. As methods to save energy in individual production process, the introduction of the following was proposed: pressure recovery turbine of blast furnace, equipment for high temperature stove exhaust heat recovery, sintering cooler exhaust heat recovery, oxygen combustion furnace exhaust gas recovery, etc. By the introduction of these equipment, the reduction amount of greenhouse effect gas emissions per year will be approximately 180,000 ton-CO2. (NEDO)

  19. Basic survey for Joint Implementation on Jinling Petrochemical Corporation, China. Energy conservation project for Nanjing Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of reducing greenhouse effect gas emissions, the basic survey was conducted on potential energy conservation at Nanjing Refinery, Jiangsu Nanjing city, China. Investigational studies were made on the repair of the power recovery system in line with the plan to enlarge the fluid catalytic cracker (FCC) and the power recovery using exhaust gas from the RFCC catalytic regeneration system. Moreover, the energy conservation technology to reduce power loads of the refining system was adopted to this project. As a result, it was found out that this repair plan makes recovery of the power equivalent to 10.6MW possible and produces the effect of reducing the fuel to be used. The realization of this project brings the CO2 reduction amount of approximately 70,000 t/y. It was also found out that this project not only reduces a large amount of greenhouse effect gas emissions, but contributes to profits of the plant concerned and helps improve the environment in the area concerned. For the implementation of this project, the detailed plan is expected to be further discussed. (NEDO)

  20. Conservation and care: material politics and Atlantic salmon on Newfoundland’s Gander River

    Directory of Open Access Journals (Sweden)

    Jennifer Daniels

    2017-11-01

    Full Text Available Abstract This paper aims to contribute to an emerging and vibrant body of post-structural scholarship situated within science technology and society (STS on practices and their role in world making. Our focus is Atlantic salmon conservation in the Canadian province of Newfoundland and Labrador. We examine the different material and social orders that have over time connected human and salmon bodies. These different socio-material orders do not exist in harmony. On the contrary, they are in tension and reflect different visions/versions of how to conserve and care for Atlantic salmon. Our contribution is to interfere with the dominant narrative of Atlantic salmon conservation by drawing on the concept of care, and by introducing a new salmon that we call the willful salmon.

  1. Episode of Care Payments in Total Joint Arthroplasty and Cost Minimization Strategies.

    Science.gov (United States)

    Nwachukwu, Benedict U; O'Donnell, Evan; McLawhorn, Alexander S; Cross, Michael B

    2016-02-01

    Total joint arthroplasty (TJA) is receiving significant attention in the US health care system for cost containment strategies. Specifically, payer organizations have embraced and are implementing bundled payment schemes in TJA. Consequently, hospitals and providers involved in the TJA care cycle have sought to adapt to the new financial pressures imposed by episode of care payment models by analyzing what components of the total "event" of a TJA are most essential to achieve a good outcome after TJA. As part of this review, we analyze and discuss a health economic study by Snow et al. As part of their study, the authors aimed to understand the association between preoperative physical therapy (PT) and post-acute care resource utilization, and its effect on the total cost of care during total joint arthroplasty. The purpose of this current review therefore is to (1) describe and analyze the findings presented by Snow et al. and (2) provide a framework for analyzing and critiquing economic analyses in orthopedic surgery. The study under review, while having important strengths, has several notable limitations that are important to keep in mind when making policy and coverage decisions. We support cautious interpretation and application of study results, and we encourage maintained attention to economic analysis in orthopedics as well as continued care path redesign to maximize value for patients and health care providers.

  2. Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta.

    Science.gov (United States)

    Jones, C Allyson; Martin, Ruben San; Westby, Marie D; Beaupre, Lauren A

    2016-11-04

    Comprehensive and timely rehabilitation for total joint arthroplasty (TJA) is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care. A cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods. Of the 80 respondents, 26 (33 %) stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %), whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %). Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format. Variation of practice reported with pre-and post-operative care in the community will stimulate dialogue within the profession as to what is the minimal

  3. Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating From the Sacroiliac Joint

    Science.gov (United States)

    Dengler, Julius; Duhon, Bradley; Whang, Peter; Frank, Clay; Glaser, John; Sturesson, Bengt; Garfin, Steven; Cher, Daniel; Rendahl, Aaron; Polly, David

    2017-01-01

    Study Design. A pooled patient-level analysis of two multicenter randomized controlled trials and one multicenter single-arm prospective trial. Objective. The aim of this study was to identify predictors of outcome of conservative and minimally invasive surgical management of pain originating from the sacroiliac joint (SIJ). Summary of Background Data. Three recently published prospective trials have shown that minimally invasive SIJ fusion (SIJF) using triangular titanium implants produces better outcomes than conservative management for patients with pain originating from the SIJ. Due to limitations in individual trial sample size, analyses of predictors of treatment outcome were not conducted. Methods. We pooled individual patient data from the three trials and used random effects models with multivariate regression analysis to identify predictors for treatment outcome separately for conservative and minimally invasive surgical treatment. Outcome was measured using visual analogue scale (VAS), Oswestry Disability Index (ODI), and EuroQOL-5D (EQ-5D). Results. We included 423 patients assigned to either nonsurgical management (NSM, n = 97) or SIJF (n = 326) between 2013 and 2015. The reduction in SIJ pain was 37.9 points larger [95% confidence interval (95% CI) 32.5–43.4, P < 0.0001] in the SIJF group than in the NSM group. Similarly, the improvement in ODI was 18.3 points larger (95% CI 14.3–22.4), P < 0.0001). In NSM, we found no predictors of outcome. In SIJF, a reduced improvement in outcome was predicted by smoking (P = 0.030), opioid use (P = 0.017), lower patient age (P = 0.008), and lower duration of SIJ pain (P = 0.028). Conclusions. Our results support the view that SIJF leads to better treatment outcome than conservative management of SIJ pain and that a higher margin of improvement can be predicted in nonsmokers, nonopioid users, and patients of increased age and with longer pain duration. Level of Evidence: 1 PMID

  4. Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.

    Science.gov (United States)

    Karabicak, Gul Oznur; Bek, Nilgun; Tiftikci, Ugur

    2015-10-01

    The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. There was a significant reduction in goniometric measurement of hallux valgus angle (P = .001). There was a significant reduction in pain intensity (P = .001) and AOFAS and Foot Function Index scores at the end of the treatment (P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control (P = .009). For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  5. Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

    Science.gov (United States)

    Tarity, T David; Swall, Marion M

    2017-09-01

    The purpose of this manuscript is to review published literature over the last 5 years to assess recent trends and influencing factors regarding discharge disposition and post-discharge care following total joint arthroplasty. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Surgeons with defined clinical pathways and those who shape patient expectations may more effectively control costs than those without defined pathways. Further research is needed analyzing best practices in care coordination, managing patient expectations, and cost-effective analysis of home discharge while at the same time ensuring patient outcomes are optimized following total joint arthroplasty.

  6. Management of extra-capsular temporo-mandibular joint ankylosis: does conservative approach to treatment have a role?

    Science.gov (United States)

    Anyanechi, C E; Osunde, O D; Bassey, G O

    2015-06-01

    The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients. To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis. This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis. Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome. The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.

  7. Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications.

    Science.gov (United States)

    Inacio, Maria C S; Graves, Stephen E; Pratt, Nicole L; Roughead, Elizabeth E; Nemes, Szilard

    2017-08-01

    100,000; 95% PI, 402-717 per 100,000) compared with 2013 (IR = 437 per 100,000; 95% CI, 397-479 per 100,000) and the volume to increase by 142%. A large increase in the volume of arthroplasties is expected using a conservative projection model that accounts for past surgical trends and future population changes in Australia. These findings have international implications, as they show that using country- specific, conservative projection approaches, a substantial increase in the number of these procedures is expected. This increase in joint arthroplasty volume will require appropriate workforce planning, resource allocation, and budget planning so that demand can be met. Level II, economic and decision analysis.

  8. Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

    Science.gov (United States)

    Pelt, Christopher E; Anderson, Mike B; Erickson, Jill A; Gililland, Jeremy M; Peters, Christopher L

    2018-06-01

    Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described. Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements. Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Self-perceived care needs in older adults with joint pain and comorbidity.

    Science.gov (United States)

    Hermsen, Lotte A H; Hoogendijk, Emiel O; van der Wouden, Johannes C; Smalbrugge, Martin; Leone, Stephanie S; van der Horst, Henriëtte E; Dekker, Joost

    2018-05-01

    The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity. This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support). Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25-4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01-1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07-1.26). Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.

  10. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

    Science.gov (United States)

    Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

    2012-01-01

    There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

  11. Inpatient Consults and Complications During Primary Total Joint Arthroplasty in a Bundled Care Model.

    Science.gov (United States)

    Baumgartner, Billy T; Karas, Vasili; Kildow, Beau J; Cunningham, Daniel J; Klement, Mitchell R; Green, Cindy L; Attarian, David E; Seyler, Thorsten M

    2018-04-01

    The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA. Statistical comparison of episode inpatient events and payments was conducted. Multiple regression analysis was adjusted for length of stay, disposition, and Charlson-Deyo comorbidity profile. Median total payment was $21,577.36, which exceeded the median bundle target payment of $20,625.00. Adjusted analyses showed that psychiatry consults (increase of $73,123.32; P care unit admission ($14,078.37; P care unit admission, and medical/psychiatric consultation exceeded the CMS target. Although study results showed typical complication rates, acute inpatient consultation significantly increased utilization beyond the CMS target even when adjusted for length of stay, patient comorbidities, and discharge. Needed medical care should continue to be a priority for inpatients, and allowance for individual outliers should be considered in policy discussions. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study.

    Science.gov (United States)

    Umapathy, Hema; Bennell, Kim; Dickson, Chris; Dobson, Fiona; Fransen, Marlene; Jones, Graeme; Hunter, David J

    2015-07-07

    Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge for persons with OA regarding the many different treatments available to them. Our objective was to evaluate outcomes after usage of a Web-based resource called My Joint Pain that contains tailored, evidence-based information and tools aimed to improve self-management of OA on self-management and change in knowledge. A quasi-experimental design was used to evaluate the My Joint Pain website intervention over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments, and progress-tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed both baseline and 12-month questionnaires (users: n=104; nonusers: n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity, positive and active engagement in life, emotional distress, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t tests were used to compare changes between groups for the heiQ and chi-square tests to identify changes within and between groups from baseline to 12 months for each OAQI item. Baseline demographics between groups were similar for gender (152/195, 77.9% female), age (mean 60, SD 9 years) and body mass index (mean 31.1, SD 6.8 kg/m(2)). With the exception of health service navigation, mean effect sizes from all other heiQ domains

  13. Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta

    Directory of Open Access Journals (Sweden)

    C. Allyson Jones

    2016-11-01

    Full Text Available Abstract Background Comprehensive and timely rehabilitation for total joint arthroplasty (TJA is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care. Method A cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods. Results Of the 80 respondents, 26 (33 % stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %, whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %. Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format. Conclusions Variation of practice reported with pre-and post-operative care in the community will stimulate

  14. Conservative care for ESRD in the United Kingdom: a national survey.

    Science.gov (United States)

    Okamoto, Ikumi; Tonkin-Crine, Sarah; Rayner, Hugh; Murtagh, Fliss E M; Farrington, Ken; Caskey, Fergus; Tomson, Charles; Loud, Fiona; Greenwood, Roger; O'Donoghue, Donal J; Roderick, Paul

    2015-01-07

    Conservative kidney management (CKM) has been developed in the United Kingdom (UK) as an alternative to dialysis for older patients with stage 5 CKD (CKD5) and multiple comorbidities. This national survey sought to describe the current scale and pattern of delivery of conservative care in UK renal units and identify their priorities for its future development. A survey on practice patterns of CKM for patients age 75 and older with CKD5 was sent to clinical directors of all 71 adult renal units in the UK in March 2013. Sixty-seven units (94%) responded. All but one unit reported providing CKM for some patients. Terminology varied, although "conservative management" was the most frequently used term (46%). Lack of an agreed-upon definition of when a patient is receiving CKM made it difficult to obtain meaningful data on the numbers of such patients. Fifty-two percent provided the number of CKM patients age ≥ 75 years in 2012; the median was 45 per unit (interquartile range [IQR], 20-83). The median number of symptomatic CKM patients who would otherwise have started dialysis was eight (IQR, 4.5-22). CKM practice patterns varied: 35% had a written guideline, 23% had dedicated CKM clinics, 45% had dedicated staff, and 50% provided staff training on CKM. Most units (88%) provided primary care clinicians with information/advice regarding CKM. Eighty percent identified a need for better evidence comparing outcomes on CKM versus dialysis, and 65% considered it appropriate to enter patients into a randomized trial. CKM is provided in almost all UK renal units, but scale and organization vary widely. Lack of common terminology and definitions hinders the development and assessment of CKM. Many survey respondents expressed support for further research comparing outcomes with conservative care versus dialysis. Copyright © 2015 by the American Society of Nephrology.

  15. Motivating conservation: Learning to care for other species in a local ecological community

    Science.gov (United States)

    Laflamme, Michael

    Large-scale, sustainable biodiversity conservation must motivate action by local communities. I united theories and practices in biology and psychology to study the process by which people are motivated to care for other species, and to what extent caring results in helping. Participants (N = 1200), age 8--22, interacted with native fish and aquatic insects in their habitats during 21 field experiences through Lake County, Montana educational institutions. Native fish were chosen because they are familiar to local people, yet different from people in their morphology, biomechanics, and habitat. In Phase I, two activity models for conservation emerged: the Habitat approach linked concepts in ecology, reciprocation, and a moral orientation toward justice, while the Behavior approach linked concepts in behavior, kin selection, and a moral orientation toward caring. These two approaches were compared in Phase II through seven sets of experiences that varied only in point of view: toward the habitat or toward behavior. I found that through sustained contact between people and local fish in their habitats, in the field and in cold-water aquaria, people empathized with fish more than with habitats. They perceived fish states by interpreting their behavior, and created meaning by focusing on fish social interactions with their habitat, with other fish, and with people. They used the information gained from empathy to identify ongoing conservation needs and to design conservation plans. Attention to behavior increased perception of human impacts on fish; perception of relatedness with fish; similarity with the physiology, behavior, minds and lives of fish; desire for non-material benefits in return for helping fish; and cohesion within participant groups. These perceptions varied with age and gender. For example, women and children emphasized values of non-material returns for time invested. This study recommends a behavioral-ecology approach for motivating conservation and

  16. Bridging a divide: architecture for a joint hospital-primary care data warehouse.

    Science.gov (United States)

    An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle

    2015-01-01

    Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.

  17. Decreasing Postanesthesia Care Unit to Floor Transfer Times to Facilitate Short Stay Total Joint Replacements.

    Science.gov (United States)

    Sibia, Udai S; Grover, Jennifer; Turcotte, Justin J; Seanger, Michelle L; England, Kimberly A; King, Jennifer L; King, Paul J

    2018-04-01

    We describe a process for studying and improving baseline postanesthesia care unit (PACU)-to-floor transfer times after total joint replacements. Quality improvement project using lean methodology. Phase I of the investigational process involved collection of baseline data. Phase II involved developing targeted solutions to improve throughput. Phase III involved measured project sustainability. Phase I investigations revealed that patients spent an additional 62 minutes waiting in the PACU after being designated ready for transfer. Five to 16 telephone calls were needed between the PACU and the unit to facilitate each patient transfer. The most common reason for delay was unavailability of the unit nurse who was attending to another patient (58%). Phase II interventions resulted in transfer times decreasing to 13 minutes (79% reduction, P care at other institutions. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  18. Evaluating the Joint Theater Trauma Registry as a data source to benchmark casualty care.

    Science.gov (United States)

    O'Connell, Karen M; Littleton-Kearney, Marguerite T; Bridges, Elizabeth; Bibb, Sandra C

    2012-05-01

    Just as data from civilian trauma registries have been used to benchmark and evaluate civilian trauma care, data contained within the Joint Theater Trauma Registry (JTTR) present a unique opportunity to benchmark combat care. Using the iterative steps of the benchmarking process, we evaluated data in the JTTR for suitability and established benchmarks for 24-hour mortality in casualties with polytrauma and a moderate or severe blunt traumatic brain injury (TBI). Mortality at 24 hours was greatest in those with polytrauma and a severe blunt TBI. No mortality was seen in casualties with polytrauma and a moderate blunt TBI. Secondary insults after TBI, especially hypothermia and hypoxemia, increased the odds of 24-hour mortality. Data contained in the JTTR were found to be suitable for establishing benchmarks. JTTR data may be useful in establishing benchmarks for other outcomes and types of combat injuries.

  19. Factors associated with primary care prescription of opioids for joint pain.

    Science.gov (United States)

    Green, D J; Bedson, J; Blagojevic-Burwell, M; Jordan, K P; van der Windt, D

    2013-02-01

    Opioids are commonly prescribed in primary care and can offer pain relief but may also have adverse effects. Little is known about the characteristics of people likely to receive an opioid prescription in primary care. The aim is to identify what factors are associated with primary care prescribing of high-strength analgesics in a community sample of older people with joint pain. A prospective two-stage postal survey completed at baseline and 3-year follow-up in a population aged 50 and over registered with eight general practitioner (GP) practices in North Staffordshire (North Staffordshire Osteoarthritis Project cohorts) linked with data from medical records. Participants were selected who reported joint pain in one or more joints at baseline. Outcome measures were the number of prescriptions for high-strength pain medication (opioids) in the following 3 years. Socio-demographic and health status factors associated with prescription were assessed using a zero-inflated Poisson model. 873 (19%) people were prescribed opioids (out of 4652 providing complete data) ranging from 1 to 76 prescriptions over 3 years. Baseline factors significantly associated with increased rates of prescription were younger age group [65-74 group: incidence rate ratio (IRR) = 1.26 (1.18-1.35)], male gender [IRR = 1.17 (1.12-1.23)], severe joint pain [IRR = 1.19 (1.12-1.26)] poor physical function [IRR = 0.99 (0.99-0.99)] and lower frequency of alcohol consumption [once/twice a year: IRR = 1.13 (1.06-1.21), never: IRR = 1.14 (1.06-1.22)]. Restricting the analysis to those without prior prescriptions for strong opioids showed similar results. Poor physical function and participation restrictions were strongly associated with prescriptions of stronger opioids in addition to several socio-demographic and lifestyle factors. Given the uncertainties over the effectiveness and risks of opioid use, future research could investigate decision making of GPs, exploring reasons for prescribing them.

  20. Quality of life in older individuals with joint contractures in geriatric care settings.

    Science.gov (United States)

    Heise, Marco; Müller, Martin; Fischer, Uli; Grill, Eva

    2016-09-01

    The purpose of this study was to analyze the association between functioning and disability and quality of life (QoL) in older individuals with joint contractures in the geriatric care setting. More specifically, this study aimed to identify determinants of QoL out of a defined set of contracture-related categories of the International Classification of Functioning, Disability and Health (ICF). Participants for this multicenter cross-sectional survey were recruited from acute geriatric rehabilitation hospitals, nursing homes, and community nursing facilities in Germany between February and October 2013. QoL was assessed using the validated German version of the EQ-5D index score and the EQ-5D visual analog scale (VAS). Manual and automatic variable selection methods were used to identify the most relevant variables out of 125 contracture-related ICF categories. A total of 241 eligible participants (34.9 % male, mean age 80.1 years) were included. The final models contained 14 ICF categories as predictors of the EQ-5D index score and 15 categories as predictors of the EQ-5D VAS. The statistically significant ICF categories from both models were 'muscle power functions (b730),' 'memory functions (b144),' 'taking care of plants (d6505),' 'recreation and leisure (d920),' 'religion and spirituality (d930),' 'drugs (e1101),' and 'products and technology for personal use in daily living (e115).' We identified the most relevant ICF categories for older individuals with joint contractures and their health-related quality of life. These items describe potential determinants of QoL which may provide the basis for future health interventions aiming to improve QoL for the patients with joint contractures.

  1. Health Care Providers' Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia.

    Science.gov (United States)

    Gemeda, Desta Hiko; Sime, Abiot Girma; Hajito, Kifle Woldemichael; Gelalacha, Benti Deresa; Tafese, Wubit; Gebrehiwot, Tsegaye Tewelde

    2016-01-01

    Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02%) health care providers participated in the study. Three hundred sixteen (97.8%) of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2%) of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers' knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance.

  2. Health Care Providers’ Knowledge and Practice Gap towards Joint Zoonotic Disease Surveillance System: Challenges and Opportunities, Gomma District, Southwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Desta Hiko Gemeda

    2016-01-01

    Full Text Available Background. Health care providers play a crucial role for realization of joint zoonotic diseases surveillance by human and animal health sectors, yet there is limited evidence. Hence, this study aimed to determine knowledge and practice gap of health care providers towards the approach for Rabies and Anthrax in Southwest Ethiopia. Methods. A cross-sectional survey was conducted from December 16, 2014, to January 14, 2015. Eligible health care providers were considered for the study. Data were entered in to Epi-data version 3.1 and analyzed using SPSS version 20. Results. A total of 323 (92.02% health care providers participated in the study. Three hundred sixteen (97.8% of participants reported that both human and animal health sectors can work together for zoonotic diseases while 96.9% of them replied that both sectors can jointly conduct surveillance. One hundred seventeen (36.2% of them reported that their respective sectors had conducted joint surveillance for zoonotic diseases. Their involvement was, however, limited to joint outbreak response. Conclusion. There is good opportunity in health care providers’ knowledge even though the practice was unacceptably low and did not address all surveillance components. Therefore, formal joint surveillance structure should be in place for optimal implementation of surveillance.

  3. Prosthetic joint infection: A pluridisciplinary multi-center audit bridging quality of care and outcome.

    Science.gov (United States)

    Roger, P-M; Tabutin, J; Blanc, V; Léotard, S; Brofferio, P; Léculé, F; Redréau, B; Bernard, E

    2015-06-01

    Care to patients with prosthetic joint infections (PJI) is provided after pluridisciplinary collaboration, in particular for complex presentations. Therefore, to carry out an audit in PJI justifies using pluridisciplinary criteria. We report an audit for hip or knee PJI, with emphasis on care homogeneity, length of hospital stay (LOS) and mortality. Fifteen criteria were chosen for quality of care: 5 diagnostic tools, 5 therapeutic aspects, and 5 pluridisciplinary criteria. Among these, 6 were chosen: surgical bacterial samples, surgical strategy, pluridisciplinary discussion, antibiotic treatment, monitoring of antibiotic toxicity, and prevention of thrombosis. They were scored on a scale to 20 points. We included PJI diagnosed between 2010 and 2012 from 6 different hospitals. PJI were defined as complex in case of severe comorbid conditions or multi-drug resistant bacteria, or the need for more than 1 surgery. Eighty-two PJI were included, 70 of which were complex (85%); the median score was 15, with a significant difference among hospitals: from 9 to 17.5 points, P < 0.001. The median LOS was 17 days, and not related to the criterion score; 16% of the patients required intensive care and 13% died. The cure rate was 41%, lost to follow-up 33%, and therapeutic failure 13%. Cure was associated with a higher score than an unfavorable outcome in the univariate analysis (median [range]): 16 [9-18] vs 13 [4-18], P = 0.002. Care to patients with PJI was heterogeneous, our quality criteria being correlated to the outcome. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

    Science.gov (United States)

    Chaudhary, Muhammad Ali; Lange, Jeffrey K; Pak, Linda M; Blucher, Justin A; Barton, Lauren B; Sturgeon, Daniel J; Koehlmoos, Tracey; Haider, Adil H; Schoenfeld, Andrew J

    2018-05-22

    Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%. We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA. An analysis of adult TRICARE beneficiaries who underwent TJA (2006-2014) was performed. TRICARE is the insurance program of the Department of Defense, covering > 9 million beneficiaries. ED use within 90 days of surgery was the primary outcome and postoperative outpatient orthopaedic care the primary explanatory variable. Patient demographics (age, sex, race, beneficiary category), clinical characteristics (length of hospital stay, prior comorbidities, complications), and environment of care were used as covariates. Logistic regression adjusted for all covariates was performed to determine factors associated with ED use. We found that orthopaedic outpatient care (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.77) was associated with lower odds of ED use within 90 days. We also found that index hospital length of stay (OR, 1.07; 95% CI, 1.04-1.10), medical comorbidities (OR, 1.16; 95% CI, 1.08-1.24), and complications (OR, 2.47; 95% CI, 2.24-2.72) were associated with higher odds of ED use. When considering that at 90 days, only 3928 patients sustained a complication, a substantial number of ED visits (11,486 of 15,414 [75%]) after TJA may be avoidable. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after TJA. Further research should be directed toward unpacking the situations, outside of complications, that drive patients to access the ED and devise interventions that could mitigate such behavior. Level III

  5. Joint CARE-ELAN, CARE-HHH-APD, and EUROTEV-WP3 Workshop on Electron Cloud Clearing

    CERN Document Server

    Scandale, Walter; Schulte, D; Zimmermann, F; Electron Cloud Effects and Technological Consequences; ECL2

    2007-01-01

    This report contains the Proceedings of the joint CARE-HHH-APD, CARE-ELAN, and EUROTEV-WP3 Mini-Workshop on 'Electron Cloud Clearing - Electron Cloud and Technical Consequences', "ECL2", held at CERN in Geneva, Switzerland, 1-2 March 2007). The ECL2 workshop explored novel technological remedies against electron-cloud formation in an accelerator beam pipe. A primary motivation for the workshop was the expected harmful electron-cloud effects in the upgraded LHC injectors and in future linear colliders, as well as recent beam observations in operating facilities like ANKA, CESR, KEKB, RHIC, and SPS. The solutions discussed at ECL2 included enamel-based clearing electrodes, slotted vacuum chambers, NEG coating, and grooves. Several of the proposed cures were assessed in terms of their clearing efficiency and the associated beam impedance. The workshop also reviewed new simulation tools like the 3D electron-ion build-up 'Faktor', modeling assumptions, analytical calculations, beam experiments, and laboratory meas...

  6. The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty.

    Science.gov (United States)

    Dy, Christopher J; Marx, Robert G; Ghomrawi, Hassan M K; Pan, Ting Jung; Westrich, Geoffrey H; Lyman, Stephen

    2015-01-01

    Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling. The complication risk was higher (Odds Ratio 1.18 [95% CI: 1.16, 1.20]) if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks. However, patients from vulnerable groups were less likely to utilize these patterns. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

    Science.gov (United States)

    Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

    2017-11-01

    The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    Science.gov (United States)

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  9. A prospective randomized study of conservative versus surgical treatment of unstable palmar plate disruption in the proximal interphalangeal finger joint

    DEFF Research Database (Denmark)

    Werlinrud, Jens Christian; Petersen, Kirstin; Lauritsen, Jens

    2013-01-01

    study in which 83 patients were randomly assigned into 2 groups: (1) conservative treatment with a rigid splint for 2 weeks, (2) surgical reattachment of the palmar plate in local anesthesia followed by 2 weeks of immobilization in a plaster cast. Both groups were thereafter treated by taping...... to the neighboring finger for 3 weeks. With regard to hyperextension instability, stiffness, and pain, there is no significant difference in outcome between patients with traumatic palmar plate lesions and hyperextension instability treated with surgical repair and patients treated conservatively with a splint. We...

  10. Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

    Science.gov (United States)

    Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

    2013-05-01

    In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

  11. Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

    Science.gov (United States)

    Roveron, Gabriele; De Toma, Giorgio; Barbierato, Maria

    2016-01-01

    Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs.

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

    Science.gov (United States)

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

    2017-01-01

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

  13. Primary care physicians' perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study.

    Science.gov (United States)

    Tam-Tham, Helen; Hemmelgarn, Brenda; Campbell, David; Thomas, Chandra; Quinn, Robert; Fruetel, Karen; King-Shier, Kathryn

    2016-01-01

    Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. Our objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD. A sequential exploratory mixed methods design was adopted for this study. The first phase of the study will involve fundamental qualitative description and the second phase will be a cross-sectional population-based survey. The research is conducted in Alberta, Canada. The participants are primary care physicians with experience in providing care for older adults with stage 5 CKD not planning on initiating dialysis. The first objective will be achieved by undertaking interviews with primary care physicians from southern Alberta. Participants will be selected purposively to include physicians with a range of characteristics (e.g., age, gender, and location of clinical practice). Interviews will be recorded, transcribed verbatim, and analyzed using conventional content analysis to generate themes. The second objective will be achieved by undertaking a population-based survey of primary care physicians in Alberta. The questionnaire will be developed based on the findings from the qualitative interviews and pilot tested for face and content validity. Physicians will be provided multiple options to complete the questionnaire including mail, fax, and online methods. Descriptive statistics and associations between demographic factors and barriers and facilitators to

  14. Basic survey project for Joint Implementation, etc. for energy conservation in ethylene production at Yangzi Petrochemical Company

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of reducing greenhouse effect gas emissions, a potential study was conducted of energy conservation in Yangzi Petrochemical Company in Nanking City, China. The project is aimed at realizing energy conservation and reduction in greenhouse effect gas emissions by generating power by installation of gas turbine and by using waste gas as fuel for ethylene cracking furnace. In the project, the following are carried out: introduction of 35MW gas turbine generator, and repairs of fuel burner of ethylene cracking furnace, fuel gas compressor of gas turbine, emergency use air blower, duct, etc. The construction work is to be done in 30 months from April, 2005. The initial investment is approximately 45 million US$. The energy conservation to be brought by this project is 37,958 tons/year, or 759,160 tons in the total project term. Further, the reduction amount of greenhouse effect gas emissions is 117,452 CO2 tons/year, or 2,349,040 CO2 tons in the total project term. (NEDO)

  15. Basic survey project for joint implementation, etc. Basic feasibility study on energy conservation at Karaganda Steelworks, Kazakhstan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    In relation with introducing energy saving facilities in the coke process and steel making process at Karaganda Steelworks consuming a great amount of energy in the Republic of Kazakhstan, surveys and discussions were given by Nippon Steel Corporation. While this steel mill is the only one steel making factory in the Republic of Kazakhstan, even the small-size facilities related to energy conservation and environment protection are not being used because of fund shortage. As a result of the surveys, it was revealed that this steel mill consumes much greater amount of energy per ton of crude steel than in steelworks in Japan, leaving much room for energy conservation. It was also found that achieving the conservation of energies and the reduction of global warming gas emission can be made by introducing the coke dry quenching (CDQ) facilities, coal water content adjusting equipment, and automatic combustion controls into the coke process, introducing the top-pressure recovery turbine (TRT) into the energy process, and introducing the oxygen reduced gas recovery system into the steel making process. However, it was indicated that the investment return is not very attractive because the energy price in the Republic of Kazakhstan is much cheaper than in Japan. (NEDO)

  16. Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing.

    Science.gov (United States)

    Pelt, Christopher E; Anderson, Mike B; Pendleton, Robert; Foulks, Matthew; Peters, Christopher L; Gililland, Jeremy M

    2017-03-01

    An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours. After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed. Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change ( P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change ( P  = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 ( P  = .038) and had longer hospital stays ( P < .001). Early mobilization in the entire cohort was associated with a greater cost savings ( P < .001). A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

  17. Conservative care of De Quervain's tenosynovitis/ tendinopathy in a warehouse worker and recreational cyclist: a case report.

    Science.gov (United States)

    Howell, Emily R

    2012-06-01

    This case study was conducted to evaluate the conservative management of a patient presenting with right sided wrist and thumb pain diagnosed as De Quervain's tenosynovitis/tendinopathy. A 49-year-old female warehouse worker and recreational cyclist with right-sided De Quervain's tenosynovitis/tendinopathy that began after a long-distance cycling trip. Treatment included ultrasound, soft tissue and myofascial release therapy, tool assisted fascial stripping or "guasha", acupuncture, mobilizations and kinesiology taping. Home advice included icing, rest, wrist bracing, elevation and eccentric rehabilitation exercises. The positive outcome was a complete resolution of the patient's complaint. This case demonstrates how De Quervain's disease is a challenging condition to treat with conservative methods and can be aggravated with new exacerbating factors as treatment continues. In this case, the addition of the active care (including eccentric exercises and self-care) helped to reinforce the passive care given in the office and accelerate the recovery.

  18. FY 1999 report on basic survey for joint implementations, etc. Basic feasibility study on energy conservation at Novolipetsk Steelworks

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    The survey involves COP (Conference of the Parties) joint implementations, etc., at the Russian Novolipetsk Steelworks (NLMK) who produces crude steel at 9.9-million tons/year. A large waste heat recovery system is introduced into the NLMK for reduction in natural gas consumption and in electric power purchase. The waste heat recovery facilities involve a sintering cooler/heater, TRT (top-pressure recovery turbine), and LD (Linz-Donawitz) converter gas recovery. Energy will be saved at 1730 Tcal/year, and greenhouse gas (CO2) will be reduced at 408,000 tons/year. A total of 20.9 times 1-billion yen needs to be invested. Since energy is priced low in Russia, the investment will result in but a little economic effect. In the Russian industrial circle, however, there is a move to raise the energy price by stages to secure corporation operating funds and refurbish obsolete facilities. Accordingly, probabilities are quite high that the project proposed here will be implemented if low-interest financing is available. Talks will continue between the two parties over yen credit availability, etc. It is indispensable to construct a framework which will enable implementations in compliance with COP3 (Third Session of the Conference of the Parties to the United Nations Framework Convention on Climate Change). (NEDO)

  19. Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

    Science.gov (United States)

    Zaforteza, Concha; Gastaldo, Denise; Moreno, Cristina; Bover, Andreu; Miró, Rosa; Miró, Margalida

    2015-12-01

    This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained. © 2015 John Wiley & Sons Ltd.

  20. Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review.

    Science.gov (United States)

    Siddiqi, Ahmed; White, Peter B; Mistry, Jaydev B; Gwam, Chukwuweike U; Nace, James; Mont, Michael A; Delanois, Ronald E

    2017-08-01

    In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models. A literature search was performed using PubMed and the CMMSIC to explore different APMs and clinical results after implementation. All studies that were not in English or unrelated to the topic were excluded. Preliminary results of bundled payment models have shown reduced costs in total joint arthroplasty largely by reducing hospital length of stay, decreasing readmission rates, as well as reducing the number of patients sent to in-patient rehabilitation facilities. In order to refine episode of care bundles, CMMSIC has also developed other initiatives such as the Comprehensive Care for Joint Replacement (CJR) pathway and Surgical Hip and Femur Fracture (SHFFT). Despite the unknown future of the Affordable Care Act, BPCI, and CJR, preliminary results of alternative models have shown promise to reduce costs and improve quality of care. Moving into the future, surgeon control of the BPCI and CJR bundle should be investigated to further improve patient care and maximize financial compensation. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Delivery of integrated diabetes care using logistics and information technology--the Joint Asia Diabetes Evaluation (JADE) program.

    Science.gov (United States)

    Chan, Juliana C N; Ozaki, Risa; Luk, Andrea; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C; Wong, Patrick; Wong, Rebecca; Chung, Harriet; Chiu, Cherry; Wolthers, Troels; Tong, Peter C Y; Ko, Gary T C; So, Wing-Yee; Lyubomirsky, Greg

    2014-12-01

    Diabetes is a global epidemic, and many affected individuals are undiagnosed, untreated, or uncontrolled. The silent and multi-system nature of diabetes and its complications, with complex care protocols, are often associated with omission of periodic assessments, clinical inertia, poor treatment compliance, and care fragmentation. These barriers at the system, patient, and care-provider levels have resulted in poor control of risk factors and under-usage of potentially life-saving medications such as statins and renin-angiotensin system inhibitors. However, in the clinical trial setting, use of nurses and protocol with frequent contact and regular monitoring have resulted in marked differences in event rates compared to epidemiological data collected in the real-world setting. The phenotypic heterogeneity and cognitive-psychological-behavioral needs of people with diabetes call for regular risk stratification to personalize care. Quality improvement initiatives targeted at patient education, task delegation, case management, and self-care promotion had the largest effect size in improving cardio-metabolic risk factors. The Joint Asia Diabetes Evaluation (JADE) program is an innovative care prototype that advocates a change in clinic setting and workflow, coordinated by a doctor-nurse team and augmented by a web-based portal, which incorporates care protocols and a validated risk engine to provide decision support and regular feedback. By using logistics and information technology, supported by a network of health-care professionals to provide integrated, holistic, and evidence-based care, the JADE Program aims to establish a high-quality regional diabetes database to reflect the status of diabetes care in real-world practice, confirm efficacy data, and identify unmet needs. Through collaborative efforts, we shall evaluate the feasibility, acceptability, and cost-effectiveness of this "high tech, soft touch" model to make diabetes and chronic disease care more

  2. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    services. This association was sustained after adjusting for comorbidities, demographic characteristics, and procedural variables. Health-care providers can use this methodology to achieve an integrative, cost-effective, patient care pathway using preoperative physical therapy. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

  3. Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

    Science.gov (United States)

    Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

    2015-11-01

    Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources. ©2015 The British Editorial Society of Bone & Joint Surgery.

  4. Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

    Science.gov (United States)

    Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

    2016-12-07

    In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and

  5. Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

    Science.gov (United States)

    Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

    2018-01-01

    Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

  6. Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home".

    Science.gov (United States)

    Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J

    2014-06-01

    Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

  7. Report of fiscal 1999 basic survey for joint implementation, etc. Basic survey on energy conservation at Severstal Steelworks in Russian Federation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    This paper explains fiscal 1999 survey on energy conservation at Severstal Steelworks in Russian Federation for the purpose of materializing the COP3 joint implementation, etc. With the crude steel production capacity of about 8.8 million tons/year, this works has established a leading position in Russia as a manufacturer of flat-rolled steel products. Introduced as energy-saving measures are reduction in fuel consumption by modification of sintering machine ignition furnaces, recovery of sinter cooler waste heat for use in electricity generation, LD converter gas recovery, and installation of top pressure recovery turbines (recovering top pressure in the form of electricity). Expected energy saving effect is 969.2, 739.4, 4.18 x 10{sup 3}, and 815TJ/year for each case respectively. Expected greenhouse gas reduction effect is 54,100, 41,273, 2.3x10{sup 5}, and 44,198t-CO2/year respectively. Profitability was examined. With the total investment of 104.5 million yen, Return on investment (ROI) is each 0.33, 0.81, 1.83, and 0.86 or 4.3 in total. In conclusion, the investment recovery period was unacceptable. In order to materialize this project, a favorable financing is necessary such as yen funding by the Japanese Government. Also, on the part of the Steelworks, reduction in the equipment cost for example need to be examined. (NEDO)

  8. Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System

    Science.gov (United States)

    Costa, Ediná Alves; Araújo, Patrícia Sodré; Pereira, Marcelo Tavares; Souto, Ana Cristina; Souza, Gisélia Santana; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

    2017-01-01

    ABSTRACT OBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of

  9. Flexible parents: joint effects of handicapping and brood size manipulation on female parental care in Nicrophorus vespilloides.

    Science.gov (United States)

    Ratz, Tom; Smiseth, Per T

    2018-02-22

    Parental care is highly variable, reflecting that parents make flexible decisions in response to variation in the cost of care to themselves and the benefit to their offspring. Much of the evidence that parents respond to such variation derives from handicapping and brood size manipulations, the separate effects of which are well understood. However, little is known about their joint effects. Here, we fill this gap by conducting a joint handicapping and brood size manipulation in the burying beetle Nicrophorus vespilloides. We handicapped half of the females by attaching a lead weight to their pronotum, leaving the remaining females as controls. We also manipulated brood size by providing each female with 5, 20 or 40 larvae. In contrast to what we predicted, handicapped females spent more time provisioning food than controls. We also found that handicapped females spent more time consuming carrion. Furthermore, handicapped females spent a similar amount of time consuming carrion regardless of brood size, whereas controls spent more time consuming carrion as brood increased. Females spent more time provisioning food towards larger broods, and females were more likely to engage in carrion consumption when caring for larger broods. We conclude that females respond to both handicapping and brood size manipulations, but these responses are largely independent of each other. Overall, our results suggest that handicapping might lead to a higher investment into current reproduction and that it might be associated with compensatory responses that negate the detrimental impact of higher cost of care in handicapped parents. © 2018 Crown copyright. Journal of Evolutionary Biology © 2018 European Society For Evolutionary Biology This article is published with the permission of the Controller of HMSO and the Queen’s Printer for Scotland. Note: some government agencies may require additional wording and acknowledgement.

  10. A Joint Force Medical Command is Required to Fix Combat Casualty Care

    Science.gov (United States)

    2017-10-05

    DISTRIBUTION STATEMENT: A Approved for Public Release Distribution is Unlimited The views expressed herein are those of the author(s) and do not...MHS) is required to provide medical operational forces for military and contingency operations while also providing services that maintain a healthy...provide timely support of joint forcible entry or other contingencies requiring rapid response. Further, the complexity and cost of the beneficiary

  11. Joint Instability and Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Darryl Blalock

    2015-01-01

    Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

  12. Joint instability and osteoarthritis.

    Science.gov (United States)

    Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

    2015-01-01

    Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

  13. Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

    Science.gov (United States)

    Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

    2015-01-01

    In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

  14. Language Differences as a Barrier to Quality and Safety in Health Care: The Joint Commission Perspective

    OpenAIRE

    Schyve, Paul M.

    2007-01-01

    Effective communication with patients is critical to the safety and quality of care. Barriers to this communication include differences in language, cultural differences, and low health literacy. Evidence-based practices that reduce these barriers must be integrated into, rather than just added to, health care work processes.

  15. The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

    Science.gov (United States)

    Chimento, George F; Thomas, Leslie C

    2017-09-01

    The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

  16. Report of fiscal 1999 basic survey for joint implementation, etc. Feasibility study on energy conservation and reduction of CO2 emission at Omsk Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    This paper explains fiscal 1999 survey on energy conservation and reduction of CO2 at Omsk Refinery in the Russian Federation for the purpose of making the project tied to the COP3 joint implementation. This refinery is the largest class refinery in Russia having a capacity of 600,000 BPSD. The atmospheric distillation unit AVT-10, which emits 470,000 t-CO2/year, was selected for the object of the survey. As the modification plans, optimization of process system, modification of waste heat boiler and installation of new furnaces were considered. The plans 1, 2 are possible due to their low investment costs. The plan 3 to install new furnaces is able to reduce the large volume of CO2 emission though its investment cost is higher. For each modification plan, estimation was made for the investment cost, the benefit by energy saving and the volume of reduction of CO2 emission. The results for each of the plans 1, 2 and 3 were 907x10{sup 3}, 3,377x10{sup 3}, 50,400x10{sup 3} in US$; 535x10{sup 3}, 928x10{sup 3}, 1,407x10{sup 3} in US$; and 36.1x10{sup 3}, 68.2x10{sup 3}, 86.6x10{sup 3} tons/year. The Russian side showed their satisfaction of the results and keen interest in the energy saving effect. For the purpose of realizing this plan, financial assistance and technological cooperation are essential. Russia shows their great expectations for the Japanese government. (NEDO)

  17. Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

    Science.gov (United States)

    Fitzgerald, John D; Weng, Haoling H; Soohoo, Nelson F; Ettner, Susan L

    2013-01-01

    To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

  18. What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

    Science.gov (United States)

    Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

    2016-12-01

    The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

    Science.gov (United States)

    Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

    2016-02-01

    In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

    Science.gov (United States)

    Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

    2015-10-01

    Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Do dogs live in joint families? Understanding allo-parental care in free-ranging dogs

    OpenAIRE

    Paul, Manabi; Bhadra, Anindita

    2016-01-01

    Cooperative breeding is an excellent example of altruistic cooperation in social groups. Domestic dogs have evolved from cooperatively hunting and breeding ancestors, but have adapted to a facultatively social scavenging lifestyle on streets, and solitary living in human homes. Pets typically breed and reproduce under human supervision, but free-ranging dogs can provide insights into the natural breeding biology of dogs. We conducted a five year long study on parental care of free-ranging dog...

  2. What Factors are Associated With 90-day Episode-of-care Payments for Younger Patients With Total Joint Arthroplasty?

    Science.gov (United States)

    Pathak, Shweta; Ganduglia, Cecilia M; Awad, Samir S; Chan, Wenyaw; Swint, John M; Morgan, Robert O

    2017-11-01

    Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inpatient and postdischarge care service-component differences across 90-day episodes of care and factors associated with payments for younger patients is crucial for successful implementation of bundled payments in TJA in non-Medicare populations. (1) To assess the mean total payment for a 90-day primary TJA episode, including the proportion attributable to postdischarge care, and (2) to evaluate the role of procedure, patient, and hospital-level factors associated with 90-day episode-of-care payments in a non-Medicare patient population younger than 65 years. Claims data for 2008 to 2013 from Blue Cross Blue Shield of Texas were obtained for primary TJAs. A total of 11,131 procedures were examined by aggregating payments for the index hospital stay and any postacute care including rehabilitation services and unplanned readmissions during the 90-day postdischarge followup period. A three-level hierarchical model was developed to determine procedure-, patient-, and hospital-level factors associated with 90-day episode-of-care payments. The mean total payment for a 90-day episode for TJA was USD 47,700 adjusted to 2013 USD. Only 14% of 90-day episode payments in our population was attributable to postdischarge-care services, which is substantially lower than the percentage estimated in the Medicare population. A prolonged length of stay (rate ratio [RR], 1.19; 95% CI, 1.15-1.23; p ≤ 0.001), any 90-day unplanned readmission (RR, 1.64; 95% CI, 1.57-1.71; p ≤ 0.001), computer-assisted surgery (RR, 1.031; 95% CI, 1.004-1.059; p ≤ 0.05), initial home discharge with home health component (RR, 1.029; 95% CI, 1.013-1.046; p ≤ 0.001), and very high patient morbidity

  3. Has Health Care Reform Legislation Reduced the Economic Burden of Hospital Readmissions Following Primary Total Joint Arthroplasty?

    Science.gov (United States)

    Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

    2017-11-01

    The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs. The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA. The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age. Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

    Science.gov (United States)

    Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

    2016-09-01

    The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Can an arthroplasty risk score predict bundled care events after total joint arthroplasty?

    Directory of Open Access Journals (Sweden)

    Blair S. Ashley, MD

    2018-03-01

    Full Text Available Background: The validated Arthroplasty Risk Score (ARS predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS, discharge disposition, and episode-of-care cost (EOCC. Methods: We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation. Results: ARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, P = .002. There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, P = .003. Increased ARS correlated with increased EOCC (P = .003. Conclusions: Implementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models. Keywords: Bundled payments, Risk stratification, Arthroplasty

  6. Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain

    Science.gov (United States)

    2013-01-01

    Background Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Methods Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O’Brien’s test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Results Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0

  7. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation : two year results of a randomised controlled trial

    NARCIS (Netherlands)

    Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.

    2008-01-01

    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica.

  8. Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease.

    Science.gov (United States)

    Hussain, Jamilla A; Mooney, Andrew; Russon, Lynne

    2013-10-01

    There are limited data on the outcomes of elderly patients with chronic kidney disease undergoing renal replacement therapy or conservative management. We aimed to compare survival, hospital admissions and palliative care access of patients aged over 70 years with chronic kidney disease stage 5 according to whether they chose renal replacement therapy or conservative management. Retrospective observational study. Patients aged over 70 years attending pre-dialysis clinic. In total, 172 patients chose conservative management and 269 chose renal replacement therapy. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. There was also a significant reduction in the effect of renal replacement therapy on survival in patients with high Charlson's Comorbidity Index scores. The relative risk of an acute hospital admission (renal replacement therapy vs conservative management) was 1.6 (p management patients died in hospital, compared to 69% undergoing renal replacement therapy (Renal Registry data). Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients. For patients aged over 80 years, with a poor performance status or high co-morbidity scores, the survival advantage of renal replacement therapy over conservative management was lost at all levels of disease severity. Those accessing a conservative management pathway had greater access to palliative care services and were less likely to be admitted to or die in hospital.

  9. Solving a More Flexible Home Health Care Scheduling and Routing Problem with Joint Patient and Nursing Staff Selection

    Directory of Open Access Journals (Sweden)

    Jamal Abdul Nasir

    2018-01-01

    Full Text Available Development of an efficient and effective home health care (HHC service system is a quite recent and challenging task for the HHC firms. This paper aims to develop an HHC service system in the perspective of long-term economic sustainability as well as operational efficiency. A more flexible mixed-integer linear programming (MILP model is formulated by incorporating the dynamic arrival and departure of patients along with the selection of new patients and nursing staff. An integrated model is proposed that jointly addresses: (i patient selection; (ii nurse hiring; (iii nurse to patient assignment; and (iv scheduling and routing decisions in a daily HHC planning problem. The proposed model extends the HHC problem from conventional scheduling and routing issues to demand and capacity management aspects. It enables an HHC firm to solve the daily scheduling and routing problem considering existing patients and nursing staff in combination with the simultaneous selection of new patients and nurses, and optimizing the existing routes by including new patients and nurses. The model considers planning issues related to compatibility, time restrictions, contract durations, idle time and workload balance. Two heuristic methods are proposed to solve the model by exploiting the variable neighborhood search (VNS approach. Results obtained from the heuristic methods are compared with a CPLEX based solution. Numerical experiments performed on different data sets, show the efficiency and effectiveness of the solution methods to handle the considered problem.

  10. Report of year 2000 version on basic study for promotion of joint implementation. Energy conservation by renovation of reheating furnace at 'SIDEX' S.A. Galati Steel Plant, Romania

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    The purpose of this project is to perform a feasibility study on energy conservation by renovation of reheating furnace at 'SIDEX' S.A. Galati Steel Plant, and discuss the possibility of the future joint implementation project. This project is intended to contribute to reduction in greenhouse effect gas emission in Romania through energy conservation in industries, and introduction of the Japanese energy saving technologies. Furthermore, this project would be capable of contributing to modernization of the industries to achieve sustainable economic growth in Romania, where the joint implementation will be performed in the future. The fuel consumption per ton in the conventionally used reheating furnaces is actually about three times as much as in the same furnaces in Japan. Speaking of electric power consumption, it is about four times as much. The renovation will result in reduction of fuel consumption to the same level as in steel mills in Japan. This will reduce the import of natural gas by 59 million Nm{sup 3} annually after the project will have been implemented, and reduction is expected in CO2 of about 170,000 tons (on the basis of conversion to petroleum). The second effect is reduction of oxidation scale on surfaces of steel products generated in the furnaces at 3% or more presently to about 1%, which corresponds to steel products of more than 20,000 tons. (NEDO)

  11. Effect of a wildlife conservation camp experience in China on student knowledge of animals, care, propensity for environmental stewardship, and compassionate behavior toward animals

    Science.gov (United States)

    Bexell, Sarah M.

    The goal of conservation education is positive behavior change toward animals and the environment. This study was conducted to determine whether participation in a wildlife conservation education camp was effective in positively changing 8-12 year old students': (a) knowledge of animals, (b) care about animals, (c) propensity for environmental and wildlife stewardship, and (d) compassionate behavior toward animals. During the summer of 2005, 2 five-day camps were conducted at 2 zoological institutions in Chengdu, China. The camp curriculum was influenced by theory and research on the following: conservation psychology, social learning theory, empathy and moral development theory, socio-biological theory, constructivist theory, and conservation science. Camp activities were sensitive to Chinese culture and included Chinese conservation issues. Activities were designed to help children form bonds with animals and care enough about them to positively change their behavior toward animals and the environment. This mixed methods study triangulated quantitative and qualitative data from six sources to answer the following: (1) Did camp increase student knowledge of animals? (2) Did camp increase student caring about animals? (3) Did camp increase student propensity for environmental and wildlife stewardship? (4) Did camp affect student compassionate behavior toward animals? A conservation stewards survey revealed significant increases on pre-post, self-report of knowledge, care, and propensity. Pre-post, rubric-scored responses to human-animal interaction vignettes indicated a significant increase in knowledge, and stable scores on care and propensity. Qualitative data from student journals, vignettes, and end-of-camp questionnaires demonstrated knowledge, caring, and propensity, and revealed the emergent theme empathy. To address question 4, instructors tallied campers' behavior toward animals using a student behavior ethogram. Occurrence of positive behaviors was

  12. Exploration of joint working practices on anti-social behaviour between criminal justice, mental health and social care agencies: A qualitative study.

    Science.gov (United States)

    Krayer, Anne; Robinson, Catherine A; Poole, Rob

    2018-05-01

    Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti-social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti-social behaviour. We conducted a multi-method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi-structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti-social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems. © 2018 John Wiley & Sons Ltd.

  13. Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A: Background and Rationale. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

    Science.gov (United States)

    Milette, Isabelle; Martel, Marie-Josée; Ribeiro da Silva, Margarida; Coughlin McNeil, Mary

    2017-06-01

    The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

  14. Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the NICU. Part B: Recommendations and Justification. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

    Science.gov (United States)

    Milette, Isabelle; Martel, Marie-Josée; da Silva, Margarida Ribeiro; Coughlin McNeil, Mary

    2017-06-01

    The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the NICU. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for healthcare professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures require a strong framework for institutional operationalization presented in these guidelines. Part B will present the recommendations and justification of each steps behind the present guidelines to facilitate their implementation.

  15. 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.

  16. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

  17. Forming a multinational joint venture

    International Nuclear Information System (INIS)

    Bhatia, N.K.; Garb, R.H.; Statton, T.D.

    1990-01-01

    This paper discusses the basis and mechanics for forming a multinational joint venture. The topics of the paper include the motivations for a joint venture, selection of the appropriate co-venturer, management of the multinational joint venture, and the joint venture agreement. The authors state that a joint venture is not applicable or desirable in all instances and to be successful, must be carefully planned

  18. Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage: A Population-Based Analysis

    Directory of Open Access Journals (Sweden)

    Marco Stein

    2016-01-01

    Full Text Available Background. The definition of prolonged length of stay (LOS during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH. Methods. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Results. Overall, 13272 patients with ICH were included in the analysis. Surgical therapy of the hematoma was documented in 1405 (10.6% patients. Change points for LOS were 22 days (CI: 8, 22; CL 98% for surgically treated patients and 16 days (CI: 16, 16; CL: 99% for conservatively treated patients. Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P<0.001 and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P<0.001. Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5 and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3 were predictors of prolonged LOS. Conclusion. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. Preventing in-hospital complications could decrease the number of patients with prolonged LOS.

  19. Effect of Risk Acceptance for Bundled Care Payments on Clinical Outcomes in a High-Volume Total Joint Arthroplasty Practice After Implementation of a Standardized Clinical Pathway.

    Science.gov (United States)

    Kee, James R; Edwards, Paul K; Barnes, Charles L

    2017-08-01

    The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities. This practice implemented a standardized CP focused on patient education, managing patient expectations, and maximizing cost outcomes. We retrospectively reviewed all primary total joint arthroplasty patients during the initial 2-year "at risk" period for both BPCI and API and determined discharge disposition, LOS, and readmission rate. During the "at risk" period, the average LOS decreased in our total joint arthroplasty patients and our patients discharged home >94%. Patients within the BPCI group had a decreased discharge to home and decreased readmission rates after total hip arthroplasty, but also tended to be older than both API and nonbundled payment patients. While participating in the BPCI and API, continued use of a standardized CP in a high-performing, high-volume total joint practice resulted in maintenance of a low-average LOS. In addition, BPCI patients had similar outcomes after total knee arthroplasty, but had decreased rates of discharge to home and readmission after total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS).

    Science.gov (United States)

    Palmer, Katie; Marengoni, Alessandra; Forjaz, Maria João; Jureviciene, Elena; Laatikainen, Tiina; Mammarella, Federica; Muth, Christiane; Navickas, Rokas; Prados-Torres, Alexandra; Rijken, Mieke; Rothe, Ulrike; Souchet, Laurène; Valderas, Jose; Vontetsianos, Theodore; Zaletel, Jelka; Onder, Graziano

    2018-01-01

    Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. One-Year Conservative Care Using Sodium Bicarbonate Supplementation Is Associated with a Decrease in Electronegative LDL in Chronic Kidney Disease Patients: A Pilot Study.

    Science.gov (United States)

    Rizzetto, Felipe; Mafra, Denise; Barra, Ana Beatriz; Pires de Melo, Gisella; Abdalla, Dulcinéia Saes Parra; Leite, Maurilo

    2017-10-01

    Chronic kidney disease (CKD) patients develop metabolic acidosis when approaching stages 3 and 4, a period in which accelerated atherogenesis may ensue. Studies in vitro show that low pH may increase low-density lipoprotein (LDL) oxidation, suggesting a role for chronic metabolic acidosis in atherosclerosis. The present study attempted to evaluate the effects of conservative care using oral sodium bicarbonate (NaHCO 3 ) supplementation on the electronegative LDL [LDL(-)], a minimally oxidized LDL, plasma levels in CKD patients. Thirty-one CKD patients were followed by a multidisciplinary team during 15 months of care in which 1.0 mmol/kg/day oral NaHCO 3 supplementation was first given in the third month. Blood samples were collected 3 months before the initiation of oral NaHCO 3 supplementation (T1), at the time of the beginning of supplementation (T2), and thereafter, each 4 months (T3, T4 and T5) until month 15 of care. Blood parameters and LDL(-) were measured from these collections. After 12 months of conservative care, creatinine clearance (MDRD) was kept stable, and serum bicarbonate (HCO 3 - ) increased from 20.5 ± 2.9 to 22.6 ± 1.1 mM ( p < 0.003). LDL(-) plasma levels declined from 4.5 ± 3.3 to 2.1 ± 0.9 U/L ( p < 0.007) after reaching mean serum HCO 3 - levels of 22.6 ± 1.1 mM. Conservative care using oral NaHCO 3 supplementation was able to stabilize renal function and decrease serum levels of LDL(-), a modified proatherogenic lipoprotein, only when mean serum HCO 3 - levels approached 22 mM. This study constitutes evidence that alkali therapy, in addition to its beneficial effect on renal disease progression, might serve as a preventive strategy to attenuate atherogenesis in CKD patients.

  2. Basic survey for Joint Implementation on West Pacific Petrochemical Co., Ltd., Dalian, China. Energy conservation project for West Pacific Oil Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    For the purpose of reducing greenhouse effect gas emissions, a potential survey was conducted of energy conservation at West Pacific Oil Refinery, Dalian, China. In the survey, studies were made of energy conservation by introducing the hydrogen recovery equipment and the gas turbine generation system using exhaust gas as fuel, and of potentiality of reducing greenhouse effect gas emissions. As a result of the survey, a gas turbine generator of about 29MW using the surplus gas as fuel can be installed. By this, approximately 71% of the power used in refinery is to be supplied as against 25% of the power presently used. The technology was proposed on the hydrogen recovery equipment and the gas turbine generation system to discuss the revision plan with the Chinese partner. When this project is realized, the reduction amount of CO2 will be 136,000 ton/y. The Chinese side highly estimated not only the remarkable reduction in CO2, but the reduction in purchased power from outside which is to be brought by realization of this project. (NEDO)

  3. Report on basic survey project for promoting joint implementation in 1999. Feasibility study on energy conservation and reduction of CO2 emission at Balikpapan Refinery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    With an objective of implementation as the clean development mechanism (CDM), a survey was performed on energy conservation and CO2 reduction at Balikpapan Refinery in Indonesia with respect to reducing emission of greenhouse effect gases. A crude oil atmospheric distillation unit with a capacity of 200,000 BPSD, and a vacuum distillation unit with a capacity of 81,000 BPSD are in operation, which emit carbon dioxide of about 470,000 tons annually from fuels burned and consumed by these units. The result of the survey revealed that there is a room for improvement in heat recovery, and that these units are separated into two groups located far away with each other in distance, resulting in low thermal efficiency and wastes in fuel. Increase in heat recovery should be achieved, and fuel consumption in the heating furnace should be reduced. Energy saving technologies owned by JGC were applied to establish a modification plan. The plan calls for maximum annual reduction of carbon dioxide of about 61,000 tons at a reduction rate of 13%, and maximum annual fuel conservation of 190 times 10{sup 9} kcal at a saving rate of 13%. PERTAMINA also desires the realization thereof if technical and financial assistance is made available. The project has a significance that it would give a great impetus to the entire regions and industries. (NEDO)

  4. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health

  5. Fiscal 1999 survey report. Basic survey for promotion of joint implementations, etc. (Energy conservation measures for limekilns); 1999 nendo sekkai shoseirio no sho energy taisaku chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    Most of the limekilns now in operation in China are of the old type, demanding 30% more heat than limekilns in general use for instance in Japan. The survey assesses the effect of energy conservation or greenhouse gas reduction in case the old limekilns are replaced by new ones. For the implementation of this survey, the Benxi Iron and Steel Complex in Benxi City, Liaoning Province, China, who hope that their old limekilns will be replaced, is assumed to be the site of construction. A survey is conducted on this assumption, and the effect of greenhouse gas reduction in case new limekilns are popularized in China is also assessed. Under this program, the earth kilns will be abolished, to be replaced by 600 tons/day new limekilns. However, some of the single cylinder shaft kilns are to be retained. It is concluded that fuel consumption will be reduced by 7.49 times 10{sup 3} tons/year in terms of crude oil, fuel cost by 10,120,000 yuan/year, and CO2 emissions by 23,200 tons/year. The installation will cost 991-million yen, and the investment recovery period will be 7.9 years. The amount of metallurgical lime that China produces is 10-million tons/year, of which 70% comes from the old limekilns. After completion of the replacement there will be 33 limekilns, and the need is quite great. (NEDO)

  6. A systematic review assessing non-pharmacological conservative treatment studies for people with non-inflammatory multi-joint pain: clinical outcomes and research design considerations.

    Science.gov (United States)

    Comer, C; Smith, T O; Drew, B; Raja, R; Kingsbury, S R; Conaghan, Philip G

    2018-03-01

    To systematically review the evidence to determine the clinical outcomes and the important methodological quality features of interventional studies on adults with non-inflammatory multi-joint pain (MJP). Systematic search of published and unpublished literature using the databases: AMED, CINAHL, MEDLINE, EMBASE, psycINFO, SPORTDiscus, PEDro, OpenGrey, the EU Clinical Trials Register, World Health Organization International Clinical Trial Registry Platform, ClinicalTrials.gov and the ISRCTN registry (search: inception to 19th October 2017). All papers reporting the clinical outcomes of non-pharmacological interventions for people with non-inflammatory MJP were included. Studies were critically appraised using the Downs and Black Critical Appraisal and the TIDieR reporting checklists. Data were analysed using a Best Evidence Synthesis approach. From 3824 citations, four papers satisfied the eligibility criteria. Three studies reported outcomes from multidisciplinary rehabilitation programmes and one study reported the findings of a spa therapy intervention. All interventions significantly improved pain, function and quality of life in the short-term. There was limited reporting of measures for absenteeism, presenteeism and psychosocial outcomes. The evidence was 'weak', and due to a lack of controlled trials, there is limited evidence to ascertain treatment effectiveness. Design consideration for future trials surround improved reporting of participant characteristics, interventions and the standardisation of core outcome measures. There is insufficient high-quality trial data to determine the effectiveness of treatments for non-inflammatory MJP. Given the significant health burden which this condition presents on both individuals and wider society, developing and testing interventions and accurately reporting these, should be a research priority. Registration PROSPERO (CRD42013005888).

  7. Caring for the land : best practice in soil and water conservation in Beressa watershed, highlands of Ethiopia

    NARCIS (Netherlands)

    Amsalu Taye, A.

    2006-01-01

    Land degradation in the form of soil erosion and nutrient loss is a major constraint to farming activities and agricultural development in the highlands of Ethiopia. Though large-scale conservation projects have been initiated and carried out by the government during the past few decades, the

  8. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  9. Temporomandibular joint space in children without joint disease

    International Nuclear Information System (INIS)

    Larheim, T.A.

    1981-01-01

    Bilateral assessment of the temporomandibular joint space in children without joint disease is reported. Twenty-eight children were examined with conventional radiography and 23 with tomography. High prevalence of asymmetric joint spaces with both techniques indicated that great care should be taken when using narrowing or widening of the joint space as a diagnostic criterion in children with juvenile rheumatoid arthritis. Other signs, such as restricted translation of the mandibular head, and clinical symptoms should be evaluated. (Auth.)

  10. Development and Pilot Evaluation of a Novel Dignity-Conserving End-of-Life (EoL) Care Model for Nursing Homes in Chinese Societies.

    Science.gov (United States)

    Ho, Andy H Y; Dai, Annie A N; Lam, Shu-Hang; Wong, Sandy W P; Tsui, Amy L M; Tang, Jervis C S; Lou, Vivian W Q

    2016-06-01

    The provision of end-of-life (EoL) care in long-term-care settings remains largely underdeveloped in most Chinese societies, and nursing home residents often fail to obtain good care as they approach death. This paper systematically describes the development and implementation mechanisms of a novel Dignity-Conserving EoL Care model that has been successfully adopted by three nursing homes in Hong Kong and presents preliminary evidence of its effectiveness on enhancing dignity and quality of life (QoL) of terminally ill residents. Nine terminally ill nursing home residents completed the McGill Quality of Life Questionnaire and the Nursing Facilities Quality of Life Questionnaire at baseline and 6 months post-EoL program enrollment. Wilcoxon signed rank test was used to detect significance changes in each QoL domains across time. Although significant deterioration was recorded for physical QoL, significant improvement was observed for social QoL. Moreover, a clear trend toward significant improvements was identified for the QoL domains of individuality and relationships. A holistic and compassionate caring environment, together with the core principles of family-centered care, interagency and interdisciplinary teamwork, as well as cultural-specific psycho-socio-spiritual support, are all essential elements for optimizing QoL and promoting death with dignity for nursing home residents facing morality. This study provides a useful framework to facilitate the future development of EoL care in long-term-care settings in the Chinese context. © The Author 2015. 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.

  11. Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2017-12-01

    This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

  12. Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

    Science.gov (United States)

    Fedeli, Ugo; Alba, Natalia; Schievano, Elena; Visentin, Cristiana; Rosato, Rosalba; Zorzi, Manuel; Ruscitti, Giancarlo; Spolaore, Paolo

    2007-01-01

    Background Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. Methods Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. Results Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18) and high-volume (1.09, 1.03–1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. Conclusion The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers. PMID:17945000

  13. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-05-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI joint (15%–30% of cases is commonly treated with nonoperative care, but new minimally invasive surgery (MIS options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results: The cumulative 3-year (base-case analysis and 5-year (sensitivity analysis differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS were $14,545 and $6,137 per patient, respectively (2012 US dollars. Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality

  14. Save the patient a trip. Outcome difference between conservatively treated patients with traumatic brain injury in a nonspecialized intensive care unit vs a specialized neurosurgical intensive care unit in the Sultanate of Oman.

    Science.gov (United States)

    Al-Kashmiri, Ammar M; Al-Shaqsi, Sultan Z; Al-Kharusi, Adil S; Al-Tamimi, Laila A

    2015-06-01

    Traumatic brain injury (TBI) continues to be the main cause of death among trauma patients. Accurate diagnosis and timely surgical interventions are critical steps in reducing the mortality from this disease. For patients who have no surgically reversible head injury pathology, the decision to transfer to a dedicated neurosurgical unit is usually controversial. To compare the outcome of patients with severe TBI treated conservatively in a specialized neurosurgical intensive care unit (ICU) and those treated conservatively at a general ICU in the Sultanate of Oman. Retrospective cohort study. This is a retrospective study of patients with severe TBI admitted to Khoula Hospital ICU (specialized neurosurgical ICU) and Nizwa Hospital ICU (general ICU) in Oman in 2013. Surgically treated patients were excluded. Data extracted included demographics, injury details, interventions, and outcomes. The outcome variables included mortality, length of stay, length of ICU days, and ventilated days. There were 100 patients with severe TBI treated conservatively at Khoula Hospital compared with 74 patients at Nizwa Hospital. Basic demographics were similar between the 2 groups. No significant difference was found in mortality, length of stay, ICU days, and ventilation days. There is no difference in outcome between patients with TBI treated conservatively in a specialized neurosurgical ICU and those treated in a general nonspecialized ICU in Oman in 2013. Therefore, unless neurosurgical intervention is warranted or expected, patients with TBI may be managed in a general ICU, saving the risk and expense of a transfer to a specialized neurosurgical ICU. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. An analysis of a joint shear model for jointed media with orthogonal joint sets

    International Nuclear Information System (INIS)

    Koteras, J.R.

    1991-10-01

    This report describes a joint shear model used in conjunction with a computational model for jointed media with orthogonal joint sets. The joint shear model allows nonlinear behavior for both joint sets. Because nonlinear behavior is allowed for both joint sets, a great many cases must be considered to fully describe the joint shear behavior of the jointed medium. An extensive set of equations is required to describe the joint shear stress and slip displacements that can occur for all the various cases. This report examines possible methods for simplifying this set of equations so that the model can be implemented efficiently form a computational standpoint. The shear model must be examined carefully to obtain a computationally efficient implementation that does not lead to numerical problems. The application to fractures in rock is discussed. 5 refs., 4 figs

  16. 18 CFR 154.307 - Joint facilities.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Joint facilities. 154... Changes § 154.307 Joint facilities. The Statements required by § 154.312 must show all costs (investment... in the subject rate change and are associated with joint facilities. The methods used in making such...

  17. Survey report of year 2000 version. Basic survey project for promoting joint implementation. Comprehensive feasibility study on energy conservation and reduction of CO2 emission at PT Indocement Tunggal Prakarsa Tbk.

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    In order to promote the COP3 joint implementation, discussions were given on the Citeureup factory of Indocement in Indonesia. The discussions were given on improvement of the grate type air quenching clinker cooler (AQC), improvement in the final crushing process, and waste heat recovering electric power generation utilizing exhaust gas from the AQC. Annual energy conservation would amount to 61,866 toe at the energy saving rate of 10.9%. CO2 emission will be reduced annually by 191,417 tons. The total investment amount was calculated 5,988,025,000 yen. Profitability was discussed under an assumption of fund raised from long-term loan at 90% and from the own fund at 10%. When using the environmental special Yen credit, the FIRR on investment after tax would be 5.8%, and the recovery period would be 11 years, which are within the range of feasibility. Even on the ex-Exim Bank Export Finance base, the period would be 12 years, which is also within the range of feasibility. However, if the plan is based on general loans, the FIRR after tax would be 6.4%, being lower than the interest rate of 8.2%, which is inadequate. In order to apply the environmental special Yen credit to energy saving measures in private businesses, clarification of the CDM and basic agreement between the governments are indispensable. (NEDO)

  18. Sacroiliac joint dysfunction.

    Science.gov (United States)

    Ilaslan, Hakan; Arslan, Ahmet; Koç, Omer Nadir; Dalkiliç, Turker; Naderi, Sait

    2010-07-01

    Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome. Four cases with sacroiliac dysfunction are presented. The clinical and radiological signs supported the evidence of sacroiliac dysfunction, and exact diagnosis was made after positive response to sacroiliac joint block. A percutaneous sacroiliac fixation provided pain relief in all cases. The mean VAS scores reduced from 8.2 to 2.2. It is concluded that sacroiliac joint dysfunction diagnosis requires a careful physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases.

  19. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala.

    Science.gov (United States)

    Roche, Stephanie; Hall-Clifford, Rachel

    2015-01-01

    Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.

  20. Exploring the potential for joint training between legal professionals in the criminal justice system and health and social care professionals in the mental-health services.

    Science.gov (United States)

    Hean, Sarah; Heaslip, Vanessa; Warr, Jerry; Staddon, Sue

    2011-05-01

    Effective screening of mentally-ill defendants in the criminal court system requires cooperation between legal professionals in the criminal justice system (CJS), and health and social care workers in the mental-health service (MHS). This interagency working, though, can be problematic, as recognized in the Bradley inquiry that recommended joint training for MHS and CJS professionals. The aim of this study was to examine the experiences and attitudes of workers in the CJS and MHS to inform the development of relevant training. The method was a survey of mental-health workers and legal professionals in the court. The results showed that both agencies were uncertain of their ability to work with the other and there is little training that supports them in this. Both recognized the importance of mentally-ill defendants being dealt with appropriately in court proceedings but acknowledged this is not achieved. There is a shared willingness to sympathize with defendants and a common lack of willingness to give a definite, unqualified response on the relationship between culpability, mental-illness and punishment. Views differ around defendants' threat to security.Findings suggest there is scope to develop interprofessional training programs between the CJS and MHS to improve interagency working and eventually impact on the quality of defendants' lives. Recommendations are made on the type of joint training that could be provided.

  1. Ethics of conservation triage

    Directory of Open Access Journals (Sweden)

    Kerrie A Wilson

    2016-09-01

    Full Text Available Conservation triage seems to be at a stalemate between those who accept triage based on utilitarian rationalization, and those that reject it based on a number of ethical principles. We argue that without considered attention to the ethics of conservation triage we risk further polarization in the field of conservation. We draw lessons from the medical sector, where triage is more intuitive and acceptable, and also from disaster planning, to help navigate the challenges that triage entails for conservation science, practice, and policy. We clarify the consequentialist, deontological, and virtue ethical stances that influence the level of acceptance of triage. We emphasize the ethical dimensions of conservation triage in principle and in practice, particularly in the context of stakeholder diversity, a wide range of possible objectives and actions, broader institutions, and significant uncertainties. A focus on a more diverse set of ethics, more considered choice of triage as a conservation tool, open communication of triage objectives and protocols, greater consideration of risk preferences, and regular review and adaptation of triage protocols is required for conservation triage to become more acceptable among diverse conservation practitioners, institutions, and the general public. Accepting conservation triage as fundamentally an ethical problem would foster more open dialogue and constructive debate about the role of conservation triage in a wider system of care.

  2. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN).

    Science.gov (United States)

    Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J

    2016-08-31

    Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology

  3. Joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

  4. Determination of Parachute Joint Factors using Seam and Joint Testing

    Science.gov (United States)

    Mollmann, Catherine

    2015-01-01

    This paper details the methodology for determining the joint factor for all parachute components. This method has been successfully implemented on the Capsule Parachute Assembly System (CPAS) for the NASA Orion crew module for use in determining the margin of safety for each component under peak loads. Also discussed are concepts behind the joint factor and what drives the loss of material strength at joints. The joint factor is defined as a "loss in joint strength...relative to the basic material strength" that occurs when "textiles are connected to each other or to metals." During the CPAS engineering development phase, a conservative joint factor of 0.80 was assumed for each parachute component. In order to refine this factor and eliminate excess conservatism, a seam and joint testing program was implemented as part of the structural validation. This method split each of the parachute structural joints into discrete tensile tests designed to duplicate the loading of each joint. Breaking strength data collected from destructive pull testing was then used to calculate the joint factor in the form of an efficiency. Joint efficiency is the percentage of the base material strength that remains after degradation due to sewing or interaction with other components; it is used interchangeably with joint factor in this paper. Parachute materials vary in type-mainly cord, tape, webbing, and cloth -which require different test fixtures and joint sample construction methods. This paper defines guidelines for designing and testing samples based on materials and test goals. Using the test methodology and analysis approach detailed in this paper, the minimum joint factor for each parachute component can be formulated. The joint factors can then be used to calculate the design factor and margin of safety for that component, a critical part of the design verification process.

  5. Coracoclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Chan Il; Ahn, Jae Doo; Lim, Chong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1970-10-15

    The coracoclvicular joint, a rear abnormality which may be the cause of pain in the shoulder and limitation of motion of the shoulder joint, is discussed. A case of coracoclvicular joint with shoulder pain was observed in 65 yrs old Korean male.

  6. Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

    Science.gov (United States)

    Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

    2018-03-01

    The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series.

    Science.gov (United States)

    Walston, Zachary; Hernandez, Luis; Yake, Dale

    2018-06-06

    Conservative therapies for complex regional pain syndrome (CRPS) have traditionally focused on exercise and desensitization techniques targeted at the involved extremity. The primary purpose of this case series is to report on the potential benefit of utilizing manual therapy to the lumbar spine in conjunction with traditional conservative care when treating patients with lower extremity CRPS. Two patients with the diagnosis of lower extremity CRPS were treated with manual therapy to the lumbar spine in conjunction with education, exercise, desensitization, and soft tissue techniques for the extremity. Patient 1 received 13 sessions over 6 weeks resulting in a 34-point improvement in oswestry disability index (ODI) and 35-point improvement in lower extremity functional scale (LEFS). Patient 2 received 21 sessions over 12 weeks resulting in a 28-point improvement in ODI and a 41-point improvement in LEFS. Both patients exhibited reductions in pain and clinically meaningful improvements in function. Manual therapies when applied to the lumbar spine in these patients as part of a comprehensive treatment plan resulted in improved spinal mobility, decreased pain, and reduction is distal referred symptoms. Although one cannot infer a cause and effect relationship from a case series, this report identifies meaningful clinical outcomes potentially associated with manual physical therapy to the lumbar spine for two patients with complex regional pain syndrome type 1.

  8. Basic research on energy conservation in developing countries. Basic research on promotion of activities implemented jointly (AIJ) (research on possibility of AIJ in developing countries); Hatten tojokoku energy shohi koritsuka kiso chosanado jigyo kyodo jisshi suishin kiso chosa. Hatten tojokoku ni okeru kyodo jisshi katsudo no kanosei chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    The activities implemented jointly (AIJ) is expected as global measures to reduce greenhouse gas (such as CO2) emission. In this report, the possibility of AIJ projects in developing countries was researched. The United Nations Framework Convention on Climate Change was signed by 155 countries in 1992. This convention parties approved AIJ projects for measures against global warming. The 1st Conference of the Parties (COPI) held in 1995 approved the pilot phase of AIJ by voluntary workers jointly with developing countries until the end of this century. The trend, level and future plan of energy conservation technologies were researched and analyzed for steelmaking, cement and electric power supply industries in both the Philippine and Thailand. The possibility of AIJ projects was studied by selecting several Japanese energy conservation technologies transferable to both countries. The same research was also carried out for forest as carbon absorption source. 5 refs., 23 figs., 58 tabs.

  9. Skilled nursing facilities after joint replacement

    Science.gov (United States)

    ... care providers in the weeks before your joint replacement. They can advise you about whether going directly ... of many people who have had a joint replacement? Can they tell you how many? A good ...

  10. The patterns of care study for breast-conserving therapy in Japan: Analysis of process survey from 1995 to 1997

    International Nuclear Information System (INIS)

    Mitsumori, Michihide; Hiraoka, Masahiro; Negoro, Yoshiharu; Yamauchi, Chikako; Shikama, Naoto; Sasaki, Shigeru; Yamamoto, Tokihiro; Teshima, Teruki; Inoue, Toshihiko

    2005-01-01

    Purpose: To present the results of a process survey on breast-conserving therapy (BCT) in Japan from 1995 to 1997. Methods and Materials: From September 1998 to December 1999, data on the treatment process of 865 randomly selected BCT patients were collected by extramural audits. Results: For primary surgery, wide excision or tumorectomy was performed in 372 patients (43.0%), and quadrantectomy or segmental mastectomy was performed in 493 patients (57%). The extent of axillary dissection was equal or beyond Level II in 590 patients (68.2%). Systemic chemotherapy was administered to 103 of 160 node-positive patients (64.4%) and 180 of 569 node-negative patients (31.6%). Tamoxifen was administered to 234 of 323 hormone receptor-positive patients (72.5%) and 68 of 130 hormone receptor-negative patients (52.3%). Photon energy of 10 MV was administered for whole breast irradiation in 38 patients (4.4%) without bolus. Conclusions: The extent of surgical resection for BCT was large in Japan. Pathologic assessment and the technique of radiation therapy were apparently suboptimal in some cases. Information on prognostic/predictive factors was not fully utilized to individualize systemic adjuvant therapy. Establishment and widespread use of guidelines for BCT for in Japan are desirable. Repeated surveys will demonstrate how such guidelines affect clinical practices

  11. Acromioclavicular joint separation

    Directory of Open Access Journals (Sweden)

    Devan Pandya, BS

    2018-04-01

    forearm.1,9 Type II injuries involve a torn AC ligament, disrupting the AC joint. The AC joint appears widened on radiographs.1,9 The AC and CC ligaments are disrupted in type III injuries with an increased CC distance of 25%-100% on plain films.1,10 In addition to torn AC and CC ligaments, the clavicle is posteriorly displaced in a type IV injury. Because the AP film may not reveal the posterior displacement of the clavicle, the axillary view is vital for correct classification of type IV injuries.1 A type V injury involves disruption of the AC and CC ligaments as well as torn muscle attachments of the trapezius and deltoid on the clavicle and scapula, leading to greater AC joint displacement on radiographs. The CC distance appears 100%-300% greater than normal.1,10 Type VI injuries are caused by a direct blow to the superior surface of the clavicle resulting in inferior displacement. On X-ray, the lateral end of the clavicle is inferior to the acromion and coracoid processes in Type VI injuries.1 Treatment for types I, II, and III is conservative, which consist of analgesics, non-steroidal anti-inflammatory drugs (NSAIDs, and progressive range of motion exercises.11 Patients with type III injuries who fail conservative management are referred for operative repair.11,12 Type IV, V, and VI injuries require orthopedic consult and surgical management. Type IV injuries are treated with closed reduction to type III, followed by the treatment regimen for type III injuries.11 Like type III injuries, if conservative management of type IV injuries is unsuccessful, surgical management should follow.11 Topics: Acromioclavicular joint, Rockwood classification, shoulder injury

  12. Joint ventures: to pursue or not to pursue?

    Science.gov (United States)

    Blaszyk, Michael D; Hill-Mischel, Jody

    2007-11-01

    Hospitals should carefully select joint venture partners. The joint venture evaluation process should involve a high-level screen of strategic opportunities. Hospitals should develop a full business plan for the joint venture.

  13. Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program

    Science.gov (United States)

    Erhart-Hledik, Jennifer C; Kinsella, Rose; Hunter, Simon; Mecklenburg, Gabriel; Perez, Daniel

    2017-01-01

    Background Chronic knee pain (CKP) affects a large number of adults, many of whom do not receive best-practice care and are at high risk for unnecessary surgery. Objective The aim of this study was to investigate the effect of the Hinge Health 12-week digital care program (DCP) for CKP on knee pain and function, with secondary outcomes of surgery interest and satisfaction, at 12 weeks and 6 months after starting the program. Methods Individuals with CKP were recruited onto the 12-week program, comprising sensor-guided physical exercises, weekly education, activity tracking, and psychosocial support such as personal coaching and cognitive behavioral therapy (CBT). We used a single-arm design with assessment of outcomes at baseline, 12 weeks, and 6 months after starting the program. We used a linear mixed effects model with Tukey contrasts to compare timepoints and report intention-to-treat statistics with last observation carried forward. Results The cohort consisted of 41 individuals (32 female, mean age 52 years, SD 9 years). Between baseline and week 12, participants reported clinically significant improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) function scales of 16 points (95% CI 12-21, P<.001) and 10 points (95% CI 6-14, P<.001), respectively. Significant reductions of 57% (mean difference 30, 95% CI 21-38, P<.001) and 51% (mean difference 25, 95% CI 16-33, P<.001) in visual analog scale (VAS) knee pain and stiffness, respectively, were observed at 12 weeks, as well as a 67% reduction in surgery interest (mean reduction 2.3 out of 10, 95% CI 1.5-3.1, P<.001). Average satisfaction at week 12 was 9.2 out of 10. Critically, all improvements were maintained at 6 months at similar or greater magnitude. Conclusions Participants on the Hinge Health DCP for CKP showed substantial clinical improvements that were maintained 6 months after enrolling in the

  14. A New Conservative Cold Front? Democrat and Republican Responsiveness to the Passage of the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Stephen L. Morgan

    2015-09-01

    Full Text Available Through an analysis of the 2004 through 2014 General Social Survey (GSS, this article demonstrates that the 2010 passage of the Affordable Care Act (ACA decreased support for spending on health among Democrats, Independents, and Republicans, contrary to the conjecture that a rigid partisanship equilibrium has taken hold among voters in the United States. Instead, only a partisan deflection is present, with spending preferences declining more for Republicans than for Democrats, and with Independents in between. Through supplemental analysis of the GSS panel data, as well as comparative analysis of other GSS items on national spending preferences, government responsibility, and confidence in leaders, this article also undermines support for an alternative explanation that cannot be entirely eliminated from plausibility, which is that the identified period effect that emerged in 2010 and persisted through 2014 is a response to the Great Recession and resulting deficit spending by the federal government. Implications for public opinion research are discussed, lending support to current models of thermostat effects and policy-specific political mood from the political science literature, which are informed by an older literature on weather fronts in public opinion that originated in the sociology literature.

  15. Grafting with Cryopreserved Amniotic Membrane versus Conservative Wound Care in Treatment of Pressure Ulcers: A Randomized Clinical Trial.

    Science.gov (United States)

    Dehghani, Mehdi; Azarpira, Negar; Mohammad Karimi, Vahid; Mossayebi, Hamid; Esfandiari, Elaheh

    2017-10-01

    To compare the healing process of pressure ulcers treated with cryopreserved human amniotic membrane allograft and routine pressure ulcer care in our hospital. From January 2012 to December 2013, in a prospective randomized clinical trial (IRCT201612041335N2), 24 patients with second and third stage of pressure ulcers were enrolled in this study. All patients needed split-thickness skin grafts for pressure ulcer-wound coverage. Selected patients had symmetric ulcers on both upper and lower extremities. The patients were randomly divided into two groups: amnion and control. In the amnion group, the ulcer was covered with cryopreserved amniotic membrane and in the control group it was treated with local Dilantin powder application. The duration and success rate of complete healing was compared between the two groups. The study group was composed of 24 pressure ulcers in 24 patients (19 males and 5 females) with a mean age of 44±12.70 years. The demographic characteristics, ulcer area, and underlying diseases were similar in both groups. The early sign of response, such as decrease in wound discharge, was detected 12-14 days after biological dressing. Complete pressure ulcer healing occurred only in the amnion group ( p pressure ulcers.

  16. Distal radioulnar joint injuries

    Directory of Open Access Journals (Sweden)

    Binu P Thomas

    2012-01-01

    Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

  17. Primary care physicians' perceptions about and confidence in deciding which patients to refer for total joint arthroplasty of the hip and knee.

    Science.gov (United States)

    Waugh, E J; Badley, E M; Borkhoff, C M; Croxford, R; Davis, A M; Dunn, S; Gignac, M A; Jaglal, S B; Sale, J; Hawker, G A

    2016-03-01

    The purpose of this study is to examine the perceptions of primary care physicians (PCPs) regarding indications, contraindications, risks and benefits of total joint arthroplasty (TJA) and their confidence in selecting patients for referral for TJA. PCPs recruited from among those providing care to participants in an established community cohort with hip or knee osteoarthritis (OA). Self-completed questionnaires were used to collect demographic and practice characteristics and perceptions about TJA. Confidence in referring appropriate patients for TJA was measured on a scale from 1 to 10; respondents scoring in the lowest tertile were considered to have 'low confidence'. Descriptive analyses were conducted and multiple logistic regression was used to determine key predictors of low confidence. 212 PCPs participated (58% response rate) (65% aged 50+ years, 45% female, 77% >15 years of practice). Perceptions about TJA were highly variable but on average, PCPs perceived that a typical surgical candidate would have moderate pain and disability, identified few absolute contraindications to TJA, and overestimated both the effectiveness and risks of TJA. On average, PCPs indicated moderate confidence in deciding who to refer. Independent predictors of low confidence were female physicians (OR = 2.18, 95% confidence interval (CI): 1.06-4.46) and reporting a 'lack of clarity about surgical indications' (OR = 3.54, 95% CI: 1.87-6.66). Variability in perceptions and lack of clarity about surgical indications underscore the need for decision support tools to inform PCP - patient decision making regarding referral for TJA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  18. Conservation Value

    OpenAIRE

    Tisdell, Clement A.

    2010-01-01

    This paper outlines the significance of the concept of conservation value and discusses ways in which it is determined paying attention to views stemming from utilitarian ethics and from deontological ethics. The importance of user costs in relation to economic decisions about the conservation and use of natural resources is emphasised. Particular attention is given to competing views about the importance of conserving natural resources in order to achieve economic sustainability. This then l...

  19. Temporomandibular joint

    International Nuclear Information System (INIS)

    Westesson, P.L.; Hatala, M.; Tallents, R.H.; Katzberg, R.W.; Musgrave, M.; Levitt, S.

    1990-01-01

    This paper determines the frequency of MR signs of abnormal temporomandibular joints (TMJs) in asymptomatic volunteers. Forty-two volunteers with 84 clinically normal TMJs were imaged in the sagittal and coronal planes with surface coil MR imaging. Sagittal closed and open and coronal closed views were obtained bilaterally in all volunteers. The images were classified as normal (superior disk position) or abnormal (disk displacement of degenerative joint disease). Eighteen joints in 11 volunteers were abnormal; 12 had disk displacement with reduction and six had disk displacement without reduction, with associated degenerative joint disease in three of the six. Asymptomatic internal derangement and degenerative joint disease occur in about one-fourth of asymptomatic volunteers

  20. Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

    Science.gov (United States)

    Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

    2014-06-01

    In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

  1. Prosthetic Joint Infection

    Science.gov (United States)

    Tande, Aaron J.

    2014-01-01

    SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

  2. Fold and Fit: Space Conserving Shape Editing

    KAUST Repository

    Ibrahim, Mohamed; Yan, Dong-Ming

    2017-01-01

    We present a framework that folds man-made objects in a structure-aware manner for space-conserving storage and transportation. Given a segmented 3D mesh of a man-made object, our framework jointly optimizes for joint locations, the folding order

  3. Osteoligamentous injuries of the medial ankle joint.

    Science.gov (United States)

    Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

    2015-12-01

    Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

  4. Joint diseases

    International Nuclear Information System (INIS)

    Weissman, S.D.

    1989-01-01

    The authors discuss how x-ray examination is essential in the diagnosis and evaluation of the arthritides. Most arthritides are first suspected by the clinician, and x-ray evaluation of these entities along with laboratory testing is important for confirmation of the clinical diagnosis and in staging of the disease process. Several arthritides are often diagnosed first by the podiatrist on x-ray evaluation, including pseudogout, ankylosing spondylitis, early rheumatoid arthritis, degenerative joint disease, and tuberculosis of bone. The joint responds to insult in only a limited number of ways that become apparent on x-ray. The soft tissues surrounding the joint, the articulating bones, and alignment of the joint space may all be involved by the arthritic process. On roentgenographic examination, the soft tissues must be examined for edema, masses, calcifications, and atrophy. The articulating bones must be examined for demineralization, erosions, osteophytes, periosteal reaction, cysts and sclerosis

  5. Joint pain

    Science.gov (United States)

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: Gout (especially ...

  6. Joint Commission

    Science.gov (United States)

    ... for the latest publication of The Joint Commission Journal on Quality and Patient Safety (JQPS). . How We Work Process improvement program breeds quality culture, empowers staff An article in Quality Progress, June ...

  7. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    OpenAIRE

    --- Various Authors

    2017-01-01

    Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR), European Society for Neonatology (ESN), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI)ORGANIZING COMMITTEELuc Zi...

  8. The temporomandibular joint

    International Nuclear Information System (INIS)

    Campbell, W.

    1984-01-01

    Whilst the temporomandibular joint is in many ways unique, it is subject to all the diseases and disorders found in joints in other parts of the human skeleton. By far the most common disorder is injury, followed by arthropathy, acute and chronic dislocations, ankylosis, and in rare instances, neoplasms. The diagnosis and management of the temporomandibular joint are the primary responsibility of the oral surgeon. Nevertheless, this anatomical region is an area in which the cooperation of medical and dental disciplines may be required for the satisfactory conclusion of treatment. The more so when the disease process involves either associated psychosomatic illness or malignancy. The mainstay of the diagnosis is a careful radiological examination of the joint. There exists a delicate relationship between the dentition, the muscles of mastication, and the temporomandibular articulation, which is controlled by arthrokinetic reflex activity of the branches of the 5th cranial nerve. Imbalance between one or more of the components of this integrated system frequently leads to disturbances in function. Pain-dysfunction disorders constitute the larger part of temporomandibular joint disturbances generally encountered

  9. Joint Intentionality

    Directory of Open Access Journals (Sweden)

    Koreň Ladislav

    2016-03-01

    Full Text Available According to the shared intentionality hypothesis proposed by Michael Tomasello, two cognitive upgrades – joint and collective intentionality, respectively – make human thinking unique. Joint intentionality, in particular, is a mindset supposed to account for our early, species-specific capacity to participate in collaborative activities involving two (or a few agents. In order to elucidate such activities and their proximate cognitive-motivational mechanism, Tomasello draws on philosophical accounts of shared intentionality. I argue that his deference to such cognitively demanding accounts of shared intentional activities is problematic if his theoretical ambition is in part to show that and how early (prelinguistic and precultural capacities for joint action contribute to the development of higher cognitive capacities.

  10. Survey on nursing of breast cancer patients treated with radiotherapy following to breast-conserving surgery. Actual states and problems for nursing care by certified nurses in breast cancer nursing

    International Nuclear Information System (INIS)

    Kobayashi, Mariko; Higuchi, Yuki; Hirose, Kiyomi; Nakanishi, Yoko; Ichikawa, Kayo; Horikoshi, Masataka; Futawatari, Tamae

    2011-01-01

    The purpose of the present study is to elucidate the actual states and problems of nursing care provided by certified nurses in breast cancer patients treated with radiotherapy following to breast-conserving surgery. The survey was conducted by a postal anonymous questionnaire. Participants were drawn from the list of certified nurses on the website of Japanese Nursing Association. The questionnaires consisted of multiple choice questions regarding the contents of care performed before, during and after radiotherapy, and free questionnaire on the related problems. The rate of valid replies was 41.2% (40 out of 97 subjects). Before radiotherapy, the accomplishing rate exceeded 70% in about half of all nursing cares. The accomplishing rates were 30 to 50% in about 90% of all cares and 40 to 60% in all cares during and after radiotherapy, respectively. Problems were classified into three categories high-quality practice of radiotherapy nursing, establishment of continuing care system and improvement of cooperation. It is recommended to achieve high quality radiotherapy nursing by certified nurses, the establishment of continuing care system and the improvement of cooperation in order to improve nursing care during and after radiotherapy. (author)

  11. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2013-11-01

    Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were

  12. Conservation endocrinology

    Science.gov (United States)

    McCormick, Stephen; Romero, L. Michael

    2017-01-01

    Endocrinologists can make significant contributions to conservation biology by helping to understand the mechanisms by which organisms cope with changing environments. Field endocrine techniques have advanced rapidly in recent years and can provide substantial information on the growth, stress, and reproductive status of individual animals, thereby providing insight into current and future responses of populations to changes in the environment. Environmental stressors and reproductive status can be detected nonlethally by measuring a number of endocrine-related endpoints, including steroids in plasma, living and nonliving tissue, urine, and feces. Information on the environmental or endocrine requirements of individual species for normal growth, development, and reproduction will provide critical information for species and ecosystem conservation. For many taxa, basic information on endocrinology is lacking, and advances in conservation endocrinology will require approaches that are both “basic” and “applied” and include integration of laboratory and field approaches.

  13. Joint imaging

    International Nuclear Information System (INIS)

    Hengst, W.

    1984-01-01

    Joint imaging is a proven diagnostic procedure which has become indispensable to the detection and treatment of different joint diseases in almost all disciplines. The method is suited for early diagnosis of joint affections both in soft tissue and bone which cannot be detected by X-ray or other procedures. The local activity accumulation depends on the rate of metabolism and is visualized in the scan, which in turn enables the extension and floridity of focal lesions to be evaluated and followed-up. Although joint scans may often give hints to probabilities relevant to differential diagnosis, the method is non-specific and only useful if based on the underlying clinical picture and X-ray finding, if possible. The radiation exposure is very low and does not represent a hazard in cases of adequate assessment of indication. In pregnant women and children the assessment of indication has to be based on very strict principles. The method is suited for out-patient diagnosis and can be applied in all installations equipped with a gamma camera and a technetium generator. (orig.) [de

  14. Joint purpose?

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    2013-01-01

    Starting from Crenshaw´s point that antiracism often fails to interrogate patriarchy and that feminism often reproduces racist practices (1991: 1252), this paper asks: What are the theoretical reasons for believing that feminism and anti-racism can be regarded as fighting for the joint purpose...

  15. [Conservation Units.

    Science.gov (United States)

    Texas Education Agency, Austin.

    Each of the six instructional units deals with one aspect of conservation: forests, water, rangeland, minerals (petroleum), and soil. The area of the elementary school curriculum with which each correlates is indicated. Lists of general and specific objectives are followed by suggested teaching procedures, including ideas for introducing the…

  16. Creative conservation

    NARCIS (Netherlands)

    Bentham, Roelof J.

    1968-01-01

    The increasing exploitation of our natural resources, the unlimited occupation of ever more new areas, and the intensification of land-use, make it necessary for us to expand the concept of conservation. But we also need to reconsider that concept itself. For the changing conditions in the

  17. Reshaping conservation

    DEFF Research Database (Denmark)

    Funder, Mikkel; Danielsen, Finn; Ngaga, Yonika

    2013-01-01

    members strengthen the monitoring practices to their advantage, and to some extent move them beyond the reach of government agencies and conservation and development practitioners. This has led to outcomes that are of greater social and strategic value to communities than the original 'planned' benefits...

  18. Features of nursing care provided for breast cancer patients treated with radiotherapy following breast-conserving surgery. Comparison of nursing practices between certified nurses in breast cancer nursing and non-specialist nurses working with breast cancer patients

    International Nuclear Information System (INIS)

    Kobayashi, Mariko; Takahira, Yumi; Ichikawa, Kayo; Horikoshi, Masataka; Futawatari, Tamae

    2012-01-01

    This study aimed to identifying features of nursing care provided for breast cancer patients during the course of radiotherapy following breast-conserving surgery and improve the quality of nursing care. Subjects were certified nurses in breast cancer nursing (CN) and non-specialist nurses working with breast cancer patients (NS). An anonymous survey questionnaire on nursing care and other practices provided before, during, and after radiotherapy was conducted by postal mail and the results were compared between CN and NS. Valid responses were obtained from 40 CN (41.2%) and 102 NS (56.7%). Significant differences between CN and NS were observed for 15 of 27 (55.6%) care items before radiotherapy, 18 of 18 (100%) items during radiotherapy, and 9 of 20 (45.0%) items after radiotherapy. Among the items with significant differences, significantly more NS than CN performed all nursing care items during the course of radiotherapy, except for one item provided before radiotherapy. These results demonstrate that it is necessary to facilitate enhanced collaboration and coordination between CN and NS providing nursing care for breast cancer patients in order to improve the quality of nursing care delivered to patients. (author)

  19. Conservation of Charge and Conservation of Current

    OpenAIRE

    Eisenberg, Bob

    2016-01-01

    Conservation of current and conservation of charge are nearly the same thing: when enough is known about charge movement, conservation of current can be derived from conservation of charge, in ideal dielectrics, for example. Conservation of current is enforced implicitly in ideal dielectrics by theories that conserve charge. But charge movement in real materials like semiconductors or ionic solutions is never ideal. We present an apparently universal derivation of conservation of current and ...

  20. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2013-01-01

    Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare

  1. Joint Operation Planning

    National Research Council Canada - National Science Library

    2006-01-01

    .... It sets forth joint doctrine to govern the joint operation planning activities and performance of the Armed Forces of the United States in joint operations, and provides the joint doctrinal basis...

  2. Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle".

    Science.gov (United States)

    Kansagra, Ankit; Andrzejewski, Chester; Krushell, Robert; Lehman, Andrew; Greenbaum, Jordan; Visintainer, Paul; McGirr, Joan; Mahoney, Kathleen; Cloutier, Darlene; Ehresman, Alice; Stefan, Mihaela S

    Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.

  3. Anaerobic prosthetic joint infection.

    Science.gov (United States)

    Shah, Neel B; Tande, Aaron J; Patel, Robin; Berbari, Elie F

    2015-12-01

    In an effort to improve mobility and alleviate pain from degenerative and connective tissue joint disease, an increasing number of individuals are undergoing prosthetic joint replacement in the United States. Joint replacement is a highly effective intervention, resulting in improved quality of life and increased independence [1]. By 2030, it is predicted that approximately 4 million total hip and knee arthroplasties will be performed yearly in the United States [2]. One of the major complications associated with this procedure is prosthetic joint infection (PJI), occurring at a rate of 1-2% [3-7]. In 2011, the Musculoskeletal Infectious Society created a unifying definition for prosthetic joint infection [8]. The following year, the Infectious Disease Society of America published practice guidelines that focused on the diagnosis and management of PJI. These guidelines focused on the management of commonly encountered organisms associated with PJI, including staphylococci, streptococci and select aerobic Gram-negative bacteria. However, with the exception of Propionibacterium acnes, management of other anaerobic organisms was not addressed in these guidelines [1]. Although making up approximately 3-6% of PJI [9,10], anaerobic microorganisms cause devastating complications, and similar to the more common organisms associated with PJI, these bacteria also result in significant morbidity, poor outcomes and increased health-care costs. Data on diagnosis and management of anaerobic PJI is mostly derived from case reports, along with a few cohort studies [3]. There is a paucity of published data outlining factors associated with risks, diagnosis and management of anaerobic PJI. We therefore reviewed available literature on anaerobic PJI by systematically searching the PubMed database, and collected data from secondary searches to determine information on pathogenesis, demographic data, clinical features, diagnosis and management. We focused our search on five commonly

  4. FY 2000 report on the basic survey to promote the joint implementation. Conversion of raw materials in fertilizer plants and energy conservation in India; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Indo hiryo plant genryo tenkan to shoene

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    As a project contributing to reduction in greenhouse effect gas emissions by introducing energy conservation technology of Japan to India and to sustainable economic development in India, study of 'conversion of raw materials in fertilizer plants in India' was made, and the results were reported. The Indian government has been controlling the retail price of fertilizer by the subsidy policy for the protection of the domestic fertilizer production. Therefore, plants, which use coal/heavy oil/naphtha with much greenhouse gas emission as raw materials, have been behind improvement and now have no competitive force in the international market. In this project, concerning ZIL's fertilizer plant, the ammonia production capacity was set at 750 t/d and the urea production capacity at 1,300 t/d, and the energy conservation technology and the conversion of raw materials from naphtha to natural gas were studied. As a result, the amount of energy conservation was 55,705 toe/y, and the amount of CO2 reduction was 245,139 t-CO2/y. Further, this project indicated that profits were expected to increase and the cash flow would change for the better. (NEDO)

  5. FY 2000 report on the basic survey to promote Joint Implementation, etc. Survey on the energy conservation of the Lianyuan Iron and Steel Group Complex, China; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Lianyuan tekko sho energy chosa

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    For the purpose of conserving energy and reducing greenhouse effect gas emission, a feasibility study was carried out of the installation of energy conservation facilities at the steelworks of Lianyuan Iron and Steel Group Complex, Loudi City, Hunan Province, China. The installation of the following facilities was studied: coke dry quenching (CDQ) equipment, coal moisture control (CMC) equipment, sintering ignition furnace equipment, cooler exhaust heat recovery equipment, top pressure recovery turbine (TRT), and hot stove exhaust heat recovery equipment. As a result of the study, the energy conservation amount was 20,000 toe/y by CDQ, 2,530 toe/y by CMC, 900 toe/y by improvement of ignition furnace in the sintering process, 12,300 toe/y by sintering cooler, 13,200 toe/y by TRT, and 10,300 toe/y by hot stove exhaust heat recovery equipment. Further, the amount of greenhouse effect gas reduction was 61,022 t-CO2/y, 7,843 t-CO2/y, 2,896 t-CO2/y, 38,060 t-CO2/y, 55,295 t-CO2/y, and 40,621 t-CO2/y, respectively. In the estimation of effects vs. expenses, the sintering ignition furnace, sintering cooler exhaust heat recovery, and hot stove exhaust heat recovery indicated the comparatively favorable values. (NEDO)

  6. Conservation and ethnobotanical exploration.

    Science.gov (United States)

    Martin, G J

    1994-01-01

    In recent years conservationists have realized that the maintenance of protected areas is closely linked to rural development. As part of their efforts to improve local people's standards of living, they have sought the advice of researchers who work in communities, especially those that border on nature reserves. Ethnobotanists, who are turning their attention to the cultural and ecological crises confronting the regions in which they work, are natural allies in this venture. The joint efforts of conservationists and ethnobotanists are being supported by non-profit organizations, intergovernmental agencies and research institutes. The search for new drugs and other natural products from plants is an important element in this collaboration, but it cannot be divorced from the broader objective of promoting the survival of biological and cultural diversity. Conservationists will support biodiversity prospecting and related efforts only if there is a clear benefit for local communities and protected areas. An example of the concrete actions being taken by conservation agencies is the People and Plants Initiative, a joint effort of the World Wide Fund for Nature, the United Nations Educational, Scientific and Cultural Organization and the Royal Botanic Gardens, Kew. The main objective is to support the work of ethnobotanists in developing countries in studies of sustainable plant use and application of their work to conservation and community development. The initiative provides training workshops and relevant literature; coordinators work in collaboration with local people to create inventories of useful plants and appraise the impact of harvesting specific plant resources in and around protected areas. Phytochemical screening of medicinal plants and preparation of extracts are carried out as part of some projects.

  7. Conservative treatment and rehabilitation of shoulder problems

    International Nuclear Information System (INIS)

    Paternostro-Sluga, T.; Zoech, C.

    2004-01-01

    The shoulder joint has an important influence on arm- and handfunction. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy. (orig.) [de

  8. Sacroiliac joint: A review

    Directory of Open Access Journals (Sweden)

    Khushali Tilvawala

    2018-01-01

    Full Text Available Sacroiliac joint (SIJ pain is one of the common but underdiagnosed source of mechanical low back pain. The incidence is estimated to be in the range of 15%–30% in patients with nonradicular low back pain. The signs and symptoms of SIJ pain mimic pain arising from other causes of low back pain. There is no single symptom or physical examination finding that can firmly diagnose SIJ as a source of patient's pain. There is good evidence suggesting that a combination of three or more positive provocative tests strongly suggests SIJ dysfunction. Intra-articular injection with local anesthetic is considered the gold standard for diagnosis of SIJ pain. Many treatment modalities are available for SIJ pain, ranging from conservative management to surgical interventions. This review article covers all the aspects of SIJ pain, with treatment section mainly covering evidence-based interventional procedures.

  9. Crowdfunding biodiversity conservation.

    Science.gov (United States)

    Gallo-Cajiao, E; Archibald, C; Friedman, R; Steven, R; Fuller, R A; Game, E T; Morrison, T H; Ritchie, E G

    2018-05-26

    mechanisms, its contribution goes beyond funding research and providing capital. Embraced with due care, crowdfunding could potentially become an increasingly important financial mechanism for biodiversity conservation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Blood Conservation.

    Science.gov (United States)

    Martin, Jeremiah T; Ferraris, Victor A

    2015-01-01

    Patient blood management requires multi-modality and multidisciplinary collaboration to identify patients who are at increased risk of requiring blood transfusion and therefore decrease exposure to blood products. Transfusion is associated with poor postoperative outcomes, and guidelines exist to minimize transfusion requirements. This review highlights recent studies and efforts to apply patient blood management across disease processes and health care systems. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty?

    Science.gov (United States)

    Parvizi, Javad; Barnes, Sue; Shohat, Noam; Edmiston, Charles E

    2017-11-01

    In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (<2.5%); however, the personal and fiscal morbidity is significant. Although the pharmaceutic and computer industries enforce stringent air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

    Science.gov (United States)

    Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

    2014-01-01

    Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in

  13. Basic investigation on promotion of joint implementation in fiscal 2000. Efficiency improvement and energy conservation at Uong Bi power plant; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Uong Bi hatsudensho no koritsuka to sho energy

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Discussions have been given on energy conservation, and reduction in greenhouse gas emission through efficiency improvement at the Uong Bi coal burning power plant in Vietnam. The Uong Bi power plant, which has become using coal of lower quality than the design value, has had incomplete combustion, resulting in increase of unburned components in ash, and decrease of the boiler efficiency to 65 to 70%. Clinker hopper troubles have been occurring frequently, causing plant shutdown at a number of times. The turbine efficiency also shows as very low value as 26 to 27%. The plan has envisaged replacement of combustion parts of the boilers, withdrawal and replacement of the turbine generation systems, new installation of electric dust collectors, modification of the ash treatment system, additional installation of the re-circulation system, new installation of waste water treatment facilities, and modification of the waste water treatment equipment in the plant premises. As a result of the discussions, the annual energy saving quantity was found to be 62,936 tons of crude oil equivalent for the case where only one turbine is renewed, and 93,298 tons for the case where both of the two turbines are renewed. The annual reduction quantity of the greenhouse gas emission was found to be 251,215 tons and 372,402 t-CO2, respectively. (NEDO)

  14. U.S.– India Joint Center for Building Energy Research and Development (CBERD) Caring for the Energy Health of Healthcare Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Reshma [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mathew, Paul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Granderson, Jessica [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Srivastava, Rohini [Carnegie Mellon Univ., Pittsburgh, PA (United States); Shukla, Rash [Center for Environmental Planning and Technology (India)

    2016-03-01

    The U.S.-India Joint Center for Building Energy Research & Development (CBERD), created through the Partnership to Accelerate Clean Energy (PACE) agreement between the United States and India, is a research and development (R&D) center with over 30 institutional and industry partners from both nations. This five-year presidential initiative is jointly funded by the U.S. Department of Energy and the Government of India. CBERD aims to build upon a foundation of collaborative knowledge, tools, and technologies, and human capabilities that will increase development of high-performance buildings. To reach this goal, the R&D focuses on energy use reduction throughout the entire life cycle of buildings—i.e., design, construction, and operations. During the operations phase of buildings, even with best-practice energy-efficient design, actual energy use can be much higher than the design intent. Every day, much of the energy consumed by buildings serves no purpose (Roth et al. 2005). Building energy information systems (EIS) are commercially available systems that building owners and facility managers use to assess their building operations, measure, visualize, analyze, and report energy cost and consumption. Energy information systems can enable significant energy savings by tracking energy use, identifying consumption patterns, and benchmarking performance against similar buildings, thereby identifying improvement opportunities. The CBERD team has identified potential energy savings of approximately 2 quads of primary energy in the United States, while industry building energy audits in India have indicated potential energy savings of up to 30 percent in commercial buildings such as offices. Additionally, the CBERD team has identified healthcare facilities (e.g., hospitals, clinics), hotels, and offices as the three of the highest-growth sectors in India that have significant energy consumption, and that would benefit the most from implementation of EIS.

  15. Basic research on energy conservation in developing countries. Joint research on oil conservation (research report on the industrial basis of Socialist Republic of Vietnam); Hatten tojokoku energy shohi koritsuka kiso chosanado jigyo sekiyu shohi koritsuka kyoryoku chosa. Betonamu shakai shugi kyowakoku sangyo kiso chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    The field research of oil conservation was conducted in developing countries, in particular, Vietnam where a steep increase in oil consumption is anticipated in the future. Energy conservation is the most effective direct measures to control combustion of fossil fuels, and an important issue to be promoted by all countries in the world to prevent global warming and reserve energy resources. In fiscal 1994, main industries in the northern part of Vietnam were researched. In fiscal 1995, the report meeting of plant survey results in the northern part and the technical seminar of energy-saving in industrial field were held, and plants around Ho Chi Minh City in the southern part of Vietnam were researched. Although Vietnam has recently acquired membership in ASEAN and is undergoing dramatic economic growth, has many problems in environmental measures. Japan has top-ranking results on energy-saving in industrial field, and the transfer of such superior technologies and techniques will greatly contribute to resource and global warming problems as well as pollution control measures in Vietnam. 13 refs., 25 figs., 26 tabs.

  16. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2017-10-01

    Full Text Available Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR, European Society for Neonatology (ESN, Union of European Neonatal & Perinatal Societies (UENPS, European Foundation for the Care of Newborn Infants (EFCNIORGANIZING COMMITTEELuc Zimmermann (President of ESPR, Morten Breindahl (President of ESN, Manuel Sánchez Luna (President of UENPS, Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNISCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair, Pierre Gressens (Past Scientific President, Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Quality Improvement, Parents Centered Care"ABS 1. REDUCING MEDICATION ERRORS IN NICU – A QUALITY IMPROVEMENT PROJECT • D.A. Al Masri, B. Ofoegbu, L. Yahya, K. Catroon, A. Saliba, H. IbrahimABS 2. PRETERM INFANTS WITH MEDICAL COM­PLEXITY: IMPACT ON HEALTH CARE RESOURCE USE, FAMILY EMPLOYMENT AND NEURODEVELOPMENTAL OUTCOMES • D. Nassel, C. Chartrand, M.-J. Doré-Bergeron, M. Ballantyne, F. Lefebvre, T.M. LuuABS 3. BREAST MILK DONATION IN THE MUSLIM POPULATION • S. Jebali, E. Ayachi, R. Terki Hassaine, A. Giuseppi, D. Vaiman, S. Brunet, V. RigourdABS 4. CORE OUTCOMES IN NEONATOLOGY: PRELIMINARY RESULTS • J. Webbe, N. Modi, C. Gale, on behalf of the COIN Steering GroupABS 5. A PILOT STUDY ASSESSING THE EFFECTIVENESS OF A FAMILY-CENTERED CARE INTERVENTION IN PRETERM INFANTS IN CHINA • R. Zhang, R. Huang, X. Gao, X. Peng, L. Zhu, R. Ramanathan, J. LatourABS 6. TO DETERMINE HOW MANY MOTHERS OF PRETERM BABIES, WHO WERE DELIVERED BETWEEN 24 AND 34 WEEKS GESTATION AND WERE ADMITTED TO NEONATAL UNIT AT ST. MARY’ S HOSPITAL, DID NOT RECEIVE ANTENATAL STEROIDS • A. Arunoday, A. Manou

  17. International joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    2001-01-01

    The article analysis problems connected with corporate joint ventures. Among others the possible conflicts between the joint venture agreement and the statutes of the companies is examined, as well as certain problems connected to the fact that the joint venture partners have created commen control...... over their joint company....

  18. Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

    Science.gov (United States)

    Siletz, Anaar E.; Singer, Emily S.; Faltermeier, Claire; Hu, Q. Lina; Ko, Clifford Y.; Golladay, Gregory J.; Kates, Stephen L.; Wick, Elizabeth C.; Maggard-Gibbons, Melinda

    2018-01-01

    Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving

  19. Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.

    Science.gov (United States)

    Childers, Christopher P; Siletz, Anaar E; Singer, Emily S; Faltermeier, Claire; Hu, Q Lina; Ko, Clifford Y; Golladay, Gregory J; Kates, Stephen L; Wick, Elizabeth C; Maggard-Gibbons, Melinda

    2018-01-01

    Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/ Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and

  20. Improving livestock production using indigenous resources and conserving the environment. A publication prepared under the framework of a Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific project with technical support of the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture

    International Nuclear Information System (INIS)

    2010-03-01

    Livestock farming is very important in Asia and the pacific region as a source of livelihood for resource poor farmers' - provision of food and food products and as a source of income. However, livestock productivity in many countries is below their genetic potential because of inadequate and imbalanced feeds and feeding, poor reproductive management and animal diseases exacerbated by lack of effective support services, such as animal husbandry extension, artificial insemination (AI) and/or veterinary services. The International Atomic Energy Agency (IAEA) and the Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific (RCA), with technical support of the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, implemented a Technical Cooperation (TC) project entitled 'Integrated Approach for Improving Livestock Production using Indigenous Resources and Conserving the Environment' (RAS/5/044). The overall objective of the project was to improve livestock productivity through better nutritional and reproduction strategies while conserving the environment. The specific objectives were (i) to improve animal productivity and decrease emission of selected greenhouse gases, (methane and carbon dioxide) and selected nutrients (nitrogen and phosphorus) into the environment; and (ii) to identify and adopt better breeding strategies that would improve animal productivity. This publication contains research results presented by scientists during the final review meeting incorporating the contributions of the experts associated with RAS/5/044. It is hoped that this publication will help stimulate further discussion, research and development into ways of improving the efficiency and productivity of livestock thus leading to higher income for smallholder farmers in the region

  1. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2014-01-01

    Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.

  2. Lyme disease and conservation

    Science.gov (United States)

    Ginsberg, H.

    1994-01-01

    Lyme disease is a tick-borne illness that is wide-spread in North America, especially in the northeastern and northcentral United States. This disease could negatively influence efforts to conserve natural populations in two ways: (1) the disease could directly affect wild animal health; and (2) tick control efforts could adversely affect natural populations and communities. Lyme disease affects several domestic animals, but symptoms have been reported in only a few wild species. Direct effects of Lyme disease on wild animal populations have not been reported, but the disease should be considered as a possible cause in cases of unexplained population declines in endemic areas. Methods available to manage ticks and Lyme disease include human self-protection techniques, manipulation of habitats and hosts species populations, biological control, and pesticide applications. The diversity of available techniques allows selection of approaches to minimize environmental effects by (1) emphasizing personal protection techniques, (2) carefully targeting management efforts to maximize efficiency, and (3) integrating environmentally benign techniques to improve management while avoiding broad-scale environmentally destructive approaches. The environmental effects of Lyme disease depend, to a large extent, on the methods chosen to minimize human exposure to infected ticks. Conservation biologists can help design tick management programs that effectively lower the incidence of human Lyme disease while simultaneously minimizing negative effects on natural populations.

  3. Fabrication of high-quality brazed joints

    International Nuclear Information System (INIS)

    Orlov, A.V.

    1980-01-01

    Problem of ensuring of joint high-quality when brazing different parts in power engineering is considered. To obtain high-quality joints it is necessary to correctly design brazed joint and to choose a gap width, overlap length and fillet radius; to clean up carefully the surfaces to be brazed and fix them properly one relative to another; to apply a solder so as to provide its flowing into the gap and sticking in it; to exactly regulate thermal conditions of brazing. High quality and reliability of brazed joints are ensured by the application of solders based on noble metals, and cheap solders based on nickel, manganese and copper. Joints brazed with nickel base solders may operate at temperatures as high as 888 deg C

  4. Identifying research priorities in anaesthesia and perioperative care: final report of the joint National Institute of Academic Anaesthesia/James Lind Alliance Research Priority Setting Partnership.

    Science.gov (United States)

    Boney, Oliver; Bell, Madeline; Bell, Natalie; Conquest, Ann; Cumbers, Marion; Drake, Sharon; Galsworthy, Mike; Gath, Jacqui; Grocott, Michael P W; Harris, Emma; Howell, Simon; Ingold, Anthony; Nathanson, Michael H; Pinkney, Thomas; Metcalf, Leanne

    2015-12-16

    To identify research priorities for Anaesthesia and Perioperative Medicine. Prospective surveys and consensus meetings guided by an independent adviser. UK. 45 stakeholder organisations (25 professional, 20 patient/carer) affiliated as James Lind Alliance partners. First 'ideas-gathering' survey: Free text research ideas and suggestions. Second 'prioritisation' survey: Shortlist of 'summary' research questions (derived from the first survey) ranked by respondents in order of priority. Final 'top ten': Agreed by consensus at a final prioritisation workshop. First survey: 1420 suggestions received from 623 respondents (49% patients/public) were refined into a shortlist of 92 'summary' questions. Second survey: 1718 respondents each nominated up to 10 questions as research priorities. Top ten: The 25 highest-ranked questions advanced to the final workshop, where 23 stakeholders (13 professional, 10 patient/carer) agreed the 10 most important questions: ▸ What can we do to stop patients developing chronic pain after surgery? ▸ How can patient care around the time of emergency surgery be improved? ▸ What long-term harm may result from anaesthesia, particularly following repeated anaesthetics?▸ What outcomes should we use to measure the 'success' of anaesthesia and perioperative care? ▸ How can we improve recovery from surgery for elderly patients? ▸ For which patients does regional anaesthesia give better outcomes than general anaesthesia? ▸ What are the effects of anaesthesia on the developing brain? ▸ Do enhanced recovery programmes improve short and long-term outcomes? ▸ How can preoperative exercise or fitness training, including physiotherapy, improve outcomes after surgery? ▸ How can we improve communication between the teams looking after patients throughout their surgical journey? Almost 2000 stakeholders contributed their views regarding anaesthetic and perioperative research priorities. This is the largest example of patient and public

  5. Joint Replacement (Finger and Wrist Joints)

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Joint Replacement Email to a friend * required fields ...

  6. Blood Conservation Strategies in Total Hip and Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    David Liu

    2015-01-01

    Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  7. Conservation potential of agricultural water conservation subsidies

    Science.gov (United States)

    Huffaker, Ray

    2008-07-01

    A current policy subsidizes farmers to invest in improved on-farm irrigation efficiency, expecting water to be conserved off farm. Contrary to expectation, water has been increasingly depleted in some regions after such improvements. This paper investigates the policy's failure to conserve water consistently by (1) formulating an economic model of irrigated crop production to determine a profit-maximizing irrigator's range of responses to a subsidy and (2) embedding these responses into hypothetical streamflow diagrams to ascertain their potential to conserve water under various hydrologic regimes. Testable hypotheses are developed to predict the conservation potential of a subsidy in real-world application.

  8. Hip joint injection

    Science.gov (United States)

    ... medicine into the joint. The provider uses a real-time x-ray (fluoroscopy) to see where to place ... Wakefield RJ. Arthrocentesis and injection of joints and soft tissue. In: Firestein GS, Budd RC, Gabriel SE, ...

  9. Sacroiliac joint pain - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000610.htm Sacroiliac joint pain - aftercare To use the sharing features on this page, please enable JavaScript. The sacroiliac joint (SIJ) is a term used to describe ...

  10. Reliability of Tubular Joints

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Thoft-Christensen, Palle

    In this paper the preliminary results obtained by tests on tubular joints are presented. The joints are T-joints and the loading is static. It is the intention in continuation of these tests to perform tests on other types of joints (e.g. Y-joints) and also with dynamic loading. The purpose...... of the test is partly to obtain empirical data for the ultimate load-carrying capacity of tubular T-joints and partly to obtain some experience in performing tests with tubular joints. It is well known that tubular joints are usually designed in offshore engineering on the basis of empirical formulas obtained...... by experimental test results. Therefore, there is a need for performing experimental tests in this area....

  11. Hip joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: ...

  12. Conservation Triage Falls Short Because Conservation Is Not Like Emergency Medicine

    Directory of Open Access Journals (Sweden)

    John A. Vucetich

    2017-05-01

    Full Text Available Conservation triage, as a concept, seems to have been born from analogizing circumstances that characterize conservation with triage, as the concept applies to emergency medicine. Careful consideration—facilitated through the aid of formal argumentation—demonstrates the critical limitations of the analogy. Those limitations reveal how the concept of conservation triage falls short. For example, medical triage presupposes that resources available for an emergency are limited and fixed. By contrast, the resources available for conservation are not fixed. Moreover, the ethics of prioritization in medical triage is characterized by there being universal agreement on the moral value of the patients. However, in conservation there is not universal agreement on the value of various objects of conservation concern. The looming importance of those features of conservation—disputed values and unfixed resources—make conservation triage a largely un-useful concept.

  13. Design of mechanical joints

    CERN Document Server

    Blake, Alexander

    2018-01-01

    A cornerstone publication that covers the basic principles and practical considerations of design methodology for joints held by rivets, bolts, weld seams, and adhesive materials, Design of Mechanical Joints gives engineers the practical results and formulas they need for the preliminary design of mechanical joints, combining the essential topics of joint mechanics...strength of materials...and fracture control to provide a complete treatment of problems pertinent to the field of mechanical connections.

  14. Managing Joint Production Motivation

    DEFF Research Database (Denmark)

    Lindenberg, Siegwart; Foss, Nicolai Juul

    2011-01-01

    We contribute to the microfoundations of organizational performance by proffering the construct of joint production motivation. Under such motivational conditions individuals see themselves as part of a joint endeavor, each with his or her own roles and responsibilities; generate shared...... representations of actions and tasks; cognitively coordinate cooperation; and choose their own behaviors in terms of joint goals. Using goal-framing theory, we explain how motivation for joint production can be managed by cognitive/symbolic management and organizational design....

  15. Conservative management of neuromuscular scoliosis: personal experience and review of literature.

    Science.gov (United States)

    Kotwicki, Tomasz; Jozwiak, Marek

    2008-01-01

    The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

  16. The sacroiliac joint: anatomy, physiology and clinical significance.

    Science.gov (United States)

    Forst, Stacy L; Wheeler, Michael T; Fortin, Joseph D; Vilensky, Joel A

    2006-01-01

    The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.

  17. Fold and Fit: Space Conserving Shape Editing

    KAUST Repository

    Ibrahim, Mohamed

    2017-09-01

    We present a framework that folds man-made objects in a structure-aware manner for space-conserving storage and transportation. Given a segmented 3D mesh of a man-made object, our framework jointly optimizes for joint locations, the folding order, and folding angles for each part of the model, enabling it to transform into a spatially efficient configuration while keeping its original functionality as intact as possible. That is, if a model is supposed to withstand several forces in its initial state to serve its functionality, our framework places the joints between the parts of the model such that the model can withstand forces with magnitudes that are comparable to the magnitudes applied on the unedited model. Furthermore, if the folded shape is not compact, our framework proposes further segmentation of the model to improve its compactness in its folded state.

  18. The Degredation and Conservation of Leather

    Directory of Open Access Journals (Sweden)

    Vicki Dirksen

    1997-11-01

    Full Text Available This paper examines the tanning processes used in the manufacture of leather and the implications such processes have on the deterioration of aging leather. Improving the understanding of the processes used to create leather should result in a museum professional who is better able to address the conservation and care of leather artefacts. Present methods of leather conservation are examined with regard to the advantages and disadvantages of each method.

  19. Functional disorders of the temporomandibular joints: Internal derangement of the temporomandibular joint.

    Science.gov (United States)

    Chang, Chih-Ling; Wang, Ding-Han; Yang, Mu-Chen; Hsu, Wun-Eng; Hsu, Ming-Lun

    2018-04-01

    Temporomandibular joint (TMJ) is one of the most complex joints of the human body. Due to its unique movement, in terms of combination of rotation and translator movement, disc of the joint plays an important role to maintain its normal function. In order to sustain the normal function of the TMJ, disc must be kept in proper position as well as maintain normal shape in all circumstances. Once the disc is not any more in its normal position during function of the joint, disturbance of the joint can be occurred which will lead to subsequent distortion of the disc. Shape of the disc can be influenced by many factors i.e.: abnormal function or composition of the disc itself. Etiology of the internal derangement of the disc remains controversial. Multifactorial theory has been postulated in most of previous manuscripts. Disc is composed of mainly extracellular matrix. Abnormal proportion of collagen type I & III may also leads to joint hypermobility which may be also a predisposing factor of this disorder. Thus it can be recognized as local manifestation of a systemic disorder. Different treatment modalities with from conservative treatment to surgical intervention distinct success rate have been reported. Recently treatment with extracellular matrix injection becomes more and more popular to strengthen the joint itself. Since multifactorial in character, the best solution of the treatment modalities should be aimed to resolve possible etiology from different aspects. Team work may be indication to reach satisfied results. Copyright © 2018. Published by Elsevier Taiwan.

  20. Lasers in the Conservation of Artworks

    CERN Document Server

    Nimmrichter, Johann; Schreiner, Manfred; LACONA VI Proceedings

    2007-01-01

    Within the last decades, the use of lasers in artworks conservation became an important tool for many conservators, scientists, architects and other experts, who are involved in the care of monuments and artefacts or laser technology. For the first time in 1995 Professor Costas Fotakis brought together restorers and scientists to discuss the potential of lasers in art conservation. Since then the field of "Lasers in the Conservation of Artworks" has gained enormously in importance. Nowadays restorers and laser scientists work close together in order to develop new fields of applications during the last years. Furthermore a large number of national and international research projects have been carried out by conservator-restorers, architects and scientists. In the last 10 years a number of historical and artistic high quality monuments (e.g. St. Stephens Cathedral in Vienna) have been cleaned or measured by laser and brought the laser in the spectra of tools which are useful in the sensible field of artworks. ...

  1. Joint implementation along two ways

    International Nuclear Information System (INIS)

    De Vos, R.

    1997-01-01

    In the test phase to the year 2000 joint implementation (JI) must prove to be a valuable tool for the climate change policy. The Dutch Ministries of Housing, Planning and Environmental Protection (VROM) and Economic Affairs (EZ) would like to form a basis for a JI-protocol during the Climate Conference in Kyoto, Japan, which will be held at the end of 1997. However, the Ministry of Development Cooperation wants to follow a more careful approach towards the cooperation with developing countries. Special attention is paid to a JI-project in Romania

  2. Conservation: Toward firmer ground

    Science.gov (United States)

    1975-01-01

    The following aspects of energy conservation were reviewed in order to place the problems in proper perspective: history and goals, conservation accounting-criteria, and a method to overcome obstacles. The effect of changing prices and available supplies of energy sources and their causes on consumption levels during the last few decades were described. Some examples of attainable conservation goals were listed and justified. A number of specific criteria applicable to conservation accounting were given. Finally, a discussion was presented to relate together the following aspects of energy conservation: widespread impact, involvement of government, industry, politics, moral and ethical aspects, urgency and time element.

  3. Mechanics of Suture Joints

    Science.gov (United States)

    Li, Yaning; Song, Juha; Ortiz, Christine; Boyce, Mary; Ortiz Group/DMSE/MIT Team; Boyce Group/ME/MIT Team

    2011-03-01

    Biological sutures are joints which connect two stiff skeletal or skeletal-like components. These joints possess a wavy geometry with a thin organic layer providing adhesion. Examples of biological sutures include mammalian skulls, the pelvic assembly of the armored fish Gasterosteus aculeatus (the three-spined stickleback), and the suture joints in the shell of the red-eared slider turtle. Biological sutures allow for movement and compliance, control stress concentrations, transmit loads, reduce fatigue stress and absorb energy. In this investigation, the mechanics of the role of suture geometry in providing a naturally optimized joint is explored. In particular, analytical and numerical micromechanical models of the suture joint are constructed. The anisotropic mechanical stiffness and strength are studied as a function of suture wavelength, amplitude and the material properties of the skeletal and organic components, revealing key insights into the optimized nature of these ubiquitous natural joints.

  4. Evaluation of aural manifestations in temporo-mandibular joint dysfunction.

    Science.gov (United States)

    Sobhy, O A; Koutb, A R; Abdel-Baki, F A; Ali, T M; El Raffa, I Z; Khater, A H

    2004-08-01

    Thirty patients with temporo-mandibular joint dysfunction were selected to investigate the changes in otoacoustic emissions before and after conservative treatment of their temporo-mandibular joints. Pure tone audiometry, transient-evoked otoacoustic emissions (TEOAE), distortion-product otoacoustic emissions (DPOAE) as well as a tinnitus questionnaire were administered to all patients before and after therapy. Therapy was conservative in the form of counselling, physiotherapy, anti-inflammatory agents, muscle relaxants, and occlusal splints. Results indicated insignificant changes in the TEOAEs, whereas there were significant increases in distortion product levels at most of the frequency bands. These results were paralleled to subjective improvement of tinnitus.

  5. Expansion joints for LMFBR

    Energy Technology Data Exchange (ETDEWEB)

    Dzenus, M.; Hundhausen, W.; Jansing, W.

    1979-10-15

    This discourse recounts efforts put into the SNR-2 project; specifically the development of compensation devices. The various prototypes of these compensation devices are described and the state of development reviewed. The expansion joints were developed on the basis of specific design criteria whereby differentiation is made between expansion joints of small and large nominal diameter. Expansion joints for installation in the sodium-filled primary piping are equipped with safety bellows in addition to the actual working bellows.

  6. Ecological, biological balances and conservation

    International Nuclear Information System (INIS)

    Perttu, K.L.

    1995-01-01

    The scientific work within the activity ''ecological/biological balances and conservation'' is summarised in this report. The aims of the activity during its existence between 1992 and 1994 have been to: (i) arrange a workshop and publish the presentations on the environmental aspects of energy forest cultivations, (ii) perform joint scientific work together with the activity group on ''biological disposal of wastewaters and sludges'', that is closely related to environmental problems, and (iii) produce ecological guidelines concerning energy forestry, suitable for advisers and farmers dealing with bioenergy problems. The most important results from the workshop were the environmental benefits from energy forestry when compared with intensive agriculture and forestry. Energy forestry has positive influence on the carbon balances, nutrient recycling, and soil sustainability. The effects are also positive on the natural flora and fauna, which in most cases are enriched when compared with agricultural crops. From the joint efforts of the two activities the main result was a study tour, conference and workshop, concentrating on biological purification systems. The most promising system seems to be the vegetation filters of short rotation coppice. The report on ecological guidelines contains a number of ideas and recommendations for establishment, management, and harvesting of energy forests in an environmentally acceptable way. It also gives advice on how to locate the stands to minimise the risk of nutrient leakage from arable land. (Author)

  7. JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT.

    Science.gov (United States)

    Jayaseelan, Dhinu J; Post, Andrew A; Mischke, John J; Sault, Josiah D

    2017-02-01

    Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. Therapy, Level 4.

  8. Achieving open access to conservation science.

    Science.gov (United States)

    Fuller, Richard A; Lee, Jasmine R; Watson, James E M

    2014-12-01

    Conservation science is a crisis discipline in which the results of scientific enquiry must be made available quickly to those implementing management. We assessed the extent to which scientific research published since the year 2000 in 20 conservation science journals is publicly available. Of the 19,207 papers published, 1,667 (8.68%) are freely downloadable from an official repository. Moreover, only 938 papers (4.88%) meet the standard definition of open access in which material can be freely reused providing attribution to the authors is given. This compares poorly with a comparable set of 20 evolutionary biology journals, where 31.93% of papers are freely downloadable and 7.49% are open access. Seventeen of the 20 conservation journals offer an open access option, but fewer than 5% of the papers are available through open access. The cost of accessing the full body of conservation science runs into tens of thousands of dollars per year for institutional subscribers, and many conservation practitioners cannot access pay-per-view science through their workplace. However, important initiatives such as Research4Life are making science available to organizations in developing countries. We urge authors of conservation science to pay for open access on a per-article basis or to choose publication in open access journals, taking care to ensure the license allows reuse for any purpose providing attribution is given. Currently, it would cost $51 million to make all conservation science published since 2000 freely available by paying the open access fees currently levied to authors. Publishers of conservation journals might consider more cost effective models for open access and conservation-oriented organizations running journals could consider a broader range of options for open access to nonmembers such as sponsorship of open access via membership fees. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of the Society for

  9. Surgical treatment of a concurrent type 5 acromioclavicular joint dislocation and a failed anterior glenohumeral joint stabilization

    OpenAIRE

    Rashid, Abbas; Lawrence, Christopher; Tytherleigh-Strong, Graham

    2016-01-01

    Traumatic glenohumeral joint dislocation and acromioclavicular joint subluxations tend to occur in young active males. Use of the coracoid process either as a transfer in recurrent instability or in suspensory reconstructions of the coracoclavicular ligaments have gained popularity. However this requires careful consideration in the event of concomitant injuries if they both require surgery.

  10. Numerical rigid plastic modelling of shear capacity of keyed joints

    DEFF Research Database (Denmark)

    Herfelt, Morten Andersen; Poulsen, Peter Noe; Hoang, Linh Cao

    2015-01-01

    Keyed shear joints are currently designed using simple and conservative design formulas, yet these formulas do not take the local mechanisms in the concrete core of the joint into account. To investigate this phenomenon a rigid, perfectly plastic finite element model of keyed joints is used....... The model is formulated for second-order conic optimisation as a lower bound problem, which yields a statically admissible stress field that satisfies the yield condition in every point. The dual solution to the problem can be interpreted as the collapse mode and will be used to analyse the properties...

  11. Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the medicare population.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hansen, Hans; Pampati, Vidyasagar; Falco, Frank J E

    2013-01-01

      The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. To evaluate the utilization and growth patterns of sacroiliac joint injections. This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including

  12. JET Joint Undertaking

    International Nuclear Information System (INIS)

    Keen, B.E.

    1987-03-01

    The paper presents the progress report of the Joint European Torus (JET) Joint Undertaking, 1986. The report contains a survey of the scientific and technical achievements on JET during 1986; the more important articles referred to in this survey are reproduced as appendices to this Report. The last section discusses developments which might improve the overall performance of the machine. (U.K.)

  13. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.

    2010-01-01

    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  14. Transversely Compressed Bonded Joints

    DEFF Research Database (Denmark)

    Hansen, Christian Skodborg; Schmidt, Jacob Wittrup; Stang, Henrik

    2012-01-01

    The load capacity of bonded joints can be increased if transverse pressure is applied at the interface. The transverse pressure is assumed to introduce a Coulomb-friction contribution to the cohesive law for the interface. Response and load capacity for a bonded single-lap joint was derived using...

  15. Joint Newspaper Operating Agreements.

    Science.gov (United States)

    Parsons, Marie

    The number of competing daily newspapers in American cities has dwindled until only about 50 cities boast two papers. Of the newspapers in those cities, 23 now maintain separate editorial operations but have joint printing, advertising, and circulation departments. The concept of joint operation is 50 years old, dating from the Depression years…

  16. Joint Hub Network Development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.

    2007-01-01

    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once.

  17. Elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole

    1994-01-01

    The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...

  18. Bistable Articulated Joint

    Science.gov (United States)

    Graighead, Norwood D., II; Preliasco, R. J.; Hult, T. D.

    1986-01-01

    Joint with four-bar-linkage geometry has following attributes: Springs to fully extended fully folded positions. Automatically locks in its extended position. Joint combines zero backlash, positive locking, and centerline pivoting. Used in folding tool handles, portable antenna booms, and many other deployable structures.

  19. MP Joint Arthritis

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy MP Joint Arthritis Email to a friend * required ...

  20. Creep of timber joints

    NARCIS (Netherlands)

    Van de Kuilen, J.W.G.

    2008-01-01

    A creep analysis has been performed on nailed, toothed-plates and split-ring joints in a varying uncontrolled climate. The load levels varied between 30% and 50% of the average ultimate short term strength of these joints, tested in accordance with ISO 6891. The climate in which the tests were

  1. MR diagnosis of temporomandibular joint. A study of joint effusion

    International Nuclear Information System (INIS)

    Kaneda, Takashi; Yamashiro, Mitsuaki; Ozawa, Kaoru; Suzuki, Hiromi; Okada, Hiroyuki; Yamamoto, Hirotsugu

    1998-01-01

    The purposes of this study were to evaluate the relationship between correlation of MR joint effusion of the temporomandibular joint and disk position, to evaluate the relationship between joint effusion and aging, and to assess the frequency of MR joint effusion of bilateral temporomandibular joints. The temporomandibular joints of 192 patients with clinical symptoms of temporomandibular joint disorders were imaged bilaterally using high field, surface-coil MR imaging. Oblique sagittal and coronal proton density-weighted and T2-weighted images were obtained. Imaging findings of joint effusion were correlated with disk position, aging, and bilateral temporomandibular joints. MR showed effusion in 4% of the joints with normal superior disk position, 36% of the joints with disk displacement with reduction, and 45% of the joints with disk displacement without reduction. There were significant differences in the incidence of joint effusion between normal disk position and anterior disk displacement with or without reduction. Younger patients less than 40 years were significant higher the incidence of joint effusion than those of older patients. A significant association was seen between joint effusion and aging. MR showed effusion in 17% of the unilateral temporomandibular joint, 24% of the bilateral temporomandibular joints. There was no significant difference between unilateral and bilateral case. These results indicated that joint effusion using MR imaging was associated with varied temporomandibular joint pathologic states. (author)

  2. Conservation: Toward firmer ground

    Science.gov (United States)

    1975-01-01

    The following aspects of energy conservation were discussed: conservation history and goals, conservation modes, conservation accounting-criteria, and a method to overcome obstacles. The conservation modes tested fall into one of the following categories: reduced energy consumption, increased efficiency of energy utilization, or substitution of one or more forms of energy for another which is in shorter supply or in some sense thought to be of more value. The conservation accounting criteria include net energy reduction, economic, and technical criteria. A method to overcome obstacles includes (approaches such as: direct personal impact (life style, income, security, aspiration), an element of crisis, large scale involvement of environmental, safety, and health issues, connections to big government, big business, big politics, involvement of known and speculative science and technology, appeal to moral and ethical standards, the transient nature of opportunities to correct the system.

  3. Econometric modelling of conservation

    International Nuclear Information System (INIS)

    Parker, J.C.; Seal, D.J.

    1990-01-01

    The issue of energy conservation in general, and conservation in the natural gas markets in particular, has recently had a much lower profile than in the past, when energy prices were significantly higher and energy costs composed a much larger proportion of industrial operating costs than today. The recent downward trend in energy prices has diverted attention away from this issue. In the face of expected significant real price increases, increasing pressure from environmental groups, and directives on the part of regulator authorities, conservation is once again becoming a topic of consideration in the energy industry. From the point of view of gas demand forecasting, conservation has received too little attention. The intentions of this paper are to establish the need for forecasting conservation in the natural gas utility sector, and to construct a model of industrial demand which incorporates conservation and is appropriate for use as a forecasting tool

  4. Arthrocentesis as initial treatment for temporomandibular joint arthropathy : A randomized controlled trial

    NARCIS (Netherlands)

    Vos, L. M.; Huddleston Slater, J. J. R.; Stegenga, B.

    Objective: To determine the effectiveness of arthrocentesis compared to conservative treatment as initial treatment with regard to temporomandibular joint pain and mandibular movement. Patients and methods: In this randomized controlled trial, 80 patients with arthralgia of the TMJ (classified

  5. Generalised joint hypermobility and knee joint hypermobility

    DEFF Research Database (Denmark)

    Junge, Tina; Henriksen, Peter; Hansen, Sebrina

    2018-01-01

    . Respondents with GJHk and KJH reported lower HRQoL. CONCLUSION: GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower...

  6. Handbook on energy conservation

    International Nuclear Information System (INIS)

    1989-12-01

    This book shows energy situation in recent years, which includes reserves of energy resource in the world, crude oil production records in OPEC and non OPEC, supply and demand of energy in important developed countries, prospect of supply and demand of energy and current situation of energy conservation in developed countries. It also deals with energy situation in Korea reporting natural resources status, energy conservation policy, measurement for alternative energy, energy management of Korea, investment in equipment and public education for energy conservation.

  7. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

    OpenAIRE

    Block, Jon; Miller,Larry

    2014-01-01

    Larry E Miller,1,2 Jon E Block21Miller Scientific Consulting, Inc., Asheville, NC, USA; 2The Jon Block Group, San Francisco, CA, USA Abstract: Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The...

  8. Biodiversity Conservation and Conservation Biotechnology Tools

    Science.gov (United States)

    This special issue is dedicated to the in vitro tools and methods used to conserve the genetic diversity of rare and threatened species from around the world. Species that are on the brink of extinction, due to the rapid loss of genetic diversity and habitat, come mainly from resource poor areas the...

  9. Paradigms for parasite conservation.

    Science.gov (United States)

    Dougherty, Eric R; Carlson, Colin J; Bueno, Veronica M; Burgio, Kevin R; Cizauskas, Carrie A; Clements, Christopher F; Seidel, Dana P; Harris, Nyeema C

    2016-08-01

    Parasitic species, which depend directly on host species for their survival, represent a major regulatory force in ecosystems and a significant component of Earth's biodiversity. Yet the negative impacts of parasites observed at the host level have motivated a conservation paradigm of eradication, moving us farther from attainment of taxonomically unbiased conservation goals. Despite a growing body of literature highlighting the importance of parasite-inclusive conservation, most parasite species remain understudied, underfunded, and underappreciated. We argue the protection of parasitic biodiversity requires a paradigm shift in the perception and valuation of their role as consumer species, similar to that of apex predators in the mid-20th century. Beyond recognizing parasites as vital trophic regulators, existing tools available to conservation practitioners should explicitly account for the unique threats facing dependent species. We built upon concepts from epidemiology and economics (e.g., host-density threshold and cost-benefit analysis) to devise novel metrics of margin of error and minimum investment for parasite conservation. We define margin of error as the risk of accidental host extinction from misestimating equilibrium population sizes and predicted oscillations, while minimum investment represents the cost associated with conserving the additional hosts required to maintain viable parasite populations. This framework will aid in the identification of readily conserved parasites that present minimal health risks. To establish parasite conservation, we propose an extension of population viability analysis for host-parasite assemblages to assess extinction risk. In the direst cases, ex situ breeding programs for parasites should be evaluated to maximize success without undermining host protection. Though parasitic species pose a considerable conservation challenge, adaptations to conservation tools will help protect parasite biodiversity in the face of

  10. National Proceedings: Forest and Conservation Nursery Associations - 2013

    Science.gov (United States)

    K. M. Wilkinson; D. L. Haase; J. R. Pinto

    2014-01-01

    These proceedings are a compilation of 14 papers that were presented at the regional meetings of the forest and conservation nursery associations in the United States in 2013. The Joint Northeast and Southern Forest Nursery Conference was held at the Holiday Inn City Centre, Lafayette, Indiana, July 22 to 25, 2013. Subject matter for the technical sections included...

  11. Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management

    Directory of Open Access Journals (Sweden)

    Andrew L Young

    2015-01-01

    Full Text Available Internal derangements of the temporomandibular joint are conditions in which the articular disc has become displaced from its original position the condylar head. Relevant anatomic structures and their functional relationships are briefly discussed. The displacement of the disc can result in numerous presentations, with the most common being disc displacement with reduction (with or without intermittent locking, and disc displacement without reduction (with or without limited opening. These are described in this article according to the standardized Diagnostic Criteria for Temporomandibular Disorders, as well as the less common posterior disc displacement. Appropriate management usually ranges from patient education and monitoring to splints, physical therapy, and medications. In rare and select cases, surgery may be necessary. However, in for the majority of internal derangements, the prognosis is good, particularly with conservative care.

  12. Joint Electromagnetic Spectrum Management Operations

    Science.gov (United States)

    2012-03-20

    promulgate command-specific policy and guidance for EMS use, the joint restricted frequency list (JRFL) process, the joint communications–electronics...joint communications–electronics operating instructions (JCEOI) and joint restricted frequency list (JRFL). Examples of FM include providing the...joint restricted frequency list Figure III-4. Joint Frequency Management Office Spectrum Management Process Chapter III III-10 JP 6-01 assignments

  13. Conservation Documentation and the Implications of Digitisation

    Directory of Open Access Journals (Sweden)

    Michelle Moore

    2001-11-01

    Full Text Available Conservation documentation can be defined as the textual and visual records collected during the care and treatment of an object. It can include records of the object's condition, any treatment done to the object, any observations or conclusions made by the conservator as well as details on the object's past and present environment. The form of documentation is not universally agreed upon nor has it always been considered an important aspect of the conservation profession. Good documentation tells the complete story of an object thus far and should provide as much information as possible for the future researcher, curator, or conservator. The conservation profession will benefit from digitising its documentation using software such as databases and hardware like digital cameras and scanners. Digital technology will make conservation documentation more easily accessible, cost/time efficient, and will increase consistency and accuracy of the recorded data, and reduce physical storage space requirements. The major drawback to digitising conservation records is maintaining access to the information for the future; the notorious pace of technological change has serious implications for retrieving data from any machine- readable medium.

  14. Introducing Conservation of Momentum

    Science.gov (United States)

    Brunt, Marjorie; Brunt, Geoff

    2013-01-01

    The teaching of the principle of conservation of linear momentum is considered (ages 15 + ). From the principle, the momenta of two masses in an isolated system are considered. Sketch graphs of the momenta make Newton's laws appear obvious. Examples using different collision conditions are considered. Conservation of momentum is considered…

  15. Water Conservation Resource List.

    Science.gov (United States)

    NJEA Review, 1981

    1981-01-01

    Alarmed by the growing water shortage, the New Jersey State Office of Dissemination has prepared this annotated list of free or inexpensive instructional materials for teaching about water conservation, K-l2. A tipsheet for home water conservation is appended. (Editor/SJL)

  16. Controllability of conservative behaviours

    NARCIS (Netherlands)

    Rao, Shodhan

    2012-01-01

    In this article, we first define the class of J-conservative behaviours with observable storage functions, where J is a symmetric two-variable polynomial matrix. We then provide two main results. The first result states that if J(-xi,xi) is nonsingular, the input cardinality of a J-conservative

  17. Conservation Science Fair Projects.

    Science.gov (United States)

    Soil Conservation Society of America, Ankeny, IA.

    Included are ideas, suggestions, and examples for selecting and designing conservation science projects. Over 70 possible conservation subject areas are presented with suggested projects. References are cited with each of these subject areas, and a separate list of annotated references is included. The references pertain to general subject…

  18. Fixism and conservation science.

    Science.gov (United States)

    Robert, Alexandre; Fontaine, Colin; Veron, Simon; Monnet, Anne-Christine; Legrand, Marine; Clavel, Joanne; Chantepie, Stéphane; Couvet, Denis; Ducarme, Frédéric; Fontaine, Benoît; Jiguet, Frédéric; le Viol, Isabelle; Rolland, Jonathan; Sarrazin, François; Teplitsky, Céline; Mouchet, Maud

    2017-08-01

    The field of biodiversity conservation has recently been criticized as relying on a fixist view of the living world in which existing species constitute at the same time targets of conservation efforts and static states of reference, which is in apparent disagreement with evolutionary dynamics. We reviewed the prominent role of species as conservation units and the common benchmark approach to conservation that aims to use past biodiversity as a reference to conserve current biodiversity. We found that the species approach is justified by the discrepancy between the time scales of macroevolution and human influence and that biodiversity benchmarks are based on reference processes rather than fixed reference states. Overall, we argue that the ethical and theoretical frameworks underlying conservation research are based on macroevolutionary processes, such as extinction dynamics. Current species, phylogenetic, community, and functional conservation approaches constitute short-term responses to short-term human effects on these reference processes, and these approaches are consistent with evolutionary principles. © 2016 Society for Conservation Biology.

  19. Setting conservation priorities.

    Science.gov (United States)

    Wilson, Kerrie A; Carwardine, Josie; Possingham, Hugh P

    2009-04-01

    A generic framework for setting conservation priorities based on the principles of classic decision theory is provided. This framework encapsulates the key elements of any problem, including the objective, the constraints, and knowledge of the system. Within the context of this framework the broad array of approaches for setting conservation priorities are reviewed. While some approaches prioritize assets or locations for conservation investment, it is concluded here that prioritization is incomplete without consideration of the conservation actions required to conserve the assets at particular locations. The challenges associated with prioritizing investments through time in the face of threats (and also spatially and temporally heterogeneous costs) can be aided by proper problem definition. Using the authors' general framework for setting conservation priorities, multiple criteria can be rationally integrated and where, how, and when to invest conservation resources can be scheduled. Trade-offs are unavoidable in priority setting when there are multiple considerations, and budgets are almost always finite. The authors discuss how trade-offs, risks, uncertainty, feedbacks, and learning can be explicitly evaluated within their generic framework for setting conservation priorities. Finally, they suggest ways that current priority-setting approaches may be improved.

  20. Madagascar Conservation & Development

    African Journals Online (AJOL)

    Madagascar Conservation & Development welcomes the results of original research, field surveys, advances in field and laboratory techniques, book reviews, and informal status reports from research, conservation, development and management programs and in-field projects in Madagascar. In addition, notes on changes ...

  1. Resource Conservation Glossary.

    Science.gov (United States)

    Soil Conservation Society of America, Ankeny, IA.

    This glossary is a composite of terms selected from 13 technologies, and is the expanded revision of the original 1952 edition of "The Soil and Water Conservation Glossary." The terms were selected from these areas: agronomy, biology, conservation, ecology, economics, engineering, forestry, geology, hydrology, range, recreation, soils, and…

  2. Creative Soil Conservation

    Science.gov (United States)

    Smith, Martha

    2010-01-01

    Take plant lessons outdoors with this engaging and inquiry-based activity in which third-grade students learn how to apply soil conservation methods to growing plants. They also collect data and draw conclusions about the effectiveness of their method of soil conservation. An added benefit to this activity is that the third-grade students played…

  3. Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 3: Focus on Cardiorespiratory Dysfunction, Infections, Liver Dysfunction, and Delirium.

    Science.gov (United States)

    Ovchinsky, Nadia; Frazier, Warren; Auletta, Jeffery J; Dvorak, Christopher C; Ardura, Monica; Song, Enkyung; McArthur, Jennifer; Jeyapalan, Asumthia; Tamburro, Robert; Mahadeo, Kris M; Traube, Chani; Duncan, Christine N; Bajwa, Rajinder P S

    2018-02-01

    Some patients with veno-occlusive disease (VOD) have multiorgan dysfunction, and multiple teams are involved in their daily care in the pediatric intensive care unit. Cardiorespiratory dysfunction is critical in these patients, requiring immediate action. The decision of whether to use a noninvasive or an invasive ventilation strategy may be difficult in the setting of mucositis or other comorbidities in patients with VOD. Similarly, monitoring of organ functions may be very challenging in these patients, who may have fulminant hepatic failure with or without hepatic encephalopathy complicated by delirium and/or infections. In this final guideline of our series on supportive care in patients with VOD, we address some of these questions and provide evidence-based recommendations on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  4. Japan's energy conservation policy

    International Nuclear Information System (INIS)

    Yoda, Kenichi

    1990-01-01

    This article reviews developments in Japanese energy conservation since the 1970s. The industrial sector has achieved the greatest success, due to industrial restructuring as well as improvements in energy efficiency. In the residential/commercial sector, the efficiency of appliances has been much improved. Although improvements have been made in the fuel efficiency of passenger cars, energy consumption in the transportation sector has risen slightly owing to increased transport of passengers and freight. The overall responsibility for energy conservation policy rests with the Ministry of International Trade and Industry. MITI is also responsible for implementing specific conservation policies in regard to the industrial and commercial sectors. In the residential sector, MITI works with the Ministry of Construction and in the transportation sector with the Ministry of Transport. To realize the goals of energy conservation policy through general research, dissemination of public information and other activities, MITI works with the Energy Conservation Center (ECC). (author). 2 figs, 3 tabs

  5. Tests of conservation laws

    International Nuclear Information System (INIS)

    Goldhaber, M.

    1988-01-01

    For quite a while it has been realized that some discrete quantum numbers are conserved in some interactions but not in others. The most conspicuous cases are parity P, charge conjugation C, and the product CP which are conserved in strong and electromagnetic interactions but not in weak interactions. The question arises whether for some of the other conserved quantities, which are conserved in strong, electromagnetic and weak interactions, there is an interaction intermediate in strength between weak and gravitational which violates these quantum numbers, e.g., baryon number B and lepton number L. The possibility exists that these conservation laws, if they are broken at all, are only broken by the gravitational force which would make the mass of an intermediate boson which induces the break-down equal to the Planck mass. (orig.)

  6. Lower bound element and submodel for modelling of joints between precast concrete panels

    DEFF Research Database (Denmark)

    Herfelt, Morten Andersen; Poulsen, Peter Noe; Hoang, Linh Cao

    2015-01-01

    In practice, precast concrete structures are designed using either analytical methods or linear finite element tools, and the in-situ cast joints between the precast panels are assessed using conservative empirical design formulas. This often leads to a suboptimal design, and local mechanisms ins....... The computational time and problem size of the joint element and detailed model will be discussed....

  7. 76 FR 31305 - Pacific Whiting; Advisory Panel and Joint Management Committee

    Science.gov (United States)

    2011-05-31

    ... experienced in the harvesting, processing, marketing, management, conservation, or research of the offshore... Whiting; Advisory Panel and Joint Management Committee AGENCY: National Oceanic and Atmospheric.... SUMMARY: NMFS solicits nominations for the Advisory Panel (AP) and the Joint Management Committee (JMC) on...

  8. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    Energy Technology Data Exchange (ETDEWEB)

    Becce, Fabio, E-mail: fabio.becce@chuv.ch [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Mouhsine, Elyazid [Clinique Hirslanden Bois-Cerf, Department of Orthopaedic Surgery (Switzerland); Mosimann, Pascal John; Anaye, Anass [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Letovanec, Igor [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (Switzerland); Theumann, Nicolas [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland)

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  9. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    International Nuclear Information System (INIS)

    Becce, Fabio; Mouhsine, Elyazid; Mosimann, Pascal John; Anaye, Anass; Letovanec, Igor; Theumann, Nicolas

    2012-01-01

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography—guided retrograde drilling and debridement.

  10. Strategic conservation planning for the Eastern North Carolina/Southeastern Virginia Strategic Habitat Conservation Team

    Science.gov (United States)

    Alexander-Vaughn, Louise B.; Collazo, Jaime A.; Drew, C. Ashton

    2014-01-01

    The Eastern North Carolina/Southeastern Virginia Strategic Habitat Conservation Team (ENCSEVA) is a partnership among local federal agencies and programs with a mission to apply Strategic Habitat Conservation to accomplish priority landscape-level conservation within its geographic region. ENCSEVA seeks to further landscape-scale conservation through collaboration with local partners. To accomplish this mission, ENCSEVA is developing a comprehensive Strategic Habitat Conservation Plan (Plan) to provide guidance for its members, partners, and collaborators by establishing mutual conservation goals, objectives, strategies, and metrics to gauge the success of conservation efforts. Identifying common goals allows the ENCSEVA team to develop strategies that leverage joint resources and are more likely to achieve desired impacts across the landscape. The Plan will also provide an approach for ENCSEVA to meet applied research needs (identify knowledge gaps), foster adaptive management principles, identify conservation priorities, prioritize threats (including potential impacts of climate change), and identify the required capacity to implement strategies to create more resilient landscapes. ENCSEVA seeks to support the overarching goals of the South Atlantic Landscape Conservation Cooperative (SALCC) and to provide scientific and technical support for conservation at landscape scales as well as inform the management of natural resources in response to shifts in climate, habitat fragmentation and loss, and other landscape-level challenges (South Atlantic LCC 2012). The ENCSEVA ecoregion encompasses the northern third of the SALCC geography and offers a unique opportunity to apply landscape conservation at multiple scales through the guidance of local conservation and natural resource management efforts and by reporting metrics that reflect the effectiveness of those efforts (Figure 1). The Environmental Decision Analysis Team, housed within the North Carolina Cooperative

  11. Joint Quantum Institute

    Data.gov (United States)

    Federal Laboratory Consortium — The Joint Quantum Institute (JQI) is pursuing that goal through the work of leading quantum scientists from the Department of Physics of the University of Maryland...

  12. Temporomandibular Joint Disorder

    Science.gov (United States)

    ... Baby Bottle Tooth Decay? Pacifiers Have Negative and Positive Effects What is Dental Amalgam (Silver Filling)? Check Menstrual Calendar for Tooth Extraction Temporomandibular Joint Disorder Learn what those dental words mean. Check out how your teeth and mouth ...

  13. Hip joint replacement

    Science.gov (United States)

    Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

  14. Knee joint replacement

    Science.gov (United States)

    ... to make everyday tasks easier. Practice using a cane, walker , crutches , or a wheelchair correctly. On the ... ask your doctor Knee joint replacement - discharge Preventing falls Preventing falls - what to ask your doctor Surgical ...

  15. Concrete pavement joint deterioration.

    Science.gov (United States)

    2015-12-01

    Concrete pavements are an important part of our national infrastructure. In recent years the relatively small number of reported joints deteriorating prematurely in concrete pavements around Indiana has increased. Changes over the past 45 years in IN...

  16. Joint Hub Network Development

    OpenAIRE

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.

    2007-01-01

    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once. Rather, the partners will have a more cautious attitude and build the hub facilities one-by-one. In the proposed framework, every time a new hub is introduced, partners will have the opportunity to dec...

  17. Prosthetic Joint Infections

    Science.gov (United States)

    Aslam, Saima; Darouiche, Rabih O.

    2012-01-01

    Prosthetic joint infections represent a major therapeutic challenge for both healthcare providers and patients. This paper reviews the predisposing factors, pathogenesis, microbiology, diagnosis, treatment and prophylaxis of prosthetic joint infection. The most optimal management strategy should be identified based on a number of considerations including type and duration of infection, antimicrobial susceptibility of the infecting pathogen, condition of infected tissues and bone stock, patient wishes and functional status. PMID:22847032

  18. Benign joint hypermobility syndrome

    Directory of Open Access Journals (Sweden)

    Iwona Słowińska

    2014-11-01

    Full Text Available Benign joint hypermobility syndrome (BJHS, commonly known as loose ligament syndrome, is a non-inflammatory rheumatic condition. It is characterised by a greater than normal range of motion of the joints of the limbs and spine. The prevalence of the syndrome in preschool-age children is estimated to be between 2% and 30%, depending on ethnic background (with higher prevalence in Asian and African populations, occurring most often in families with a history of the condition and more frequently in girls. This paper presents a case report of a 12-year-old girl. A broad differential diagnostic approach to recurrent joint inflammation with joint effusion and pain made it possible to establish a diagnosis of benign joint hypermobility syndrome. The child met the Brighton criteria; her Beighton score was 7 out of 9. Patient education aimed at eliminating abnormal joint movement and an appropriate rehabilitation programme play key roles in the treatment of BJHS.

  19. Gnathological splint therapy in temporomandibular joint disorder

    Directory of Open Access Journals (Sweden)

    K Gnanashanmugham

    2015-01-01

    Full Text Available Temporomandibular joint (TMJ forms an integral functional part of stomatognathic system. Position, shape, structure and function of teeth have an influence on the proper functioning and health of TMJ. But a problem associated with TMJ is often neglected, and treatment for it is mostly restricted to palliative therapy. A proper understanding of the underlying cause of temporomandibular joint disorder (TMD is necessary to device a proper treatment plan. Etiology of TMDs varies from idiopathic reasons to systemic disorders. The option of Gnathological splint is a conservative, safe and an effective mode of therapy for TMDs caused by occlusal discrepancies (fulcrum/interferences. This article presents a case report of a patient with TMD caused by occlusal discrepancy

  20. Freshwater conservation planning: the case for systematic approaches

    CSIR Research Space (South Africa)

    Linke, S

    2011-01-01

    Full Text Available The authors review recent advances in systematic conservation planning in fresh waters. Most modern systematic planning approaches are based on the CARE principles: comprehensiveness, adequacy, representativeness and efficiency. Efficiency...

  1. Septic Shock after Conservative Management for Placenta Accreta

    Directory of Open Access Journals (Sweden)

    Ying-Cheng Chiang

    2006-03-01

    Conclusion: At present, there is no consensus about the optimal treatment for placenta accreta. Conservative treatment appears to be an alternative in selected patients, but the complications such as sepsis should be carefully identified and appropriately managed.

  2. The Urgent Need for a Comprehensive, Fully Integrated, Joint Intra-Theater Aeromedical Evacuation System

    Science.gov (United States)

    2017-04-06

    the Middle East and Africa , it is critical for the Army’s Medical Department (AMEDD) and the Joint Staff continue to leverage joint patient...Service and a single Service would prevent the establishment of a watered -down, lowest-common-denominator AE system that would result from a joint...to provide quality enroute care to increase survivability rates and decrease long-term morbidity. The current joint intra-theater AE system lacks

  3. Jointness for the Rest of Us: Reforming Joint Professional Development

    Science.gov (United States)

    2016-06-10

    transferred to the Joint Staff. 13 DOD’s instinct to “overly centralize planning, organization, and management.”20 The authors contend that this...2. 3 John F. Schank and others, Who is Joint? Reevaluating the Joint Duty Assignment List : A Study Prepared for the Joint Staff, by the RAND...and code those billets as such. Once identified, DOD must expand the Joint Duty Assignment List (JDAL) to include billets that offer enlisted personnel

  4. Personality traits and energy conservation

    International Nuclear Information System (INIS)

    Shen, Meng; Cui, Qingbin; Fu, Liping

    2015-01-01

    As a cost-effective solution to energy conservation, behavior based method focuses on changing people's behavior through normative feedback for energy efficiency. While the application of behavior-based method is promising, the challenge exists to achieve efficiently sustainable behavioral change. Based on multi-period observation of energy behavior at the Joint Base Andrews in Maryland, this paper presents a model-based approach aimed to improve the nationally popular and deep-seated benchmark setting strategy for normative feedback used in home energy reports. The improved approach has its merits of countering the undesirable boomerang effect and enhancing the effectiveness of normative feedback targeting different personalities. By introducing a modified opinion dynamics model, this paper simulates the process of energy behavior change and therefore identifies the driver and elementary rules of behavioral change. In particular, the paper defines various behavioral zones in accordance with people's personality and proposes a new customized energy reporting mechanism that maps normative benchmark to personality trait. The new energy reporting policy has strong industrial implication for promoting behavior-based method towards a sustained energy conservation movement. -- Highlights: •We explore the personality driving resident behavior change under peer pressure. •We map the distribution of behavior clusters driven by personality and benchmarks. •The model is tested using data from an experiment conducted in Maryland, U.S. •The population exposed to normative feedback can be divided into six categories. •A personality trait-based home energy reporting mechanism is proposed

  5. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

    Directory of Open Access Journals (Sweden)

    Miller LE

    2014-05-01

    Full Text Available Larry E Miller,1,2 Jon E Block21Miller Scientific Consulting, Inc., Asheville, NC, USA; 2The Jon Block Group, San Francisco, CA, USA Abstract: Chronic sacroiliac (SI joint-related low back pain (LBP is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. Keywords: arthrodesis, fusion, minimally invasive, sacroiliac, SImmetry

  6. Prevention of Periprosthetic Joint Infection

    Directory of Open Access Journals (Sweden)

    Alisina Shahi

    2015-04-01

    Full Text Available Prosthetic joint infection (PJI is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.

  7. A Resource Conservation Unit.

    Science.gov (United States)

    Porter, Philip D.

    1979-01-01

    Describes a variety of learning activities for teaching elementary and junior high students about air, water, and energy conservation techniques. Suggests community resources, social studies objectives, language skills, and 20 activities. (CK)

  8. Hearing Conservation Team

    Data.gov (United States)

    Federal Laboratory Consortium — The Hearing Conservation Team focuses on ways to identify the early stages of noise-induced damage to the human ear.Our current research involves the evaluation of...

  9. Madagascar Conservation & Development

    African Journals Online (AJOL)

    Madagascar Conservation & Development. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 1 (2014) >. Log in or Register to get access to full text downloads.

  10. Metro Conservation Corridors

    Data.gov (United States)

    Minnesota Department of Natural Resources — The Metro Conservation Corridors (MeCC) grow out of the natural resource analysis work done by the DNR in the late '90's, documented in the Metro Greenprint...

  11. Madagascar Conservation & Development

    African Journals Online (AJOL)

    www.journalmcd.com

    2012-02-19

    Feb 19, 2012 ... MADAGASCAR CONSERVATION & DEVELOPMENT. VOLUME 7 ... die within a short period of time (e.g., infanticide) (Erhart and. Overdorff 1998 .... been as deep or may have healed by the time of examination. Falls during ...

  12. Birds of Conservation Concern

    Data.gov (United States)

    Department of the Interior — The 1988 amendment to the Fish and Wildlife Conservation Act mandates the U.S. Fish and Wildlife Service (USFWS) to “identify species, subspecies, and populations of...

  13. Mesocycles in conserving plastics

    DEFF Research Database (Denmark)

    Shashoua, Yvonne

    2016-01-01

    driven by the need to balance the requirements for reversibility in conservation practices with the artist’s intent and significance. Developments within each of the three mesocycles from the 1990s to date are discussed in this article. Environmental science and toxicology of waste plastics offer a novel...... source of information about real time degradation in terrestrial and marine microenvironments that seems likely to contribute to the conservation of similar materials in contemporary artworks....

  14. Soil conservation measures: exercises

    OpenAIRE

    Figueiredo, Tomás de; Fonseca, Felícia

    2009-01-01

    Exercises proposed under the topic of Soil Conservation Measures addresses to the design of structural measure, namely waterways in the context of a soil conservation plan. However, to get a better insight on the actual meaning of soil loss as a resource loss, a prior exercise is proposed to students. It concerns calculations of soil loss due to sheet (interrill) erosion and to gully erosion, and allows the perception through realistic number of the impact of these mechanism...

  15. Genealogy of nature conservation: a political perspective

    Directory of Open Access Journals (Sweden)

    Yrjo Haila

    2012-03-01

    Full Text Available Modern nature conservation is a product of post-Enlightenment modernity; I explore the heterogeneity of its conceptual and ideological background. The 19th century legacy comprises concern over human-caused extinctions; protests against excessive hunting and cruelty toward animals; utilitarian care for natural resources; and romantic sensibility concerning the value of nature for human health and spirituality. The 20th century added into conservation thinking increasing consciousness about human biospheric dependence; efforts to identify appropriate conservation targets; and most recently concern over the loss of biodiversity. The politics of nature conservation has taken shape within the framework of politics of nature, that is, choices vis-á-vis nature that have been made either as deliberate decisions on resource use or as side-effects of subsistence practices of various types. Because of tensions and conflicts with alternative ways of using nature, formulating realistic conservation policies has been a complicated task. Problems and uncertainties emerge: pursuing material aspirations of the current world society will necessarily bring about damage to ecological systems of the Earth. The way forward is to identify feasible alternatives in the midst of the tensions and ambiguities that arise, and to open up space for carrying through conservation initiatives.

  16. Facet joint syndrome

    International Nuclear Information System (INIS)

    Zigrai, M.; Zakovic, J.; Brezinova, M.; Pavlovicova, M.

    2002-01-01

    It is the purpose of the study to demonstrate the clinical relevance of degenerative changes in the facet joint of patients with low back pain irradiating to the lower extremities, and discuss some problems relating to diagnosis and different diagnosis. 119 patients presenting the listed bellow syndromes are covered by the study: scoliosis, polytopic pain vertebral syndrome, paresis and history of trauma. all patients undergo comprehensive neurological examination with special attention focused on the spine: CT and plain x-rays are taken of the lumbosacral segment to assess the condition of the facet joints. The neurological examination demonstrates in all cases pain syndrome in the lumbar spine referred to one or both lower extremities. In 56% it is a matter of persisting pain, and in 44% - recurrent. More than half of the patients complain of sacroiliac (SI) dislocation and palpatory pain. Unilateral or bilateral degenerative changes are documented by imaging studies in all patients, including: subchondral thickening, osteopathy narrowing the lateral or central part of the spinal canal with ensuing nerve root compression. The lumbosacral zygoapophyseal joints are source of pseudoradicular pain. A correlation between clinical picture and GT changes is noted in all patients with facet joint syndrome. CT is an indispensable method in diagnosing facet joint syndrome. (authors)

  17. Temporomandibular joint examination reviewed

    Directory of Open Access Journals (Sweden)

    L. Guarda Nardini

    2011-09-01

    Full Text Available The temporo-mandibular joint (TMJ it’s a joint closely related to the skull base, the spine, and the jaws; all these anatomical structures must be taken in consideration when evaluating pain involving the tmj. In order to detect patients affected by pathology or dysfunctions of the tmj, physical examination is of great value in orienting the diagnosis. Inspection must consider the symmetry of the body, the dental status and the type of occlusion. Palpation is a way to assess contractiont involving the muscles of the masticatory system and of the neck. Auscultation, based on articular noise provides means to determine whether we are dealing with degeneration of the joint or a dislocation of the intrarticular disc. In order to confirm the diagnosis obtained with the clinical evaluation, it’s useful to perform imaging techniques as opt, tomography and TC of the tmj and electromyokineosiography – index of the mandibular functionality and of the muscles status. MRI and dynamic MRI are among the non invasive exams which give the greatest amount of information, regarding the disc position and the joint degeneration. Arthroscopy is an invasive technique that allows early diagnosis of degeneration and is helpful to reveal early inflammatory processes of the joint.

  18. Formation of Exfoliation Joints

    Science.gov (United States)

    Martel, S. J.

    2004-12-01

    The Earth's internal stresses interact with the topographic surface to affect many phenomena. Exfoliation joints, or sheeting joints, are widespread manifestations of this interaction. These opening-mode fractures form subparallel to the Earth's surface, bounding roughly concentric slabs of rock that resemble the layers of an onion. They occur worldwide in all major bedrock types, attain in-plane dimensions of hundreds of meters, exert a strong influence on groundwater flow, and help produce spectacular scenery, as in Yosemite National Park. The mechanism that causes them has been enigmatic. They are widely regarded as forming in response to "removal of overburden", but large fractures do not open in rocks merely by relieving a compressive stress. High fluid pressures, thermal effects, rock heterogeneity, and weathering also are rejected as primary causes of these fractures. Tensile stresses normal to the surface are required for large exfoliation fractures to open. Intriguingly, high surface-parallel compressive stresses are widely documented where exfoliation joints occur. Both numerical and analytical solutions for two-dimensional elastic bodies show that localized tensile stresses perpendicular to the ground surface must develop beneath certain topographies subject to strong compressive stresses parallel to the surface. This highly non-intuitive effect reflects the profound influence that topography can have on stresses near the surface of the Earth, and it can explain how exfoliation joints open. The theoretical results also indicate that exfoliation joint distributions could be used to infer the horizontal stresses near the Earth's surface.

  19. The prevalence of sacroiliac joint degeneration in asymptomatic adults.

    Science.gov (United States)

    Eno, Jonathan-James T; Boone, Christopher R; Bellino, Michael J; Bishop, Julius A

    2015-06-03

    Degenerative changes of the sacroiliac joint have been implicated as a cause of lower back pain in adults. The purpose of this study was to determine the prevalence of sacroiliac joint degeneration in asymptomatic patients. Five hundred consecutive pelvic computed tomography (CT) scans, made at a tertiary-care medical center, of patients with no history of pain in the lower back or pelvic girdle were retrospectively reviewed and analyzed for degenerative changes of the sacroiliac joint. After exclusion criteria were applied, 373 CT scans (746 sacroiliac joints) were evaluated for degenerative changes. Regression analysis was used to determine the association between age and the degree of sacroiliac joint degeneration. The prevalence of sacroiliac joint degeneration was 65.1%, with substantial degeneration occurring in 30.5% of asymptomatic subjects. The prevalence steadily increased with age, with 91% of subjects in the ninth decade of life displaying degenerative changes. Radiographic evidence of sacroiliac joint degeneration is highly prevalent in the asymptomatic population and is associated with age. Caution must be exercised when attributing lower back or pelvic girdle pain to sacroiliac joint degeneration seen on imaging. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  20. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. JOINT INVOLVEMENT IN SYPHILIS

    Directory of Open Access Journals (Sweden)

    T. I. Zlobina

    2016-01-01

    Full Text Available Joint involvement in syphilis has been considered as casuistry in recent years. At the same time, the high incidence of primary syphilis and the notified cases of late neurosyphilis may suggest that joint involvement in this disease is by no means always verified. Traditionally there are two forms of syphilitic arthritis: primary synovial (involving the articular membranes and sac and primary bone (involving the articular bones and cartilages ones. The paper describes the authors' clinical case of the primary bone form of articular syphilis in a 34-year-old man. 

  2. Expansion joints for LMFBR

    International Nuclear Information System (INIS)

    Dzenus, M.; Hundhausen, W.; Jansing, W.

    1980-01-01

    This discourse recounts efforts put into the SNR-2 project; specifically the development of compensation devices. The various prototypes of these compensation devices are described and the state of the development reviewed. Large Na (sodium)-heat transfer systems require a lot of valuable space if the component lay-out does not include compensation devices. So, in order to condense the spatial requirement as much as possible, expansion joints must be integrated into the pipe system. There are two basic types to suit the purpose: axial expansion joints and angular expansion joints. The expansion joints were developed on the basis of specific design criteria whereby differentiation is made between expansion joints of small and large nominal diameter. Expansion joints for installation in the sodium-filled primary piping are equipped with safety bellows in addition to the actual working bellows. Expansion joints must be designed and mounted in a manner to completely withstand seismic forces. The design must exclude any damage to the bellows during intermittent operations, that is, when sodium is drained the bellows' folds must be completely empty; otherwise residual solidified sodium could destroy the bellows when restarting. The expansion joints must be engineered on the basis of the following design data for the secondary system of the SNR project: working pressure: 16 bar; failure mode pressure: 5 events; failure mode: 5 sec., 28.5 bar, 520 deg. C; working temperature: 520 deg. C; temperature transients: 30 deg. C/sec.; service life: 200,000 h; number of load cycles: 10 4 ; material: 1.4948 or 1.4919; layer thickness of folds: 0.5 mm; angular deflection (DN 800): +3 deg. C or; axial expansion absorption (DN 600): ±80 mm; calculation: ASME class. The bellows' development work is not handled within this scope. The bellows are supplied by leading manufacturers, and warrant highest quality. Multiple bellows were selected on the basis of maximum elasticity - a property

  3. Sacroiliac Joint Interventions.

    Science.gov (United States)

    Soto Quijano, David A; Otero Loperena, Eduardo

    2018-02-01

    Sacroiliac joint (SIJ) pain is an important cause of lower back problems. Multiple SIJ injection techniques have been proposed over the years to help in the diagnosis and treatment of this condition. However, the SIJ innervation is complex and variable, and truly intra-articular injections are sometimes difficult to obtain. Different sacroiliac joint injections have shown to provide pain relief in patients suffering this ailment. Various techniques for intraarticular injections, sacral branch blocks and radiofrequency ablation, both fluoroscopy guided and ultrasound guided are discussed in this paper. Less common techniques like prolotherapy, platelet rich plasma injections and botulism toxin injections are also discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India.

    Science.gov (United States)

    Sikka, Veronica; Gautam, V; Galwankar, Sagar; Guleria, Randeep; Stawicki, Stanislaw P; Paladino, Lorenzo; Chauhan, Vivek; Menon, Geetha; Shah, Vijay; Srivastava, R P; Rana, B K; Batra, Bipin; Kalra, O P; Aggarwal, P; Bhoi, Sanjeev; Krishnan, S Vimal

    2017-01-01

    The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

  5. Hydrology and Conservation Ecology

    Science.gov (United States)

    Narayanan, M.

    2006-12-01

    Responses to change in the behavior of ecological systems are largely governed by interactions at different levels. Research is essential and is to be necessarily designed to gain insights into various interactions at the community level. Sustainable resource management is only possible if conservation of biodiversity can be accomplished by properly using the knowledge discovered. It is well known that the United States Department of Agriculture provides technical information, resources, and data necessary to assist the researchers in addressing their conservation needs. Conservation aims to protect, preserve and conserve the earth's natural resources. These include, but not limited to the conservation of soil, water, minerals, air, plants and all living beings. The United States Department of Agriculture also encourages farmers and ranchers to voluntarily address threats to soil and water. Protection of wetlands and wildlife habitat has been on the radar screen of conservation experts for a very long time. The main objective has always been to help farmers and landowners conform and comply with federal and state environmental laws. During the implementation phase, farmers should be encouraged to make beneficial, cost-effective changes to methods of irrigation systems. In some cases, the hydrologic regime of the project area can be thought of as principally an issue of river flow regimes for floodplain forests. In this presentation, the author tries to focus on the impact of hydrology and conservation ecology on global warming. He also discusses the impact of hydrology and conservation ecology global air concerns such as greenhouse gas concentrations in the atmosphere. References: Chow, V. T, D. R. Maidment, and L. W. Mays. 1988. Applied Hydrology. McGraw-Hill, Inc. U.S. Soil Conservation Service. Technical Release 55: Urban Hydrology for Small Watersheds. USDA (U.S. Department of Agriculture). June 1986. Lehner, B. and P. Döll (2004). Development and validation

  6. Regeneration of limb joints in the axolotl (Ambystoma mexicanum).

    Science.gov (United States)

    Lee, Jangwoo; Gardiner, David M

    2012-01-01

    In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander) model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints.

  7. Regeneration of limb joints in the axolotl (Ambystoma mexicanum.

    Directory of Open Access Journals (Sweden)

    Jangwoo Lee

    Full Text Available In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints.

  8. Imaging findings of charcot joint

    International Nuclear Information System (INIS)

    Meng Quanfei; Zhou Chunxiang; Chen Yingming; Jiang Bo

    2003-01-01

    Objective: To analyze the MRI characters of Charcot joint, and to evaluate the diagnostic value of X-ray, CT, and MRI on Charcot joint. Methods: Eight patients with 8 Charcot joints underwent X-ray, CT, and MR examinations. 6 of them had syringomyelia, 1 patient had injury of the spinal cord, and 1 case had diabetes. All 8 patients had sensory reduction or deficit in the sick extremities. Results: There were two types of Charcot joint, hypertrophic and atrophic. Radiographic and CT features of hypertrophic joint (n=3) showed hyperostotic osteosclerosis and mammoth osteophytes in the sick bones, periarticular ossification, and articular disorganization. Radiographic and CT features of atrophic joint (n=5) showed extensive bone resorption (destruction), periarticular debris, and articular disorganization. Main MRI features of Charcot joint included hydrarthrosis within joint capsule, thickened, loose, and elongated joint capsule with para-joint, peri-diaphysis, and inter-muscular extension in a pseudopodia pattern. The irregular joint capsule wall was presented as mild hypointensity on T 1 WI, slight hyper-intensity on T 2 WI, and was markedly enhanced after Gd-DTPA was administrated, which was considered as a characteristic manifestation of the lesion. Soft tissue mass containing hypo-intense stripes on both T 1 WI and T 2 WI was commonly noted adjacent to the involved joint. Conclusion: X-rays plain film is the first choice for the diagnosis of Charcot joint, and MRI is pretty useful in the diagnosis of Charcot joint

  9. Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra.

    Science.gov (United States)

    Wang, Zhuo; Sakakibara, Toshihiko; Kasai, Yuichi

    2013-01-01

    A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.

  10. Tourism and Conservation

    DEFF Research Database (Denmark)

    Budeanu, Adriana

    2017-01-01

    Tourism is promoted by policy makers and international organizations as a tool for advancing conservation agendas, while contributing to poverty alleviation and human development, under the banner of ecotourism or sustainable tourism. However, the indiscriminating use of complex and ambiguous...... concepts such as “poverty” and “sustainability” hide important nuances with regards to the variety of processes and subsequent effects that are triggered when tourism and conservation are being adjoined. Experiences with tourism developments show that destinations that are weak economically find it harder...... to draw benefits from tourism developments or to decline participation in tourism with only little or no losses of sources of income and wealth. If tourism should fulfil sustainability goals related to conservation, poverty, and human development, it needs consistent governmental intervention...

  11. Conservation of Mangifera sylvatica

    DEFF Research Database (Denmark)

    Akhter, Sayma

    and conservation of these valuable species. The present study considers an underutilised and threatened species of Bangladesh, namely wild mango (Mangifera sylvatica Roxb.). Although this wild mango is one of the genetically closest species to the common mango (Mangifera indica L.) research is very limited...... and mostly focused on wood quality and phylogenetic relationships. Therefore, this study investigated the conservation potential of wild mango considering its contribution for food, nutrition and livelihoods. To do so, an assessment was made of the current and future distribution of the species, which...... explored. The study conveyed five key messages: 1. Wild mango may become extinct under future climate change scenarios so it is high time to start thinking about conservation initiatives. 2. Wild mango is a small sized mango with a large kernel in relation to other Mangifera species which provides...

  12. Resource conservation management

    International Nuclear Information System (INIS)

    Miller, W.

    1999-01-01

    Resource conservation management is a management program similar to financial management in that its success requires commitment by all levels of the organization to the process as well as an accounting procedure and auditing of critical components. Resource conservation management provides a framework for all elements of efficient building operations and maintenance. The savings connected with the program are principally connected with changes in the way buildings are operated and maintained. Given the reduction in rebates for the installation of energy-efficient equipment, this approach has considerable promise. This paper discusses the evolution of the resource conservation management service and the savings associated with a two-year pilot effort with seven school districts, as well as the critical components of a successful program

  13. Joint venture versus outreach: a financial analysis of case studies.

    Science.gov (United States)

    Forsman, R W

    2001-01-01

    Medical centers across the country are facing cost challenges, and national commercial laboratories are experiencing financial declines that necessitate their capturing market share in any way possible. Many laboratories are turning to joint ventures or partnerships for financial relief. However, it often is in the best interest of the patient and the medical center to integrate laboratory services across the continuum of care. This article analyzes two hypothetical joint ventures involving a laboratory management agreement and full laboratory outsourcing.

  14. Temporomandibular Joint Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Gianfranco Frojo, MD

    2018-01-01

    Full Text Available Summary:. Infection of the temporomandibular joint (TMJ is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.

  15. Joint-Use Libraries

    Science.gov (United States)

    Casstevens, Susan

    2017-01-01

    The joint-use library is a place where people of all ages, interests, and income levels can find items of interest at no personal cost. The mission of A. H. Meadows Public and High School Library in Midlothian, Texas, is to offer what other public libraries provide: educational and entertainment resources to a community. Yet, the staff also wants…

  16. Keyed shear joints

    DEFF Research Database (Denmark)

    Hansen, Klaus

    This report gives a summary of the present information on the behaviour of vertical keyed shear joints in large panel structures. An attemp is made to outline the implications which this information might have on the analysis and design of a complete wall. The publications also gives a short...

  17. Jointness: A Selected Bibliography

    Science.gov (United States)

    2007-08-01

    AD-A431-767) http://handle.dtic.mil/100.2/ADA431767 Lamb , William L. Moving beyond Goldwater-Nichols: The Case for Continued Reform of the DoD...in Support of the Joint Force’." Army Aviation 55 (May 2006): 22-24. Magnuson, Stew . "Turf Battles: Strategic Command’s Expanded Portfolio

  18. Gonococcal Prosthetic Joint Infection.

    Science.gov (United States)

    Gassiep, Ian; Gilpin, Bradley; Douglas, Joel; Siebert, David

    2017-01-01

    Neisseria gonorrhoea is a common sexually transmitted infection worldwide. Disseminated gonococcal infection is an infrequent presentation and rarely can be associated with septic arthritis. Incidence of this infection is rising, both internationally and in older age groups. We present the first documented case of N. gonorrhoea prosthetic joint infection which was successfully treated with laparoscopic debridement and antimicrobial therapy.

  19. Conservation reaches new heights.

    Science.gov (United States)

    Pepall, J; Khanal, P

    1992-10-01

    The conservation program with the management assistance of the Woodlands Mountain Institute in 2 contiguous parks, the Mount Everest National Park in Nepal and the Qomolangma Nature Reserve in China, in 2 countries is described. The focus is on conservation of the complex ecosystem with sustainable development by showing local people how to benefit from the park without environmental damage. Cultural diversity is as important as biological diversity. The area has been designated by UNESCO as a World Heritage Site with the "last pure ecological seed" of the Himalayas. The regional geography and culture are presented. Population growth has impacted natural resources through overgrazing, cultivation of marginal land, and deforestation; future plans to build a dam and road bordering the nature reserve pose other threats. Proposed management plans for the Makalu-Barun Nature Park (established in November 1991) and Conservation Area include a division of the park into nature reserve areas free of human activity, protected areas which permit traditional land use, and special sites and trail for tourists and religious pilgrims. The conservation area will act as a buffer for the park and provide economic opportunities; further subdivisions include land use for biodiversity protection, community forest and pasture, agroforestry, and agriculture and settlement. Efforts will be made to increase the welfare of women and local people; proposed projects include the introduction of higher milk-producing animals for stall feeding. Also proposed is a cultural and natural history museum. 70% of the project's resources will be directed to local community participation in consultation and park maintenance. The project is a model of how conservation and protection of natural resources can coexist with local economic development and participation; an integration of preservation of biological diversity, mountain wisdom, and the value of local people as resources for conservation.

  20. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    %) was the least common. On bivariate analysis ... the power to determine what their wives do or fail to ... pregnancy care while joint decision-making ... Other maternal health services rendered This data collection was done by a team of trained.

  1. Energy conservation in industry

    International Nuclear Information System (INIS)

    Pembleton, P.

    1992-01-01

    Energy Conservation in Industry is the first number in the Energy and Environmental Series of the Industrial and Technological Information Bank (INTIB). The Series supersedes the INECA Journal and reflects the broader information programme undertaken by INTIB. The present number of the Series contains contributions from three major international databases and five topic-specific sources, including three United Nations Organizations. The present publication consists of a recent technical report on a current topic: reducing energy loss in four industrial sectors and improving energy conservation through waste-heat recovery, followed by two sections containing abstracts of technical materials

  2. Local instant conservation equations

    International Nuclear Information System (INIS)

    Delaje, Dzh.

    1984-01-01

    Local instant conservation equations for two-phase flow are derived. Derivation of the equation starts from the recording of integral laws of conservation for a fixed reference volume, containing both phases. Transformation of the laws, using the Leibniz rule and Gauss theory permits to obtain the sum of two integrals as to the volume and integral as to the surface. Integrals as to the volume result in local instant differential equations, in particular derivatives for each phase, and integrals as to the surface reflect local instant conditions of a jump on interface surface

  3. Diesel conservation: GSRTC'S experience

    Energy Technology Data Exchange (ETDEWEB)

    Ramesh Kumar, I V

    1980-01-01

    The Gujarat State Road Transport Corporation (GSRTC) in India has a fleet of about 6000 buses. The increasing cost of fuel and lubricants added to uncertainty in supplies, has necessitated the need for conserving High Speed Diesel Oil (HSD). GSRTC had achieved an overall average Kilometre Per Litre (kmpl) of 4.44 in the year 1976-1977 due to a variety of measures. In the year 1978-1979 the average kmpl was 4.52 and it is expected to be 4.60 for 1979-1980. The case study outlined describes the measures taken by GSRTC in conserving high speed diesel oil by various methods.

  4. Information, conservation and retrieval

    Energy Technology Data Exchange (ETDEWEB)

    Eng, T [Swedish Nuclear Fuel and Waste Management Co., Stockholm (Sweden); Norberg, E [National Swedish Archives, Stockholm (Sweden); Torbacke, J [Stockholm Univ. (Sweden). Dept. of History; Jensen, M [Swedish Radiation Protection Inst., Stockholm (Sweden)

    1996-12-01

    The seminar took place on the Swedish ship for transportation of radioactive wastes, M/S Sigyn, which at summer time is used for exhibitions. The seminar treated items related to general information needs in society and questions related to radioactive waste, i.e. how knowledge about a waste repository should be passed on to future generations. Three contributions are contained in the report from the seminar and are indexed separately: `Active preservation - otherwise no achieves`; `The conservation and dissemination of information - A democratic issue`; and, `Conservation and retrieval of information - Elements of a strategy to inform future societies about nuclear waste repositories`.

  5. Information, conservation and retrieval

    International Nuclear Information System (INIS)

    Eng, T.; Norberg, E.; Torbacke, J.

    1996-12-01

    The seminar took place on the Swedish ship for transportation of radioactive wastes, M/S Sigyn, which at summer time is used for exhibitions. The seminar treated items related to general information needs in society and questions related to radioactive waste, i.e. how knowledge about a waste repository should be passed on to future generations. Three contributions are contained in the report from the seminar and are indexed separately: 'Active preservation - otherwise no achieves'; 'The conservation and dissemination of information - A democratic issue'; and, 'Conservation and retrieval of information - Elements of a strategy to inform future societies about nuclear waste repositories'

  6. Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery.

    Science.gov (United States)

    Kube, Richard A; Muir, Jeffrey M

    2016-01-01

    Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited. To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion. SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure. Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported. Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure.

  7. The impact of joint ventures on U.S. hospitals.

    Science.gov (United States)

    Harrison, Jeffrey P

    2006-01-01

    This quantitative research study assesses the organizational characteristics, market factors, and profitability of US hospitals that operate joint ventures with other health care organizations. Data was obtained from the 2001 American Hospital Association annual survey, the Area Resource File, and the Center for Medicare and Medicaid Services Minimum Data Set. These data files provide essential information on individual acute care hospitals, the communities they serve, and the level of financial performance. Descriptive statistics were evaluated and a logistic regression model was utilized to examine hospitals operating joint ventures. The study found hospitals that operate joint ventures are located in communities with more elderly patients, lower unemployment, and lower HMO penetration. From an operating performance perspective, hospitals that operate joint ventures have a higher occupancy rate, a higher average length of stay, more clinical services, lower long-term debt, and a greater number of managed care contracts. The results also appear to indicate that joint ventures have a positive financial impact on US hospitals. The study has managerial implications supporting the use of joint ventures to improve hospital performance and policy implications on resource allocation.

  8. Disability in patients with trapeziometacarpal joint arthrosis: incidental versus presenting diagnosis.

    Science.gov (United States)

    Becker, Stéphanie J E; Makarawung, Dennis J S; Spit, Silke A; King, John D; Ring, David

    2014-10-01

    To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis. We compared 64 patients presenting for care of TMC joint arthrosis with 64 with incidental TMC joint arthrosis. For both groups, the diagnosis was based on crepitation on examination. Bivariate and multivariate analyses assessed factors associated with symptoms and disability related to TMC joint arthrosis. In bivariate analysis, patients presenting for care of TMC joint arthrosis had significantly more symptoms and disability from TMC joint arthrosis than those with incidental TMC joint arthrosis. The best multivariate linear regression model for fewer TMC joint arthrosis-related symptoms and disability included patients with incidental TMC joint arthrosis, male sex, no other painful conditions, less catastrophic thinking, and fewer depressive symptoms and explained 74% of the variability. Having incidental TMC joint arthrosis (25%) and more adaptive coping strategies (less catastrophic thinking; 5%) were the most important contributors to fewer symptoms and less disability. Future studies are merited to determine whether training in better coping strategies (eg, less catastrophic thinking and fewer depressive symptoms) can decrease symptoms and disability in patients with TMC joint arthrosis. Prognostic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. Increasing participation in incentive programs for biodiversity conservation.

    Science.gov (United States)

    Sorice, Michael G; Oh, Chi-Ok; Gartner, Todd; Snieckus, Mary; Johnson, Rhett; Donlan, C Josh

    2013-07-01

    levels of landowner participation in conservation agreement programs that deliver lasting, landscape-level benefits requires careful attention not only to how the program structure influences potential conservation benefits, but also how it influences landowners and their potential to participate.

  10. The KineSpring® Knee Implant System: an implantable joint-unloading prosthesis for treatment of medial knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Clifford AG

    2013-05-01

    Full Text Available Anton G Clifford,1 Stefan M Gabriel,1 Mary O’Connell,1 David Lowe,1 Larry E Miller,2,3 Jon E Block31Moximed, Inc, Hayward, CA, USA; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USAAbstract: Symptomatic medial compartment knee osteoarthritis (OA is the leading cause of musculoskeletal pain and disability in adults. Therapies intended to unload the medial knee compartment have yielded unsatisfactory results due to low patient compliance with conservative treatments and high complication rates with surgical options. There is no widely available joint-unloading treatment for medial knee OA that offers clinically important symptom alleviation, low complication risk, and high patient acceptance. The KineSpring® Knee Implant System (Moximed, Inc, Hayward, CA, USA is a first-of-its-kind, implantable, extra-articular, extra-capsular prosthesis intended to alleviate knee OA-related symptoms by reducing medial knee compartment loading while overcoming the limitations of traditional joint-unloading therapies. Preclinical and clinical studies have demonstrated excellent prosthesis durability, substantial reductions in medial compartment and total joint loads, and clinically important improvements in OA-related pain and function. The purpose of this report is to describe the KineSpring System, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The KineSpring System has potential to bridge the gap between ineffective conservative treatments and irreversible surgical interventions for medial compartment knee OA.Keywords: KineSpring, knee, medial, osteoarthritis, prosthesis

  11. Conservative treatment of perforated upper gastrointestinal tract

    International Nuclear Information System (INIS)

    Naoi, Daishi; Sano, Wataru; Nakata, Yasuyuki; Yano, Kentaro; Suzuki, Takeshi; Chiku, Tsuyoshi; Tashiro, Tsuguhiko

    2009-01-01

    In order to clarify the validity of indication criteria of the conservative treatment for perforated upper gastrointestinal tract, a retrospective study was carried out. We enrolled 28 patients with perforation of the gastrointestinal tract who were determined to receive conservative treatment at the time of hospitalization from January 2000 to December 2007. When the following criteria were satisfied, we treated the patients by the conservative treatment after informed consent was gained from them and their families: stable condition of vital signs; peritoneal signs localized in the upper abdomen; and no or slight fluid collection at the Douglas' pouch determined by computed tomography. Patients who showed changes for the worse of peritonitis or increased fluid collection during follow-up were promptly converted to surgery. Six patients were converted to surgery, but all of them were discharged very much improved. We compared patient's data of the conservative treatment group and the converted surgery group at the time of consultation. All data were not statistically different between two groups. If all criteria are satisfied, it seemed that we can start conservative treatment for perforated gastrointestinal tract with careful observation and the system of prompt conversion to operation for patients who showed changes for the worse of peritonitis or increased fluid collection. (author)

  12. The effectiveness of celebrities in conservation marketing.

    Directory of Open Access Journals (Sweden)

    Elizabeth Duthie

    Full Text Available Celebrities are frequently used in conservation marketing as a tool to raise awareness, generate funding and effect behaviour change. The importance of evaluating effectiveness is widely recognised in both marketing and conservation but, to date, little research into the effectiveness of celebrity endorsement as a tool for conservation marketing has been published. Using a combination of interviews and an online choice survey instrument, we investigated the extent to which a sample of UK-based conservation organisations, and other charities, evaluate their own usage of celebrity endorsement, and then carried out an experimental evaluation of a hypothetical marketing campaign. This experiment compared participants' willingness-to-engage (WTE with, and recall of, a conservation message presented in versions of an advert featuring one of three prominent UK celebrities (David Beckham, Chris Packham or HRH Prince William or a non-celebrity control treatment (featuring Crawford Allan, a director of TRAFFIC USA. We find that the organisations we interviewed did not routinely evaluate their marketing campaigns featuring celebrities. Furthermore, our experiment provides evidence that celebrity endorsement can produce both positive and negative effects. Participants were more willing to engage when presented with an advert featuring one of the three celebrities than the non-celebrity control, and WTE varied according to the characteristics of the celebrity and the respondent. However, celebrities were less effective at generating campaign message recall than non-celebrities. These findings suggest that celebrity endorsement should be used carefully. Further work is required to fully understand the role celebrity endorsers can play in conservation but, drawing on best practice from the field of marketing, this study introduces an approach to evaluation which could be applied more widely to improve the effectiveness of conservation marketing.

  13. The effectiveness of celebrities in conservation marketing.

    Science.gov (United States)

    Duthie, Elizabeth; Veríssimo, Diogo; Keane, Aidan; Knight, Andrew T

    2017-01-01

    Celebrities are frequently used in conservation marketing as a tool to raise awareness, generate funding and effect behaviour change. The importance of evaluating effectiveness is widely recognised in both marketing and conservation but, to date, little research into the effectiveness of celebrity endorsement as a tool for conservation marketing has been published. Using a combination of interviews and an online choice survey instrument, we investigated the extent to which a sample of UK-based conservation organisations, and other charities, evaluate their own usage of celebrity endorsement, and then carried out an experimental evaluation of a hypothetical marketing campaign. This experiment compared participants' willingness-to-engage (WTE) with, and recall of, a conservation message presented in versions of an advert featuring one of three prominent UK celebrities (David Beckham, Chris Packham or HRH Prince William) or a non-celebrity control treatment (featuring Crawford Allan, a director of TRAFFIC USA). We find that the organisations we interviewed did not routinely evaluate their marketing campaigns featuring celebrities. Furthermore, our experiment provides evidence that celebrity endorsement can produce both positive and negative effects. Participants were more willing to engage when presented with an advert featuring one of the three celebrities than the non-celebrity control, and WTE varied according to the characteristics of the celebrity and the respondent. However, celebrities were less effective at generating campaign message recall than non-celebrities. These findings suggest that celebrity endorsement should be used carefully. Further work is required to fully understand the role celebrity endorsers can play in conservation but, drawing on best practice from the field of marketing, this study introduces an approach to evaluation which could be applied more widely to improve the effectiveness of conservation marketing.

  14. Experimental study of metal gasketed joints for ultra-high vacuums; Etude experimentale de joints metalliques pour ultra-vide

    Energy Technology Data Exchange (ETDEWEB)

    Boulloud, J. P.; Schweitzer, J. [Commissariat a l' energie atomique et aux energies alternatives - CEA, Service de Physique Appliquee, groupe de Vide, Centre d' Etudes Nucleaires de Saclay (France)

    1960-07-01

    Various type of leak-tight metal joints have been studied with their application in assemblies containing total vacuums in mind. Their integrity has been tested with a helium leak detector, and leaks of about 2 x 10{sup -12} cm{sup 3} Atm/s per meter of joint have been measured, simultaneously with the clamping effort applied at the joint and the deformation of the metal gasket. The integrity to clamping effort ratio curve is not retraced in reverse upon relaxation of the clamping effort, but a 'return curve' analogous to a hysteresis cycle explains why certain types of joint retain their integrity at high temperatures. The use of a tracer gas permits discrimination between external permeation of the joint and gas from occlusions between its mating surfaces. The authors have been led to consider that neither the nature nor the purity or surface condition of the joint have any basic influence on its integrity. Clamping effort values in respect of various joints and necessary for total integrity are indicated. Reprint of a paper published in Le vide, no. 82, Jul-Aug 1959 [French] L'etude de differents types de joints metalliques etanches, en vue de leur application a l'ultra-vide, a ete effectuee a l'aide d'un detecteur de fuite a helium. On a mesure simultanement le debit de fuite, l'effort applique sur le joint et sa deformation. On a reussi a mesurer des debits de fuite de l'ordre de 2 x 10{sup -12} cm{sup 3} Atm/s/m de joint pour l'air. La courbe de l'etancheite en fonction de l'effort applique n'est pas reversible et on a pu mettre en evidence un 'cycle d'hysteresis' qui explique que certains joints conservent leur etancheite a haute temperature. La methode de mesure d'etancheite au moyen d'un gaz traceur a amene a faire une distinction entre la permeation et le degazage des gaz occlus dans l'interface des joints et a considerer que ni la nature, ni la purete et ni l'etat de surface du joint n'ont une influence primordiale sur l'etancheite de joint. Des valeurs

  15. Longitudinal joint specifications and performance.

    Science.gov (United States)

    2012-08-01

    Deterioration of longitudinal joints is widely recognized as one of the major factors contributing to failure of asphalt pavements. Finding : ways to improve the durability of longitudinal joints will lead to improved service lives and lower life cyc...

  16. Science Experience Unit: Conservation.

    Science.gov (United States)

    Ferguson-Florissant School District, Ferguson, MO.

    GRADES OR AGES: Intermediate grades. SUBJECT MATTER: Conservation. ORGANIZATION AND PHYSICAL APPEARANCE: The guide is divided into 24 experiments. It is mimeographed and staple-bound with a paper cover. OBJECTIVES AND ACTIVITIES: A specific skill or knowledge objective is stated at the beginning of each experiment. Detailed procedures are listed…

  17. (ICTs) And Environmental Conservation

    African Journals Online (AJOL)

    ICTs have a potential for improving the accessibility of environmental information, and if appropriately applied, they can empower local people to make informed decisions regarding environmental issues, thus enhancing environmental conservation. However, the challenge is on how to define particular roles that ...

  18. Conservative Delta Hedging

    Science.gov (United States)

    1997-09-01

    an exact method for converting such intervals into arbitrage based prices of financial derivatives or industrial or contractual options. We call this...procedure conservative delta hedging . As existing procedures are of an ad hoc nature, the proposed approach will permit an institution’s man agement a greater oversight of its exposure to risk.

  19. [Lateral epicondylitis: conservative - operative].

    Science.gov (United States)

    Altintas, Burak; Greiner, Stefan

    2016-10-01

    Lateral epicondylitis is a common disease of the common extensor origin at the lateral humerus. Despite its common self-limitation it can lead to chronic therapy-resistant pain with remarkable functional disability of the affected arm. Different conservative and operative treatment options of lateral epicondylitis are described and compared regarding benefits and risks. Additionally, recent surgical techniques and their complications are mentioned. Based on the current literature, it is shown which treatment option can be recommended. This review was based on the literature analysis in PubMed regarding "conservative and operative therapy of lateral epicondylitis" as well as the clinical experience of the authors. Conservative treatment is the primary choice for the treatment of lateral epicondylitis if concomitant pathologies such as instability among others can be excluded. It should include strengthening against resistance with eccentric stretching of the extensor group. In persistent cases, operative treatment is warranted. Resection of the pathologic tissue at the extensor origin with debridement and refixation of the healthy tendinous tissue yields good results. Most patients with lateral epicondylitis can be treated conservatively with success. Radiological evaluation should be performed in therapy-resistant cases. In the case of partial or complete rupture of the extensor origin, operative therapy is indicated.

  20. Biological science in conservation

    Science.gov (United States)

    David M. Johns

    2000-01-01

    Large-scale wildlands reserve systems offer one of the best hopes for slowing, if not reversing, the loss of biodiversity and wilderness. Establishing such reserves requires both sound biology and effective advocacy. Attempts by The Wildlands Project and its cooperators to meld science and advocacy in the service of conservation is working, but is not without some...

  1. Speyeria (Lepidoptera: Nymphalidae Conservation

    Directory of Open Access Journals (Sweden)

    Steven R. Sims

    2017-04-01

    Full Text Available Speyeria (Nymphalidae are a conspicuous component of the North American butterfly fauna. There are approximately 16 species and >100 associated subspecies (or geographical variants. Speyeria are univoltine, occupy a wide range of habitats, overwinter as first instar larvae, and feed only on native violets. Speyeria species have become a model group for studies of evolution, speciation, and conservation. Several species and subspecies are threatened or endangered. The reasons for this vary with the taxa involved, but always involve the degradation or loss of quality habitat for larvae and adults. The impacts of climate change must be considered among the causes for habitat degradation and in the establishment of conservation measures. In addition to increasing the available habitat, conservation efforts should consider maintaining habitat in a seral “disturbed” successional stage that selectively favors the growth of violets and preferred adult nectar sources. A major future challenge will be determining the most effective allocation of conservation resources to those species and subspecies that have the greatest potential to respond favorably to these efforts.

  2. Conservation and gene banking

    Science.gov (United States)

    Plant conservation has several objectives the main ones include safeguarding our food supply, preserving crop wild relatives for breeding and selection of new cultivars, providing material for industrial and pharmaceutical uses and preserving the beauty and diversity of our flora for generations to ...

  3. Validation of functional calibration and strap-down joint drift correction for computing 3D joint angles of knee, hip, and trunk in alpine skiing

    OpenAIRE

    Fasel, Benedikt; Spörri, Jörg; Schütz, Pascal; Lorenzetti, Silvio; Aminian, Kamiar

    2017-01-01

    To obtain valid 3D joint angles with inertial sensors careful sensor-to-segment calibration (i.e. functional or anatomical calibration) is required and measured angular velocity at each sensor needs to be integrated to obtain segment and joint orientation (i.e. joint angles). Existing functional and anatomical calibration procedures were optimized for gait analysis and calibration movements were impractical to perform in outdoor settings. Thus, the aims of this study were 1) to propose and va...

  4. Blood conservation in cardiac surgery.

    Science.gov (United States)

    Blaudszun, G; Butchart, A; Klein, A A

    2017-09-21

    This article aims at reviewing the currently available evidence about blood conservation strategies in cardiac surgery. Pre-operative anaemia and perioperative allogeneic blood transfusions are associated with worse outcomes after surgery. In addition, transfusions are a scarce and costly resource. As cardiac surgery accounts for a significant proportion of all blood products transfused, efforts should be made to decrease the risk of perioperative transfusion. Pre-operative strategies focus on the detection and treatment of anaemia. The management of haematological abnormalities, most frequently functional iron deficiency, is a matter for debate. However, iron supplementation therapy is increasingly commonly administered. Intra-operatively, antifibrinolytics should be routinely used, whereas the cardiopulmonary bypass strategy should be adapted to minimise haemodilution secondary to circuit priming. There is less evidence to recommend minimally invasive surgery. Cell salvage and point-of-care tests should also be a part of the routine care. Post-operatively, any unnecessary iatrogenic blood loss should be avoided. © 2017 British Blood Transfusion Society.

  5. FY 2000 report on the basic survey to promote Joint Implementation, etc. Environmental improvement and energy conservation measures in Pakistan Steel, a state-run enterprise in Pakistan; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Pakistan koku kokuei Pakistan Steel ni okeru kankyo kaizen sho energy taisaku

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    For the state-run plant of Pakistan Steel in Pakistan, an investigational study was conducted on energy conservation and reduction in greenhouse effect gas emission. In the project, energy conservation technology on the following was tried to be introduced: coke oven coal moisture control (CMC) equipment, sintering cooler waste heat recovery equipment, blast furnace hot stove waste heat recovery equipment, blast furnace pulverized coal injection (PCI) equipment, blast furnace top pressure recovery turbine (TRT) equipment, and hot strip mill heating furnace regenerative type burner equipment. Further, in the project on environmental improvement, studies were made on coke oven environmental improvement and blast furnace cast house dust collection. The results of the study indicated that economical effects of the energy conservation project were considered as low because the unit price of energy of Pakistan Steel is low. However, substitution of the low-priced domestic coal for the imported coal has a good effect, and energy conservation in the TRT power generation and by the regenerative type burner produces a highly economical effect. Therefore, Pakistan Steel also agrees to positively promote the project. Moreover, concerning the environmental improvement project, it was considered that the necessity of the project is high in the relation of the coke oven aimed at reducing emissions of toxic substances. (NEDO)

  6. Swivel Joint For Liquid Nitrogen

    Science.gov (United States)

    Milner, James F.

    1988-01-01

    Swivel joint allows liquid-nitrogen pipe to rotate through angle of 100 degree with respect to mating pipe. Functions without cracking hard foam insulation on lines. Pipe joint rotates on disks so mechanical stress not transmitted to thick insulation on pipes. Inner disks ride on fixed outer disks. Disks help to seal pressurized liquid nitrogen flowing through joint.

  7. Joint audits - benefit or burden?

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    a joint audit regime to a single auditor/voluntary joint audit regime. The dataset used in this paper has been collected for the full population of non-financial Danish companies listed on the Copenhagen Stock Exchange (CSE) in the years 2004 and 2005. We find that a majority of firms perceive joint...

  8. Joint International Accelerator School

    CERN Multimedia

    CERN Accelerator School

    2014-01-01

    The CERN and US Particle Accelerator Schools recently organised a Joint International Accelerator School on Beam Loss and Accelerator Protection, held at the Hyatt Regency Hotel, Newport Beach, California, USA from 5-14 November 2014. This Joint School was the 13th in a series of such schools, which started in 1985 and also involves the accelerator communities in Japan and Russia.   Photo courtesy of Alfonse Pham, Michigan State University.   The school attracted 58 participants representing 22 different nationalities, with around half from Europe and the other half from Asia and the Americas. The programme comprised 26 lectures, each of 90 minutes, and 13 hours of case study. The students were given homework each day and had an opportunity to sit a final exam, which counted towards university credit. Feedback from the participants was extremely positive, praising the expertise and enthusiasm of the lecturers, as well as the high standard and quality of their lectures. Initial dis...

  9. Posterolateral elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole; Nielsen, K K

    1998-01-01

    Thirty-five osteoligamentous elbows were included in a study on the kinematics of posterolateral elbow joint instability during the pivot shift test (PST) before and after separate ligament cuttings in the lateral collateral ligament complex (LCLC). Division of the annular ligament or the lateral...... ulnar collateral ligament caused no laxity during the PST. Division of the lateral collateral ligament caused maximal laxity of 4 degrees and 23 degrees during forced PST in valgus and external rotation (supination), respectively. Cutting of the LCLC at the ulnar or the humeral insertion was necessary...... for any PST stressed elbow joint laxity to occur. Total division of the LCLC induced a maximal laxity of 7.9 degrees and 37 degrees during forced PST in valgus and external rotation (supination), respectively. This study suggests the lateral collateral ligament to be the primary soft tissue constraint...

  10. JET Joint Undertaking

    International Nuclear Information System (INIS)

    Keen, B.E.; Lallia, P.; O'Hara, G.W.; Pollard, I.E.

    1987-06-01

    The paper presents the annual report of the Joint European Torus (JET) Joint Undertaking, 1986. The report is divided into two parts: a part on the scientific and technical programme of the project, and a part setting out the administration and organisation of the Project. The first part includes: a summary of the main features of the JET apparatus, the JET experimental programme, the position of the Project in the overall Euratom programme, and how JET relates to other large fusion devices throughout the world. In addition, the technical status of JET is described, as well as the results of the JET operations in 1986. The final section of the first part outlines the proposed future programme of JET. (U.K.)

  11. Peripheral degenerative joint diseases

    Directory of Open Access Journals (Sweden)

    Nilzio Antonio da Silva

    2008-03-01

    Full Text Available Osteoarthritis, a degenerative joint disease, is the most commonrheumatic disorder mainly in a geriatric population. Manifestationsare pain, stiffness and functional loss in the affected joint.According to etiology it is classifi ed as primary (or idiopathicand secondary. Some risk factors for disease development aregenetics, race, age, sex, obesity, occupational activities andarticular biomechanics. Pathogenesis is the same for any cause orlocalization, being catabolic alterations, with synthesis, inhibitionand reparing intent of the cartilage matrix. Metalloproteinases andcytokines (IL-1,IL-6,TNF-α actions promote infl ammatory reactionand cartilage degradation. Pain, the most important symptom,does not correlate with radiologic fi ndings. Peripheral osteoarthritisoccurs predominantly in the knee, hip and hand. Diagnosis is basedon clinical features, laboratorial tests and radiological changes.Rheumatological associations’ guidelines for treatment includenon-pharmacologic (education, physiotherapy, assistive devices,and pharmacologic (analgesics, anti-infl ammatory drugs therapyand surgery. Arthroplasty seems to work better than medicines, butshould be used if other treatments have failed.

  12. Influence of Different Hip Joint Centre Locations on Hip and Knee Joint Kinetics and Kinematics During the Squat

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan

    2014-12-01

    Full Text Available Identification of the hip joint centre (HJC is important in the biomechanical examination of human movement. However, there is yet to be any published information regarding the influence of different HJC locations on hip and knee joint kinetics during functional tasks. This study aimed to examine the influence of four different HJC techniques on 3- D hip and knee joint kinetics/kinematics during the squat. Hip and knee joint kinetics/kinematics of the squat were obtained from fifteen male participants using an eight camera motion capture system. The 3-D kinetics/kinematics of the squat were quantified using four hip joint centre estimation techniques. Repeated measures ANOVAs were used to compare the discrete parameters as a function of each HJC location. The results show that significant differences in joint angles and moment parameters were evident at both the hip and knee joint in the coronal and transverse planes. These observations indicate that when calculating non-sagittal joint kinetics/kinematics during the squat, researchers should carefully consider their HJC method as it may significantly affect the interpretation of their data.

  13. Joint Counterdrug Operations

    Science.gov (United States)

    1998-02-17

    Chapter II Joint Pub 3-07.4 cocaine HCL production. There are over 150 groups trafficking in cocaine, with cartels centered in Medellin and Cali. These...nontraditional mapping products and several digital mapping data bases for geological information and intelligence systems. • Defense Security Assistance Agency...variety of means. Dissemination means include personal contact, physical transfer or courier of hard copy textual and graphic materials, digital and

  14. Jet Joint Undertaking

    International Nuclear Information System (INIS)

    Keen, B.E.; O'Hara, G.W.; Pollard, I.E.

    1988-07-01

    The paper presents the Jet Joint Undertaking annual report 1987. A description is given of the JET and Euratom and International Fusion Programmes. The technical status of JET is outlined, including the development and improvements made to the system in 1987. The results of JET Operation in 1987 are described within the areas of: density effects, temperature improvements, energy confinement studies and other material effects. The contents also contain a summary of the future programme of JET. (U.K.)

  15. Joint Fire Support

    Science.gov (United States)

    2010-06-30

    intelligence application package for theater battle management core system ( TBMCS ) functionality at wing and squadron levels. The automated four... TBMCS , Joint Surveillance and Target Attack Radar System (Ground Control Station), and Global Command and Control System, as well as with Allied FA...The TBMCS is a force level integrated air C2 system. TBMCS provides hardware, software, and communications interfaces to support the preparation

  16. Australias Joint Approach

    Science.gov (United States)

    2015-09-01

    headquarters command and control architecture , including consideration of our suggestion of formalising the strategic J staff system for the support of... architecture … to support successful joint operations.”28 Our analysis involving consultation with a number of senior officers indicates that a more...transported armies into battle since ancient Egyptian times.57 The cooperation between the Royal Australian Navy (RAN) and the Australian Army began with

  17. Conservation businesses and conservation planning in a biological diversity hotspot.

    Science.gov (United States)

    Di Minin, Enrico; Macmillan, Douglas Craig; Goodman, Peter Styan; Escott, Boyd; Slotow, Rob; Moilanen, Atte

    2013-08-01

    The allocation of land to biological diversity conservation competes with other land uses and the needs of society for development, food, and extraction of natural resources. Trade-offs between biological diversity conservation and alternative land uses are unavoidable, given the realities of limited conservation resources and the competing demands of society. We developed a conservation-planning assessment for the South African province of KwaZulu-Natal, which forms the central component of the Maputaland-Pondoland-Albany biological diversity hotspot. Our objective was to enhance biological diversity protection while promoting sustainable development and providing spatial guidance in the resolution of potential policy conflicts over priority areas for conservation at risk of transformation. The conservation-planning assessment combined spatial-distribution models for 646 conservation features, spatial economic-return models for 28 alternative land uses, and spatial maps for 4 threats. Nature-based tourism businesses were competitive with other land uses and could provide revenues of >US$60 million/year to local stakeholders and simultaneously help meeting conservation goals for almost half the conservation features in the planning region. Accounting for opportunity costs substantially decreased conflicts between biological diversity, agricultural use, commercial forestry, and mining. Accounting for economic benefits arising from conservation and reducing potential policy conflicts with alternative plans for development can provide opportunities for successful strategies that combine conservation and sustainable development and facilitate conservation action. © 2013 Society for Conservation Biology.

  18. Formation of tough composite joints

    International Nuclear Information System (INIS)

    Brun, M.K.

    1997-05-01

    Joints which exhibit tough fracture behavior were formed in a composite with a Si/SiC matrix reinforced with Textron SCS-6 fibers with either boron nitride or silicon nitride fiber coatings. In composites with BN coatings fibers were aligned uniaxially, while composites with Si 3 N 4 -coated fibers had a 0/90 degree architecture. Lapped joints (joints with overlapping fingers) were necessary to obtain tough behavior. Geometrical requirements necessary to avoid brittle joint failure have been proposed. Joints with a simple overlap geometry (only a few fingers) would have to be very long in order to prevent brittle failure. Typical failure in these joints is caused by a crack propagating along the interfaces between the joint fingers. Joints of the same overall length, but with geometry changed to be symmetric about the joint centerline and with an extra shear surface exhibited tough fractures accompanied with extensive fiber pullout. The initial matrix cracking of these joints was relatively low because cracks propagated easily through the ends of the fingers. Joints with an optimized stepped sawtooth geometry produced composite-like failures with the stress/strain curves containing an elastic region followed by a region of rising stress with an increase of strain. Increasing the fiber/matrix interfacial strength from 9 to 25 MPa, by changing the fiber coating, increased matrix cracking and ultimate strength of the composite significantly. The best joints had matrix cracking stress and ultimate strength of 138 and 240 MPa, respectively. Joint failure was preceded by multiple matrix cracking in the entire composite. The high strength of the joints will permit building of structures containing joints with only a minor reduction of design stresses

  19. Methods of equipment conservation of a carboelectric

    International Nuclear Information System (INIS)

    Hurtado Higuera, Julio Cesar

    2001-01-01

    Several conservation methods are mentioned like they are those of conservation in dry, in humid, conservation of bombs of water conservation, of turbines, of generators, of transformers, of electric motors and conservation of coal piles

  20. Fluid extravasation of the articular capsule as a complication of temporomandibular joint pumping and perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Kenichi; Watahiki, Ryuichirou; Tamura, Hidetoshi; Ogura, Motoi; Shibuya, Masayuki [Kameda General Hospital, Kamogawa, Chiba (Japan)

    2002-11-01

    This report is a retrospective study of fluid extravasation as a complication of temporomandibular joint pumping and perfusion. Contrast-enhanced 3D-CT of the upper joint compartment was performed for presurgical diagnosis before temporomandibular joint arthroscopic surgery in our hospital from 1996 to 2000. From these cases, 43 joints and 38 patients were selected because they had not improved under conservative treatment during the previous six months. Fluid extravasation of the articular capsule was recognized in 9 joints (20.9%) in 9 patients, 3 males and 6 females. Two of the nine patients had undergone arthroscopic observation before surgery. This test had revealed only thin articular capsule, not a perforation, in any of these cases. The data indicate only extremely tiny perforations or infiltration leakage due to the fluid pressure in the upper joint compartment during pumping or perfusion. Oral and maxillofacial surgeons should be aware of this complication. (author)

  1. On momentum conservation

    International Nuclear Information System (INIS)

    Karastoyanov, A.

    1990-01-01

    The relativistic law of momentum transformation shows that the sum of momenta of even isolated particles is not invariable in all inertial reference systems. This is connected with the relativistic change of kinetic energy and mass of a system of particles in result of internal interactions. The paper proposes a short and simple proof on the necessity of potential momentum. The momentum conservation law (for all interactions in the Minkowski world) is expressed in a generalized form. The constancy of the sum of kinetic and potential momentum of closed system of particles is shown. The energy conservation is a necessary condition. The potential momentum is defined as usual (e.g. as in the Berkeley Physics Course). (author). 13 refs

  2. Conservation laws shape dissipation

    Science.gov (United States)

    Rao, Riccardo; Esposito, Massimiliano

    2018-02-01

    Starting from the most general formulation of stochastic thermodynamics—i.e. a thermodynamically consistent nonautonomous stochastic dynamics describing systems in contact with several reservoirs—we define a procedure to identify the conservative and the minimal set of nonconservative contributions in the entropy production. The former is expressed as the difference between changes caused by time-dependent drivings and a generalized potential difference. The latter is a sum over the minimal set of flux-force contributions controlling the dissipative flows across the system. When the system is initially prepared at equilibrium (e.g. by turning off drivings and forces), a finite-time detailed fluctuation theorem holds for the different contributions. Our approach relies on identifying the complete set of conserved quantities and can be viewed as the extension of the theory of generalized Gibbs ensembles to nonequilibrium situations.

  3. Promoting household energy conservation

    International Nuclear Information System (INIS)

    Steg, Linda

    2008-01-01

    It is commonly assumed that households must change their behaviour to reduce the problems caused by increasing levels of fossil energy use. Strategies for behaviour change will be more effective if they target the most important causes of the behaviour in question. Therefore, this paper first discusses the factors influencing household energy use. Three barriers to fossil fuel energy conservation are discussed: insufficient knowledge of effective ways to reduce household energy use, the low priority and high costs of energy savings, and the lack of feasible alternatives. Next, the paper elaborates on the effectiveness and acceptability of strategies aimed to promote household energy savings. Informational strategies aimed at changing individuals' knowledge, perceptions, cognitions, motivations and norms, as well as structural strategies aimed at changing the context in which decisions are made, are discussed. This paper focuses on the psychological literature on household energy conservation, which mostly examined the effects of informational strategies. Finally, this paper lists important topics for future research

  4. Laboratory characterization of rock joints

    International Nuclear Information System (INIS)

    Hsiung, S.M.; Kana, D.D.; Ahola, M.P.; Chowdhury, A.H.; Ghosh, A.

    1994-05-01

    A laboratory characterization of the Apache Leap tuff joints under cyclic pseudostatic and dynamic loads has been undertaken to obtain a better understanding of dynamic joint shear behavior and to generate a complete data set that can be used for validation of existing rock-joint models. Study has indicated that available methods for determining joint roughness coefficient (JRC) significantly underestimate the roughness coefficient of the Apache Leap tuff joints, that will lead to an underestimation of the joint shear strength. The results of the direct shear tests have indicated that both under cyclic pseudostatic and dynamic loadings the joint resistance upon reverse shearing is smaller than that of forward shearing and the joint dilation resulting from forward shearing recovers during reverse shearing. Within the range of variation of shearing velocity used in these tests, the shearing velocity effect on rock-joint behavior seems to be minor, and no noticeable effect on the peak joint shear strength and the joint shear strength for the reverse shearing is observed

  5. FY 2000 report on the basic survey to promote Joint Implementation, etc. Energy conservation by modernization of a cement plant (Double Horse Cement Co.) in China; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Chugoku cement kojo (Double Horse Cement) kindaika ni yoru sho energy

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    An investigational study was conducted of possibilities of energy conservation and greenhouse effect gas emission reduction in the cement production process of Double Horse Cement Co., Mianyang City, Sichuan Province, China. Double Horse Cement adopts the wet type long kiln production system and has a production ability of approximately 1.5 million t/y. In the project, as to three production lines out of the six production lines, improvement was planned to be made of the technologies on the following: mixing of raw materials, grinding of raw materials, NSP, clinker cooler, clinker pre-grinder, high-efficiency separator, waste heat use power generation, etc. As a result of the study, it was found that the energy conservation amount obtained was 54,646 toe/y. And, the amount of greenhouse effect gas reduction was 169,086 t-CO2/y. The total fund required for this project was approximately 5.553 billion yen and the internal earning rate was 7.36% after tax. When the project is carried out, expenses vs. effects are 9.8 toe/million yen in energy conservation amount and 30.4 t-CO2/million yen in greenhouse effect gas reduction. (NEDO)

  6. Basic investigation on promotion of joint implementation in fiscal 2000. Feasibility survey on conservation of energy and reduction of warming gas emission; 2000 nendo kyodo jisshi nado suishin kiso chosa hokokusho. Seitogyo no sho energy oyobi ondanka gas sakugen kanosei chosa

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Upon the request from the Ministry of Agriculture of the Polish Government, a survey has been performed on three sugar production factories (Lesmierz, Lapy and Werbkowice) in Poland in relation with conservation of energy and reduction of warming gas emission. The survey has been made from the following two aspects: improvement of energy utilization efficiency in the sugar production processes, and efficiency improvement and fuel conversion in the boilers being the energy supplying source. As a result of the discussions on the sugar production process improvement, annual fuel conservation of 304,495 GJ (or 12,688 tons as converted to coal) in total for the three factories, or the energy saving rate of 28% was obtained. Regarding the greenhouse gas emission, an effect of reducing 25,235 tons, or a reduction rate of 27% was achieved. In the combination of the sugar production process improvement and the boiler improvement, the fuel conservation will be 18,363 tons as converted into coal, and the reduction of the greenhouse gas emission will be 56,107 tons. However, when based on the present coal price and natural gas price, the improvement efforts will not be realizable economically for both of Lesmierz and Werbkowice factories, hence comprehensive judgment is required from the viewpoint of the fuel price and environment preservation expense in the future. (NEDO)

  7. Public Knowledge of Monarchs and Support for Butterfly Conservation

    Directory of Open Access Journals (Sweden)

    Jerrod Penn

    2018-03-01

    Full Text Available Pollinator populations in North America are in decline, including the iconic monarch butterfly. In order to determine if public knowledge of monarchs informs opinions on butterfly conservation, we surveyed the public to assess their knowledge of monarchs. We also asked participants about their attitudes towards general butterfly conservation and if they believe that butterfly gardens contribute to conservation. Respondents generally had some knowledge of monarchs but were unaware of monarch population declines and the necessity of milkweed to their life cycle. Respondent knowledge was correlated with more positive attitudes about butterfly conservation. Furthermore, membership in an environmental organization increased the likelihood that the participant had prior knowledge of monarchs and cared about monarch conservation. Respondent socioeconomic factors of age and sex were also significantly correlated with conservation attitudes—older and female participants had more positive attitudes towards general butterfly conservation. Interestingly, females were also less likely than males to admit having prior knowledge of monarchs, indicating that gender may also play an important role in conservation outreach efforts. Our study indicates that educational efforts need to be directed more toward individuals not already associated with an environmental organization as these individuals are predisposed to regard conservation positively.

  8. Patient Portals as a Means of Information and Communication Technology Support to Patient- Centric Care Coordination - the Missing Evidence and the Challenges of Evaluation. A joint contribution of IMIA WG EVAL and EFMI WG EVAL.

    Science.gov (United States)

    Rigby, M; Georgiou, A; Hyppönen, H; Ammenwerth, E; de Keizer, N; Magrabi, F; Scott, P

    2015-08-13

    To review the potential contribution of Information and Communication Technology (ICT) to enable patient-centric and coordinated care, and in particular to explore the role of patient portals as a developing ICT tool, to assess the available evidence, and to describe the evaluation challenges. Reviews of IMIA, EFMI, and other initiatives, together with literature reviews. We present the progression from care coordination to care integration, and from patient-centric to person-centric approaches. We describe the different roles of ICT as an enabler of the effective presentation of information as and when needed. We focus on the patient's role as a co-producer of health as well as the focus and purpose of care. We discuss the need for changing organisational processes as well as the current mixed evidence regarding patient portals as a logical tool, and the reasons for this dichotomy, together with the evaluation principles supported by theoretical frameworks so as to yield robust evidence. There is expressed commitment to coordinated care and to putting the patient in the centre. However to achieve this, new interactive patient portals will be needed to enable peer communication by all stakeholders including patients and professionals. Few portals capable of this exist to date. The evaluation of these portals as enablers of system change, rather than as simple windows into electronic records, is at an early stage and novel evaluation approaches are needed.

  9. Water Well Locations - Conservation Wells

    Data.gov (United States)

    NSGIC Education | GIS Inventory — The conservation well layer identifies the permitted surface location of oil and gas conservation wells that have not been plugged. These include active, regulatory...

  10. Guatemala conservation concession for the Maya Biosphere Reserve

    OpenAIRE

    Conservation International

    2007-01-01

    Metadata only record The national government of Guatemala has issued timber concessions to local communities within its 2 million hectare Maya Biosphere Reserve. Working under this framework, CI is proposing a conservation concession contract with two communities. The concessions would be designed to pay salaries for conservation managers, to invest in projects such as guiding tourists to nearby archaeological sites and to provide community services such as education and health care, in ex...

  11. Conservation Education: A Position Statement.

    Science.gov (United States)

    Soil Conservation Society of America, Ankeny, IA.

    The Soil Conservation Society of America's (SCSA) aim is to advance the science and art of good land and water use. Conservation education has a significant role in achieving the wise use of these resources. In this report, perspectives are offered on: (1) the requirements for effective conservation education programs; (2) rationale for…

  12. Madagascar Conservation & Development: Editorial Policies

    African Journals Online (AJOL)

    ... of the Madagascar Conservation & Development community. Finally, Madagascar Conservation & Development serves as a conduit for debate and discussion and welcomes contributions on any aspect of the legal or scientific status of any species living in Madagascar, or on conservation and development philosophy.

  13. Temporomandibular joint motion

    International Nuclear Information System (INIS)

    Maeda, M.; Kawamura, Y.; Matsuda, T.; Itou, S.; Odori, T.; Ishii, Y.; Torizuka, K.

    1990-01-01

    This paper evaluates MR imaging with the therapeutic effect after splint therapy in internal derangement of the temporomandibular joint (TMJ). Fifteen patients (19 TMJs) with internal derangement of the TMJ and five normal volunteers (10 TMJs) were examined with sagittal T1-weighted spin-echo and gradient recalled acquisition in a steady state (GRASS) MR imaging. MR studies of the patients undergoing splint therapy were performed with an without splints. Pseudodynamic images of TMJ motion provide information that was not available from spin-echo T1-weighted images

  14. Joint Advisory Appeals Board

    CERN Multimedia

    2013-01-01

    The Joint Advisory Appeals Board has examined the internal appeal lodged by a former member of the personnel, a beneficiary of the CERN Pension Fund, against the calculation of his pension in the framework of the Progressive Retirement Programme.   The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be available from 26 July to 11 August 2013 at the following link. HR Department Head Office

  15. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Luc Vos with regard to advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 14 to 28 June 2002. Human Resources Division Tel. 74128

  16. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2008-01-01

    The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel against the decision to grant him only a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main building (bldg. 500) from 1 September to 14 September 2008. Human Resources Department (73911)

  17. Joint Advisory Appeals Board

    CERN Multimedia

    2003-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Poul Frandsen concerning his assimilation into the new career structure. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 13 to 24 January 2003. Human Resources Division Tel. 74128

  18. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Personnel Division

    1999-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Joào Bento with regard to residential category. As the appellant has not objected, the recommendations of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article RÊVIÊ1.20 of the Staff Regulations.The relevant documents will therefore be posted on the notice boards of the Administration Building (N¡ 60) from 29 October to 12 November 1999.Personnel DivisionTel. 74128

  19. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2006-01-01

    The Joint Advisory Appeals Board was convened to examine an appeal lodged by a member of the personnel with regard to advancement. The person concerned has requested that the report of the Board and the final decision of the Director-General be brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (No. 60) from 24 March to 10 April 2006. Human Resources Department Tel. 74128

  20. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2007-01-01

    The Joint Advisory Appeals Board was convened to examine an internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has requested that the report of the Board and the final decision of the Director-General be brought to the notice of the members of the personnel, in accordance with Article R VI 1.18 of the Staff Regulations. The relevant documents will therefore be posted on the notice board of the Main building (Bldg. 60) from 24 September to 7 October 2007. Human Resources Department

  1. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Olivier Francis Martin with regard to indefinite contract. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 8 to 25 June 2001.

  2. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Jack Blanchard with regard to 'non recognition of specific functions'. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 12th to 26th April 2002. Human Resources Division Tel. 74128

  3. Joint Advisory Appeals Board

    CERN Multimedia

    2003-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mrs Judith Igo-Kemenes concerning the application of procedures foreseen by Administrative Circular N§ 26 (Rev. 3). As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 6 to 20 June 2003. Human Resources Division Tel. 74128

  4. Joint Advisory Appeals Board

    CERN Multimedia

    2004-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mrs Maria DIMOU with regard to a periodic one-step increase. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 30 April to 14 May 2004. Human Resources Department Tel. 74128

  5. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Joël Lahaye with regard to non-resident allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 18 May to 1st June 2001.

  6. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2008-01-01

    The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel with regard to the decision not to award him a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main building (Bldg. 500) from 17 March to 30 March 2008. Human Resources Department Tel. 73911

  7. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Bertrand Nicquevert with regard to the non-resident allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 29 November to 13 December 2002. Human Resources Division Tel. 74128

  8. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Antonio Millich with regard to advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 27 September to 11 October 2002. Human Resources Division Tel. 74128

  9. Joint Advisory Appeals Board

    CERN Multimedia

    Human Resources Department

    2005-01-01

    The Joint Advisory Appeals Board was convened to examine an appeal lodged by a member of the personnel with regard to a periodic one-step increase. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 1 to 15 April 2005. Human Resources Department Tel. 74128

  10. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2008-01-01

    The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel against the decision to grant him only a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main Building (Bldg. 500) from 1 September to 14 September 2008. Human Resources Department (73911)

  11. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Gert Jan Bossen with regard to dependent child allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 1st to 15 March 2002. Human Resources Division Tel. 74128

  12. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2008-01-01

    The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main Building (Bldg. 500) from 26 May to 6 June 2008. Human Resources Department (73911)

  13. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Serge Peraire with regard to exceptional advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 17 to 31 May 2002. Human Resources Division Tel. 74128

  14. Joint Advisory Appeals Board

    CERN Multimedia

    HR Department

    2008-01-01

    The Joint Advisory Appeals Board was convened to examine an internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel, in accordance with Article R VI 1.18 of the Staff Regulations. These documents will therefore be posted on the notice board of the Main Building (Bldg. 60) from 21 January to 3 February 2008. Human Resources Department (73911)

  15. Patellofemoral joint motion

    International Nuclear Information System (INIS)

    Stanford, W.; Phelan, J.; Albright, J.; Kathol, M.; Rooholamini, S.A.; El-Khoury, G.Y.; Palutsis, G.R.

    1988-01-01

    This paper describes the use of ultrafast computed tomography (CT) to obtain dynamic images of the patellofemoral joint during active motion. Thirty-eight patients underwent measurements of tangent offset, bisect offset, congruence angle, patellar tilt angle, lateral patellofemoral angle, sulcus angle, and sulcus depth made during leg movement. Selected parameters were compared with Merchant views. Significant correlations were obtained between Merchant views and comparable ultrafast CT views for all parameters except sulcus angle. Correlations between the other parameters were poor. Cine strips showed two patterns of movement; the patella remained centered either throughout excursion or until the last 20 0 of full extension, when it would sublux laterally

  16. Joint Advisory Appeals Board

    CERN Multimedia

    2003-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Aloïs Girardoz with regard to classification and advancement. As the appellant has not objected, the Board's report and the Director-General's decision will be brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 15 to 29 August 2003. Human Resources Division Tel. 74128

  17. Integrating conservation costs into sea level rise adaptive conservation prioritization

    Directory of Open Access Journals (Sweden)

    Mingjian Zhu

    2015-07-01

    Full Text Available Biodiversity conservation requires strategic investment as resources for conservation are often limited. As sea level rises, it is important and necessary to consider both sea level rise and costs in conservation decision making. In this study, we consider costs of conservation in an integrated modeling process that incorporates a geomorphological model (SLAMM, species habitat models, and conservation prioritization (Zonation to identify conservation priorities in the face of landscape dynamics due to sea level rise in the Matanzas River basin of northeast Florida. Compared to conservation priorities that do not consider land costs in the analysis process, conservation priorities that consider costs in the planning process change significantly. The comparison demonstrates that some areas with high conservation values might be identified as lower priorities when integrating economic costs in the planning process and some areas with low conservation values might be identified as high priorities when considering costs in the planning process. This research could help coastal resources managers make informed decisions about where and how to allocate conservation resources more wisely to facilitate biodiversity adaptation to sea level rise.

  18. Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

    Science.gov (United States)

    Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

    2018-02-01

    Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis

    OpenAIRE

    Young, Rebekah; Nix, Sheree; Wholohan, Aaron; Bradhurst, Rachael; Reed, Lloyd

    2013-01-01

    Background Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and meta-analysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations. Methods Keyword searches of Embase, Medline, Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclu...

  20. Hearing Conservation Live #2430

    Energy Technology Data Exchange (ETDEWEB)

    Chochoms, Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-08-09

    Occupational hearing loss is one of the most common work-related illnesses in the United States (US). From 22 to 30 million US workers are exposed to hazardous noise levels at work, and 25% of these workers will develop permanent hearing loss. Hearing loss from noise is slow and painless, and you can have a disability before you notice it. This course presents the hazards associated with workplace noise, the purpose and elements of the Los Alamos National Laboratory (LANL) Hearing Conservation Program (HCP), and controls that are available to reduce your exposure to hazardous levels of noise.

  1. Energy conservation technologies

    Energy Technology Data Exchange (ETDEWEB)

    Courtright, H.A. [Electric Power Research Inst., Palo Alto, CA (United States)

    1993-12-31

    The conservation of energy through the efficiency improvement of existing end-uses and the development of new technologies to replace less efficient systems is an important component of the overall effort to reduce greenhouse gases which may contribute to global climate change. Even though uncertainties exist on the degree and causes of global warming, efficiency improvements in end-use applications remain in the best interest of utilities, their customers and society because efficiency improvements not only reduce environmental exposures but also contribute to industrial productivity, business cost reductions and consumer savings in energy costs.

  2. Integrating Agriculture and Conservation

    Science.gov (United States)

    Vandever, Mark W.

    2010-01-01

    The USGS produces the needed science-based information to guide management actions and policy decisions that support wildlife habitat and other environmental services compatible with USDA conservation goals and farm operations. The Policy Analysis and Science Assistance Branch of the Fort Collins Science Center (FORT) has conducted research involving a national landowner survey and numerous short- and long-term evaluations regarding vegetation responses to land management practices. This research helps land and resource managers to make informed decisions and resolve resource management conflicts.

  3. Glenohumeral Joint Injections

    Science.gov (United States)

    Gross, Christopher; Dhawan, Aman; Harwood, Daniel; Gochanour, Eric; Romeo, Anthony

    2013-01-01

    Context: Intra-articular injections into the glenohumeral joint are commonly performed by musculoskeletal providers, including orthopaedic surgeons, family medicine physicians, rheumatologists, and physician assistants. Despite their frequent use, there is little guidance for injectable treatments to the glenohumeral joint for conditions such as osteoarthritis, adhesive capsulitis, and rheumatoid arthritis. Evidence Acquisition: We performed a comprehensive review of the available literature on glenohumeral injections to help clarify the current evidence-based practice and identify deficits in our understanding. We searched MEDLINE (1948 to December 2011 [week 1]) and EMBASE (1980 to 2011 [week 49]) using various permutations of intra-articular injections AND (corticosteroid OR hyaluronic acid) and (adhesive capsulitis OR arthritis). Results: We identified 1 and 7 studies that investigated intra-articular corticosteroid injections for the treatment of osteoarthritis and adhesive capsulitis, respectively. Two and 3 studies investigated the use of hyaluronic acid in osteoarthritis and adhesive capsulitis, respectively. One study compared corticosteroids and hyaluronic acid injections in the treatment of osteoarthritis, and another discussed adhesive capsulitis. Conclusion: Based on existing studies and their level of evidence, there is only expert opinion to guide corticosteroid injection for osteoarthritis as well as hyaluronic acid injection for osteoarthritis and adhesive capsulitis. PMID:24427384

  4. Phytomedicine in Joint Disorders

    Directory of Open Access Journals (Sweden)

    Dorin Dragos

    2017-01-01

    Full Text Available Chronic joint inflammatory disorders such as osteoarthritis and rheumatoid arthritis have in common an upsurge of inflammation, and oxidative stress, resulting in progressive histological alterations and disabling symptoms. Currently used conventional medication (ranging from pain-killers to biological agents is potent, but frequently associated with serious, even life-threatening side effects. Used for millennia in traditional herbalism, medicinal plants are a promising alternative, with lower rate of adverse events and efficiency frequently comparable with that of conventional drugs. Nevertheless, their mechanism of action is in many cases elusive and/or uncertain. Even though many of them have been proven effective in studies done in vitro or on animal models, there is a scarcity of human clinical evidence. The purpose of this review is to summarize the available scientific information on the following joint-friendly medicinal plants, which have been tested in human studies: Arnica montana, Boswellia spp., Curcuma spp., Equisetum arvense, Harpagophytum procumbens, Salix spp., Sesamum indicum, Symphytum officinalis, Zingiber officinalis, Panax notoginseng, and Whitania somnifera.

  5. Jointly Sponsored Research Program

    Energy Technology Data Exchange (ETDEWEB)

    Everett A. Sondreal; John G. Hendrikson; Thomas A. Erickson

    2009-03-31

    U.S. Department of Energy (DOE) Cooperative Agreement DE-FC26-98FT40321 funded through the Office of Fossil Energy and administered at the National Energy Technology Laboratory (NETL) supported the performance of a Jointly Sponsored Research Program (JSRP) at the Energy & Environmental Research Center (EERC) with a minimum 50% nonfederal cost share to assist industry in commercializing and effectively applying highly efficient, nonpolluting energy systems that meet the nation's requirements for clean fuels, chemicals, and electricity in the 21st century. The EERC in partnership with its nonfederal partners jointly performed 131 JSRP projects for which the total DOE cost share was $22,716,634 (38%) and the nonfederal share was $36,776,573 (62%). Summaries of these projects are presented in this report for six program areas: (1) resource characterization and waste management, (2) air quality assessment and control, (3) advanced power systems, (4) advanced fuel forms, (5) value-added coproducts, and (6) advanced materials. The work performed under this agreement addressed DOE goals for reductions in CO{sub 2} emissions through efficiency, capture, and sequestration; near-zero emissions from highly efficient coal-fired power plants; environmental control capabilities for SO{sub 2}, NO{sub x}, fine respirable particulate (PM{sub 2.5}), and mercury; alternative transportation fuels including liquid synfuels and hydrogen; and synergistic integration of fossil and renewable resources.

  6. Joint resistance measurements of pancake and terminal joints for JT-60SA EF coils

    Energy Technology Data Exchange (ETDEWEB)

    Obana, Tetsuhiro, E-mail: obana.tetsuhiro@LHD.nifs.ac.jp [National Institute for Fusion Science, 322-6 Oroshi, Toki, Gifu 509-5292 (Japan); Takahata, Kazuya; Hamaguchi, Shinji; Mito, Toshiyuki; Imagawa, Shinsaku [National Institute for Fusion Science, 322-6 Oroshi, Toki, Gifu 509-5292 (Japan); Kizu, Kaname; Murakami, Haruyuki; Yoshida, Kiyoshi [Japan Atomic Energy Agency, 801-1 Mukoyama, Naka, Ibaraki 311-0193 (Japan)

    2013-11-15

    Highlights: • To evaluate the joint fabrication technology for the JT-60SA EF coils, joint resistance measurements were conducted with a joint sample. • The joint sample was composed of pancake and terminal joints. • The measurements demonstrated that both joints fulfilled the design requirement. • Considering the measurements, the characteristics of both joints were investigated using an analytical model that represents the joints. -- Abstract: To evaluate the joint fabrication technology for the JT-60SA EF coils, joint resistance measurements were conducted using a sample consisting of pancake and terminal joints. Both joints are shake-hands lap joints composed of cable-in-conduit conductors and a pure copper saddle-shaped spacer. The measurements demonstrated that both joints fulfilled the design requirement. Considering these measurements, the characteristics of both joints were investigated using analytical models that represent the joints. The analyses indicated that the characteristics of the conductors used in the joints affect the characteristics of the joints.

  7. The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

    Science.gov (United States)

    Lipira, Lauren; Kemp, Christopher; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner; Puttkammer, Nancy

    2018-01-01

    Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition. © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Radiosynoviorthesis in haemaphilic joint disease

    International Nuclear Information System (INIS)

    Pad Bosch, P.J.I. van't; Putte, L.B.A. van de; Boerbooms, A.M.T.; Geerdink, P.J.

    1981-01-01

    The effects of radiosynoviorthesis on chronic haemophilic arthropathic joints were studied in six patients with severe haemophilia by a follow up study which spanned two and a half years. On clinical grounds the treatment was successful because pain and bleeding frequency diminished, although radiographic examination showed further deterioration of the treated joint. Chromosome damage was not detected. We conclude that radiosynoviorthesis is apparently changing the bleeding pattern of articular tissues without arresting the destruction and deformation of joints. (orig.) [de

  9. What is a conservation actor?

    Directory of Open Access Journals (Sweden)

    Paul Jepson

    2011-01-01

    Full Text Available As a crisis-oriented discipline, conservation biology needs actions to understand the state of nature and thwart declines in biodiversity. Actors-traditionally individuals, institutions, and collectives-have been central to delivering such goals in practice. However, the definition of actors within the discipline has been narrow and their role in influencing conservation outcomes inadequately conceptualised. In this paper, we examine the question ′What is a conservation actor?′ Who or what creates the capacity to influence conservation values and actions? Drawing from theoretical developments in Actor-Network Theory and collective governance, we argue that the concept of an actor in conservation biology should be broadened to include non-humans, such as species and devices, because they have the agency and ability to influence project goals and outcomes. We illustrate this through four examples: the Asian elephant, International Union for Conservation of Nature red lists, the High Conservation Value approach, and an Integrated Conservation and Development Project. We argue that a broader conceptualisation of actors in conservation biology will produce new forms of understanding that could open up new areas of conservation research, enhance practice and draw attention to spheres of conservation activity that might require stronger oversight and governance.

  10. CONSERVATION STARTERS IN ENGLISH TEACHING

    Directory of Open Access Journals (Sweden)

    Amir Sisbiyanto

    2017-04-01

    Full Text Available The global issue of environment which needs specific attention has made all countries think about possible solution or creative responses. Indonesia, which is in the process of boosting its economy and people‘s prosperity, is inevitably prone to industrial exposure that leads the country to environmental-deterioration. Consequently, environment should be prioritized in the national-development design. This issue has actually been positively responded by the Indonesian authority of national education program with one of the spirits of curriculum 2013, that is to integrate characters, including ‗caring for the environment‘, in the teaching of discrete subjects including English. However, the theme concerning environmental awareness, though explicitly mentioned in the curriculum, seems to still be ignored by some English teachers due to their being badly preoccupied with the stage of understanding/interpreting the newly-implemented curriculum itself. To fill the gap, this paper tries to offer alternative techniques called ‗conservation starters‘ to be used in English teaching & learning. The techniques are modified from some already familiar activities such as ‗find someone who‘, ‗hunting‘, and ‗word description‘ games. It is expected that the techniques can help English teachers improve students‘ motivation in getting engaged to the English teaching & learning programs, introduce students to environmental issues, and, finally, improve students‘ achievement.

  11. Beyond conservation agriculture.

    Science.gov (United States)

    Giller, Ken E; Andersson, Jens A; Corbeels, Marc; Kirkegaard, John; Mortensen, David; Erenstein, Olaf; Vanlauwe, Bernard

    2015-01-01

    Global support for Conservation Agriculture (CA) as a pathway to Sustainable Intensification is strong. CA revolves around three principles: no-till (or minimal soil disturbance), soil cover, and crop rotation. The benefits arising from the ease of crop management, energy/cost/time savings, and soil and water conservation led to widespread adoption of CA, particularly on large farms in the Americas and Australia, where farmers harness the tools of modern science: highly-sophisticated machines, potent agrochemicals, and biotechnology. Over the past 10 years CA has been promoted among smallholder farmers in the (sub-) tropics, often with disappointing results. Growing evidence challenges the claims that CA increases crop yields and builds-up soil carbon although increased stability of crop yields in dry climates is evident. Our analyses suggest pragmatic adoption on larger mechanized farms, and limited uptake of CA by smallholder farmers in developing countries. We propose a rigorous, context-sensitive approach based on Systems Agronomy to analyze and explore sustainable intensification options, including the potential of CA. There is an urgent need to move beyond dogma and prescriptive approaches to provide soil and crop management options for farmers to enable the Sustainable Intensification of agriculture.

  12. Beyond conservation agriculture

    Science.gov (United States)

    Giller, Ken E.; Andersson, Jens A.; Corbeels, Marc; Kirkegaard, John; Mortensen, David; Erenstein, Olaf; Vanlauwe, Bernard

    2015-01-01

    Global support for Conservation Agriculture (CA) as a pathway to Sustainable Intensification is strong. CA revolves around three principles: no-till (or minimal soil disturbance), soil cover, and crop rotation. The benefits arising from the ease of crop management, energy/cost/time savings, and soil and water conservation led to widespread adoption of CA, particularly on large farms in the Americas and Australia, where farmers harness the tools of modern science: highly-sophisticated machines, potent agrochemicals, and biotechnology. Over the past 10 years CA has been promoted among smallholder farmers in the (sub-) tropics, often with disappointing results. Growing evidence challenges the claims that CA increases crop yields and builds-up soil carbon although increased stability of crop yields in dry climates is evident. Our analyses suggest pragmatic adoption on larger mechanized farms, and limited uptake of CA by smallholder farmers in developing countries. We propose a rigorous, context-sensitive approach based on Systems Agronomy to analyze and explore sustainable intensification options, including the potential of CA. There is an urgent need to move beyond dogma and prescriptive approaches to provide soil and crop management options for farmers to enable the Sustainable Intensification of agriculture. PMID:26579139

  13. Beyond Conservation Agriculture

    Directory of Open Access Journals (Sweden)

    Ken E Giller

    2015-10-01

    Full Text Available Global support for Conservation Agriculture (CA as a pathway to Sustainable Intensification is strong. CA revolves around three principles: no-till (or minimal soil disturbance, soil cover, and crop rotation. The benefits arising from the ease of crop management, energy/cost/time savings and soil and water conservation led to widespread adoption of CA, particularly on large farms in the Americas and Australia, where farmers harness the tools of modern science: highly-sophisticated machines, potent agrochemicals and biotechnology. Over the past ten years CA has been promoted among smallholder farmers in the (sub- tropics, often with disappointing results. Growing evidence challenges the claims that CA increases crop yields and builds-up soil carbon although increased stability of crop yields in dry climates is evident. Our analyses suggest pragmatic adoption on larger mechanized farms, and limited uptake of CA by smallholder farmers in developing countries. We propose a rigorous, context-sensitive approach based on Systems Agronomy to analyze and explore sustainable intensification options, including the potential of CA. There is an urgent need to move beyond dogma and prescriptive approaches to provide soil and crop management options for farmers to enable the Sustainable Intensification of agriculture.

  14. Selling energy conservation.

    Science.gov (United States)

    Hinrichsen, D

    1995-01-01

    This article concerns the Organization of the Petroleum Exporting Countries (OPEC) crisis and its impact on energy efficiency measures in the US. In 1985, when the OPEC collapsed, the US government had avoided the need to construct 350 gigawatts of new electric capacity. The most successful efficiency improvements, especially in household appliances and equipment, lighting and tightened energy efficiency standards in new buildings, resulted from the OPEC event. The real innovation of that time was the change in profit rules for utilities. This revolution and the way some US utilities view energy have not caught on elsewhere. Despite the initiative toward improving energy efficiency in homes, offices and industries, the change has been slow. Partly to blame are the big development banks, which pointed out that short-term conservation and efficiency measures could save at least 15% of the total energy demand without the need for major investment. The benefits of energy conservation was shown during the oil shock when per capita energy consumption fell by 5% in the member states of the Organization of Economic Cooperation and Development, while the per capita gross domestic product grew by a third. There has been a decrease in energy expenditure worldwide, and the scope for further energy savings is enormous, but governments need to recognize and seize the opportunity.

  15. Intensity Conserving Spectral Fitting

    Science.gov (United States)

    Klimchuk, J. A.; Patsourakos, S.; Tripathi, D.

    2015-01-01

    The detailed shapes of spectral line profiles provide valuable information about the emitting plasma, especially when the plasma contains an unresolved mixture of velocities, temperatures, and densities. As a result of finite spectral resolution, the intensity measured by a spectrometer is the average intensity across a wavelength bin of non-zero size. It is assigned to the wavelength position at the center of the bin. However, the actual intensity at that discrete position will be different if the profile is curved, as it invariably is. Standard fitting routines (spline, Gaussian, etc.) do not account for this difference, and this can result in significant errors when making sensitive measurements. Detection of asymmetries in solar coronal emission lines is one example. Removal of line blends is another. We have developed an iterative procedure that corrects for this effect. It can be used with any fitting function, but we employ a cubic spline in a new analysis routine called Intensity Conserving Spline Interpolation (ICSI). As the name implies, it conserves the observed intensity within each wavelength bin, which ordinary fits do not. Given the rapid convergence, speed of computation, and ease of use, we suggest that ICSI be made a standard component of the processing pipeline for spectroscopic data.

  16. Disability in Patients With Trapeziometacarpal Joint Arthrosis: Incidental Versus Presenting Diagnosis

    NARCIS (Netherlands)

    Becker, Stéphanie J. E.; Makarawung, Dennis J. S.; Spit, Silke A.; King, John D.; Ring, David

    2014-01-01

    Purpose To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis. Methods We compared 64 patients presenting for care

  17. Leveraging Technology for Joint Training

    National Research Council Canada - National Science Library

    Walker, Jack

    1997-01-01

    .... While this innovation will have a significant impact on education and training, it will not fulfill its potential unless joint and component commanders understand what the technologies represent...

  18. The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report.

    Science.gov (United States)

    Kocabay, Ceyda; Ataç, Mustafa Sancar; Oner, Burak; Güngör, Nadir

    2007-08-01

    The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.

  19. A global assessment of the social and conservation outcomes of protected areas.

    Science.gov (United States)

    Oldekop, J A; Holmes, G; Harris, W E; Evans, K L

    2016-02-01

    Protected areas (PAs) are a key strategy for protecting biological resources, but they vary considerably in their effectiveness and are frequently reported as having negative impacts on local people. This has contributed to a divisive and unresolved debate concerning the compatibility of environmental and socioeconomic development goals. Elucidating the relationship between positive and negative social impacts and conservation outcomes of PAs is key for the development of more effective and socially just conservation. We conducted a global meta-analysis on 165 PAs using data from 171 published studies. We assessed how PAs affect the well-being of local people, the factors associated with these impacts, and crucially the relationship between PAs' conservation and socioeconomic outcomes. Protected areas associated with positive socioeconomic outcomes were more likely to report positive conservation outcomes. Positive conservation and socioeconomic outcomes were more likely to occur when PAs adopted comanagement regimes, empowered local people, reduced economic inequalities, and maintained cultural and livelihood benefits. Whereas the strictest regimes of PA management attempted to exclude anthropogenic influences to achieve biological conservation objectives, PAs that explicitly integrated local people as stakeholders tended to be more effective at achieving joint biological conservation and socioeconomic development outcomes. Strict protection may be needed in some circumstances, yet our results demonstrate that conservation and development objectives can be synergistic and highlight management strategies that increase the probability of maximizing both conservation performance and development outcomes of PAs. © 2015 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

  20. Fiscal 2000 project of inviting proposals for international joint research - invitation for international proposal (Energy conservation No.4). Development of passive cooling mechanism fit for high-temperature high-humidity region; 2000 nendo kokusai kyodo kenkyu teian kobo jigyo - kokusai teian kobo (Shoe No.4). Koon tashitsu chiiki tekigogata passive reikyaku kiko no kaihatsu seika hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Efforts are made in cooperation with Vietnam to develop a heat insulating material for buildings, to be used for passive cooling mechanisms symbiotic with the environment and capable of energy conservation. Vegetables are planted on the surface of this building material. Activities are conducted in the three domains of (1) the development of energy conservation-conscious basic materials, (2) selection of vegetables, and (3) the simulation of the effect of the developed materials on temperature. The basic type of the newly developed building material is an asbestos-free vegetable fiber-reinforced cement slate which is covered by such vegetables as members of the Passifloraceae, Vitaceae, and Araliaceae. Conducted in domain (1) are surveys of the actual state of basic material manufacturing in Vietnam and studies of the basic properties of vegetable fiber, properties displayed by vegetable fiber under various chemical environments, selection of vegetable fiber as the basic aggregate, mineral fiber, and the basic material manufacturing conditions. The result of heat load calculation carried out using SMASH for Windows ver.2, which is a program developed for thermal load calculation for houses, shows that the new material lowers the temperature by approximately 3 degrees C. (NEDO)

  1. Pseudodynamic MR imaging of temporomandibular joint disorders

    International Nuclear Information System (INIS)

    Nakasato, Tatsuhiko; Ehara, Shigeru

    1992-01-01

    Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.5 Tesla MR unit and 8 cm circular planar surface coil. For depiction of each compartment of the meniscus, the optimum sequence was 200/15/2 (TR/TE/excitations) with 50 deg or 60 deg flip angle in gradient refocused acquisition in steady-state (GRASS) sequences. Three contiguous slices on sagittal MR images were routinely obtained at 14-18 different phases of the opening cycle and displayed in closed-loop cine fashion. Internal derangement was observed in 57% of 68 joints. The most common type was anterior meniscal displacement without reduction. Sideway and rotational displacements, observed in 10% each, were noted on both sagittal multislice images and axial reference images. As a pseudodynamic MR technique, jaw movement specifically designed to check bite procedure to adjust splints is useful for detecting the exact time of meniscal redisplacement on the second click. After conservative therapy for arthrosis, pseudodynamic MR provided information on changes in the meniscus and condylar relationship. Pseudodynamic MR with multiple phases is suitable for evaluating subtle motion abnormality of the meniscus and for post-therapeutic monitoring. (author)

  2. Pseudodynamic MR imaging of temporomandibular joint disorders

    Energy Technology Data Exchange (ETDEWEB)

    Nakasato, Tatsuhiko; Ehara, Shigeru (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1992-09-01

    Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.5 Tesla MR unit and 8 cm circular planar surface coil. For depiction of each compartment of the meniscus, the optimum sequence was 200/15/2 (TR/TE/excitations) with 50 deg or 60 deg flip angle in gradient refocused acquisition in steady-state (GRASS) sequences. Three contiguous slices on sagittal MR images were routinely obtained at 14-18 different phases of the opening cycle and displayed in closed-loop cine fashion. Internal derangement was observed in 57% of 68 joints. The most common type was anterior meniscal displacement without reduction. Sideway and rotational displacements, observed in 10% each, were noted on both sagittal multislice images and axial reference images. As a pseudodynamic MR technique, jaw movement specifically designed to check bite procedure to adjust splints is useful for detecting the exact time of meniscal redisplacement on the second click. After conservative therapy for arthrosis, pseudodynamic MR provided information on changes in the meniscus and condylar relationship. Pseudodynamic MR with multiple phases is suitable for evaluating subtle motion abnormality of the meniscus and for post-therapeutic monitoring. (author).

  3. "A mission-driven discipline": the growth of conservation biology.

    Science.gov (United States)

    Meine, Curt; Soulé, Michael; Noss, Reed E

    2006-06-01

    Conservation biology emerged in the mid-1980s, drawing on established disciplines and integrating them in pursuit of a coherent goal: the protection and perpetuation of the Earth's biological diversity. Opportunistic in its borrowing and application of knowledge, conservation biology had its roots within the established biological sciences and resource management disciplines but has continually incorporated insights from the empirical experience of resource managers, from the social sciences and humanities, and from diverse cultural sources. The Society for Conservation Biology (SCB) has represented the field's core constituency, while expanding that constituency in keeping with the field's integrative spirit. Conservation Biology has served as SCB's flagship publication, promoting research, dialog, debate, and application of the field's essential concepts. Over the last 20 years the field, SCB, and the journal have evolved to meet changing conservation needs, to explore gaps in our knowledge base, to incorporate new information from related fields, to build professional capacity, and to provide expanded opportunities for international participation. In turn, the field, SCB, and journal have prompted change in related fields, organizations, and publications. In its dedication to advancing the scientific foundations of biodiversity conservation and placing that science at the service of society in a world whose variety, wildness, and beauty we care for conservation biology represents both a continuation and radical reconfiguration of the traditional relationship between science and conservation.

  4. Temporomandibular joint movement

    International Nuclear Information System (INIS)

    Maeda, M.; Itou, S.; Ishii, Y.; Yamamoto, K.; Kawamura, Y.; Matsuda, T.; Hayashi, N.; Ishii, J.

    1992-01-01

    Ten temporomandibular joints (TMJs) of 5 healthy volunteers and 19 TMJs of internal derangements in 16 patients with splint therapy were examined with MR imaging. T1-weighted images were obtained only in the closed mouth position, and gradient recalled acquisition in steady state (GRASS) images were obtained in active opening and closing phases, allowing a pseudodynamic display of TMJ movement. All patients received protrusive splint treatment. The usefulness of MR imaging to assess the efficacy of splint therapy was evaluated. Corrected disk position with the splint in place was clearly demonstrated in 9 TMJs, corresponding with elimination of reciprocal clicking. Ten other TMJs of anterior disk displacement without reduction showed uncorrected disk position by the splint. This information could confirm the therapeutic efficacy, or suggest other treatment alternatives. GRASS MR imaging can provide accurate and physiologic information about disk function in initial and follow-up assessment of protrusive splint therapy. (orig.)

  5. JOINT ADVISORY APPEALS BOARD

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Neil Calder, Mrs Sudeshna Datta Cockerill, Mrs Andrée Fontbonne, Mrs Moniek Laurent and Mr Ulrich Liptow with regard to membership in the Pension Fund under the period with a Paid Associate contract, appeals dealt with on a collective basis. As the appellants have not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 10 to 31 August 2001.

  6. Temporomandibular joint arthrography

    International Nuclear Information System (INIS)

    Choi, Hyung Sik; Lee, Kyung Soo; Kim, Myoung Joon; Jun, Young Hwan; Chang, Duk Soo; Jung, Don Young; Jung, In Won

    1988-01-01

    The stress and occlusion disturbance are very important etiologic factors in the temporomandibular joint (TMJ) pain dysfunction syndromes. Authors performed TMJ arthrograms in the patients with TMJ problem such as pain, click sound, limited motion and locking, etc. The following results noted: 1. The arthrographic findings of 22 TMJ were analyzed. a) Normal: 6 cases b) Anterior disc displacement with rediction: 6 cases · Early reduction: 2 cases · Intermediate reduction: 3 cases · Late reduction: 1 case c) Anterior disc displacement without reduction: 6 cases · Two cases had adhesion between the posterior portion of disc and the posterior surfaces of the articular eminence. 2. Among 22 cases, the clinical findings of 16 cases (73%) were compatible with arthrographic findings. 6 cases showed disparity between them.

  7. Consensus Report by Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees: Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 1: Focus on Investigations, Prophylaxis, and Specific Treatment.

    Science.gov (United States)

    Bajwa, Rajinder P S; Mahadeo, Kris M; Taragin, Benjamin H; Dvorak, Christopher C; McArthur, Jennifer; Jeyapalan, Asumthia; Duncan, Christine N; Tamburro, Robert; Gehred, Alison; Lehmann, Leslie; Richardson, Paul; Auletta, Jeffery J; Woolfrey, Ann E

    2017-11-01

    Veno-occlusive disease (VOD) is a common and potentially fatal complication in children undergoing hematopoietic cell transplantation (HCT). It occurs in about one-third of all patients undergoing transplantation and is fatal in 50% of patients with severe disease. Early intervention and specific treatment with defibrotide are associated with improved outcomes. However, there is a lack of supportive care guidelines for management of the multiorgan dysfunction seen in most cases. There is high variability in the management of VOD, which may contribute to the increased morbidity and mortality. Although there is ample research in the specific treatment of VOD, there is paucity of literature regarding the management of ascites, transfusions requirements, fluids and electrolyte dysfunction, delirium, and investigations in children with VOD. The joint working committees of the Pediatric Acute Lung Injury and Sepsis Investigators and the Pediatric Blood and Marrow Transplantation Consortium collaborated to develop a series of evidence-based supportive care guidelines for management of VOD. The quality of evidence was rated and recommendations were made using Grading of Recommendations, Assessment, Development and Evaluation criteria. This manuscript is part 1 of the series and focuses on the need to develop these guidelines; methodology used to establish the guidelines; and investigations needed for diagnosis, prophylaxis, and treatment of VOD in children. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  8. Why not energy conservation?

    International Nuclear Information System (INIS)

    Carlson, Shawn

    2016-01-01

    Energy conservation is a deep principle that is obeyed by all of the fundamental forces of nature. It puts stringent constraints on all systems, particularly systems that are ‘isolated,’ meaning that no energy can enter or escape. Notwithstanding the success of the principle of stationary action, it is fair to wonder to what extent physics can be formulated from the principle of stationary energy. We show that if one interprets mechanical energy as a state function, then its stationarity leads to a novel formulation of classical mechanics. However, unlike Lagrangian and Hamiltonian mechanics, which deliver their state functions via algebraic proscriptions (i.e., the Lagrangian is always the difference between a system’s kinetic and potential energies), this new formalism identifies its state functions as the solutions to a differential equation. This is an important difference because differential equations can generate more general solutions than algebraic recipes. When applied to Newtonian systems for which the energy function is separable, these state functions are always the mechanical energy. However, while the stationary state function for a charged particle moving in an electromagnetic field proves not to be energy, the function nevertheless correctly encodes the dynamics of the system. Moreover, the stationary state function for a free relativistic particle proves not to be the energy either. Rather, our differential equation yields the relativistic free-particle Lagrangian (plus a non-dynamical constant) in its correct dynamical context. To explain how this new formalism can consistently deliver stationary state functions that give the correct dynamics but that are not always the mechanical energy, we propose that energy conservation is a specific realization of a deeper principle of stationarity that governs both relativistic and non-relativistic mechanics. (paper)

  9. Theoretical analysis of rolled joints

    International Nuclear Information System (INIS)

    Sinha, R.K.

    1975-01-01

    A procedure for theoretically analysing the case of an externally restrained sandwich joint formed by a hypothetical uniform hydrostatic expansion process is outlined. Reference is made to a computer program based on this theory. Results illustrating the effect of major joint variables on residual contact pressure are presented and analysed. The applicability and limitations of this theory are discussed. (author)

  10. Arthroscopy of the ankle joint

    NARCIS (Netherlands)

    van Dijk, C. N.; Scholte, D.

    1997-01-01

    Ankle arthroscopy has become a standard procedure for a variety of indications. Joint distraction is applied by many authors. A recent retrospective multicentre study provoked the following questions. Is there an indication for diagnostic arthroscopy? Can arthroscopic surgery of the ankle joint be

  11. From joint to single audits

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    2018-01-01

    This study analyses audit quality differences between audits by a single big audit firm and joint audits with either one or two big audit firms. We exploit the unique situation in Denmark beginning on 1 January 2005, at which time a long-standing mandatory joint audit system for listed companies ...

  12. Examining the Conservative Shift from Harsh Justice

    Directory of Open Access Journals (Sweden)

    Joycelyn Pollock

    2015-03-01

    Full Text Available Recently, a political shift has been observed, in that some political conservatives are now advocating, adjusting, or abandoning draconian drug laws, including mandatory minimums, and funding diversion, re-entry, and drug programs. Vocal proponents of this movement include Grover Norquist, Rand Paul, Edwin Meese, and Mark Levin, from the Texas Public Policy Council. Any movement away from the mass incarceration that has characterized the U.S. correctional policy for the last 30 years is welcomed; however, it is important to note carefully the philosophical foundation of the conservative’s interest in shifting correctional policy. This paper explores the potential factors contributing to this philosophical shift.

  13. Transition joints in INDUS-2

    International Nuclear Information System (INIS)

    Sridhar, R.; Amalraj, William; Shukla, S.K.; Jain, A.K.

    2003-01-01

    Full text: A large number of welding joints are being employed in the fabrication of Indus-2 synchrotron storage ring being constructed at CAT. Apart from the TIG welded joints of aluminium alloy vacuum chambers, there are many other joints which are made between dissimilar metals. Stainless steel pipes are friction welded with aluminium pipes and are to be used as pumping ducts between vacuum pumps and the vacuum chambers. Similarly stainless steel flanges are fastened with aluminium flanges through a diamond seal. These joints are tested for a leak tightness of 2 x 10 -10 torr lit/sec of helium. This paper describes the details of the friction welded joints and their application in the Indus-2 synchrotron storage ring

  14. Induction brazing of complex joints

    DEFF Research Database (Denmark)

    Henningsen, Poul; Zhang, Wenqi; Bay, Niels

    2003-01-01

    , or if the hottest area is located outside the joint interface, a number of defects may appear: the braze metal may flow away from the joint, the flux may burn off, poor binding of the braze metal may appear or the braze metal may be overheated. Joint geometry as well as electro-magnetic properties of the work piece...... presents a combined numerical and experimental method for fast determination of appropriate coil geometry and position in induction brazing tube-to-plate joints of different ratios between tube and plate thickness and different combinations of the materials stainless steel, brass and copper. The method has...... proven to give successful results in brazing tube-plate joints of copper-brass, copper-stainless steel, stainless steel-brass, and stainless steel-stainless steel....

  15. Space Station alpha joint bearing

    Science.gov (United States)

    Everman, Michael R.; Jones, P. Alan; Spencer, Porter A.

    1987-01-01

    Perhaps the most critical structural system aboard the Space Station is the Solar Alpha Rotary Joint which helps align the power generation system with the sun. The joint must provide structural support and controlled rotation to the outboard transverse booms as well as power and data transfer across the joint. The Solar Alpha Rotary Joint is composed of two transition sections and an integral, large diameter bearing. Alpha joint bearing design presents a particularly interesting problem because of its large size and need for high reliability, stiffness, and on orbit maintability. The discrete roller bearing developed is a novel refinement to cam follower technology. It offers thermal compensation and ease of on-orbit maintenance that are not found in conventional rolling element bearings. How the bearing design evolved is summarized. Driving requirements are reviewed, alternative concepts assessed, and the selected design is described.

  16. Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.

    Science.gov (United States)

    Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Mullins, C Daniel

    2017-09-01

    Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. Copyright © 2017. Published by Elsevier Inc.

  17. Care for the person, protection of health and respect for the will of the patient in Italy: support administration as a tool to jointly promote health and respect for autonomy in incompetent patients

    Directory of Open Access Journals (Sweden)

    Paola Delbon

    2014-12-01

    Full Text Available In Italy, advance health care directives are a subject of considerable debate in both legal theory and practice. This debate focuses in partic- ular not only on the appropriateness of approving ad hoc statutory reg- ulations but also on the extent to which similar advance indications of a person’s wishes are applicable under the existing legal system, albeit in the absence of a law regulating them. The authors of this paper con- sider, in particular, guidelines relating to the possible use of the mech- anism of support administration (amministrazione di sostegno (Law No. 6/2004 as a procedure to be used for the legal recognition of advance health care directives, particularly in the light of the legal pro- vision for the possible designation in advance of a support administra- tor by a beneficiary in anticipation of an eventual situation of incapac- ity. This underlines how the concept of health does not only exist in the abstract, but must be measured in relation to the particular patient in the particular situation and how beneficence and respect for auton- omy are both essential elements in the choices aimed at promoting the health and the wellbeing of its citizens.

  18. Electric energy utilization and conservation

    International Nuclear Information System (INIS)

    Tripathy, S.C.

    1991-01-01

    Various aspects of electric energy utilization and conservation are discussed. First chapter reviews thermodynamic aspects of energy conservation. Subsequent chapters describe possibilities and methods of energy conservation in thermal power plants, airconditioning and ventilation systems, electric lighting systems, electric heating systems in industries, and railway electrification. Chapter 8 describes various modes of energy storage and compares their economies. The next chapter discusses various facets of energy economics and the last chapter discusses the practical aspects of energy conservation in different industries and power utilities. (M.G.B.). 100 refs

  19. Alberta`s petroleum industry and the Conservation Board

    Energy Technology Data Exchange (ETDEWEB)

    Breen, D.H.

    1993-12-31

    The history of Alberta`s petroleum industry and Energy Resources Conservation Board (ERCB) was told. The conservation movement in Alberta was tracked from 1908 to the founding of the Petroleum and Natural Gas Conservation Board in 1938. Failure of Alberta`s first proration, and the Turner Valley `waste` gas conservation movement occurred during this period. The Leduc discovery and effects of the new regulatory environment on its development were discussed. The natural gas export debate, and the expansion of Alberta`s crude oil market were recounted in detail. The organization and regulation of field development which occurred during the period from 1948 to 1959 was presented. Past actions of the Petroleum and Natural Gas Conservation Board reviewed from today`s perspective. The petroleum industry and the ERCB were said to have been jointly responsible for the creation of a prosperous and confident new Alberta, moving it further and further away from the Canadian economic and political mainstream,, and reinforcing the sense of alienation that began to develop during the preceding agrarian decades. 53 figs., 48 tabs.

  20. Prairie Conservation in Canada: The Prairie Conservation Action Plan Experience

    Science.gov (United States)

    Dean Nernberg; David Ingstrup

    2005-01-01

    In Canada, grassland conservation has been mobilized and directed through the development of Prairie Conservation Action Plans and Action Plan Committees in the three prairie provinces of Alberta (45 partner agencies and organizations), Saskatchewan (26 partners), and Manitoba (26 partners). In Alberta, 43 percent of the native prairie remains; in Saskatchewan and...

  1. Community markets for conservation: Markets to advance conservation mission

    OpenAIRE

    Fay, J.

    2008-01-01

    This presentation describes the function and economics of COMACO (Community Markets for Conservation), discusses the current reality of climate change, and then explores how possible market mechanism approaches to ameliorating climate change may fit into COMACO's work and research. LTRA-2 (An Agricultural Markets Model for Biodiversity Conservation)

  2. BNFL and environmental care

    International Nuclear Information System (INIS)

    1992-01-01

    British Nuclear Fuel plc (BNFL) acknowledge a duty of care for the environment and aims to reduce the effects of its activities on the environment to as low as reasonably practicable. Its environmental policy statement is presented and its approach, investment policies and activities to implement this policy are outlined. The activities include energy efficiency, recycling, surveillance and research, conservation and open information. (UK)

  3. The relationship between target joints and direct resource use in severe haemophilia.

    Science.gov (United States)

    O'Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars

    2018-01-16

    Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied. Data on haemophilia patients without inhibitors was drawn from the 'Cost of Haemophilia across Europe - a Socioeconomic Survey' (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients. NDDCs were calculated using publicly available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalized linear model was developed to investigate the relationship between NDDCs and target joints (areas of chronic synovitis), adjusted for patient covariates. Five hundred and thirteen patients (42% of the sample) had no diagnosed target joints; a total of 1376 target joints (range 1-10) were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no target joints were EUR 3134 (standard error (SE) EUR 158); for persons with one or more target joints, mean adjusted NDDCs were EUR 3913 (SE EUR 157; average mean effect EUR 779; p target joints has a significant impact on NDDCs for patients with severe haemophilia, ceteris paribus. Prevention and management of target joints should be an important consideration of managing haemophilia patients.

  4. Joint action aesthetics.

    Science.gov (United States)

    Vicary, Staci; Sperling, Matthias; von Zimmermann, Jorina; Richardson, Daniel C; Orgs, Guido

    2017-01-01

    Synchronized movement is a ubiquitous feature of dance and music performance. Much research into the evolutionary origins of these cultural practices has focused on why humans perform rather than watch or listen to dance and music. In this study, we show that movement synchrony among a group of performers predicts the aesthetic appreciation of live dance performances. We developed a choreography that continuously manipulated group synchronization using a defined movement vocabulary based on arm swinging, walking and running. The choreography was performed live to four audiences, as we continuously tracked the performers' movements, and the spectators' affective responses. We computed dynamic synchrony among performers using cross recurrence analysis of data from wrist accelerometers, and implicit measures of arousal from spectators' heart rates. Additionally, a subset of spectators provided continuous ratings of enjoyment and perceived synchrony using tablet computers. Granger causality analyses demonstrate predictive relationships between synchrony, enjoyment ratings and spectator arousal, if audiences form a collectively consistent positive or negative aesthetic evaluation. Controlling for the influence of overall movement acceleration and visual change, we show that dance communicates group coordination via coupled movement dynamics among a group of performers. Our findings are in line with an evolutionary function of dance-and perhaps all performing arts-in transmitting social signals between groups of people. Human movement is the common denominator of dance, music and theatre. Acknowledging the time-sensitive and immediate nature of the performer-spectator relationship, our study makes a significant step towards an aesthetics of joint actions in the performing arts.

  5. Joint seal in tank

    International Nuclear Information System (INIS)

    Colquhoun, J.; White, G.V.

    1981-01-01

    A seal for a joint or gap between edges of adjacent wall sections (e.g. of concrete) of a liquid-containing vessel, such as a nuclear reactor cooling pond, comprises a sheet metal strip having longitudinally-extending edge parts, secured to the respective vessel-section edges, and a central part which is longitudinally corrugated to provide sufficient flexibility to accommodate slight relative movements between the vessel-section edges (e.g. due to thermal expansions). The edges of the sheet metal of the strip are turned in so that the edge parts of the strip are formed as generally U-section channels. These accommodate longitudinally extending securing bars which are bolted to the vessel wall sections by bolts which pass through the bars, through the free-edged wall of the channel section and through a longitudinally extending resilient seal pad compressed between that wall of the channel section and the vessel wall section to which it is secured. The other wall of the channel section (integral with the corrugated central part of the strip) has access windows through which the bolts are inserted and tightened, the windows being then closed off in liquid-tight manner by welding closure caps over them. (author)

  6. Temporomandibular Joint Regenerative Medicine

    Directory of Open Access Journals (Sweden)

    Xavier Van Bellinghen

    2018-02-01

    Full Text Available The temporomandibular joint (TMJ is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues.

  7. Intergenerational equity and conservation

    Science.gov (United States)

    Otoole, R. P.; Walton, A. L.

    1980-01-01

    The issue of integenerational equity in the use of natural resources is discussed in the context of coal mining conversion. An attempt to determine if there is a clear-cut benefit to future generations in setting minimum coal extraction efficiency standards in mining is made. It is demonstrated that preserving fossil fuels beyond the economically efficient level is not necessarily beneficial to future generations even in terms of their own preferences. Setting fossil fuel conservation targets for intermediate products (i.e. energy) may increase the quantities of fossil fuels available to future generations and hence lower the costs, but there may be serious disadvantages to future generations as well. The use of relatively inexpensive fossil fuels in this generation may result in more infrastructure development and more knowledge production available to future generations. The value of fossil fuels versus these other endowments in the future depends on many factors which cannot possibly be evaluated at present. Since there is no idea of whether future generations are being helped or harmed, it is recommended that integenerational equity not be used as a factor in setting coal mine extraction efficiency standards, or in establishing requirements.

  8. Energy conservation in SIMMER

    International Nuclear Information System (INIS)

    Arnold, L.A.; Knowles, J.B.

    1983-11-01

    The SIMMER code contains models of the many interacting thermo-hydraulic processes that occur during a hypothetical core disruptive accident (HCDA), to provide an overall picture from accident initiation to containment loading. In calculations of roof loadings following the HCDA, errors in computing the overall energy balance were found to be up to ten times the kinetic energy of the sodium slug which creates the loading. On this account, the results were considered to be seriously compromised. This report describes a systematic investigation into the effect, nature and origin of the energy discrepancies. Its main conclusion are that, the errors stem from a systematic rather than a random source, energy errors for individual cells can be two decades larger than the mean value provided by the code, and cellular mass and energy errors are strongly correlated and they can actually increase when the mesh is refined. A likely cause of the conservation errors is identified as the solution of the liquid phase mass and energy equations at effectively different time instants during each timestep. (author)

  9. Conservative sharp debridement: the professional and legal issues.

    Science.gov (United States)

    Ashworth, Jenny; Chivers, Marc

    2002-06-01

    In recent years there has been much debate over the use of conservative sharp debridement in the treatment of certain wound types. Here it is discussed in relation to increasing the speed of wound healing in slow-to-heal wounds. The authors examine education and skill competence in relation to the professional's duty of care to patients with wounds.

  10. What a botanist can contribute to conservation in Malesia

    NARCIS (Netherlands)

    Jacobs, M.

    1977-01-01

    Reviewing the conservation situation in Indonesia, we see that concern for animals outweighs that for plants. Sumatra with its richer fauna of large mammals, is better cared for than Borneo with its richer flora*. Too often in the reports, a forest is called a forest, to the neglect of the amazing

  11. Principles for the Conservation and Restoration of Collections in Libraries.

    Science.gov (United States)

    Dureau, Jeanne M.

    This statement of principles, which represents a general approach to the nature and objectives of conservation and restoration work rather than a detailed description of methods and practices, is designed to encourage those responsible for the care of library collections to face up to the consequences of neglect and, together with their technical…

  12. Biodiversity conservation—a place holder: introduction to papers in this issue.

    Science.gov (United States)

    Deanna H. Olson

    2006-01-01

    Biodiversity conservation in the US Pacific Northwest is gaining new attention as large reserves are recognized as not being a panacea for protection of all rare species. In February 2005, a workshop at Oregon State University, held in conjunction with the joint annual meetings of the Society for Northwestern Vertebrate Biology and the Oregon Chapter of the Wildlife...

  13. Funding conservation through use and potentials for price discrimination among scuba divers at Sipadan, Malaysia

    DEFF Research Database (Denmark)

    Emang, Diana; Lundhede, Thomas; Thorsen, Bo Jellesmark

    2016-01-01

    The protected coral reefs off the coast of Malaysia receive numerous tourists, while also being as fishing grounds. These joint environmental pressures raise the need for additional costly conservation measures. It is natural to consider the potential for expanding the ‘user pays’ principle...

  14. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... Twitter Pinterest Email Print About Preconception Care and Prenatal Care What is preconception care? Preconception care is the ... improve the health of your child. What is prenatal care? Prenatal care is the health care a woman ...

  15. Care of oral cavity in irradiated patients

    International Nuclear Information System (INIS)

    Konecny, M.

    1981-01-01

    Procedures are reviewed of therapeutic and preventive care in patients with malignant tumours in the area of the head and neck during radiotherapy and during the subsequent follow-up of patients. As compared with previous views, the care is now more conservative, indications for tooth extractions are now limited, careful oral hygiene is emphasized and, in particular, the long-term use of fluorine gel is recommended. Surgery is only recommended where conservative treatment fails. (author)

  16. Care of oral cavity in irradiated patients

    Energy Technology Data Exchange (ETDEWEB)

    Konecny, M [Onkologicky Ustav, Brno (Czechoslovakia). Betatronove Pracoviste

    1981-12-01

    Procedures are reviewed of therapeutic and preventive care in patients with malignant tumours in the area of the head and neck during radiotherapy and during the subsequent follow-up of patients. As compared with previous views, the care is now more conservative, indications for tooth extractions are now limited, careful oral hygiene is emphasized and, in particular, the long-term use of fluorine gel is recommended. Surgery is only recommended where conservative treatment fails.

  17. Mainstreaming biodiversity: conservation for the 21st century

    Directory of Open Access Journals (Sweden)

    Kent Hubbard Redford

    2015-12-01

    Full Text Available Insufficient focused attention has been paid by the conservation community to conservation of biodiversity outside of protected areas. Biodiversity mainstreaming addresses this gap in global conservation practice by embedding biodiversity considerations into policies, strategies and practices of key public and private actors that impact or rely on biodiversity, so that it is conserved, and sustainably used, both locally and globally (Huntley and Redford 2014. Biodiversity mainstreaming is designed to change those policies and practices that influence land uses outside of protected areas as well as to change economic and development decision-making by demonstrating the importance of conserving biodiversity for achieving development outcomes. The practice of mainstreaming is tied to implementation of the Convention on Biological Diversity and is practiced with billions of dollars of investment by development agencies, national government agencies, and the Global Environment Facility (GEF and its implementing organizations as well as other donors. It is essential for the long-term survival of biodiversity inside and outside protected areas. However, it is virtually unheard of in the main conservation science field. This must change so as to bring careful documentation, analysis, monitoring, publishing and improvement of practices – all things that conservation science should provide as partners to practitioners of biodiversity mainstreaming. The situation is ripe for informed coordination and consolidation and creation of a science-driven field of biodiversity mainstreaming.

  18. The joint in psoriatic arthritis.

    Science.gov (United States)

    Mortezavi, Mahta; Thiele, Ralph; Ritchlin, Christopher

    2015-01-01

    Psoriatic arthritis (PsA), a chronic inflammatory joint disease associated with psoriasis, is notable for diversity in disease presentation, course and response to treatment. Equally varied are the types of musculoskeletal involvement which include peripheral and axial joint disease, dactylitis and enthesitis. In this review, we focus on the psoriatic joint and discuss pathways that underlie synovial, cartilage and bone inflammation and highlight key histopathologic features. The pivotal inflammatory mechanisms and pathobiology of PsA parallel findings in other forms of spondyloarthritis but are distinct from disease pathways described in rheumatoid synovitis and bone disease. The diagnosis of PsA from both a clinical and imaging perspective is also discussed.

  19. Concrete: Too young for conservation

    NARCIS (Netherlands)

    Heineman, H.A.; Hees, R.P.J. van; Nijland, T.G.

    2008-01-01

    The 20th century built heritage is one of the new conservation challenges, due to its architectural differences from the traditional heritage and new materials. One major new material is concrete; its quantity and importance for the new heritage requires a tailored conservation approach. Until now,

  20. Habitat modeling for biodiversity conservation.

    Science.gov (United States)

    Bruce G. Marcot

    2006-01-01

    Habitat models address only 1 component of biodiversity but can be useful in addressing and managing single or multiple species and ecosystem functions, for projecting disturbance regimes, and in supporting decisions. I review categories and examples of habitat models, their utility for biodiversity conservation, and their roles in making conservation decisions. I...

  1. Relativistic dynamics without conservation laws

    OpenAIRE

    Rothenstein, Bernhard; Popescu, Stefan

    2006-01-01

    We show that relativistic dynamics can be approached without using conservation laws (conservation of momentum, of energy and of the centre of mass). Our approach avoids collisions that are not easy to teach without mnemonic aids. The derivations are based on the principle of relativity and on its direct consequence, the addition law of relativistic velocities.

  2. Educating Astronauts About Conservation Biology

    Science.gov (United States)

    Robinson, Julie A.

    2001-01-01

    This article reviews the training of astronauts in the interdisciplinary work of conservation biology. The primary responsibility of the conservation biologist at NASA is directing and supporting the photography of the Earth and maintaining the complete database of the photographs. In order to perform this work, the astronauts who take the pictures must be educated in ecological issues.

  3. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  4. Fiscal 2000 project of inviting proposals for international joint research - invitation for international proposal (Energy conservation No.3). Achievement report on development of micro-scale boiling aided high efficiency heat removing device; 2000 nendo kokusai kyodo kenkyu teian kobo jigyo - kokusai teian kobo (shoe No.3). Micro scale boiling ni yoru kokoritsu honetsu device no kaihatsu seika hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Studies are conducted about basic matters of heat transfer with boiling, such as critical heat flux intensification, prevention of dry-out, and the development of refrigerants suitable for use for heat transfer with boiling, for the purpose of developing boiling heat conduction type high-efficiency heat removing devices for use in electronics, and then heat removing devices usable as power devices in the future are experimentally designed. Activities are conducted in the three fields of (1) the study of basic micro-boiling technology, (2) development of micro-scale boiling element technology, and (3) international joint studies. Efforts are made to develop the technology of removing heat from ultrahigh heat fluxes using a micro-valve in field (1), to develop the technology of heat transfer by boiling in a micro-channel in field (2); and to develop the technology of critical heat flux intensification in a boiling heat exchanger in an electromagnetic field (3). In an effort to develop the technology of heat removal, a heat transfer plate is installed at the bottom of a path which is narrow, horizontal, and rectangular, and distilled water is allowed to flow and boil. Micro-bubble emission boiling occurs by a subcooling degree of 40K at an average flow rate of 0.5 m/s, and an ultrahigh heat flux of 2-7 times 10{sup 6} W/m{sup 2} is obtained. The value is 2-4 times as high as the current IC chip critical heat flux. (NEDO)

  5. Is international conservation aid enough?

    Science.gov (United States)

    Law, Elizabeth A.

    2016-02-01

    Bare et al (2015 Environ. Res. Lett. 10 125010) ask an important question: is international conservation enough? Since the 1990’s international conservation donors have spent over 3.4 billion on biodiversity conservation related projects in sub-Saharan Africa. Both donors and recipients have a right to know if this is effective. Surprisingly, this question is rarely asked. It is a difficult question—involving many rival social, environmental, and economic explanations. Bare, Kauffman and Miller uncover some interesting associations, supporting existing hypotheses and proposing their own: that conservation aid alone is insufficient to mitigate drivers of deforestation (and in some cases may even exacerbate forest loss). This controversial result warrants further investigation—but what is needed now is nuance and robustness in further analyses, to have more confidence in the critique and it’s implications for international conservation aid.

  6. Optimal conservation of migratory species.

    Directory of Open Access Journals (Sweden)

    Tara G Martin

    Full Text Available BACKGROUND: Migratory animals comprise a significant portion of biodiversity worldwide with annual investment for their conservation exceeding several billion dollars. Designing effective conservation plans presents enormous challenges. Migratory species are influenced by multiple events across land and sea-regions that are often separated by thousands of kilometres and span international borders. To date, conservation strategies for migratory species fail to take into account how migratory animals are spatially connected between different periods of the annual cycle (i.e. migratory connectivity bringing into question the utility and efficiency of current conservation efforts. METHODOLOGY/PRINCIPAL FINDINGS: Here, we report the first framework for determining an optimal conservation strategy for a migratory species. Employing a decision theoretic approach using dynamic optimization, we address the problem of how to allocate resources for habitat conservation for a Neotropical-Nearctic migratory bird, the American redstart Setophaga ruticilla, whose winter habitat is under threat. Our first conservation strategy used the acquisition of winter habitat based on land cost, relative bird density, and the rate of habitat loss to maximize the abundance of birds on the wintering grounds. Our second strategy maximized bird abundance across the entire range of the species by adding the constraint of maintaining a minimum percentage of birds within each breeding region in North America using information on migratory connectivity as estimated from stable-hydrogen isotopes in feathers. We show that failure to take into account migratory connectivity may doom some regional populations to extinction, whereas including information on migratory connectivity results in the protection of the species across its entire range. CONCLUSIONS/SIGNIFICANCE: We demonstrate that conservation strategies for migratory animals depend critically upon two factors: knowledge of

  7. Joint action aesthetics.

    Directory of Open Access Journals (Sweden)

    Staci Vicary

    Full Text Available Synchronized movement is a ubiquitous feature of dance and music performance. Much research into the evolutionary origins of these cultural practices has focused on why humans perform rather than watch or listen to dance and music. In this study, we show that movement synchrony among a group of performers predicts the aesthetic appreciation of live dance performances. We developed a choreography that continuously manipulated group synchronization using a defined movement vocabulary based on arm swinging, walking and running. The choreography was performed live to four audiences, as we continuously tracked the performers' movements, and the spectators' affective responses. We computed dynamic synchrony among performers using cross recurrence analysis of data from wrist accelerometers, and implicit measures of arousal from spectators' heart rates. Additionally, a subset of spectators provided continuous ratings of enjoyment and perceived synchrony using tablet computers. Granger causality analyses demonstrate predictive relationships between synchrony, enjoyment ratings and spectator arousal, if audiences form a collectively consistent positive or negative aesthetic evaluation. Controlling for the influence of overall movement acceleration and visual change, we show that dance communicates group coordination via coupled movement dynamics among a group of performers. Our findings are in line with an evolutionary function of dance-and perhaps all performing arts-in transmitting social signals between groups of people. Human movement is the common denominator of dance, music and theatre. Acknowledging the time-sensitive and immediate nature of the performer-spectator relationship, our study makes a significant step towards an aesthetics of joint actions in the performing arts.

  8. Joint action aesthetics

    Science.gov (United States)

    Vicary, Staci; Sperling, Matthias; von Zimmermann, Jorina; Richardson, Daniel C.

    2017-01-01

    Synchronized movement is a ubiquitous feature of dance and music performance. Much research into the evolutionary origins of these cultural practices has focused on why humans perform rather than watch or listen to dance and music. In this study, we show that movement synchrony among a group of performers predicts the aesthetic appreciation of live dance performances. We developed a choreography that continuously manipulated group synchronization using a defined movement vocabulary based on arm swinging, walking and running. The choreography was performed live to four audiences, as we continuously tracked the performers’ movements, and the spectators’ affective responses. We computed dynamic synchrony among performers using cross recurrence analysis of data from wrist accelerometers, and implicit measures of arousal from spectators’ heart rates. Additionally, a subset of spectators provided continuous ratings of enjoyment and perceived synchrony using tablet computers. Granger causality analyses demonstrate predictive relationships between synchrony, enjoyment ratings and spectator arousal, if audiences form a collectively consistent positive or negative aesthetic evaluation. Controlling for the influence of overall movement acceleration and visual change, we show that dance communicates group coordination via coupled movement dynamics among a group of performers. Our findings are in line with an evolutionary function of dance–and perhaps all performing arts–in transmitting social signals between groups of people. Human movement is the common denominator of dance, music and theatre. Acknowledging the time-sensitive and immediate nature of the performer-spectator relationship, our study makes a significant step towards an aesthetics of joint actions in the performing arts. PMID:28742849

  9. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography.

    Science.gov (United States)

    Smith, Toby O; Purdy, Rachel; Lister, Sarah; Salter, Charlotte; Fleetcroft, Robert; Conaghan, Philip G

    2014-03-01

    This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.

  10. Cost analysis of debridement and retention for management of prosthetic joint infection.

    Science.gov (United States)

    Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

    2013-02-01

    Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

  11. Education: A Joint Transformation Enabler

    National Research Council Canada - National Science Library

    Alexander, Renita

    2003-01-01

    ... in an organization not known for its adaptability. Underlying the pursuit of transformational concepts necessary to respond to 21st century challenges is an emphasis on joint operations and doctrine...

  12. Finishing touch to joint venture

    CERN Multimedia

    2003-01-01

    "A new process for polishing titanium and its alloys has been announced following an agreement between Bripol (an Anopol/Delmet joint venture) of Birmingham and the European Organisation for Nuclear Reseach (CERN) in Geneva" (1 paragraph).

  13. MRI of the hip joint

    International Nuclear Information System (INIS)

    Czerny, C.; Noebauer-Huhmann, I.M.; Imhof, H.

    2005-01-01

    Magnetic resonance imaging (MRI) is performed to diagnose many pathologic conditions affecting the hip joint. Either conventional MRI (without contrast enhancement of the joint cavity) or MR arthrography is used to detect and most accurately differentiate hip joint pathologies. Conventional MRI is performed in cases of bone marrow edema, necrosis, arthrosis and especially the so-called ''activated arthrosis'', as well as in inflammatory and tumorous entities. MR arthography, which has only recently become available for use, is excellently suited for diagnosing lesions of the acetabular labrum, cartilage lesions, and free articular bodies. This article provides an overview about MRI characteristics and their accuracy of hip joint diseases and the impact on the therapeutic procedure. (orig.)

  14. Campus/Industry Joint Ventures.

    Science.gov (United States)

    McDonald, Eugene J.

    1985-01-01

    Opportunities for joint economic ventures of colleges and industry are discussed, and a variety of ventures undertaken by Duke University are outlined, including a health club, hotel, and office building. Tax and financing considerations are noted. (MSE)

  15. Engine mounts and structural joints

    Indian Academy of Sciences (India)

    mental studies are presented, and limitations of the passive device are briefly discussed. .... For the sake of simplifying formulations, several studies have used .... that the component mode synthesis methods work well when the joint stiffness is ...

  16. Practical aspects of joint implementation

    International Nuclear Information System (INIS)

    Michaelowa, A.

    1995-01-01

    Article 4, 2a of the UN Framework Convention on Climate Change states the possibility of joint policies of different countries to achieve national greenhouse gas reduction commitments (Joint Implementation). The cost of reducing greenhouse gas emissions can be reduced drastically if industrialized countries shift abatement activities to developing countries as marginal cost of reduction is much higher in the former countries. In this way economic efficiency of abatement measures can be raised to the point where marginal cost is equal all over the world. At the Conference of the Parties in Berlin in March 1995, criteria for Joint Implementation are to be established. The paper discusses possible forms of Joint Implementation and develops criteria

  17. Joint Logistics, Fact or Fiction?

    National Research Council Canada - National Science Library

    Carroll, Walton

    1998-01-01

    ...) and the evolution of Joint doctrine to meet these new demands. The focus of this examination remains at the strategic level and the ability of the Services to meet the logistical demands of the modern theater battlefield...

  18. Joint Performance and Planning System

    Data.gov (United States)

    US Agency for International Development — A joint State/USAID system hosted by State that integrates resource and performance information at the program level and enables more flexible and frequent entry of...

  19. Torsion testing of bed joints

    DEFF Research Database (Denmark)

    Hansen, Klavs Feilberg; Pedersen, Carsten Mørk

    2008-01-01

    This paper describes a simple test method for determining the torsion strength of a single bed joint between two bricks and presents results from testing using this test method. The setup for the torsion test is well defined, require minimal preparation of the test specimen and the test can...... be carried out directly in a normal testing machine. The torsion strength is believed to be the most important parameter in out-of-plane resistance of masonry walls subjected to bending about an axis perpendicular to the bed joints. The paper also contains a few test results from bending of small walls about...... an axis perpendicular to the bed joints, which indicate the close connection between these results and results from torsion tests. These characteristics make the torsion strength well suited to act as substitute parameter for the bending strength of masonry about an axis perpendicular to the bed joints....

  20. CONSERVATION STRATEGIES FOR NEPENTHES KHASIANA IN THE NOKREK BIOSPHERE RESERVE OF GARO HILLS, NORTHEAST, INDIA

    Directory of Open Access Journals (Sweden)

    Bikarma SINGH

    2011-03-01

    Full Text Available The present paper focuses on the various disturbance agents such as coal mining, limestone extraction, stone quarrying, jhum cultivation, fire, grazing, over-exploitation of resources, road constructions etc., affecting the natural growth of Nepethes khasiana in the Nokrek Biosphere Reserve of India. N. khasiana is the prominent insectivorous scandent shrubs species of this biosphere reserve and is an important source of medicine and basic ornamental uses for the local garo tribal people of north-east India. The inevitable pressure due to commercialization of the N. khasiana is leading to severe destruction of the species and may create the scarcity of that species in the near future. Therefore, joint efforts need to be implemented by the local garo villagers with governmental and non-governmental agencies for conservation and sustainable use of N. khasiana. The government may also take initiative by allotting demarcated forests areas to the villagers as village forest, thus motivating the villagers to take special care for its protection and rehabilitation and for a sustainable output.

  1. Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study.

    Directory of Open Access Journals (Sweden)

    Uwe Schütz

    Full Text Available The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73 with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-, placebo-(sodium chloride- and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain

  2. Management of Prosthetic Joint Infection.

    Science.gov (United States)

    Tande, Aaron J; Gomez-Urena, Eric O; Berbari, Elie F; Osmon, Douglas R

    2017-06-01

    Although uncommon, prosthetic joint infection is a devastating complication. This challenging condition requires a coordinated management approach to achieve good patient outcomes. This review details the general principles to consider when managing patients with prosthetic joint infection. The different medical/surgical treatment strategies and how to appropriately select a strategy are discussed. The data to support each strategy are presented, along with discussion of antimicrobial strategies in specific situations. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Joint probabilities and quantum cognition

    International Nuclear Information System (INIS)

    Acacio de Barros, J.

    2012-01-01

    In this paper we discuss the existence of joint probability distributions for quantumlike response computations in the brain. We do so by focusing on a contextual neural-oscillator model shown to reproduce the main features of behavioral stimulus-response theory. We then exhibit a simple example of contextual random variables not having a joint probability distribution, and describe how such variables can be obtained from neural oscillators, but not from a quantum observable algebra.

  4. Joint probabilities and quantum cognition

    Energy Technology Data Exchange (ETDEWEB)

    Acacio de Barros, J. [Liberal Studies, 1600 Holloway Ave., San Francisco State University, San Francisco, CA 94132 (United States)

    2012-12-18

    In this paper we discuss the existence of joint probability distributions for quantumlike response computations in the brain. We do so by focusing on a contextual neural-oscillator model shown to reproduce the main features of behavioral stimulus-response theory. We then exhibit a simple example of contextual random variables not having a joint probability distribution, and describe how such variables can be obtained from neural oscillators, but not from a quantum observable algebra.

  5. Continuum description for jointed media

    International Nuclear Information System (INIS)

    Thomas, R.K.

    1982-04-01

    A general three-dimensional continuum description is presented for a material containing regularly spaced and approximately parallel jointing planes within a representative elementary volume. Constitutive relationships are introduced for linear behavior of the base material and nonlinear normal and shear behavior across jointing planes. Furthermore, a fracture permeability tensor is calculated so that deformation induced alterations to the in-situ values can be measured. Examples for several strain-controlled loading paths are presented

  6. Value of knee joint arthrography

    International Nuclear Information System (INIS)

    Luzsa, Gyoergy; Kiss Toth, Peter

    1985-01-01

    On the basis of the literature and the analysis of 204 examinations, the method and clinical application of knee joint arthrography are reviewed. 50 out of the 54 operated cases were perfectly diagnosed. The double contrast knee joint arthrography can be applied to detect meniscus changes, popliteal cysts, synovial disorders and chondral defects. The effectiveness of arthrography and arthroscopy was compared and the introduction of the former in each county seat is suggested. (author)

  7. The European-Japanese joint programme on neutron data evaluation

    International Nuclear Information System (INIS)

    Campbell, C.G.

    1983-01-01

    Following an initiative by the NEA Committee on Reactor Physics (NEACRP) at their meeting in September 1980, the NEA Steering Committee approved the setting up of a joint European-Japanese Programme on Neutron Data Evaluations. A Scientific Co-ordinating Group was formed to determine the content of the Joint Evaluated File (JEF) and to co-ordinate work in national research organisations associated with the periodic revisions to this library. The NEA Data Bank is taking care of the secretariat functions of the Programme and will also, among other things, assemble and maintain the Joint Evaluated File (JEF). The plans are to release a first version of the file at the end of 1982, followed by a period of re-evaluations and benchmark testing, which will lead to the release of a second version at the end of 1985. The availability of the file will be restricted to the member countries of the NEA Data Bank. (Auth.)

  8. Efficient relaxations for joint chance constrained AC optimal power flow

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Kyri; Toomey, Bridget

    2017-07-01

    Evolving power systems with increasing levels of stochasticity call for a need to solve optimal power flow problems with large quantities of random variables. Weather forecasts, electricity prices, and shifting load patterns introduce higher levels of uncertainty and can yield optimization problems that are difficult to solve in an efficient manner. Solution methods for single chance constraints in optimal power flow problems have been considered in the literature, ensuring single constraints are satisfied with a prescribed probability; however, joint chance constraints, ensuring multiple constraints are simultaneously satisfied, have predominantly been solved via scenario-based approaches or by utilizing Boole's inequality as an upper bound. In this paper, joint chance constraints are used to solve an AC optimal power flow problem while preventing overvoltages in distribution grids under high penetrations of photovoltaic systems. A tighter version of Boole's inequality is derived and used to provide a new upper bound on the joint chance constraint, and simulation results are shown demonstrating the benefit of the proposed upper bound. The new framework allows for a less conservative and more computationally efficient solution to considering joint chance constraints, specifically regarding preventing overvoltages.

  9. Estimation of RC slab-column joints effective strength using neural networks

    Directory of Open Access Journals (Sweden)

    A. A. Shah

    Full Text Available The nominal strength of slab-column joints made of highstrength concrete (HSC columns and normal strength concrete (NSC slabs is of great importance in structural design and construction of concrete buildings. This topic has been intensively studied during the last decades. Different types of column-slab joints have been investigated experimentally providing a basis for developing design provisions. However, available data does not cover all classes of concretes, reinforcements, and possible loading cases for the proper calculation of joint stresses necessary for design purposes. New numerical methods based on modern software seem to be effective and may allow reliable prediction of column-slab joint strength. The current research is focused on analysis of available experimental data on different slab-to-column joints with the aim of predicting the nominal strength of slabcolumn joint. Neural networks technique is proposed herein using MATLAB routines developed to analyze available experimental data. The obtained results allow prediction of the effective strength of column-slab joints with accuracy and good correlation coefficients when compared to regression based models. The proposed method enables the user to predict the effective design of column-slab joints without the need for conservative safety coefficients generally promoted and used by most construction codes.

  10. Oral splint for temporomandibular joint disorders with revolutionary fluid system

    Directory of Open Access Journals (Sweden)

    Rahul Srivastava

    2013-01-01

    Full Text Available Temporomandibular joint (TMJ diseases and disorders refer to a complex and poorly understood set of conditions, manifested by pain in the area of the jaw and associated muscles and limitations in the ability to make the normal movements of speech, facial expression, eating, chewing, and swallowing. The conventional soft occlusal splint therapy is a much safer and effective mode of a conservative line of therapy in comparison to the surgical therapy for temporomandibular joint disorders (TMD. The purpose of this article is to review the Aqualizer TM , an hydrostatic oral splint, as accurate, effective treatment and differential diagnostic tool in TMD that allow treating the patient′s pain quickly and accurately saving valuable treatment time. The review article has been prepared doing a literature review from the world-wide web and pubmed/medline.

  11. [Functional therapy in treatment of fractures and joint injuries].

    Science.gov (United States)

    Tscherne, H; Wippermann, B

    1990-01-01

    Full and timely restoration of the function of an injured segment of the locomotor system is the treatment goal for all fractures and joint injuries. Functional aspects therefore have to be considered, when operative or conservative forms of treatment are chosen for a particular injury. We define a treatment as purely functional if the involved limb is either not immobilized at all or whenever the immobilization is incomplete and for a limited time only. At least partial function of the involved segment is therefore restored during the treatment. Purely functional treatment ist most applicable for stable fractures. Stable can be defined as the property of biological tissues to withstand physiological loads. Many joint injuries such as AC separation, ankle ligament rupture, Achilles tendon rupture, and isolated rupture of the medial collateral ligaments of the knee can also be treated functionally.

  12. Reliability factors of tube-to-tubesheet joints

    International Nuclear Information System (INIS)

    Sang, Z.F.; Zhu, Y.Z.; Widera, G.E.O.

    1992-01-01

    The main purpose of this paper is to provide an applicable method to establish reliability factors for expanded tube-to-tubesheet joints. The paper also reports on the results of a preliminary study to validate experimentally the reliability efficiencies listed in Table A-2 of Appendix A of Section VIII, Division 1, of the ASME Boiler and Pressure Vessel Code. A comparison between the actual reliability factors f r , determined from testing the damage strength of the joint and calculated according to Appendix A-4 of the ASME Code, and those of Table A-2 is carried out. The results are discussed in light of the restrictions inherent in Table A-2. It is confirmed that some existing values of f r are conservative while others are less so. (orig.)

  13. Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI).

    Science.gov (United States)

    Kramer, Axel; Kranabetter, Rainer; Rathgeber, Jörg; Züchner, Klaus; Assadian, Ojan; Daeschlein, Georg; Hübner, Nils-Olaf; Dietlein, Edeltrut; Exner, Martin; Gründling, Matthias; Lehmann, Christian; Wendt, Michael; Graf, Bernhard Martin; Holst, Dietmar; Jatzwauk, Lutz; Puhlmann, Birgit; Welte, Thomas; Wilkes, Antony R

    2010-09-21

    An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use.THE BREATHING SYSTEM AND THE MANUAL VENTILATION BAG ARE CHANGED IMMEDIATELY AFTER THE RESPECTIVE ANAESTHESIA IF THE FOLLOWING SITUATION HAS OCCURRED OR IT IS SUSPECTED TO HAVE OCCURRED: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case.

  14. Conservation through the economics lens.

    Science.gov (United States)

    Farley, Joshua

    2010-01-01

    Although conservation is an inherently transdisciplinary issue, there is much to be gained from examining the problem through an economics lens. Three benefits of such an approach are laid out in this paper. First, many of the drivers of environmental degradation are economic in origin, and the better we understand them, the better we can conserve ecosystems by reducing degradation. Second, economics offers us a when-to-stop rule, which is equivalent to a when-to-conserve rule. All economic production is based on the transformation of raw materials provided by nature. As the economic system grows in physical size, it necessarily displaces and degrades ecosystems. The marginal benefits of economic growth are diminishing, and the marginal costs of ecological degradation are increasing. Conceptually, we should stop economic growth and focus on conservation when the two are equal. Third, economics can help us understand how to efficiently and justly allocate resources toward conservation, and this paper lays out some basic principles for doing so. Unfortunately, the field of economics is dominated by neoclassical economics, which builds an analytical framework based on questionable assumptions and takes an excessively disciplinary and formalistic approach. Conservation is a complex problem, and analysis from individual disciplinary lenses can make important contributions to conservation only when the resulting insights are synthesized into a coherent vision of the whole. Fortunately, there are a number of emerging transdisciplines, such as ecological economics and environmental management, that are dedicated to this task.

  15. Making conservation work for everyone

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, J. [Veridian Corp., Ajax, ON (Canada)

    2004-07-01

    This presentation discussed the economic value of conservation, the optimal deployment of energy conservation. A sample load profile was presented to demonstrate how much electricity the average residential customer uses on a summer day. The average customer does not have the tools to understand the financial consequences of conservation for different types of equipment at different times of the day. Smart metering technology could help in this regard. Accurate unsubsidized prices are also considered to be the best incentive to conserve because customers will reduce electricity use when the prices are high. It was also suggested that standards for new appliances should be increased effectively to their economic value. The enablers to energy conservation include solid consumer education programs, real time metering in places where it is cost effective, real time pricing in places where it is practical, and power rates that reflect real costs. Barriers to energy conservation include the residual economic advantage that may be insufficient to justify investment; support from local distribution companies and transmission companies if the lost revenue adjustment mechanism (LRAM) is not sufficient to recover lost revenue and if LDCs are not sufficiently involved in the design of the electricity conservation program. 7 figs.

  16. Space, time and conservation laws

    International Nuclear Information System (INIS)

    Aronov, R.A.; Ugarov, V.A.

    1978-01-01

    The Neter theorem establishing correspondence between conservation laws and symmetry properties (space and time in particular) is considered. The theorem is based on one of the possible ways of finding equations of motion for a physical system. From a certain expression (action functional) equations of motion for a system can be obtained which do not contain new physical assertions in principal in comparison with the Newtonian laws. Neter suggested a way of deriving conservation laws by transforming space and time coordinates. Neter theorem consequences raise a number of problems: 1). Are conservation laws (energy, momentum) consequences of space and time symmetry properties. 2). Is it possible to obtain conservation laws in theory neglecting equations of motion. 3). What is of the primary importance: equations of motion, conservation laws or properties of space and time symmetry. It is shown that direct Neter theorem does not testify to stipulation of conservation laws by properties of space and time symmetry and symmetry properties of other non-space -time properties of material systems in objective reality. It says nothing of whether there is any subordination between symmetry properties and conservation laws

  17. Translocation of threatened plants as a conservation measure in China.

    Science.gov (United States)

    Liu, Hong; Ren, Hai; Liu, Qiang; Wen, XiangYing; Maunder, Michael; Gao, JiangYun

    2015-12-01

    We assessed the current status of plant conservation translocation efforts in China, a topic poorly reported in recent scientific literature. We identified 222 conservation translocation cases involving 154 species, of these 87 were Chinese endemic species and 101 (78%) were listed as threatened on the Chinese Species Red List. We categorized the life form of each species and, when possible, determined for each case the translocation type, propagule source, propagule type, and survival and reproductive parameters. A surprisingly large proportion (26%) of the conservation translocations in China were conservation introductions, largely implemented in response to large-scale habitat destruction caused by the Three-Gorge Dam and another hydropower project. Documentation and management of the translocations varied greatly. Less than half the cases had plant survival records. Statistical analyses showed that survival percentages were significantly correlated with plant life form and the type of planting materials. Thirty percent of the cases had records on whether or not individuals flowered or fruited. Results of information theoretic model selection indicated that plant life form, translocation type, propagule type, propagule source, and time since planting significantly influenced the likelihood of flowering and fruiting on the project level. We suggest that the scientific-based application of species conservation translocations should be promoted as part of a commitment to species recovery management. In addition, we recommend that the common practice of within and out of range introductions in nature reserves to be regulated more carefully due to its potential ecological risks. We recommend the establishment of a national office and database to coordinate conservation translocations in China. Our review effort is timely considering the need for a comprehensive national guideline for the newly announced nation-wide conservation program on species with extremely

  18. Installation Art and the Museum. Presentation and Conservation of Changing Artworks

    NARCIS (Netherlands)

    van Saaze, V.E.J.P.

    2013-01-01

    Installation art has become mainstream in artistic practices. However, acquiring and displaying such artworks implies that curators and conservators are challenged to deal with obsolete technologies, ephemeral materials and other issues concerning care and management of these artworks. By analysing

  19. Mistaken identity: activating conservative political identities induces "conservative" financial decisions.

    Science.gov (United States)

    Morris, Michael W; Carranza, Erica; Fox, Craig R

    2008-11-01

    Four studies investigated whether activating a social identity can lead group members to choose options that are labeled in words associated with that identity. When political identities were made salient, Republicans (but not Democrats) became more likely to choose the gamble or investment option labeled "conservative." This shift did not occur in a condition in which the same options were unlabeled. Thus, the mechanism underlying the effect appears to be not activated identity-related values prioritizing low risk, but rather activated identity-related language (the group label "conservative"). Indeed, when political identities were salient, Republicans favored options labeled "conservative" regardless of whether the options were low or high risk. Finally, requiring participants to explain the label "conservative" before making their choice did not diminish the effect, which suggests that it does not merely reflect inattention to content or construct accessibility. We discuss the implications of these results for the literatures on identity, priming, choice, politics, and marketing.

  20. Conservation Lands and Preserves, Private - Volusia County Conservation Corridor

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — The Volusia Conservation Corridor (VCC) is a mosaic of contiguous parcels of land, approximately 55,000 acres in size, which sits essentially in the middle of the...