WorldWideScience

Sample records for science-based stockpile stewardship

  1. Science-based stockpile stewardship at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Browne, J. [Los Alamos National Lab., NM (United States)

    1995-10-01

    Let me tell you a little about the Los Alamos Neutron Science Center (LANSCE) and how some of the examples you heard about from Sig Hecker and John Immele fit together in this view of a different world in the future where defense, basic and industrial research overlap. I am going to talk about science-based stockpile stewardship at LANSCE; the accelerator production of tritium (APT), which I think has a real bearing on the neutron road map; the world-class neutron science user facility, for which I will provide some examples so you can see the connection with defense science; and lastly, testing concepts for a high-power spallation neutron target and waste transmutation.

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

    Energy Technology Data Exchange (ETDEWEB)

    Immele, J. [Los Alamos National Lab., NM (United States)

    1995-10-01

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

  3. Science Based Stockpile Stewardship

    Science.gov (United States)

    1994-11-01

    low level of radioactivity produced are comparable to those in TFTR presently operating routinely on the Forrestal Campus of Princeton University and...to nu- merous astronomical objects and processes (e.g., primordial nucleosynthesis, stellar evoiution, and hydrodynamic instabilities in supernova ... radioactive decay heat, reactivity excursions beyond the subcriticality margin etc. A specific APS system based on the thorium fuel cycle has recently

  4. Accelerator Based Tools of Stockpile Stewardship

    Science.gov (United States)

    Seestrom, Susan

    2017-01-01

    The Manhattan Project had to solve difficult challenges in physics and materials science. During the cold war a large nuclear stockpile was developed. In both cases, the approach was largely empirical. Today that stockpile must be certified without nuclear testing, a task that becomes more difficult as the stockpile ages. I will discuss the role of modern accelerator based experiments, such as x-ray radiography, proton radiography, neutron and nuclear physics experiments, in stockpile stewardship. These new tools provide data of exceptional sensitivity and are answering questions about the stockpile, improving our scientific understanding, and providing validation for the computer simulations that are relied upon to certify todays' stockpile.

  5. FY 2015 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-04-01

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

  6. FY 2016 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-03-01

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

  7. Stockpile stewardship past, present, and future

    Science.gov (United States)

    Adams, Marvin L.

    2014-05-01

    The U.S. National Academies released a report in 2012 on technical issues related to the Comprehensive Test Ban Treaty. One important question addressed therein is whether the U.S. could maintain a safe, secure, and reliable nuclear-weapons stockpile in the absence of nuclear-explosion testing. Here we discuss two main conclusions from the 2012 Academies report, which we paraphrase as follows: 1) Provided that sufficient resources and a national commitment to stockpile stewardship are in place, the U.S. has the technical capabilities to maintain a safe, secure, and reliable stockpile of nuclear weapons into the foreseeable future without nuclear-explosion testing. 2) Doing this would require: a) a strong weapons science and engineering program that addresses gaps in understanding; b) an outstanding workforce that applies deep and broad weapons expertise to deliver solutions to stockpile problems; c) a vigorous, stable surveillance program that delivers the requisite data; d) production facilities that meet stewardship needs. We emphasize that these conclusions are independent of CTBT ratification-they apply provided only that the U.S. continues its nuclear-explosion moratorium.

  8. FY 2014 - Stockpile and Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2016-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-01-07

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

  11. Proposed Laser-Based HED physics experiments for Stockpile Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    Benage, John F. [Los Alamos National Laboratory; Albright, Brian J. [Los Alamos National Laboratory; Fernandez, Juan C. [Los Alamos National Laboratory

    2012-09-04

    An analysis of the scientific areas in High Energy Density (HED) physics that underpin the enduring LANL mission in Stockpile Stewardship (SS) has identified important research needs that are not being met. That analysis has included the work done as part of defining the mission need for the High Intensity Laser Laboratory (HILL) LANL proposal to NNSA, LDRD DR proposal evaluations, and consideration of the Predictive Capability Framework and LANL NNSA milestones. From that evaluation, we have identified several specific and scientifically-exciting experimental concepts to address those needs. These experiments are particularly responsive to physics issues in Campaigns 1 and 10. These experiments are best done initially at the LANL Trident facility, often relying on the unique capabilities available there, although there are typically meritorious extensions envisioned at future facilities such as HILL, or the NIF once the ARC short-pulse laser is available at sufficient laser intensity. As the focus of the LANL HEDP effort broadens from ICF ignition of the point design at the conclusion of the National Ignition Campaign, into a more SS-centric effort, it is useful to consider these experiments, which address well-defined issues, with specific scientific hypothesis to test or models to validate or disprove, via unit-physics experiments. These experiments are in turn representative of a possible broad experimental portfolio to elucidate the physics of interest to these campaigns. These experiments, described below, include: (1) First direct measurement of the evolution of particulates in isochorically heated dense plasma; (2) Temperature relaxation measurements in a strongly-coupled plasma; (3) Viscosity measurements in a dense plasma; and (4) Ionic structure factors in a dense plasma. All these experiments address scientific topics of importance to our sponsors, involve excellent science at the boundaries of traditional fields, utilize unique capabilities at LANL

  12. 2015 Stewardship Science Academic Programs Annual

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-02-01

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

  13. Stewarding a Reduced Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Goodwin, B T; Mara, G

    2008-04-18

    The future of the US nuclear arsenal continues to be guided by two distinct drivers: the preservation of world peace and the prevention of further proliferation through our extended deterrent umbrella. Timely implementation of US nuclear policy decisions depends, in part, on the current state of stockpile weapons, their delivery systems, and the supporting infrastructure within the Department of Defense (DoD) and the Department of Energy's National Nuclear Security Administration (NNSA). In turn, the present is a product of past choices and world events. Now more than ever, the nuclear weapons program must respond to the changing global security environment and to increasing budget pressures with innovation and sound investments. As the nation transitions to a reduced stockpile, the successes of the Stockpile Stewardship Program (SSP) present options to transition to a sustainable complex better suited to stockpile size, national strategic goals and budgetary realities. Under any stockpile size, we must maintain essential human capital, forefront capabilities, and have a right-sized effective production capacity. We present new concepts for maintaining high confidence at low stockpile numbers and to effectively eliminate the reserve weapons within an optimized complex. We, as a nation, have choices to make on how we will achieve a credible 21st century deterrent.

  14. Management of coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Carpenter, A.M. [IEA Coal Research, London (United Kingdom)

    1999-10-01

    Stockpile management is an important part of the coal handling process from mine to customer. Virtually all coal producers and consumers make use of stockpiles at their facilities, either to serve as a buffer between material delivery and processing or to enable coal blending to meet quality requirements. This report begins by examining why stockpiles are employed. The stacking and reclaiming of piles, and the reduction of noise arising from the handling equipment is then discussed, along with stockpile automation and management. Good sampling and analysis procedures are essential for coal quality management. Sampling systems, representative samples and on-line analysis are described. Stock auditing to reconcile the amount of coal in the stockpiles is also covered. Coals are susceptible to weathering and atmospheric oxidation during storage in open-air piles. Properties and processes affected by coal oxidation and weathering, including heating value losses, handleability, cleaning, combustion and coking are examined. Spontaneous combustion poses safety, environmental, economic and handling problems if it becomes established in stockpiles. Factors affecting spontaneous combustion are discussed with the emphasis on prevention, detection and control. Stockyard operators are under constant social and political pressures to improve the environmental acceptability of their operations. Thus the control, prevention, and monitoring of fugitive dust emissions, and the composition, collection and treatment of stockpile runoff are addressed. The prevention and control of flowslides is also covered. Experience has shown that with good stockpile design and management, most coals can be safely stored in an environmentally acceptable way. 187 refs., 41 figs., 8 tabs.

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

    Directory of Open Access Journals (Sweden)

    Kendra A. Karr

    2017-10-01

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

  16. Analytical Characterization of the Thorium Nitrate Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Mattus, CH

    2003-12-30

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

  17. Potential Radon-222 Emissions from the Thorium Nitrate Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Terry, J.W.

    2003-09-04

    The Defense National Stockpile Center (DNSC), a field level activity of the Defense Logistics Agency, has stewardship of a stockpile of thorium nitrate that has been in storage for decades. The thorium nitrate stockpile was produced from 1959 to 1964 for the Atomic Energy Commission and previously has been under the control of several federal agencies. The stockpile consists of approximately 7 million pounds of thorium nitrate crystals (hydrate form) stored at two depot locations in the United States (75% by weight at Curtis Bay, Maryland, and 25% by weight at Hammond, Indiana). The material is stored in several configurations in over 21,000 drums. The U.S. Congress has declared the entire DNSC thorium nitrate stockpile to be in excess of the needs of the Department of Defense. Part of DNSC's mission is to safely manage the continued storage, future sales, and/or disposition of the thorium nitrate stockpile. Historically, DNSC has sold surplus thorium nitrate to domestic and foreign companies, but there is no demand currently for this material. Analyses conducted by Oak Ridge National Laboratory (ORNL) in 2001 demonstrated that disposition of the thorium nitrate inventory as a containerized waste, without processing, is the least complex and lowest-cost option for disposition. A characterization study was conducted in 2002 by ORNL, and it was determined that the thorium nitrate stockpile may be disposed of as low-level waste. The Nevada Test Site (NTS) was used as a case study for the disposal alternative, and special radiological analyses and waste acceptance requirements were documented. Among the special radiological considerations is the emission of {sup 220}Rn and {sup 222}Rn from buried material. NTS has a performance objective on the emissions of radon: 20 pCi m{sup -2} sec{sup -1} at the surface of the disposal facility. The radon emissions from the buried thorium nitrate stockpile have been modeled. This paper presents background information and

  18. Temperature profiles of coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

  19. 20 Years of Success: Science, Technology, and the Nuclear Weapons Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2015-10-22

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

  20. Assessing Environmental Stewardship Motivation

    Science.gov (United States)

    Bramston, Paul; Pretty, Grace; Zammit, Charlie

    2011-01-01

    Environmental stewardship networks flourish across Australia. Although the environment benefits, this article looks to identify what volunteers draw from their stewardship. The authors adapted 16 questions that purportedly tap environmental stewardship motivation and administered them to a convenience sample of 318 university students and then to…

  1. Stockpile Dismantlement Database Training Materials

    Energy Technology Data Exchange (ETDEWEB)

    1993-11-01

    This document, the Stockpile Dismantlement Database (SDDB) training materials is designed to familiarize the user with the SDDB windowing system and the data entry steps for Component Characterization for Disposition. The foundation of information required for every part is depicted by using numbered graphic and text steps. The individual entering data is lead step by step through generic and specific examples. These training materials are intended to be supplements to individual on-the-job training.

  2. U.S. Nuclear Weapons Modernization - the Stockpile Life Extension Program

    Science.gov (United States)

    Cook, Donald

    2016-03-01

    Underground nuclear testing of U.S. nuclear weapons was halted by President George H.W. Bush in 1992 when he announced a moratorium. In 1993, the moratorium was extended by President Bill Clinton and, in 1995, a program of Stockpile Stewardship was put in its place. In 1996, President Clinton signed the Comprehensive Nuclear Test Ban Treaty (CTBT). Twenty years have passed since then. Over the same time, the average age of a nuclear weapon in the stockpile has increased from 6 years (1992) to nearly 29 years (2015). At its inception, achievement of the objectives of the Stockpile Stewardship Program (SSP) appeared possible but very difficult. The cost to design and construct several large facilities for precision experimentation in hydrodynamics and high energy density physics was large. The practical steps needed to move from computational platforms of less than 100 Mflops/sec to 10 Teraflops/sec and beyond were unknown. Today, most of the required facilities for SSP are in place and computational speed has been increased by more than six orders of magnitude. These, and the physicists and engineers in the complex of labs and plants within the National Nuclear Security Administration (NNSA) who put them in place, have been the basis for underpinning an annual decision, made by the weapons lab directors for each of the past 20 years, that resort to underground nuclear testing is not needed for maintaining confidence in the safety and reliability of the U.S stockpile. A key part of that decision has been annual assessment of the physical changes in stockpiled weapons. These weapons, quite simply, are systems that invariably and unstoppably age in the internal weapon environment of radioactive materials and complex interfaces of highly dissimilar organic and inorganic materials. Without an ongoing program to rebuild some components and replace other components to increase safety or security, i.e., life extending these weapons, either underground testing would again be

  3. Campus Environmental Stewardship.

    Science.gov (United States)

    Eagan, David J.

    1992-01-01

    The University of Wisconsin (Madison) has developed a pilot Environmental Stewardship Initiative, a mechanism for incorporating environmental stewardship into the university's operations and curriculum. The complex and dynamic campus ecosystem serves as a model community and field station for student research on natural history and institutional…

  4. National Defense Stockpile Modernization or Suicide?

    Science.gov (United States)

    1994-03-01

    8217 REPOF AD-A280 652 Form Approved • fol this e0OMB No. 0704-.188 hk, reporting brden for this coile ng the time for reviewing Instructions. seching...vegetable tannin , asbestos, and talc, have become obsolete due to new technology. For others, such as aluminum, bauxite, copper, lead, mercury, nickel...these minerals must be a prime concern. Potential sales have been carefully reviewed by the stockpile manager and require approval by Congress

  5. The National Defense Stockpile: An Organizational Perspective.

    Science.gov (United States)

    1985-03-01

    Strategic and Critical Materials Stock Piling Act of 1939. This Act required the Treasury Department to accumulate supplies of chromite , quartz crystals...materials, the principle minerals being copper and nickel. Because of rising prices due to war demands, copper was released to defense contractors both...metal producers from raising their prices (5:66). The supply of copper or nickel was not replenished, bringing allegations of misuse of the stockpile for

  6. Driving product stewardship

    DEFF Research Database (Denmark)

    Moreno-Mantilla, Carlos Eduardo; Romero-Larrahondo, Paulo Andrés; Reyes Rodríguez, Juan Felipe

    Within the Resource-Based View of corporate environmental strategy, the firm‘s simultaneous investments in various resource domains are manifested in differentiated levels of environmental proactivity. In particular, a minimum requirement for the implementation of a product stewardship strategy...... seems to be that some form of life cycle assessment (LCA) be implemented. Henceforth, the authors set out to test empirically the extent to which firm-level investments in three resource domains, i.e. formal management systems and procedures (including LCA), employee training and participation......, and conventional green competencies related to product development and manufacturing technologies, are related to each other and configure a corporate proactive approach towards the environment. The data used in this study were collected as part of a research project conducted in Bogotá, Colombia, and obtained...

  7. Modeling of coal stockpiles using a finite elements method

    Energy Technology Data Exchange (ETDEWEB)

    Ozdeniz, A.H.; Sensogut, C. [Dumlupinar University, Kutahya (Turkey)

    2008-07-01

    In the case of coal stockpiles finding suitable environmental conditions, spontaneous combustion phenomenon will be unavoidable. In this study, an industrial-sized stockpile having a shape of triangle prism was constituted in a coal stockyard of Western Lignite Corporation (WLC), Turkey. The parameters of time, humidity and temperature of air, atmospheric pressure, velocity and direction of wind values that are effective on coal stockpile were measured in a continuous manner. These experimental works were transferred into a computer media in order to obtain similar outcomes by carrying out 2-dimensional analysis of the stockpile with Finite Elements Method (FEM). The performed experimental studies and obtained results were then compared.

  8. 75 FR 12231 - NACEPT Subcommittee on Promoting Environmental Stewardship

    Science.gov (United States)

    2010-03-15

    ... AGENCY NACEPT Subcommittee on Promoting Environmental Stewardship AGENCY: Environmental Protection Agency... Stewardship. The purpose of the Subcommittee on Promoting Environmental Stewardship (SPES) of the National... Protection Agency on how to promote environmental stewardship practices that encompass all environmental...

  9. Antimicrobial stewardship in paediatrics.

    Science.gov (United States)

    Principi, Nicola; Esposito, Susanna

    2016-08-18

    Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed. Over the last few years, there have been significant shortages in the development and availability of new antibiotics; therefore, the implementation of strategies to preserve the activity of existing antimicrobial agents has become an urgent public health priority. AS is one such approach. The need for formal AS programs in paediatrics was officially recognized only recently, considering the widespread use of antibiotics in children and the different antimicrobial resistance patterns that these subjects exhibit in comparison to adult and elderly patients. However, not all problems related to the implementation of AS programs among paediatric patients are solved. The most important remaining problems involve educating paediatricians, creating a multidisciplinary interprofessional AS team able to prepare guidelines, monitoring antibiotic prescriptions and defining corrective measures, and the availability of administrative consensuses with adequate financial support. Additionally, the problem of optimizing the duration of AS programs remains unsolved. Further studies are needed to solve the above mentioned problems. In paediatric patients, as in adults, the successful implementation of AS strategies has had a significant impact on reducing targeted- and nontargeted-antimicrobial use by improving

  10. Antimicrobial stewardship in small animal veterinary practice

    DEFF Research Database (Denmark)

    Guardabassi, Luca; Prescott, John F

    2015-01-01

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

  11. The organisational structure of urban environmental stewardship

    Science.gov (United States)

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

    2012-01-01

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

  12. 78 FR 68028 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2013-11-13

    ... Defense Stockpile Manager, maintains a stockpile of strategic and critical materials to supply the... Bureau of Industry and Security National Defense Stockpile Market Impact Committee Request for Public... is to advise the public that the National Defense Stockpile Market Impact Committee, co-chaired by...

  13. Stockpiling and Comprehensive Utilization of Red Mud Research Progress

    OpenAIRE

    Chuan-Sheng Wu; Dong-Yan Liu

    2012-01-01

    With increasing production of red mud, the environmental problems caused by it are increasingly serious, and thus the integrated treatment of red mud is imminent. This article provides an overview of the composition and the basic characteristics of red mud. The research progress of safe stockpiling and comprehensive utilization of red mud is summarized. The safe stockpiling of red mud can be divided into two aspects: the design and safe operation of the stocking yard. The comprehensive utiliz...

  14. 75 FR 20991 - NACEPT Subcommittee on Promoting Environmental Stewardship

    Science.gov (United States)

    2010-04-22

    ... AGENCY NACEPT Subcommittee on Promoting Environmental Stewardship AGENCY: Environmental Protection Agency..., EPA gives notice of a meeting of the NACEPT Subcommittee on Promoting Environmental Stewardship. The purpose of the Subcommittee on Promoting Environmental Stewardship (SPES) of the National Advisory Council...

  15. Decrease of calorific value and particle size in coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

    During storage of excess amount of coal, they lose both their economical value and cause environmental problems. In this work, two industrial-sized stockpiles were constituted at a coal stockyard of Western Lignite Corporation (WLC) in Tuncbilek, Turkey. The size of the stockpiles, formed as triangle prisms, was about 10 m x 5 m wide with a height of 3 m; each mass being approximately 120 tons of coal in total. Some of the parameters that were effective on the stockpiles were measured in a continuous manner during this experimental work. The calorific losses and the decreases that occurred in particle size due to atmospheric conditions were also examined and detailed as the result of this work.

  16. Environmental stewardship and community seed banking: An analysis of stewardship in theory and on the ground

    Directory of Open Access Journals (Sweden)

    Jeanette L. Yasol-Naval

    2017-06-01

    Full Text Available This paper explores the conceptual dimension of environmental stewardship from a neoplatonic frame, Patrick Dobel’s theology of nature, and Aldo Leopold’s philosophy on land ethic. Based on a reading of these works, stewardship as an ethical concept is normative. It seeks rational justifications that would define stewardship in relation to natural resources and the natural world. The paper aims to establish ethics of stewardship and relate it with the traditional approaches to environmental ethics, particularly land ethics. It examines how stewardship may be manifested “on the ground” and in the actual farming communities through Community Seed Banking and other seed conservation initiatives.

  17. The Six Principles of Facilities Stewardship

    Science.gov (United States)

    Kaiser, Harvey H.; Klein, Eva

    2010-01-01

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

  18. 30 CFR 77.211 - Draw-off tunnels; stockpiling and reclaiming operations; general.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Draw-off tunnels; stockpiling and reclaiming... WORK AREAS OF UNDERGROUND COAL MINES Surface Installations § 77.211 Draw-off tunnels; stockpiling and reclaiming operations; general. (a) Tunnels located below stockpiles, surge piles, and coal storage silos...

  19. Stockpiling and Comprehensive Utilization of Red Mud Research Progress

    Science.gov (United States)

    Liu, Dong-Yan; Wu, Chuan-Sheng

    2012-01-01

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

  20. Validated sampling strategy for assessing contaminants in soil stockpiles

    NARCIS (Netherlands)

    Lamé, F.; Honders, T.; Derksen, G.B.; Gadella, M.

    2005-01-01

    Dutch legislation on the reuse of soil requires a sampling strategy to determine the degree of contamination. This sampling strategy was developed in three stages. Its main aim is to obtain a single analytical result, representative of the true mean concentration of the soil stockpile. The

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

    Energy Technology Data Exchange (ETDEWEB)

    Dale, Virginia H [ORNL

    2010-06-01

    ENVIRONMENTAL MANAGEMENT is pleased to announce that Rebecca Efroymson will join Virginia Dale as Co-Editors-in-Chief of the journal. Dr. Efroymson brings extensive expertise in risk assessment and environmental toxicology. Her work has focused on land management, natural resources, water quality, and rare species, with recent work on benefits and risks of energy alternatives. ENVIRONMENTAL MANAGEMENT has been publishing research on the management and conservation of natural resources and habitats since 1976. Articles discuss implications for an international audience and examine a scientific or management hypothesis. As a premier scientific journal in applied and cross-cutting areas, articles come from a variety of disciplines including biology, botany, climatology, earth sciences, ecology, ecological economics, environmental engineering, fisheries, forest sciences, geography, information science, law, management science, politics, public affairs, social sciences, and zoology, most often in combinations determined by the interdisciplinary topic of the study. The journal strives to improve cross-disciplinary communication by making ideas and results available to environmental practitioners from other backgrounds. The goal of ENVIRONMENTAL MANAGEMENT is to present a wide spectrum of viewpoints and approaches, and to this end the journal consists of four main sections. Forum contains addresses, editorials, comments, and opinions about environmental matters. Articles in the Profile section describe and evaluate particular case histories, events, policies, problems, or organizations and their work. Papers in the Research section present the methods and findings from empirical and model-based scientific studies. The section on Environmental Assessment is for articles that cover methods of appraisal, measurement, and comparison. Generally, the debates published in the journal's Forum help construct better environmental research or policies; Research and Assessment sections foster understanding of environmental problems and usually of their solutions; and Profile articles may contribute to either aim, or both. In the event that important differences of opinion cannot be resolved between authors and referees or readers, the Forum section may be used to present a Comment on an article that has recently been published in the journal, which may be followed by the author's Reply. The journal publishes innovative research that both identifies new problems and formulates novel solutions to well-known ones. Articles are accepted from all over the world, as the international dimension is considered especially important. Research reported in the journal ranges from environmental problems that are common to a wide variety of nations to issues that are either of global concern or not limited to national boundaries. The journal provides a way for scientists to share approaches, methods, and experiences among environmental practitioners in many countries, so that the problems and opportunities of our ever more-interdependent planet may be studied in a concerted manner.

  2. Planning guidance for the Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-02-01

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

  3. Effects of alternative oil stockpiling programs on the U. S. economy, 1976--1979. Final results. [Effects of 730-/and 4380-million barrel stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Tessmer, R.G. Jr.; Behling, D.J. Jr.

    1976-06-01

    Application of Brookhaven's Energy Input-Output Model is demonstrated by analyzing economy-wide effects of an Oil Stockpile Program. The model is used to estimate the 1976-79 inter-industry output, employment, capital, and energy substitution effects of 730- and 4380-barrel stockpiles. Two policy variables--the type of stockpile facility and the method of financing--and one assumption--balance of payments effects--are examined.

  4. Product stewardship in wollastonite production.

    Science.gov (United States)

    Maxim, L Daniel; Niebo, Ron; Larosa, Salvatore; Johnston, Brad; Allison, Kimberly; McConnell, E E

    2008-11-01

    In July 2002, NYCO Minerals, Inc., discovered a heretofore unknown contaminant in its wollastonite ore. The contaminant was first believed to be tremolite asbestos. Immediate efforts were made to eliminate this material. Additional studies were initiated to fully characterize the contaminant and its distribution in the ore body. Subsequent study by NYCO and their consultants led to the identification of the contaminant as a transition material (TM) intermediate between tremolite and talc. In vitro dissolution rate measurements indicated that the TM dissolved much more rapidly than tremolite asbestos. This article provides background information on wollastonite mineralogy and NYCO's product stewardship program (PSP). At present, NYCO Minerals uses selective mining to control the trace levels of TM in the ore and finished product verified by periodic monitoring of workplace air and finished product.

  5. Antimicrobial stewardship in wound care

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing...... antibiotics. OBJECTIVES: This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds. METHODS: We assembled a group...... of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document...

  6. Double-shell target design for the NIF: Noncryogenic ignition and nonlinear mix studies for Stockpile Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    Amendt, P

    2004-02-10

    Double-shell ignition is complementary to the baseline approach by virtue of not requiring: (1) cryogenic preparation and fielding, (2) high-contrast pulse-shaping for shock-timing, and (3) demanding x-ray flux symmetry control. The use of simpler low-contrast pulse-shaping potentially allows more benign hohlraum conditions by reducing the risk of laser backscatter. In addition, the associated higher laser fluence threshold for optics damage initiation allows the possibility of more routine high-fluence shots with 2{omega} on the NIF. Based on LDRD-sponsored research in FY01-03 on NIF double-shell ignition target designs, the feasibility of this approach was advanced through both a highly successful implosion campaign on the Omega laser facility and a variety of design improvements for mitigating instability. The double-shell implosion campaign on Omega achieved the important milestone of repeatably demonstrating dominant primary (2.45 MeV) neutron production from the mix-susceptible compressional phase of a double-shell implosion, using fall-line design optimization and exacting fabrication standards. Showing effective control of fuel-pusher mix during final compression is an essential element for achieving ignition. In our studies to control mix by reducing hydrodynamic instability a new pathway for destructive Rayleigh-Taylor growth on the outer surface of the inner shell at ignition scales was identified. However, highly resolved multi-mode simulations showed that with use of a graded dopant in the inner shell and material-matching with an exterior metallic foam, this instability was significantly reduced. In addition, the resulting density-gradient stabilization was seen to quench small-wavelength growth, thereby avoiding the computationally challenging turbulent regime. A major goal of future research for realizing double-shell ignition on the NIF is experimental validation of this instability mitigation approach using the Omega laser facility.

  7. 75 FR 34924 - Conservation Stewardship Program

    Science.gov (United States)

    2010-06-21

    ... Commodity Credit Corporation 7 CFR Part 1470 RIN 0578-AA43 Conservation Stewardship Program AGENCY: Commodity Credit Corporation, Natural Resources Conservation Service, United States Department of..., Rulemaking Manager, Natural Resources Conservation Service. BILLING CODE 3410-16-P ...

  8. Pesticide Environmental Stewardship Program Member Handbook

    Science.gov (United States)

    This Pesticide Environmental Stewardship Program (PESP) handbook is a resource with information to help prospective members to learn about PESP, to understand how the program works, and to assist in applying for membership.

  9. Taimi Lynne Hoag Award for Environmental Stewardship

    Science.gov (United States)

    The Region 5 Tribal Operation Committee established this Award in the name of Taimi Hoag to recognize significant contributions in environmental management and/or environmental stewardship by a tribal government leader, program manager, or staff person.

  10. South Bay Salt Ponds : Initial stewardship plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The California Department of Fish and Game and the U.S. Fish and Wildlife Service will operate and maintain the South Bay Salt Ponds under this Initial Stewardship...

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

    Science.gov (United States)

    Zhang, Dizhe; Zhou, Zongyan; Pinson, David

    2017-06-01

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

  12. Pluvial percolation in pyrite-bearing coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Danielle Andrade Pimentel; Jose Aurelio Medeiros da Luz [Universidade Federal de Ouro Preto, Ouro Preto (Brazil)

    2009-07-01

    Acid mine drainage is a main environmental problem linked to coal and sulfide ore mining. Its treatment usually involves alkalinization and subsequent precipitation and immobilization of the dissolved species. Rainfalls over stockpiles can cause a very similar phenomenon. This work aimed to study the effluents from such a leaching process in steam-coal stockpiles Brazilian coal with a high pyrite content was used. The effluents have been chemically characterized. Effluent clarification by aggregation and settling in an attempt to simultaneously deplete heavy metal content was studied. Settling experiments were carried out with coal suspensions, in order to evaluate the efficiency of inorganic and polymeric reagents in the process. 8 refs., 13 figs., 4 tabs.

  13. West Jefferson Streetscape Revitalization Stewardship Plan

    OpenAIRE

    Gilboy, Elizabeth Truex; Browning, Lara; Rosenberger, Jack; Jessup, Jen

    2015-01-01

    The Community Design Assistance Center (CDAC) recognizes the need to incorporate detailed stewardship plans with conceptual design work. A project cannot achieve long term success without a strategy for proper planting, care, and maintenance. The information in this document describes strategies for CDAC design concepts that have been implemented. Such stewardship includes general landscape maintenance, tree and planting care, controlling nonnative and invasive plant species, pests, disease c...

  14. The Logistics of Oil Spill Dispersant Application. Volume II. Application Techniques, Stockpiling, Dispersant Selection, Strategies.

    Science.gov (United States)

    1982-11-01

    40 -𔃻. FREQUENCY , SIZE AND LOCATION OF OIL SPILLS.. 41 2. FRACTION OF SPILLED OIL AMENABLE TO DISPERSANTS S1 3. NON-USCG STOCKPILES AND...APPLICATION RATE VS DISTANCE TO SLICK FOR PATTERN LENGTH *4.0 KM 28 DISTANCE FRON BASE *10. KM AREAL DENSITY a 45 LITERS/ NECTARE SLICK/PATTERN RATIO...dispersant itself are not included above. 39 FACTORS IN DISPERSANT STOCKPILING The size, location and replenishment of U.S. Coast Guard stockpiles of

  15. Embedding Data Stewardship in Geoscience Australia

    Science.gov (United States)

    Bastrakova, I.; Fyfe, S.

    2013-12-01

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

  16. Revaluation of stockpile amount of PFOS-containing aqueous film-forming foam in Japan: gaps and pitfalls in the stockpile survey.

    Science.gov (United States)

    Zushi, Yasuyuki; Yamamoto, Atsushi; Tsunemi, Kiyotaka; Masunaga, Shigeki

    2017-03-01

    Stockpiles of perfluoro-octane sulfonic acid (PFOS) containing aqueous film-forming foam (AFFF) have the potential to be emitted by leaching, spills, and during use in fire response and other processes. Several studies have discussed the high levels of stockpiled PFOS-containing AFFF and the risk they pose to the environment; however, there are large gaps in the amounts in Japan compared with other countries. For example, 300 tons are stockpiled in Canada, 2200-2600 tons in Switzerland, 1400 tons in Norway, and 19,000 tons in Japan from their reports for publication. The gap is considered to be a result of lack of surveys of several important sources. In this study, we revaluated the stockpile of AFFF in Japan to verify the reported value and identify the source of this gap based on information available in peer-reviewed papers, governmental reports, and business reports. The major reason for the gap between Japan and other countries was considered to be the survey of stockpiles in car-parking facilities, which accounted for 46.7% of the total amounts in Japan, but were not considered in other countries. These stockpiles indicate a high potential for accidental leaching or spilling of the AFFF by careless storage. Therefore, it is recommended that continual surveys of the AFFF stockpile in car-parking facilities be conducted in the rest of the world.

  17. Optimal lay-out design for coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Oberrisser, H. [Voest-Alpine Materials Handling GmbH and Co KG, Zeltweg (Austria)

    2006-07-01

    This article reviews current 'state of the art' concepts regarding lay-out and equipment for coal terminals. It groups these ideas into a workable set of guidelines for the coal mine or stockyard operator. The article concludes with four appropriate cases. The selection of the best suitable layout of the stockpile and equipment for coal storage and coal terminals is determined by a number of important criteria. A detailed analysis of process relevant requirements as well as an economic and ecological evaluation will result either in a conventional longitudinal or in a circular coal pile layout. (orig.)

  18. Understanding social influences on wilderness fire stewardship decisions

    Science.gov (United States)

    Katie Knotek

    2006-01-01

    Federal land managers and the public engage in many decisions about stewardship of wilderness in the United States, including decisions about stewardship of fire. To date, social science research lacks a holistic examination of the decision-making context of managers and the public about stewardship of fire inside wilderness and across its boundaries. A conceptual...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-09-01

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

  20. Chemical Stockpile Emergency Preparedness Program focus groups: A manual

    Energy Technology Data Exchange (ETDEWEB)

    Carnes, S.A.; Garkovich, C.A.; Shriver, T.E. Jr.

    1991-04-01

    While completing a congressionally mandated destruction of the US stockpile of unitary chemical weapons, the US Army decided that enhanced emergency planning was needed to reduce the consequences of an accidental release of agent. This decision is being implemented cooperatively by the US Department of the Army and the Federal Emergency Management Agency in the form of the Chemical Stockpile Emergency Preparedness Program (CSEPP), with additional cooperation from other federal agencies and affected state and local governments. This manual supports that effort by providing information about a commonly used qualitative data and information gathering technique, focus group interviewing, that may be used to design public education materials and other wide enhance communication among CSEPP providers and users. The focus group technique is characterized by structured discussions on a specific topic among a carefully selected group of participants. This manual provides background information on the CSEPP and the current management plan for the CSEPP. It describes the focus group technique and how it may be applied, either by itself or in conjunction with other appropriate research techniques, by state and local government officials to investigate many of the behavioral and organizational impacts of the CSEPP. Sample questions and probes that may be useful in designing and conducting specific CSEPP focus groups are also provided. The manual also includes a list of suggested readings and other reference material that may be useful in designing focus groups. 26 refs., 5 figs., 3 tabs.

  1. Stewardship mapping and assessment project: a framework for understanding community-based environmental stewardship

    Science.gov (United States)

    Erika S. Svendsen; Lindsay K. Campbell; Dana R. Fisher; James J.T. Connolly; Michelle L. Johnson; Nancy Falxa Sonti; Dexter H. Locke; Lynne M. Westphal; Cherie LeBlanc Fisher; Morgan Grove; Michele Romolini; Dale J. Blahna; Kathleen L. Wolf

    2016-01-01

    The Stewardship Mapping and Assessment Project (STEW-MAP) is designed to answer who, where, why and how environmental stewardship groups are caring for our urbanized landscapes. This report is intended to be a guide for those who wish to start STEW-MAP in their own city. It contains step-by-step directions for how to plan and implement a STEW-MAP project. STEW-MAP is...

  2. Antimicrobial stewardship interventions: thinking inside and outside the box.

    Science.gov (United States)

    Hamilton, Keith W; Fishman, Neil O

    2014-06-01

    At present, less than half of all acute health care facilities have antimicrobial stewardship programs. By targeting areas that are vulnerable to inappropriate antimicrobial use and by using novel strategies to increase the reach of stewardship interventions, providers can make antimicrobial stewardship a universal practice in all health care settings. This review discusses how stewardship can make large impacts in areas where it has traditionally been absent in facilities both with and without formal antimicrobial stewardship programs. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Stewardship, learning, and memory in disaster resilience

    Science.gov (United States)

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

    2010-01-01

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

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

    African Journals Online (AJOL)

    Economic framework for integrating environmental stewardship into food security strategies in low-income countries: case of agroforestry in southern African ... It then discusses how the potential impacts of the technological advances made in research and development are affected by policy and institutional constraints, ...

  5. Predicting volunteer commitment in environmental stewardship programmes

    Science.gov (United States)

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

    2001-01-01

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

  6. Fostering Environmental Stewardship: The 4-H Approach.

    Science.gov (United States)

    Meredith, Joyce E.

    1997-01-01

    Describes the National 4-H Council's Environmental Stewardship Program. This program aims to enable youth and adults to develop community-based solutions to environmental problems. Activity guides and software products have been designed for ages 5 to 18 around such topics as basic ecology and energy. The program also offers technical assistance…

  7. Stewardship: a conceptual imperative for managerial effectiveness ...

    African Journals Online (AJOL)

    Unacceptable health status indicators such as high infant and maternal mortality rates and low life expectancy have continued unabated inspite of government efforts to change it. This paper espouses the concept of stewardship as a selfless, ethical, cost effective and outcome oriented approach to governance. It is believed ...

  8. Stewardship, Learning, and Memory in Disaster Resilience

    Science.gov (United States)

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

    2010-01-01

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

  9. 75 FR 31609 - Conservation Stewardship Program

    Science.gov (United States)

    2010-06-03

    ... Department of Agriculture. ACTION: Final rule. SUMMARY: Section 2301 of the Food, Conservation, and Energy Act of 2008 (2008 Act) amended the Food Security Act of 1985 to establish the Conservation Stewardship...: Soil and Water Conservation Society. This review is available at http://www.nrcs.usda.gov/technical/NRI...

  10. Towards Materials Sustainability through Materials Stewardship

    Directory of Open Access Journals (Sweden)

    Christopher D. Taylor

    2016-10-01

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

  11. Simulation of bulk solids blending in longitudinal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Francis F. Pavloudakis; Z. Agioutantis

    2003-04-01

    A bulk solid blending simulator for longitudinal stockpiles has been developed using the Visual Basic development platform for Windows{reg_sign}. The program can be applied to optimizing blending in stockyards of mines, coal-fired power plants or cement industries. Input to the simulator consists of the average value, the standard deviation and the autocorrelation of the property for which blending is attempted. The program initially creates a time series of property values for the material delivered to the stockyard. Then, this input sequence is rearranged by simulating the operation of the stacking and reclaiming equipment. The output sequence of property values reflects the quality fluctuation of the material as it is delivered to the customer.

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

    Science.gov (United States)

    Weinstein, Raymond S

    2011-04-01

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

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

    Science.gov (United States)

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

    2010-06-11

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

  14. Initiatives and resources to promote antimicrobial stewardship.

    Science.gov (United States)

    Paño-Pardo, José Ramón; Campos, José; Natera Kindelán, Clara; Ramos, Antonio

    2013-09-01

    The development of an antimicrobial stewardship program (ASP) requires institutional support. However, obtaining sufficient institutional support is often a complex task that requires convincing the hospital's managers of the benefits of these programs. Additionally, in the design and implementation of an ASP, antimicrobial stewardship (AS) leaders need tools for diverse purposes, such as measuring antimicrobial consumption, education and training and designing protocols. In this review we provide useful information for AS promoters to facilitate the task of designing and implementing an ASP. First, we summarize information about various institutions that promote AS and include evidence that supports the need for and benefits of these programs. Then, several campaigns promoting AS are described. Finally, online resources for professionals dealing with AS are briefly summarized. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  15. Stewardship in mental health policy: inspiration, influence, institution?

    Science.gov (United States)

    Brown, Lawrence D; Isett, Kimberley R; Hogan, Michael

    2010-06-01

    The venerable but amorphous concept of stewardship has lately gained prominence in discussions of public policy and management and is sometimes offered as a "strategy" with a distinctive potential to mobilize effective public leadership in the service of broad social missions. In this article we explore how stewardship may be useful to the theory and practice of mental health policy, and, reciprocally, how examples from mental health policy may elucidate the dynamics of stewardship. After examining its key political ingredients--authority, advocacy, and analysis--we discuss the practical challenges in moving stewardship from moral inspiration to institutional reality.

  16. CFD simulation of thermodynamic and temperature effects on spontaneous combustion of coal stockpiles and dumps

    CSIR Research Space (South Africa)

    Kekana, J

    2011-01-01

    Full Text Available numerical integration of stiff partial differential equations (PDE’s).The simulation results obtained from the twodimensional model provided useful information in characterising the thermal-flow and combustion properties of coal stockpiles and carbonaceous...

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

    CSIR Research Space (South Africa)

    Mushia, NM

    2016-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-09-01

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

  19. Modeling the national pediatric vaccine stockpile: supply shortages, health impacts and cost consequences.

    Science.gov (United States)

    Shrestha, Sundar S; Wallace, Gregory S; Meltzer, Martin I

    2010-08-31

    Pediatric vaccine stockpiles have been in place in the U.S. since 1983 to address the potential disruption in supply of routine pediatric vaccines. Increases in the number of vaccines recommended for pediatric and adolescent patients have increased the cost of stocking and maintaining the stockpile. Based on a spreadsheet-based model (VacStockpile) we developed, we estimated potential supply shortages of 14 stockpiled vaccines as of August 1, 2008 and its health and financial impacts under various shortage and stockpile scenarios. To illustrate the implications of policy options, we compared "high" to "low" stockpile scenarios. The high stockpile scenario ensures a 6-month vaccine supply to vaccinate all children according to recommended schedules. The low scenario comprised of 50% of the high scenario or existing stocks, whichever is smaller. For each vaccine, we used a weighted average of five shortage scenarios ranging from 0% to 100%, in 25% increments. Demand for each vaccine was based on current distribution or birth cohort size. The probabilities of shortages were based on number of manufacturers, market stability, history of manufacturing problems, and production complexity. CDC contract prices were used to estimate costs. Expert opinion and literature provided estimates of health impacts due to shortages. Applying the probabilities of shortages to all vaccines in a single year, the "low" scenario could cost $600 million, with 376,000 vaccine-preventable cases occurring and 1774 deaths. The "high" scenario could cost $2 billion, with an additional $1.6 billion initial stocking, and result in 7100 vaccine-preventable cases occurring and 508 deaths. Based on the assumptions in the model, there is the potential for large differences in outcomes between the scenarios although some outcomes could potentially be averted with measures such as catch-up campaigns after shortages. Using the VacStockpile policy makers can readily evaluate the implications of

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

    Directory of Open Access Journals (Sweden)

    Nicky M Mushia

    2016-06-01

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

  1. The Role of the National Defense Stockpile in the Supply of Strategic and Critical Materials

    Science.gov (United States)

    2008-05-09

    Department to stockpile chromite , quartz, tin, crystals, and rubber, and directed the Army and Navy Munitions Boards to set policy for the use of these...authorized release of materials, primarily aluminum and copper .15 Also during this time management of the stockpile function transferred from the Treasury...from domestic and foreign interests affected by these disposals.17 During the Vietnam era, the government released cadmium and copper from the

  2. Risk communications and the Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, B.M. [Oak Ridge National Lab., TN (United States)

    1995-12-31

    One of the greater challenges the Army faces is effectively dealing with the concerns of the public, local officials and the news media on the disposal of aging chemical agents. This paper describes the method developed for the Chemical Stockpile Emergency Preparedness Program (CSEPP). The purpose was to provide a fairly comprehensive document on risk communication research and recommended practices as they related to the CSEPP. Using the communications perspective suggested by Covello and colleagues, the existing practices of communicating risk information about chemical weapons and the associated efforts in emergency planning, storage and eventual disposal are described. Risk communication problems specific to the CSEPP are then examined and described via scenarios. A framework is developed that distinguishes between the major components of risk communication, flow and intent. Within this framework, the research and recommendations are summarized as to direction of flow -- dialogue, or two-way interaction, versus monologue, or one-way communication -- and that of intent -- exchange versus persuasion. The findings and recommendations are synthesized and related to risk events for the CSEPP as posited in the scenarios.

  3. Stewardship to tackle global phosphorus inefficiency

    DEFF Research Database (Denmark)

    Withers, Paul J. A.; Dijk, Kimo van; Neset, Tina-Simone

    2015-01-01

    The inefficient use of phosphorus (P) in the food chain is a threat to the global aquatic environment and the health and well-being of citizens, and it is depleting an essential finite natural resource critical for future food security and ecosystem function. We outline a strategic framework of 5R...... stewardship (Re-align P inputs, Reduce P losses, Recycle P in bioresources, Recover P in wastes, and Redefine P in food systems) to help identify and deliver a range of integrated, cost-effective, and feasible technological innovations to improve P use efficiency in society and reduce Europe’s dependence on P...

  4. US antibiotic stewardship and penicillin allergy.

    Science.gov (United States)

    Wada, Kara J; Calhoun, Karen H

    2017-06-01

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

  5. LX-17-1 Stockpile Returned Material Lot Comparison

    Energy Technology Data Exchange (ETDEWEB)

    Gagliardi, F. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Pease, S. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Willey, T. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-02-18

    Many different lots of LX-17 have been produced over the years. Two varieties of LX-17, LX-17-0 and LX-17-1, have at one point or another been a part of the Livermore stockpile systems. LX-17-0 was made with dry-aminated TATB whereas LX-17-1 was made with wet-aminated TATB. Both versions have the same TATB to Kel-F 800 mass ratio of 92.5%/7.5%. Both kinds of LX-17 were formulated at Holston during the late 1970s or early to mid-1980s and were certified to have met the necessary specifications that cover the purity, particle size range, explosive to binder ratio, etc. In recent years, Trevor Willy and others have performed a detailed evaluation of solid parts made from each of the LX-17 lots manufactured at Holston. Using the Advanced Light Source at LBNL, Willey and his colleagues radiographed many samples from isostatic pressings using the same scanning conditions. In their investigation they identified that even though the bulk composition can be the same, there may exist a large spread in how smoothly the TATB and binder were distributed within the radiographed volume of different lots of material.1 Overall, the dry-aminated TATB-based material, LX-17-0, had a smooth TATB and binder distribution, whereas the wet-aminated TATB-based LX-17-1 showed a wide range of binder distributions. The results for five different LX-17-1 lots are shown in Figure 1. The wide variation in material distribution has raised the question about whether or not this sort variability will cause significant differences in mechanical behavior.

  6. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after the completion of facility cleanup. Long-term stewardship is administered and overseen by the U.S. Department of Energy Environmental Management Office of Science and Technology. This report describes the background of long-term stewardship and gives general guidance about considerations when ownership and/or responsibility of a site should be transferred to a long-term stewardship program. This guidance document will assist the U.S. Department of Energy in: (a) ensuring that the long-term stewardship program leads transition planning with respect to facility and site areas, and (b) describing the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete.

  7. Making USGS Science Data more Open, Accessible, and Usable: Leveraging ScienceBase for Success

    Science.gov (United States)

    Chang, M.; Ignizio, D.; Langseth, M. L.; Norkin, T.

    2016-12-01

    In 2013, the White House released initiatives requiring federally funded research to be made publicly available and machine readable. In response, the U.S. Geological Survey (USGS) has been developing a unified approach to make USGS data available and open. This effort has involved the establishment of internal policies and the release of a Public Access Plan, which outlines a strategy for the USGS to move forward into the modern era in scientific data management. Originally designed as a catalog and collaborative data management platform, ScienceBase (www.sciencebase.gov) is being leveraged to serve as a robust data hosting solution for USGS researchers to make scientific data accessible. With the goal of maintaining persistent access to formal data products and developing a management approach to facilitate stable data citation, the ScienceBase Data Release Team was established to ensure the quality, consistency, and meaningful organization of USGS data through standardized workflows and best practices. These practices include the creation and maintenance of persistent identifiers for data, improving the use of open data formats, establishing permissions for read/write access, validating the quality of standards compliant metadata, verifying that data have been reviewed and approved prior to release, and connecting to external search catalogs such as the USGS Science Data Catalog (data.usgs.gov) and data.gov. The ScienceBase team is actively building features to support this effort by automating steps to streamline the process, building metrics to track site visits and downloads, and connecting published digital resources in line with USGS and Federal policy. By utilizing ScienceBase to achieve stewardship quality and employing a dedicated team to help USGS scientists improve the quality of their data, the USGS is helping to meet today's data quality management challenges and ensure that reliable USGS data are available to and reusable for the public.

  8. Report to Congress on stockpile reliability, weapon remanufacture, and the role of nuclear testing

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.H.; Brown, P.S.; Alonso, C.T.

    1987-10-01

    This report analyzes two issues: (1) ''whether past warhead reliability problems demonstrate that nuclear explosive testing is needed to identify or to correct stockpile reliability,'' or (2) ''whether a program of stockpile inspection, nonnuclear testing, and remanufacture would be sufficient to deal with stockpile reliability problems.'' Chapter 1 examines the reasons for nuclear testing. Although the thrust of the request from Congressman Aspin et al., has to do with the need for nuclear testing as it relates to stockpile reliability and remanufacture, there are other very important reasons for nuclear testing. Since there has been increasing interest in the US Congress for more restrictive nuclear test limits, we have addressed the overall need for nuclear testing and the potential impact of further nuclear test limitations. Chapter 1 also summarizes the major conclusions of a recent study conducted by the Scientific and Academic Advisory Committee (SAAC) for the President of the University of California; the SAAC report is entitled, ''Nuclear Weapon Tests: The Role of the University of California-Department of Energy Laboratories.'' Chapter 2 presents a brief history of stockpile problems that involved post-deployment nuclear testing for their resolution. Chapter 3 addresses the problems involved in remanufacturing nuclear weapons, and Chapter 4 discusses measures that should be taken to prepare for possible future restrictive test limits.

  9. Internet-based monitoring and prediction system of coal stockpile behaviors under atmospheric conditions.

    Science.gov (United States)

    Yilmaz, Nihat; Ozdeniz, A Hadi

    2010-03-01

    Spontaneous combustion on industrial-scale stockpiles causes environmental problems and economic losses for the companies consuming large amounts of coal. In this study, an effective monitoring and prediction system based on internet was developed and implemented to prevent losses and environmental problems. The system was performed in a coal stockpile with 5 m width, 10 m length, 3 m height, and having 120 t of weight. The inner temperature data of the stockpile was recorded by 17 temperature sensors placed inside the stockpile at certain points. Additionally, the data relating to the air temperature, air humidity, atmospheric pressure, wind velocity, and wind direction that are the parameters affecting the coal stockpile were also recorded. The recorded values were analyzed with artificial neural network and Statistical modeling methods for prediction of spontaneous combustion. Real-time measurement values and model outputs were published with a web page on internet. The internet-based system can also provide real-time monitoring (combustion alarms, system status) and tele-controlling (Parameter adjusting, system control) through internet exclusively with a standard web browser without the need of any additional software.

  10. Numerical modeling of flow structures over various flat-topped stockpiles height: Implications on dust emissions

    Science.gov (United States)

    Turpin, C.; Harion, J.-L.

    Fugitive dust emissions from open stock yards for bulk materials, such as coal or ores, can represent a significant part of overall estimated atmospheric emission on industrial site, as example on steel plant sites. Stockpile topography is known to modify the near field uptake force of the wind through changes of the mean flow. Various studies have shown that aeolian erosion strongly occurs on the stockpile crest, so it appears relevant to carry out a study to analyze the effect on the dust emissions of the stockpile clipping. Three-dimensional numerical simulations were done with the aim of simulating wind flow over different flat-topped pile scenarios, corresponding to a constant material volume. Various wind flow directions were tested to determine its impact on particle emissions. Data obtained from Computational Fluid Dynamics simulations were then integrated in order to estimate the effect of the clipping on the stockpiles dust emission rates by using the EPA's emission factors method. Results provide evidence to suggest that clipping stockpiles does not reduce dust emissions. This study provides to industrial operators some informations on the best geometrical pile characteristics in order to limit particles emissions.

  11. Implementation of rapid diagnostics with antimicrobial stewardship.

    Science.gov (United States)

    Minejima, Emi; Wong-Beringer, Annie

    2016-11-01

    Antimicrobial stewardship (ASP) is an intervention-based program to improve patient outcomes to infection while limiting spread of resistance and unintended consequences. Many rapid diagnostic tools are now FDA cleared for clinical use, with three evaluated across multiple settings: Matrix Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry, Verigene, and FilmArray. Areas covered: This review will focus on studies published that evaluated ASP intervention with rapid diagnostic implementation on outcomes of infection. A description of the key ASP personnel, rapid diagnostic notification methods, hours of notification, and scope of ASP intervention is summarized. Expert commentary: It is critical that ASPs continually re-evaluate and evolve with technological advances. Rapid diagnostic tools are powerful in their ability to identify organisms quickly. A trained clinician is needed to evaluate the results and interact with the providers to educate them on result interpretation and optimal antimicrobial selection to maximize treatment success.

  12. Antimicrobial Stewardship in Laboratory Animal Facilities.

    Science.gov (United States)

    Narver, Heather L

    2017-01-01

    Bacterial resistance to antimicrobial drugs has become a global health crisis. Physicians and veterinarians are embracing the concept of 'antimicrobial stewardship' (AMS) to preserve the efficacy of antibiotics for future generations. Antimicrobials are used in laboratory animals to treat clinical disease, to protect populations that may be vulnerable to infection, and in research projects including studies of the microbiome and to influence expression in genetically engineered animals. This overview provides a critical look at the use of antimicrobials in contemporary vivaria, with special attention to rodents because they are the most commonly used species in research and because antimicrobial use in rodents is not straightforward. Improvements in antibiotic use are encouraged with the goal of decreasing bacterial resistance while continuing to provide quality clinical care and research support. Suggestions are framed by using the 5 Rs: Reduce, Refine, Replace, and Review antimicrobial use in the vivarium, and take Responsibility for the judicious use of antibiotics in research animals.

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

    DEFF Research Database (Denmark)

    Simonsen, Marianne; Skipper, Lars; Skipper, Niels

    -rate to a non-linear insurance plan for prescription drugs that incentivizes stockpiling at the end of the coverage year. We extend the original framework of Keeler et al. (1977) and discuss how the institutional features of most health insurance contracts, at least theoretically, incentivize intertemporal......This paper provides evidence of forward-looking behavior in the demand for prescription drugs, while relying on registry-based, individual-level information about the universe of Danish prescription drug purchases from 1995–2014. We exploit a universal shift in policy in early 2000 from a flat...... of the response by individual-level characteristics, proxies for health status, and drug type. We find no evidence of any immediate adverse health utilization effects associated with the stockpiling. We round off the paper with an analysis of the importance of stockpiling for estimates of price sensitivity. We...

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

    Energy Technology Data Exchange (ETDEWEB)

    Franssila, T.; Leinonen, A.

    1996-12-31

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

  15. How to educate prescribers in antimicrobial stewardship practices

    NARCIS (Netherlands)

    Pulcini, C.; Gyssens, I.C.J.

    2013-01-01

    Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection

  16. Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship.

    Science.gov (United States)

    Morency-Potvin, Philippe; Schwartz, David N; Weinstein, Robert A

    2017-01-01

    SUMMARYAntimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. Copyright © 2016 American Society for Microbiology.

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

    NARCIS (Netherlands)

    Dik, J.W.H.; Vemer, P.; Friedrich, A.W.; Hendrix, R.; Lo-Ten-Foe, J.R.; Sinha, B.; Postma, M.J.

    2015-01-01

    Introduction: There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the

  18. Using Watershed Stewardship to Build Sustainability and Resilience

    Science.gov (United States)

    This presentation is designed to help build understanding of how stewardship of water resources can help local communities develop sustainably and become more resilient; discuss how monitoring can engage communities and increase environmental awareness; and explore how monitoring...

  19. Antibiotic stewardship er etableret på Herlev Hospital

    DEFF Research Database (Denmark)

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

    2014-01-01

    A high incidence of Clostridium difficile and multiresistant organisms and increasing consumption of cephalosporins and quinolones have required an antibiotic stewardship programme, and antibiotic audits with feedback, revised guidelines and stringent prescription rules have been successful...

  20. Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

    Science.gov (United States)

    Schwartz, David N.; Weinstein, Robert A.

    2016-01-01

    SUMMARY Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. PMID:27974411

  1. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

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

  2. Restoration, stewardship, environmental health, and policy: understanding stakeholders' perceptions.

    Science.gov (United States)

    Burger, Joanna

    2002-11-01

    In recent years there has been considerable interest in the health of humans and the environment, restoration of contaminated or otherwise degraded lands, and in long-term stewardship of public lands. Unfortunately, it is unclear whether governmental agencies and the public hold similar views about the meanings of these concepts, making policy decisions about restoration and stewardship difficult. In this paper, I explore how the public conceptualizes restoration and stewardship by examining the relative rating of several attributes of restoration, stewardship, environmental health, ecological health, environmental restoration, and ecological restoration. People were interviewed in Santa Fe, New Mexico, USA, near the Department of Energy's Los Alamos National Laboratory. The ratings of attributes of environmental health and ecological health reported in this paper can be used to understand how the public understands these concepts. The attributes rated most highly by the subjects were more similar to definitions in the scientific literature for these terms than they were to those used by the Department of Energy. For environmental health, the highest rating related to human sanitation, while for ecological health the highest rating was for maintaining functioning ecosystems. Reduction of exposure to hazardous substances was rated the second highest for both environmental and ecological health. The wise use of natural resources, preservation of natural resources, and hazardous waste site cleanup were rated the highest attributes of stewardship. These data suggest that both expert and nonexpert perceptions about restoration and stewardship should be incorporated into environmental management decisions.

  3. Reducing drying energy and costs by process alterations at aggregate stockpiles

    NARCIS (Netherlands)

    Thijssen, G.J.; Schott, D.L.; Demmink, E.W.; Lodewijks, G.

    2010-01-01

    In the field of bulk solids, handling knowledge on moisture behaviour in aggregate stockpiles can be useful for process optimisation in terms of energy consumption. In the asphalt industry, an increase in moisture content leads to a significant increase in energy consumption. To determine the

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

    NARCIS (Netherlands)

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

    1999-01-01

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

  5. 77 FR 16205 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-03-20

    ... interest to the National Defense Stockpile Manager. In Attachment 1, the Defense Logistics Agency (DLA) lists the quantities of materials associated with three proposed material research and development... quantities listed in Attachment 1 are not acquisition target quantities, but rather a statement of the...

  6. 77 FR 42271 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-07-18

    ... interest to the National Defense Stockpile Manager. In Attachment 1, the Defense Logistics Agency (DLA) lists the quantities of materials associated with the two material research and development projects to... material research and development projects. The quantities listed in Attachment 1 are not acquisition...

  7. Science-based natural resource management decisions: what are they?

    Science.gov (United States)

    T.J. Mills; T.M. Quigley; F.J. Everest

    2001-01-01

    While many people interested in natural resources management propose science-based decisions, it is not clear what “science-based” means. Science-based decisions are those that result from the full and complete consideration of the relevant science information. We offer five guidelines to focus the scientist’s contributions to science-based decisionmaking and use the...

  8. Antiviral resistance during pandemic influenza: implications for stockpiling and drug use

    Directory of Open Access Journals (Sweden)

    Bowman Christopher S

    2009-01-01

    Full Text Available Abstract Background The anticipated extent of antiviral use during an influenza pandemic can have adverse consequences for the development of drug resistance and rationing of limited stockpiles. The strategic use of drugs is therefore a major public health concern in planning for effective pandemic responses. Methods We employed a mathematical model that includes both sensitive and resistant strains of a virus with pandemic potential, and applies antiviral drugs for treatment of clinical infections. Using estimated parameters in the published literature, the model was simulated for various sizes of stockpiles to evaluate the outcome of different antiviral strategies. Results We demonstrated that the emergence of highly transmissible resistant strains has no significant impact on the use of available stockpiles if treatment is maintained at low levels or the reproduction number of the sensitive strain is sufficiently high. However, moderate to high treatment levels can result in a more rapid depletion of stockpiles, leading to run-out, by promoting wide-spread drug resistance. We applied an antiviral strategy that delays the onset of aggressive treatment for a certain amount of time after the onset of the outbreak. Our results show that if high treatment levels are enforced too early during the outbreak, a second wave of infections can potentially occur with a substantially larger magnitude. However, a timely implementation of wide-scale treatment can prevent resistance spread in the population, and minimize the final size of the pandemic. Conclusion Our results reveal that conservative treatment levels during the early stages of the outbreak, followed by a timely increase in the scale of drug-use, will offer an effective strategy to manage drug resistance in the population and avoid run-out. For a 1918-like strain, the findings suggest that pandemic plans should consider stockpiling antiviral drugs to cover at least 20% of the population.

  9. Nutrigenomics and the stewardship of scientific promises.

    Science.gov (United States)

    Penders, Bart; Goven, Joanna

    2010-09-01

    Here we analyze the rise and establishment of nutrigenomics versus nutrition science from a political perspective. We argue that the exceptionalist status of nutrigenomics has been brought about by a carefully orchestrated economy of expectation, enabling the nutrigenomics community to develop its own research agenda that differs significantly from that of nutrition science. Nutrigenomics promotes research specifically directed towards the heterogeneity of dietary guidelines, while nutrition science pursues a public health goal dominated by homogeneous health messages. Through the development of genomic technology and the protective niche created by large global funding initiatives, this heterogeneity-research agenda has been able to develop itself. Those pursuing and supporting it have, through nutrigenomics' economy of expectation, influenced public opinion, and regulatory and political structures dealing with food and health. With many big global nutrigenomics initiatives slowly approaching their end, this article hints at some of the possible political consequences of its economy of expectation and suggests that a "stewardship" of promises and expectations is in order

  10. NASA'S Earth Science Data Stewardship Activities

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    A. Paige. Fischer

    2015-12-01

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

  12. Long-Term Stewardship Program Science and Technology Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Joan McDonald

    2002-09-01

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

  13. Cultural Stewardship Accountability of Seed Bank Institutions for Indigenous Knowledge

    Directory of Open Access Journals (Sweden)

    Mark L Shepheard

    2015-01-01

    Full Text Available A growing emphasis among seed banks in Australia and globally is the collection of seed and information associated with wild crop relatives of food and fodder crops. This is part of scientific efforts to store and document plant traits that may prove useful to deal with risks to food and bio security in the face of global climate changes. This has implications for indigenous communities because of the risk that indigenous knowledge may be collected and included as ‘data’ rather than as knowledge with significant cultural tethering. This articl provides a theoretical context for institutional seed banks to engage with indigenous people and specify indigenous knowledge stewardship accountability. This should help seed banks to operate with sensitivity to cultural wellbeing and minimise the risks from failure to satisfy accountability for indigenous knowledge stewardship. The article identifies four interrelated dimensions of indigenous knowledge stewardship, and identifies a tentative process for institutions to adapt this to indigenous knowledge stewardship strategy and practice. The process for realising indigenous knowledge stewardship accountability is the subject of further research.

  14. Integrating Information Networks for Collective Planetary Stewardship

    Science.gov (United States)

    Tiwari, A.

    2016-12-01

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

  15. Valuation and Remuneration of Countryside Stewardship Performed by Agriculture and Forestry

    OpenAIRE

    Merlo, Maurizio; Ferro, Ottone; Povellato, Andrea

    1995-01-01

    The scope of this paper is to clarify the concept of countryside stewardship. Attention is focused on Western Europe, where the concept has political, legal and economic connotations, and where ethical and cultural values are also important. The economic nature and value of stewardship are examined, and the policy instruments aimed at inducing countryside stewardship are probed. This paper refers to the benefits of stewardship, defined as the production of positive environmental effects or sa...

  16. Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era.

    Science.gov (United States)

    Desai, Sachin N; Pezzoli, Lorenzo; Alberti, Kathryn P; Martin, Stephen; Costa, Alejandro; Perea, William; Legros, Dominique

    2017-03-04

    Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.

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

    Science.gov (United States)

    Molsher, Robyn; Townsend, Mardie

    2016-03-01

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

  18. Evaluating ecological monitoring of civic environmental stewardship in the Green-Duwamish watershed, Washington

    Science.gov (United States)

    Jacob C. Sheppard; Clare M. Ryan; Dale J. Blahna

    2017-01-01

    The ecological outcomes of civic environmental stewardship are poorly understood, especially at scales larger than individual sites. In this study we characterized civic environmental stewardship programs in the Green-Duwamish watershed in King County, WA, and evaluated the extent to which stewardship outcomes were monitored. We developed a four-step process based on...

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

    Science.gov (United States)

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

    2013-01-01

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

  20. 77 FR 38267 - Information Collection; Role of Communities in Stewardship Contracting Projects

    Science.gov (United States)

    2012-06-27

    ..., Role of Communities in Stewardship Contracting Projects. DATES: Comments must be received in writing on.... SUPPLEMENTARY INFORMATION: Title: Role of Communities in Stewardship Contracting Projects. OMB Number: 0596-0201...; ] DEPARTMENT OF AGRICULTURE Forest Service Information Collection; Role of Communities in Stewardship...

  1. Exceptions or alternatives to labeling requirements for products held by the Strategic National Stockpile. Final rule.

    Science.gov (United States)

    2012-02-06

    The Food and Drug Administration (FDA) is adopting as a final rule, without change, the interim final rule that issued regulations permitting FDA Center Directors to grant exceptions or alternatives to certain regulatory labeling requirements applicable to human drugs, biological products, or medical devices that are or will be included in the Strategic National Stockpile (SNS). FDA is taking this action to complete the rulemaking initiated with the interim final rule.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J.R.

    1998-11-01

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

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

    Science.gov (United States)

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

    2017-11-01

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

  4. Characterization of outbreak response strategies and potential vaccine stockpile needs for the polio endgame.

    Science.gov (United States)

    Duintjer Tebbens, Radboud J; Pallansch, Mark A; Wassilak, Steven G F; Cochi, Stephen L; Thompson, Kimberly M

    2016-03-24

    Following successful eradication of wild polioviruses and planned globally-coordinated cessation of oral poliovirus vaccine (OPV), national and global health leaders may need to respond to outbreaks from reintroduced live polioviruses, particularly vaccine-derived polioviruses (VDPVs). Preparing outbreak response plans and assessing potential vaccine needs from an emergency stockpile require consideration of the different national risks and conditions as they change with time after OPV cessation. We used an integrated global model to consider several key issues related to managing poliovirus risks and outbreak response, including the time interval during which monovalent OPV (mOPV) can be safely used following homotypic OPV cessation; the timing, quality, and quantity of rounds required to stop transmission; vaccine stockpile needs; and the impacts of vaccine choices and surveillance quality. We compare the base case scenario that assumes aggressive outbreak response and sufficient mOPV available from the stockpile for all outbreaks that occur in the model, with various scenarios that change the outbreak response strategies. Outbreak response after OPV cessation will require careful management, with some circumstances expected to require more and/or higher quality rounds to stop transmission than others. For outbreaks involving serotype 2, using trivalent OPV instead of mOPV2 following cessation of OPV serotype 2 but before cessation of OPV serotypes 1 and 3 would represent a good option if logistically feasible. Using mOPV for outbreak response can start new outbreaks if exported outside the outbreak population into populations with decreasing population immunity to transmission after OPV cessation, but failure to contain outbreaks resulting in exportation of the outbreak poliovirus may represent a greater risk. The possibility of mOPV use generating new long-term poliovirus excretors represents a real concern. Using the base case outbreak response assumptions, we

  5. Developing the first national antimicrobial prescribing and stewardship competences.

    Science.gov (United States)

    Ashiru-Oredope, D; Cookson, B; Fry, C

    2014-11-01

    Antimicrobial resistance is a national and worldwide threat to the future of healthcare. Educating both healthcare staff and the public in the prudent use of antimicrobials is an essential part of antimicrobial stewardship programmes that aim to contain and control resistance and preserve the usefulness of currently available antibiotics. Using current available evidence, regulatory documents and national antimicrobial stewardship guidance for primary and secondary care, five dimensions for antimicrobial prescribing and stewardship competences have been developed in England, through an independent multiprofessional group led by the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) of the Department of Health (England). They are designed to complement the generic competency framework for all prescribers from the UK National Prescribing Centre (now part of National Institute for Health and Care Excellence) and are relevant to all independent prescribers, including doctors, dentists and non-medical practitioners. The antimicrobial prescribing and stewardship competences published jointly by ARHAI and PHE in 2013 are believed to be the first of their kind. Implementation of these competences will be an important contribution to the delivery of the UK government's 5 year Antimicrobial Resistance Strategy. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

    Holmes, Tiffany

    2007-01-01

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

  8. Mixed methods analysis of urban environmental stewardship networks

    Science.gov (United States)

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

    2015-01-01

    While mixed methods approaches to research have been accepted practice within the social sciences for several decades (Tashakkori and Teddlie 2003), the rising demand for cross-disciplinary analyses of socio-environmental processes has necessitated a renewed examination of this approach within environmental studies. Urban environmental stewardship is one area where it...

  9. Characteristics of stewardship in the Chicago Wilderness Region

    Science.gov (United States)

    Lynne M. Westphal; Amelie Y. Davis; Cindy Copp; Laurel M. Ross; Mark J. Bouman; Cherie L. Fisher; Mark K. Johnston

    2014-01-01

    We report on the early results of a survey-based assessment of stewardship activities within the Chicago Wilderness region, work conducted as a part of the Chicago ULTRA-Ex project. Chicago Wilderness is a 270 member alliance focused on preserving and enhancing biodiversity throughout northern Illinois and parts of Wisconsin, Indiana and Michigan (USA). The results...

  10. Watershed management contributions to land stewardship: A literature review

    Science.gov (United States)

    Malchus B. Baker; Peter F. Folliott; Carleton B. Edminster; Karen L. Mora; Madelyn C. Dillon

    2000-01-01

    An international conference to increase people's awareness of the contributions that watershed management can make to future land stewardship was held in Tucson, Arizona, March 13-16, 2000. This bibliography is a compilation of the synthesis and poster papers presented at the conference along with the literature cited in these papers on watershed research projects...

  11. Social and institutional influences on wilderness fire stewardship

    Science.gov (United States)

    Katie Knotek

    2005-01-01

    One of the priority research areas at the Aldo Leopold Wilderness Research Institute addresses the “need for improved information to guide the stewardship of fire as a natural process in wilderness while protecting social and ecological values inside and outside wilderness.” This research topic area was developed with the knowledge that wildland fire, as a natural...

  12. 75 FR 80566 - Meeting of the Regional Resource Stewardship Council

    Science.gov (United States)

    2010-12-22

    ... Environmental Impact Statement (EIS) in which TVA will evaluate the preferred strategy for the NRP, as well as other viable alternative strategies. TVA would like to utilize the RRSC as a key stakeholder group.... Written comments are also invited and may be mailed to the Regional Resource Stewardship Council...

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  14. Stewardship: A Biblical Model for the Formation of Christian Scholars

    Science.gov (United States)

    Smith, Julien C. H.; Scales, T. Laine

    2013-01-01

    This article explores theological dimensions of the academic vocation, taking its cue from the research undertaken by the Carnegie Initiative on the Doctorate, which envisions the scholar as a steward of an academic discipline. We contend, however, that the Christian scholar's sense of stewardship extends beyond one's academic…

  15. Implementation of a proton pump inhibitor stewardship program.

    Science.gov (United States)

    Davis, Kelly W; Hanners, Rachel E; Lockwood, Sean M

    2017-06-15

    The development and implementation of a proton pump inhibitor (PPI) stewardship program at a single institution are described. Due to the overuse of PPIs and the increasing awareness of the adverse drug events associated with long-term PPI therapy, the pharmacy and internal medicine services of a medical center implemented a PPI stewardship program. All patients admitted to the internal medicine service were evaluated by the PPI stewardship team to determine if they had an appropriate indication for PPI continuation in the hospital as well as after discharge. If patients did not meet specified criteria for continuation of PPI use during hospitalization, PPI therapy was suspended and replaced by as-needed acid suppressive therapy, and the patients received discharge counseling regarding the implemented medication regimen changes. Challenges encountered during program development included establishing appropriate criteria for PPI continuation and determining the best method for discontinuing PPIs in order to reduce the risk of rebound hyperacidity. In an effort to reduce unnecessary PPI use, a PPI stewardship program was developed and implemented to ensure appropriate continuation of PPIs for patients admitted and discharged from an internal medicine service. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  16. New models of antibiotic stewardship for South Africa?

    African Journals Online (AJOL)

    resistance, and antibiotic stewardship (AS), the optimisation of appropriate antibiotic use. A practical guide to AS for ... compounded by geographical disparity, and a lack of understanding of the contextual and behavioural ... and their outreach sites, which focused on AS ward rounds to change prescribing practice.[14] The ...

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

    African Journals Online (AJOL)

    To achieve the desired accountability and probity in the corporate world, the accounting profession has crucial roles to perform in this regard. Users of accounting information all over the world expect the Accountant to attest to the accuracy of stewardship report provided by management while the auditor provides assurance ...

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

    NARCIS (Netherlands)

    Kok, H.B.

    2011-01-01

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

  19. Assessment of Undergraduate Students' Environmental Stewardship Reasoning and Knowledge

    Science.gov (United States)

    Hartman, Christie-Joy Brodrick; DeMars, Christine E.; Griscom, Heather Peckham; Butner, Harold Martin

    2017-01-01

    Purpose: The purpose of this paper is to present a public university's design and implementation of an assessment approach that measures the change in undergraduate students' environmental stewardship reasoning and knowledge abilities over time. Design/methodology/approach: In support of a university's strategic emphasis on environmental…

  20. Considerations for Future Climate Data Stewardship

    Science.gov (United States)

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

    2009-12-01

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

  1. The Role of Stewardship in Addressing Antibacterial Resistance: Stewardship and Infection Control Committee of the Antibacterial Resistance Leadership Group.

    Science.gov (United States)

    Anderson, Deverick J; Jenkins, Timothy C; Evans, Scott R; Harris, Anthony D; Weinstein, Robert A; Tamma, Pranita D; Han, Jennifer H; Banerjee, Ritu; Patel, Robin; Zaoutis, Theoklis; Lautenbach, Ebbing

    2017-03-15

    Antibacterial resistance is increasing globally and has been recognized as a major public health threat. Antibacterial stewardship is the coordinated effort to improve the appropriate use of antibiotics with the aim to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents. This article describes the activities of the Antibacterial Resistance Leadership Group (ARLG) in the area of antibacterial stewardship. To date, the ARLG has focused intensely on development of rapid diagnostic tests, which (when coupled with educational and institutional initiatives) will enable the robust stewardship that is needed to address the current crisis of antibacterial resistance. In addition to exploring the effectiveness of stewardship techniques in community hospitals, the ARLG has also developed strategy trials to assess the feasibility of reducing antibacterial usage while preserving patient outcome. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  2. NEAR REAL TIME CHARACTERIZATION OF BNL STOCKPILED SOILS, ANOTHER ASTD SUCCESS STORY.

    Energy Technology Data Exchange (ETDEWEB)

    BOWERMAN,B.S.; ADAMS,J.W.; KALB,P.D.; LOCKWOOD,A.

    2003-02-23

    As of October 2001, approximately 7,000 yd{sup 3} of stockpiled soil, contaminated to varying degrees with radioactive materials and heavy metals, remained at Brookhaven National Laboratory (BNL) after the remediation of the BNL Chemical/Animal/Glass Pits disposal area. During the 1997 removal action, the more hazardous/radioactive materials were segregated, along with, chemical liquids and solids, animal carcasses, intact gas cylinders, and a large quantity of metal and glass debris. Nearly all of these materials have been disposed of. In order to ensure that all debris was removed and to characterize the large quantity of heterogeneous soil, BNL initiated an extended sorting, segregation, and characterization project, co-funded by the BNL Environmental Management Directorate and the DOE EM Office of Science and Technology Accelerated Site Technology Deployment (ASTD) program. Project objectives were to remove any non-conforming items, and to assure that mercury and radioactive contaminant levels were within acceptable limits for disposal as low-level radioactive waste. Sorting and segregation were conducted simultaneously. Large stockpiles, ranging from 150 to 1,200 yd{sup 3}, were subdivided into manageable 20 yd{sup 3} ''subpiles'' after powered vibratory screening. The 1/2 inch screen removed gravel and almost all non-conforming items, which were separated for further characterization. Soil that passed through the screen was also visually inspected before being moved to a subpile. Eight samples plus QA duplicates were collected from each subpile for chemical analysis, and a 1-Liter jar of material for gamma spectroscopy. A field lab equipped for chemical analysis and gamma spectroscopy was set up in a trailer close by the stockpile site. Chemical analysis included X-ray fluorescence (XRF) to screen for high (>260 ppm) total mercury concentrations, and modified Toxicity Characteristic Leaching Procedure (TCLP) tests to verify that the soils

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

    Directory of Open Access Journals (Sweden)

    Joseph T Wu

    2009-05-01

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

  4. Promoting science-based prevention in communities.

    Science.gov (United States)

    Hawkins, J David; Catalano, Richard F; Arthur, Michael W

    2002-01-01

    In the past decade, prevention science has emerged as a discipline built on the integration of life course development research, community epidemiology, and preventive intervention trials [Am. Psychol. 48 (1993) 1013; Am. J. Community Psychol. 27 (1999) 463; Kellam, S. G., & Rebok, G. W. (1992). Building developmental and etiological theory through epidemiologically based preventive intervention trials. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: interventions from birth through adolescence (pp. 162-195). New York: Guilford Press.]. Prevention science is based on the premise that empirically verifiable precursors (risk and protective factors) predict the likelihood of undesired health outcomes including substance abuse and dependence. Prevention science postulates that negative health outcomes like alcohol abuse and dependence can be prevented by reducing or eliminating risk factors and enhancing protective factors in individuals and their environments during the course of development. A growing number of interventions have been found to be effective in preventing adolescent tobacco, alcohol, and other drug abuse, delinquency, violence, and related health risk behaviors by reducing risk and enhancing protection. During the same decade, comprehensive community-based interventions to prevent adolescent health and behavior problems have been widely implemented in the U.S. with federal and foundation support. Despite the advances in the science base for effective preventive interventions and the investments in community-wide preventive interventions, many communities continue to invest in prevention strategies with limited evidence of effectiveness [Am. J. Public Health 84 (1994) 1394; J. Res. Crime Delinq. 39 (2002) 3; J. Community Psychol. 28 (2000) 237; J. Community Psychol. 28 (2000) 237; J. Consult. Clin. Psychol. 67 (1999) 590; Eval. Program Plann. 20 (1997) 367.]. Translating prevention science into community prevention systems has

  5. Municipal solid waste combustor bottom ash stockpile runoff and dust emissions evaluation: Volume I, Part I & Part II

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-05-01

    This report describes a phase of the stockpile demonstration program concerned with the storage of ash from municipal waste combustion. To implement this program, bottom ash (BA) collected from the 400 ton per day Warren County Resource Recovery Facility (WCRRF), located in Oxford Township Warren County, New Jersey, was in processed to produce a sand-like aggregate product; stored on a specially constructed pad at the Warren County Landfill site; and monitored for approximately 12 months. During this time, the air, stormwater runoff and soil quality in the vicinity of the stockpile were monitored. An electronic weather station was also installed on site to monitor and record meteorological conditions. The data obtained during the monitoring period were then used to develop a bottom ash stockpile source model to project potential air emissions and runoff loadings from the stockpile. Model generated emissions and loadings figures were used to estimate potential acts on air, groundwater, surface water and soil quality in the vicinity of the stockpile.

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

    Science.gov (United States)

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

    2015-03-01

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

  7. Intermediation in Open Development: A Knowledge Stewardship Approach

    Directory of Open Access Journals (Sweden)

    Katherine M. A. Reilly

    2016-06-01

    Full Text Available Open Development (OD is a subset of ICT4D that studies the potential of IT-enabled openness to support social change among poor or marginalized populations. Early OD work examined the potential of IT-enabled openness to decentralize power and enable public engagement by disintermediating knowledge production and dissemination. However, in practice, intermediaries have emerged to facilitate open data and related knowledge production activities in development processes. We identify five models of intermediation in OD work: decentralized, arterial, ecosystem, bridging, and communities of practice and examine the implications of each for stewardship of open processes. We conclude that studying OD through these five forms of intermediation is a productive way of understanding whether and how different patterns of knowledge stewardship influence development outcomes. We also offer suggestions for future research that can improve our understanding of how to sustain openness, facilitate public engagement, and ensure that intermediation contributes to open development.

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Science.gov (United States)

    Weiss, Marjorie D

    2013-08-01

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

  10. Antibiotic stewardship through the EU project "ABS International".

    Science.gov (United States)

    Allerberger, Franz; Frank, Annegret; Gareis, Roland

    2008-01-01

    The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.

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

    Directory of Open Access Journals (Sweden)

    Samuel I. Watson

    2017-03-01

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

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

    Science.gov (United States)

    Pfaller, Michael A; Castanheira, Mariana

    2016-01-01

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

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

    Science.gov (United States)

    Vilhelmsson, Andreas; Mulinari, Shai

    2017-08-09

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

  14. Benefit-Cost Analysis of Radiocesium Decorporation by a Prussian Blue Treatment and Stockpiling.

    Science.gov (United States)

    Rump, Alexis; Stricklin, Daniela; Lamkowski, Andreas; Eder, Stefan; Port, Matthias

    2017-10-16

    In the case of an attack by a "dirty bomb" with cesium-137 there is a risk of internal contamination. The excretion of cesium-137 can be enhanced by Prussian Blue (PB), and thus the committed effective dose be reduced. We analyzed the benefit and costs of PB decorporation treatment. We simulated the reduction of the radiological dose by PB treatment after cesium-137 incorporation by inhalation. The saving of life time was quantified using the monetary "value of a statistical life" (VSL). Treatment costs were based on the market price of PB in Germany. Moreover we considered the holding costs of stockpiling. The benefit of PB treatment increases with its duration up to about 90 days. If treatment initiation is delayed, the maximum achievable benefit is decreased. For a VSL of 1.646 million €, the net benefit of a 90-days treatment started 1 day after the incorporation remains positive up to a stockpiling duration of 10 years. If starting PB treatment as late as the 180th day after incorporation, the costs will surpass the benefit. We conclude that a prompt decision making and early treatment initiation greatly impacts on the medical but also economic efficiency of a PB treatment. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Model predictions and experimental results on self-heating prevention of stockpiled coals

    Energy Technology Data Exchange (ETDEWEB)

    Fierro, V.; Miranda, J.L.; Romero, C.; Andres, J.M.; Arriaga, A.; Schmal, D. [Instituto de Carboquimica, Zaragoza (Spain)

    2001-01-01

    The spontaneous combustion of coal stockpiles is a serious economic and safety problem. This phenomenon is analysed using a TNO-model modified to predict the spontaneous heating behaviour of coal piles built with 'Mezcla', a mixture of low rank coals from Teruel (Spain). The simulation carried out with the mathematical model for this coal showed that the pile porosity or voidage and wind speed play an important role, although voidage is decisive and controls the effect of the wind velocity. To reduce the negative effects of both factors, five test coal piles (2000-3000 t) were built and several measures were applied to four of them: periodic compaction, use of a low angle slope, protection of the stockpiled coal with an artificial wind barrier and covering it with an ash-water slurry. The heat losses were experimentally determined and it was found that the mathematical model gave predictions of the right order of magnitude of time, site of spontaneous combustion and magnitude of calorific losses. All the methods of protection applied to decrease the self-heating of coal were effective, but the experimental results indicate that the most economical way to avoid the heat losses is the use of an ash-water slurry to cover the coal pile. 28 refs., 8 figs., 5 tabs.

  16. Science-based Framework for Environmental Benefits Assessment

    Science.gov (United States)

    2013-03-01

    studied and may be coarsely divided into four major categories: 1) narrative description, 2) arithmetic combination, 3) multicriteria decision analysis ...ER D C/ EL T R -1 3 -4 Environmental Benefits Analysis Program Science-based Framework for Environmental Benefits Assessment E nv ir...acwc.sdp.sirsi.net/client/default. Environmental Benefits Analysis Program ERDC/EL TR-13-4 March 2013 Science-based Framework for Environmental Benefits

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

    Energy Technology Data Exchange (ETDEWEB)

    Shah, M.M.

    1999-01-18

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

  18. Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists

    OpenAIRE

    Gilchrist, Mark; Wade, Paul; Ashiru-Oredope, Diane; Howard, Philip; Sneddon, Jacqueline; Whitney, Laura; Wickens, Hayley

    2015-01-01

    Antimicrobial stewardship in the UK has evolved dramatically in the last 15 years. Factors driving this include initial central funding for specialist pharmacists and mandatory reductions in healthcare-associated infections (particularly Clostridium difficile infection). More recently, the introduction of national stewardship guidelines, and an increased focus on stewardship as part of the UK five-year antimicrobial resistance strategy, have accelerated and embedded developments. Antimicrobia...

  19. 15 CFR Supplement No. 1 to Part 710 - States Parties to the Convention on the Prohibition of the Development, Production, Stockpiling...

    Science.gov (United States)

    2010-01-01

    ... the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their... the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their Destruction List of... Timor) Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab...

  20. 15 CFR Supplement No. 2 to Part 745 - States Parties to the Convention on the Prohibition of the Development, Production, Stockpiling...

    Science.gov (United States)

    2010-01-01

    ... the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their... Parties to the Convention on the Prohibition of the Development, Production, Stockpiling, and Use of... The United Arab Emirates Timor Leste (East Timor) Togo Tonga Trinidad and Tobago Tunisia Turkey...

  1. When pharmacodynamics trump costs: an antimicrobial stewardship program's approach to selecting optimal antimicrobial agents

    National Research Council Canada - National Science Library

    Goff, Debra A; Nicolau, David P

    2013-01-01

    .... Antimicrobial stewardship programs provide guidance for clinicians regarding use of the most appropriate antimicrobial at the right dose, duration, and route in addition to being cost-effective...

  2. Materials and Sensor R&D to Transform the Nuclear Stockpile: Livermore?s Transformational Materials Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Maxwell, R; Fried, L; Campbell, G; Saab, A; Kotovsky, J; Carter, C; Chang, J

    2009-10-11

    As the nation's nuclear weapons age and the demands placed on them change, significant challenges face the nuclear stockpile. Risks include material supply issues, ever-increasing lifecycle costs, and loss of technical expertise across the weapons complex. For example, non-nuclear materials are becoming increasingly difficult to replace because manufacturing methods and formulations have evolved in such a way as to render formerly available materials unprofitable, unsafe, or otherwise obsolete. Subtle formulation changes in available materials that occur without the knowledge of the weapons community for proprietary reasons have frequently affected the long-term performance of materials in the nuclear weapon environment. Significant improvements in performance, lifetime, or production cost can be realized with modern synthesis, modeling, and manufacturing methods. For example, there are currently supply and aging issues associated with the insensitive high explosive formulations LX-17 and PBX 9502 that are based on triaminotrinitrobenzene (TATB) and Kel-F, neither of which are commercially available today. Assuring the reliability of the stockpile through surveillance and regularly scheduled Life Extension Programs is an increasingly expensive endeavor. Transforming our current stockpile surveillance--a system based on destructive testing of increasingly valuable assets--to a system based on embedded sensors has a number of potential advantages that include long-term cost savings, reduced risk associated with asset transportation, state-of-health assessments in the field, and active management of the stockpile.

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

    Directory of Open Access Journals (Sweden)

    Jaco Barendse

    2016-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-09-10

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

  5. COMPARISON BETWEEN MULTICOPTER UAV AND TOTAL STATION FOR ESTIMATING STOCKPILE VOLUMES

    Directory of Open Access Journals (Sweden)

    C. Arango

    2015-08-01

    Full Text Available Currently the UAV (Unmanned Aerial Vehicle have become an alternative for different engineering applications, especially in surveying, one of these applications is the calculation of volumes of stockpiled material, but there are questions about its accuracy and efficiency, the purpose of this article is to compare traditional surveying methods for estimating total volumes through data obtained by total stations and data obtained by a multicopter UAV. In order to answer these questions we obtain data from the same location and the results were compared. After comparing the results it was found that there was a 2,88% difference between the volume calculated with the total station data and the actual volume, and −0,67% difference between the volume calculated with the UAV data and the actual volume, concluding that the estimated volume with UAV data is more accurate.

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

    Science.gov (United States)

    Greenberg, Michael R.

    2003-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    No name listed on publication

    2011-08-01

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

  8. Sensors for environmental monitoring and long-term environmental stewardship.

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David Russell; Robinson, Alex Lockwood; Ho, Clifford Kuofei; Davis, Mary Jo (Science Applications International Corporation, Albuquerque, NM)

    2004-09-01

    This report surveys the needs associated with environmental monitoring and long-term environmental stewardship. Emerging sensor technologies are reviewed to identify compatible technologies for various environmental monitoring applications. The contaminants that are considered in this report are grouped into the following categories: (1) metals, (2) radioisotopes, (3) volatile organic compounds, and (4) biological contaminants. Regulatory drivers are evaluated for different applications (e.g., drinking water, storm water, pretreatment, and air emissions), and sensor requirements are derived from these regulatory metrics. Sensor capabilities are then summarized according to contaminant type, and the applicability of the different sensors to various environmental monitoring applications is discussed.

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

    Science.gov (United States)

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

    2012-01-01

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

  10. 77 FR 33239 - Prairie Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park

    Science.gov (United States)

    2012-06-05

    ... National Park Service Prairie Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park AGENCY: National Park Service, Interior. ACTION: Notice of Intent to Prepare an Environmental... stewardship actions, and nature and extent of potential environmental consequences and appropriate mitigation...

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

    Science.gov (United States)

    Erika s. Svendsen; Lindsay K. Campbell

    2008-01-01

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

  12. Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

    Science.gov (United States)

    Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

    2016-03-01

    We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

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

    Directory of Open Access Journals (Sweden)

    Franciska von Heland

    2014-07-01

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

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

    Science.gov (United States)

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

    2014-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Edwin J.M. Oberjé

    2017-03-01

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

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

    Science.gov (United States)

    Oberjé, Edwin J M; Tanke, Marit A C; Jeurissen, Patrick P T

    2017-03-30

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

  17. Science Based Governance? EU Food Regulation Submitted to Risk Analysis

    NARCIS (Netherlands)

    Szajkowska, A.; Meulen, van der B.M.J.

    2014-01-01

    Anna Szajkowska and Bernd van der Meulen analyse in their contribution, Science Based Governance? EU Food Regulation Submitted to Risk Analysis, the scope of application of risk analysis and the precautionary principle in EU food safety regulation. To what extent does this technocratic,

  18. UK provides "step increase" in funding for its science base

    CERN Multimedia

    1998-01-01

    The British government has come good on pre-election promises when this week, it agreed to inject an extra 700 million into the country's science base over the next three years. This extra funding is boosted by a further 400 million pounds from the Welcome Trust over the same period (1 page).

  19. Strengthening Science-based Environmental Policy Development in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Strengthening Science-based Environmental Policy Development in Burma's Democratic Transition. For decades, it was very difficult to complete, share or access development research in Burma. However, in the past two years, the Burmese political landscape has seen far-reaching changes. The military junta has ...

  20. A dual justification for science-based policy-making

    DEFF Research Database (Denmark)

    Pedersen, David Budtz

    2014-01-01

    Science-based policy-making has grown ever more important in recent years, in parallel with the dramatic increase in the complexity and uncertainty of the ways in which science and technology interact with society and economy at the national, regional and global level. Installing a proper framework...

  1. Antimicrobial stewardship programme in critical care medicine: A prospective interventional study.

    Science.gov (United States)

    Ruiz, J; Ramirez, P; Gordon, M; Villarreal, E; Frasquet, J; Poveda-Andres, J L; Salavert-Lletí, M; Catellanos, A

    2017-09-04

    Hospital antimicrobial stewardship programmes have achieved savings and a more rational use of antimicrobial treatments in general wards. The purpose of this report is to evaluate the experience of an antimicrobial stewardship programme in an intensive care unit (ICU). Prospective interventional, before-and-after study. 24-bed medical ICU in a tertiary hospital. Prospective audit and feedback antimicrobial stewardship programme. Antimicrobial consumption, antimicrobial related costs, multi-drug resistant microorganisms (MDRM) prevalence, nosocomial infections incidence, ICU length of stay, and ICU mortality rates were compared before and after one-year intervention. A total of 218 antimicrobial episodes of 182 patients were evaluated in 61 team meetings. Antimicrobial stewardship suggestions were accepted in 91.5% of the cases. Total antimicrobial DDD/100 patient-days consumption was reduced from 380.6 to 295.2 (-22.4%; p=0.037). Antimicrobial stewardship programme was associated with a significant decrease in the prescription of penicillins plus b-lactamase inhibitors, linezolid, cephalosporins, and aminoglycosides. Overall antimicrobial spending was reduced by €119,636. MDRM isolation and nosocomial infections per 100 patient-days did not change after the intervention period. No changes in length of stay or mortality rate were observed. An ICU antimicrobial stewardship programme significantly reduced antimicrobial use without affecting inpatient mortality and length of stay. Our results further support the implementation of an antimicrobial stewardship programme in critical care units. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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

    DEFF Research Database (Denmark)

    Larsen, Anna Bira; Haugbølle, Lotte Stig

    2007-01-01

    ' handling and consumption of medication in terms of compliance behavior, and how does the assumption of user benefits made by health professionals and legislators measure up to users' experiences with ADD? METHODS: The results built on a secondary analysis of 9 qualitative interviews with a varied selection...... the more frequent type of behavior. After switching to ADD, most users experienced no change in understanding of their medications. ADD did not lead to automatic removal of old medications in users' homes; in fact for some users, ADD led to even larger medication stockpiles. Overall, reports from patients...... understanding, nor does it automatically eliminate stockpiles of old medication in users' homes. The gap between the perspectives of users and health professionals makes a compelling case for considering users' voices in the development and implementation of future health technologies....

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

    DEFF Research Database (Denmark)

    Borhan, Mohamad Termizi Bin; Ismail, Zurida

    2011-01-01

    students and promote an understanding of their responsibility to care for the world and its resources. This paper presents the findings from a study conducted to investigate the effect of project-based learning on students’ attitudes and behaviors towards the environment. A total of 173 pre......Environmental stewardship is living responsibly as a caretaker of the environment for the benefit of present and future generations and is quickly becoming one of the most pressing public priorities for communities today. As stewards, we are personally responsible for the care and preservation...... of our fellow communities: human, plant or animal. It is grounded in an understanding of the importance of environmental quality and natural resources to the human race and the effects of human actions on the environment. Thus, it is important to provide relevant educational experiences that involve...

  4. Health care provider education as a tool to enhance antibiotic stewardship practices.

    Science.gov (United States)

    Ohl, Christopher A; Luther, Vera P

    2014-06-01

    Antibiotic stewardship education for health care providers provides a foundation of knowledge and an environment that facilitates and supports optimal antibiotic prescribing. There is a need to extend this education to medical students and health care trainees. Education using passive techniques is modestly effective for increasing prescriber knowledge, whereas education using active techniques is more effective for changing prescribing behavior. Such education has been shown to enhance other antibiotic stewardship interventions. In this review, the need and suggested audience for antibiotic stewardship education are highlighted, and effective education techniques are recommended for increasing knowledge of antibiotics and improving their use. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-08-01

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

  6. Toxicity of vesicant agents scheduled for destruction by the chemical stockpile disposal program

    Energy Technology Data Exchange (ETDEWEB)

    Watson, A.P.; Griffin, G.D. (Oak Ridge National Lab., TN (United States))

    1992-11-01

    The vesicant agents of the unitary chemical munitions stockpile include various formulations of sulfur mustard [bis-(2-chloroethyl) sulfide; agents H, HD, and HT] and small quantities of the organic arsenical Lewisite [dichloro(2-chlorovinyl)arsine; agent L]. These agents can be dispersed in liquid, aerosol, or vapor form and are capable of producing severe chemical burns upon direct contact with tissue. Moist tissues such as the eyes, respiratory tract, and axillary areas are particularly affected. Available data summarizing acute dose response in humans and laboratory animals are summarized. Vesicant agents are also capable of generating delayed effects such as chronic bronchitis, carcinogenesis, or keratitis/keratopathy of the eye under appropriate conditions of exposure and dose. These effects may not become manifest until years following exposure. Risk analysis derived from carcinogenesis data indicates that sulfur mustard possesses a carcinogenic potency similar to that of benzo[a]pyrene. Because mustard agents are alkylating compounds, they destroy individual cells by reaction with cellular proteins, enzymes, RNA, and DNA. Once begun, tissue reaction is irreversible. Mustard agents are mutagenic; data for cellular and laboratory animal assays are presented. Reproductive effects have not been demonstrated in the offspring of laboratory rats. Acute Lewisite exposure has been implicated in cases of Bowen's disease, an intraepidermal squamous cell carcinoma. Lewisite is not known to generate reproductive or teratogenic effects. 112 refs., 1 fig., 6 tabs.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-07-01

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

  8. Recycling of plastics from stockpiles performed by means of low-pressure injection

    Directory of Open Access Journals (Sweden)

    J. Gintowt

    2010-07-01

    Full Text Available A viability analysis of manufacturing goods out of plastics, from stockpiles and municipal residues, has been carried out. The analysispertains goods in the form of inserts manufactured in light molds of big-sizes, by means of low-pressure injection. The cost analysis of the investment and manufacturing suggests that those goods are not price-competitive, as compared to other ones used in similar situations. Exploitation analysis proves that the goods, used outdoors are easily damaged on the surface by UV exposure, temperature differences of 24-hour cycle, as well as by water and plants. Re-recycling, and especially, the grinding of the product poses another challenge in the future. An analysis of the environmental impact of energy acquisition during the manufacturing of those goods was also carried out. The analysis also pertains the method of identifying the type of raw-material, in the process of segregation that stems from the necessity of a complex content training of staff running waste segregation posts.

  9. Integrated Baseline System (IBS), Version 1. 03. [Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, B.M.; Burford, M.J.; Downing, T.R.; Matsumoto, S.W.; Schrank, E.E.; Williams, J.R.; Winters, C.

    1993-01-01

    The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factored into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.

  10. Integrated Baseline System (IBS), Version 1.03. User guide: Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, B.M.; Burford, M.J.; Downing, T.R.; Matsumoto, S.W.; Schrank, E.E.; Williams, J.R.; Winters, C.

    1993-01-01

    The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factored into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.

  11. Aquaculture and environmental stewardship: Milford shellfish biology seminar—1991

    Science.gov (United States)

    Blogoslawski, Walter J.

    1992-07-01

    For the past 11 years the annual Shellfish Biology Seminar at Milford CT has provided a unique forum for aquaculture scientists and industry officials to exchange information about estuaries facing increased pollution problems, especially Long Island Sound and the Great South Bay. Because these two areas are so rich in productivity and diversity, fish and shellfish farmers utilize their waters, shellfish beds, and shore land for hatcheries and grow-out facilities. These individuals seek better management of the coastal estuarine environment and its resources, providing a working example of environmental stewardship. In aquaculture, good science is required to understand the complex variables and interaction of estuarine currents, tides, temperature, and cycles of reproduction. Aquaculturists are beginning to understand the need for specific nutrients and how the wastes of one species can be utilized for enhanced production of another species. Over the years, this meeting has formed an amalgam of both the aquaculture industry and research scientists where both groups foster mutual environmental concern. Science is able to focus on the theoretical aspects of pollutant damage. while the aquaculture industry is able to define the problem and need for assistance to eliminate pollutants from their crops—shellfish and finfish. Overfishing is not an issue at these meetings, as the group accepts the damage already done to wild resources and seeks new technologies to grow food sources under controlled and stable market conditions. Therefore, it could be said that the seminar serves as a meeting ground where the theoretical knowledge of scientific study finds practical application in the industry and is fueled by the needs of that industry. This ideal blend of the two groups produces better management of the resource and a safer environment—the goal of stewardship.

  12. Science-based bioprocess design for filamentous fungi.

    Science.gov (United States)

    Posch, Andreas E; Herwig, Christoph; Spadiut, Oliver

    2013-01-01

    Industrial bioprocesses are commonly based on empiricism rather than scientific process understanding. In this review, we summarize current strategies for science-based bioprocess design and control for filamentous fungi aiming at reducing development times and increasing process economics. We discuss recent developments and trends regarding three crucial aspects throughout the bioprocess life cycle of filamentous fungi, namely (i) strain and inoculum characterization, (ii) morphology, and (iii) rheology, as well as their effects on process performance. Complex interconnections between strain, inoculum, morphology, rheology, and process design are outlined and discussed. Only combining different hard type sensors with soft sensor technology and the development of simplified mechanistic models can enable science-based bioprocess design for filamentous fungi. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    KAUST Repository

    Phillips, F. A.

    2016-05-05

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

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

    Data.gov (United States)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-11-01

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

  16. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

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

    2014-01-01

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

  17. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

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

    2014-01-01

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

  18. Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): A Quality Improvement Collaborative.

    Science.gov (United States)

    Newland, Jason G; Gerber, Jeffrey S; Kronman, Matthew P; Meredith, Georgann; Lee, Brian R; Thurm, Cary; Hersh, Adam L

    2017-04-04

    Although many children's hospitals have established antimicrobial stewardship programs (ASPs), data-driven benchmarks for optimizing antimicrobial use across centers are lacking. We developed a multicenter quality improvement collaborative focused on sharing data reports and benchmarking antimicrobial use to improve antimicrobial prescribing among hospitalized children. A national antimicrobial stewardship collaborative among children's hospitals, Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), was established in 2013. Characteristics of the hospitals and their ASPs were obtained through a standardized survey. Antimicrobial-use data reports were developed on the basis of input from the participating hospitals. Collaborative learning opportunities were provided through monthly webinars and annual meetings. Since 2013, 36 US hospitals have participated in the SHARPS collaborative. The median full-time equivalent (pharmacist and physician) dedicated to 30 of these ASPs was 0.75 (interquartile range, 0.45-1.4). To date, the collaborative has developed 26 data reports that include benchmarking reports according to specific antimicrobial agents, indications, and clinical service lines. The collaborative has conducted 27 webinars and 3 in-person meetings to highlight the stewardship work being conducted in the hospitals. The data reports and learning opportunities have resulted in approximately 36 distinct stewardship interventions. A pediatric antimicrobial stewardship collaborative has been successful in promoting the development of and innovation among pediatric ASPs. Additional research is needed to determine the impact of these efforts.

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

    Directory of Open Access Journals (Sweden)

    Aysegul Nalca

    2010-05-01

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

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

    Science.gov (United States)

    Glaser, Alexander

    2017-11-01

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

  1. Evaluating environmental education, citizen science, and stewardship through naturalist programs.

    Science.gov (United States)

    Merenlender, Adina M; Crall, Alycia W; Drill, Sabrina; Prysby, Michelle; Ballard, Heidi

    2016-12-01

    Amateur naturalists have played an important role in the study and conservation of nature since the 17th century. Today, naturalist groups make important contributions to bridge the gap between conservation science and practice around the world. We examined data from 2 regional naturalist programs to understand participant motivations, barriers, and perspectives as well as the actions they take to advance science, stewardship, and community engagement. These programs provide certification-based natural history and conservation science training for adults that is followed by volunteer service in citizen science, education, and stewardship. Studies in California and Virginia include quantitative and qualitative evaluation data collected through pre- and postcourse surveys, interviews, and long-term tracking of volunteer hours. Motivations of participants focused on learning about the local environment and plants and animals, connecting with nature, becoming certified, and spending time with people who have similar interests. Over half the participants surveyed were over 50 years old, two-thirds were women, and a majority reported household incomes of over $50,000 (60% in California, 85% in Virginia), and <20% of those surveyed in both states described themselves as nonwhite. Thus, these programs need to improve participation by a wider spectrum of the public. We interviewed younger and underrepresented adults to examine barriers to participation in citizen science. The primary barrier was lack of time due to the need to work and focus on career advancement. Survey data revealed that participants' ecological knowledge, scientific skills, and belief in their ability to address environmental issues increased after training. Documented conservation actions taken by the participants include invasive plant management, habitat restoration, and cleanups of natural areas and streams. Long-term data from Virginia on volunteer hours dedicated to environmental citizen science

  2. LONG-TERM STEWARDSHIP AT DOE HANFORD SITE - 12575

    Energy Technology Data Exchange (ETDEWEB)

    MOREN RJ; GRINDSTAFF KD

    2012-01-11

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-10

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

  4. Generalizable principles for ecosystem stewardship-based management of social-ecological systems: lessons learned from Alaska

    OpenAIRE

    Hansen, Winslow D.

    2014-01-01

    Human pressure could compromise the provision of ecosystem services if we do not implement strategies such as ecosystem stewardship to foster sustainable trajectories. Barriers to managing systems based on ecosystem stewardship principles are pervasive, including institutional constraints and uncertain system dynamics. However, solutions to help managers overcome these barriers are less common. How can we better integrate ecosystem stewardship into natural resource management practices? I dr...

  5. [Implementation of the stewardship model in public health: proposal of an assessment tool for the Italian national prevention plan].

    Science.gov (United States)

    De Belvis, Antonio Giulio; La Torre, G; Marino, M; Di Thiene, D; Specchia, M L; Tanzariello, M; Saulle, R; Federici, A; Villari, P; Ricciardi, W; Boccia, A

    2012-01-01

    The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

  6. The anthropocene: from global change to planetary stewardship.

    Science.gov (United States)

    Steffen, Will; Persson, Asa; Deutsch, Lisa; Zalasiewicz, Jan; Williams, Mark; Richardson, Katherine; Crumley, Carole; Crutzen, Paul; Folke, Carl; Gordon, Line; Molina, Mario; Ramanathan, Veerabhadran; Rockström, Johan; Scheffer, Marten; Schellnhuber, Hans Joachim; Svedin, Uno

    2011-11-01

    Over the past century, the total material wealth of humanity has been enhanced. However, in the twenty-first century, we face scarcity in critical resources, the degradation of ecosystem services, and the erosion of the planet's capability to absorb our wastes. Equity issues remain stubbornly difficult to solve. This situation is novel in its speed, its global scale and its threat to the resilience of the Earth System. The advent of the Anthropence, the time interval in which human activities now rival global geophysical processes, suggests that we need to fundamentally alter our relationship with the planet we inhabit. Many approaches could be adopted, ranging from geoengineering solutions that purposefully manipulate parts of the Earth System to becoming active stewards of our own life support system. The Anthropocene is a reminder that the Holocene, during which complex human societies have developed, has been a stable, accommodating environment and is the only state of the Earth System that we know for sure can support contemporary society. The need to achieve effective planetary stewardship is urgent. As we go further into the Anthropocene, we risk driving the Earth System onto a trajectory toward more hostile states from which we cannot easily return.

  7. Introducing an antibiotic stewardship program in a humanitarian surgical hospital.

    Science.gov (United States)

    Bhalla, Naina; Hussein, Nagham; Atari, Maha; Fakhri, Rasheed M; Lepora, Chiara; Walsh, Nadia; Cosgrove, Sara E; Murphy, Richard A

    2016-11-01

    Antibiotic stewardship program (ASP) implementation in humanitarian settings is a new endeavor. Doctors Without Borders/Médecins Sans Frontières introduced an ASP within a hospital in Amman, Jordan, where patients from Iraq, Syria, and Yemen with chronic, often multidrug-resistant, infections related to war are managed. Antibiotics were reviewed, and real-time recommendations were made to optimize choice, dose, duration, and route by a small team. Over the first year of implementation, acceptance of the ASP's recommendations improved. When compared with the year prior to implementation, antibiotic cost in 2014 declined considerably from approximately $252,077 (average, $21,006/month) to <$159,948 ($13,329/month), and a reduction in use of broad-spectrum agents was observed. An ASP in a humanitarian surgical hospital proved acceptable and effective, reducing antibiotic expenditures and use of broad-spectrum agents. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Antibiotic stewardship programs and the internist’s role

    Directory of Open Access Journals (Sweden)

    Massimo Giusti

    2016-12-01

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

  9. Antibiotic Stewardship Programs in Nursing Homes: A Systematic Review.

    Science.gov (United States)

    Feldstein, Diana; Sloane, Philip D; Feltner, Cynthia

    2017-08-07

    Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systematic review evaluated the current evidence regarding outcomes of ASPs in the NH. PubMed, CINAHL, EMBASE, and the Cochrane Library were systematically searched for intervention trials of ASPs performed in NHs that evaluated final health outcomes (mortality and Clostridium difficile infections), healthcare utilization outcomes (emergency department visits and hospital admissions) and intermediate health outcomes (number of antibiotics prescribed, adherence to recommended guidelines). A total of 14 studies rated good or fair quality were included. Eight studies reported a reduction in antibiotic prescriptions. Ten found an increase in adherence to guidelines proposed by the studied ASP. None reported a statistically significant change in NH mortality rates, C. difficile infection rates, or hospitalizations. The limited research to date suggests that NH ASPs can affect intermediate health outcomes, but not key health outcomes or health care utilization. Larger trials evaluating more intensive interventions over longer durations may be needed to determine whether ASPs in NHs improve health outcomes as they have in hospitals. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  10. Environmental stewardship for gold mining in tropical regions

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    A.Isahak

    2013-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-11-01

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

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

    Science.gov (United States)

    Dik, Jan-Willem H; Vemer, Pepijn; Friedrich, Alex W; Hendrix, Ron; Lo-Ten-Foe, Jerome R; Sinha, Bhanu; Postma, Maarten J

    2015-01-01

    There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. A systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list). 1233 studies were found, of which 149 were read completely. Ninety-nine were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n = 23), costs for hospital stay (n = 18), and/or other costs (n = 19). Nine studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19. This review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.

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

    Science.gov (United States)

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

    2008-01-01

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

  14. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    Directory of Open Access Journals (Sweden)

    Kristen Ellis

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Muhammad Umair Khan

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

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

    Science.gov (United States)

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

    2014-02-01

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

  17. Mining and biodiversity offsets: a transparent and science-based approach to measure "no-net-loss".

    Science.gov (United States)

    Virah-Sawmy, Malika; Ebeling, Johannes; Taplin, Roslyn

    2014-10-01

    Mining and associated infrastructure developments can present themselves as economic opportunities that are difficult to forego for developing and industrialised countries alike. Almost inevitably, however, they lead to biodiversity loss. This trade-off can be greatest in economically poor but highly biodiverse regions. Biodiversity offsets have, therefore, increasingly been promoted as a mechanism to help achieve both the aims of development and biodiversity conservation. Accordingly, this mechanism is emerging as a key tool for multinational mining companies to demonstrate good environmental stewardship. Relying on offsets to achieve "no-net-loss" of biodiversity, however, requires certainty in their ecological integrity where they are used to sanction habitat destruction. Here, we discuss real-world practices in biodiversity offsetting by assessing how well some leading initiatives internationally integrate critical aspects of biodiversity attributes, net loss accounting and project management. With the aim of improving, rather than merely critiquing the approach, we analyse different aspects of biodiversity offsetting. Further, we analyse the potential pitfalls of developing counterfactual scenarios of biodiversity loss or gains in a project's absence. In this, we draw on insights from experience with carbon offsetting. This informs our discussion of realistic projections of project effectiveness and permanence of benefits to ensure no net losses, and the risk of displacing, rather than avoiding biodiversity losses ("leakage"). We show that the most prominent existing biodiversity offset initiatives employ broad and somewhat arbitrary parameters to measure habitat value and do not sufficiently consider real-world challenges in compensating losses in an effective and lasting manner. We propose a more transparent and science-based approach, supported with a new formula, to help design biodiversity offsets to realise their potential in enabling more responsible

  18. A Social-Ecological Framework for Urban Stewardship Network Research to Promote Sustainable and Resilient Cities

    Directory of Open Access Journals (Sweden)

    Michele Romolini

    2016-09-01

    Full Text Available To realize more sustainable and resilient urban social-ecological systems, there is great need for active engagement from diverse public agencies, non-profit organizations, businesses, natural resource managers, scientists, and other actors. Cities present unique challenges and opportunities for sustainability and resilience, as issues and organizations are frequently intertwined in networks of relations. Understanding and leveraging the range of knowledge types, motivations, skills, and goals of diverse participants and their networks is fundamental to sustainable and resilient cities. As efforts to examine and understand urban stewardship networks continue to emerge, it is increasingly clear that there are no structured or systematic frameworks to guide the integration of social and ecological phenomena. Such a framework could facilitate planning new urban stewardship network research, and provide a basis for comparisons among cities and their urban stewardship networks. In this paper, we develop and present a social-ecological framework for examining and understanding urban stewardship networks. To illustrate this framework and provide examples of its prospective and evaluative utility, we use examples from the U.S. Forest Service’s Stewardship Mapping (STEW-MAP network in the United States from Baltimore, MD, USA, New York City, NY, USA, San Juan, Puerto Rico, USA, and Seattle, WA, USA.

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

    Science.gov (United States)

    Moskell, Christine; Allred, Shorna Broussard

    2013-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Dixon J

    2014-05-01

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

  1. Perceptual indicators of environmental health, future land use, and stewardship.

    Science.gov (United States)

    Burger, Joanna; Myers, O; Boring, C S; Dixon, C; Jeitner, J C; Leonard, J; Lord, C; McMahon, M; Ramos, R; Shukla, S; Gochfeld, Michael

    2003-12-01

    There are important linkages between the health of humans and the environment, restoration of degraded lands, and long-term stewardship of public lands, yet most environmental indicators deal only with assessing the physical and biological aspects of ecosystems. In this article, we examine the ratings of perceptions of several environmental problems for their utility as indicators of environmental quality, and examine perceptions of future land use by people interviewed in Santa Fe, New Mexico, near the Department of Energy's (DOE) Los Alamos National Laboratory (LANL). Overall, people with lower incomes rated environmental problems as more severe than others, were more willing to spend federal funds to solve them, and were consistent in their ratings of severity of environmental problems and their willingness to spend federal funds. Cleaning up LANL and other Department of Energy sites, received the highest rating for expenditure of federal funds. The highest rated future uses for DOE sites were for recreation and for National Environmental Research Parks. People with less education generally gave higher ratings to most future land uses for DOE than did those with more education. However, those with higher education gave higher ratings to nuclear reprocessing, and nuclear material storage. Where there were differences, the people interviewed at Santa Fe rated all environmental problems (except pesticides) as more severe than did those previously interviewed in Albuquerque (located farther from the LANL site), and they were more willing to spend federal funds on these problems. Ratings for all future land uses did not differ between the Santa Fe and Albuquerque respondents. These perception-based indicators show general agreement among people living close and farther away from LANL with respect to cleaning up LANL and the future land uses for the site. These indicators should be considered by regulators, site personnel, and policy makers in future management and

  2. Beyond the 'nanny state': stewardship and public health.

    Science.gov (United States)

    Calman, K

    2009-01-01

    Some public health measures restrict personal freedom more than others, and deciding what type of measure will be appropriate and effective has long been a problem for policy makers. Existing bioethical frameworks are often not well suited to address the problems of public health. The Nuffield Council on Bioethics set up an expert working party to examine the ethical issues surrounding public health in January 2006. Following evidence gathering and a public consultation exercise, the Council published its conclusions and recommendations in the report 'Public health: ethical issues' in November 2007. A spectrum of views exists on the relationship between the state's authority and the individual. The Council set out a proposal to capture the best of the libertarian and paternalistic approaches, in what it calls the 'stewardship model'. This model suggests guiding principles for making decisions about public health policies, and highlights some key principles including Mill's harm principle, caring for the vulnerable, autonomy and consent. An 'intervention ladder' is also proposed, which provides a way of thinking about the acceptability of different public health measures. The report then applies these principles to a number of case studies: infectious diseases, obesity, alcohol and tobacco, and fluoridation of water supplies. The idea of a 'nanny state' is often rejected, but the state has a duty to look after the health of everyone, and sometimes that means guiding or restricting people's choices. On the other hand, the state must consider a number of principles when designing public health programmes, and justification is required if any of these principles are to be infringed.

  3. Sticking to minimum standards: implementing antibiotic stewardship in intensive care.

    Science.gov (United States)

    Chaves, N J; Ingram, R J; MacIsaac, C M; Buising, K L

    2014-12-01

    In Australia, antimicrobial stewardship programmes are a compulsory component of hospital accreditation. Good documentation around anti-microbial prescribing aids communication and can improve prescribing practice in environments with multiple decision makers. This study aims to develop and implement an intervention to improve antimicrobial prescribing practice in a 24-bed intensive care unit in a tertiary referral adult hospital. We conducted a four-phase (observation, reflection, implementation, evaluation) prospective collaborative before-after quality improvement study. Baseline audits and surveys of antimicrobial prescribing practices identified barriers to and enablers of good prescribing practice. A customised intervention was then implemented over 6 weeks and included a yellow medication record sticker, quarterly education sessions and intensive care unit-specific empiric antimicrobial prescribing guidelines. Post-implementation, the effects were monitored by serial antimicrobial prescribing audits for 1 year. The primary outcomes were clear documentation of the start date, the planned stop date or review date and the indication for an antibiotic. These were all considered the 'minimum standards' for an antimicrobial prescription on the medication record. Documentation of minimum standards specifically addressed by the sticker improved (start date (72% to 90%, P < 0.001), stop date (16% to 63%, P < 0.001), antimicrobial indication documented on medication chart (58% to 83%, P < 0.01)). Overall, adherence to all three minimum standards (start date, stop date and indication) improved from 41/306 (13%) to 306/492 (63%) (P < 0.001). One-year post-implementation, the yellow sticker had become embedded into daily practice. A systematic approach to quality improvement combined with the implementation of a tailored, multi-faceted intervention can improve antimicrobial prescribing practices. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian

  4. Antifungal stewardship: implementation in a French teaching hospital.

    Science.gov (United States)

    Alfandari, S; Berthon, C; Coiteux, V

    2014-04-01

    Invasive fungal infections are responsible for severe morbidity and mortality in immunocompromised patients. New, more effective antifungal drugs have been available for more than a decade but are extremely expensive suggesting the need for judicious prescribing. Infectious diseases physicians had been closely collaborating with hematologists on antimicrobial use since 2000. In 2002, an antifungal stewardship program (ASP) was implemented. It included discussing antifungal prescriptions with a dedicated infectious diseases physician twice weekly, telephone counseling 5 days a week from 9 A.M. to 7 P.M., and training meetings for junior/senior prescribers organized at least once yearly. The same year, a multidisciplinary group drafted evidence-based local guidelines on the use of antifungals in the hematology unit, which were published in 2004. These guidelines included decision algorithms and preprinted prescription forms that allowed only guideline-recommended drugs for a given indication. These guidelines have been updated and simplified at least every 2 years (current version 7.0; 2012). Between 2003 and 2012, in the 20-bed isolated hematology sector (allograft and acute leukemia induction chemotherapy patients), antifungal consumption decreased by 40% (from approximately 1000 to 620 defined daily doses per 1000 hospitalization days). Invasive fungal infections (IFI) remained stable in the whole 51-bed department, during the study period, with 1 to 2 IFI per month. In 2005, the 12-week survival rate for 29 cases of invasive aspergillosis was 72%. Early IFI related mortality has decreased recently. A permanent collaboration between hematologists and an infectious diseases physician can improve antifungal prescribing. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Government and industry meet to discuss environmental stewardship and economic development

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, O. Jr.

    1996-05-01

    At the New Mexico Conference on the Environment, government and industry representatives met to address environmental stewardship and economic development, particularly as these issues relate to New Mexico. The session took place March 13, 1996, from 1:30 PM to 5:00 PM, in the Cochiti/Taos room at the Albuquerque Convection Center. The first part of the session dealt with environmental stewardship. The second session discussed economic development. This paper chronicles the highlights of this unique session. It attempts to capture the essence of each speaker; therefore, rather than a strict narrative, this paper consists of a series of quotes that, when seen as a whole, provide an understanding of how government and industry view environmental stewardship and economic development. Moreover, these quotes reveal that these organizations continue to develop effective methodologies to collaborate.

  6. Eight Habits of Highly Effective Antimicrobial Stewardship Programs to Meet the Joint Commission Standards for Hospitals.

    Science.gov (United States)

    Goff, Debra A; Kullar, Ravina; Bauer, Karri A; File, Thomas M

    2017-04-15

    In an effort to decrease antimicrobial resistance and inappropriate antibiotic use, The Joint Commission (TJC) recently issued new antimicrobial stewardship standards, consisting of 8 elements of performance, applicable to hospitals effective January 1, 2017. These standards coincide with those recommended by the Infectious Diseases Society of America (IDSA) and the Society of Healthcare Epidemiology (SHEA) guidelines. Little guidance exists on the "how" from these guidance documents. We review the 8 standards and provide real-world experience from established antimicrobial stewardship programs (ASPs) on how institutions can comply with these guidelines to reduce inappropriate antibiotic usage, decrease antimicrobial resistance, and optimize patient outcomes. TJC antimicrobial stewardship standards demonstrate actions being taken at the national level to make quality and patient safety a priority. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  7. iPhones, iPads, and medical applications for antimicrobial stewardship.

    Science.gov (United States)

    Goff, Debra A

    2012-07-01

    One of the most important antimicrobial stewardship activities of the infectious diseases pharmacist and physician is to provide education and clinical information about antimicrobials to health care professionals and patients; however, clinician training and continuing education in appropriate antimicrobial use in the United States are highly variable and nonstandardized. The iPhone, iPad, and the availability of more than 12,000 medical applications (referred to as "apps") allow stewardship programs the ability to integrate novel technology with point-of-care education. This article reviews medical apps for antimicrobial stewardship programs to use on the iPhone or iPad. © 2012 Pharmacotherapy Publications, Inc. All rights reserved.

  8. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review.

    Science.gov (United States)

    Noll, Donald R

    2016-09-01

    The contemporary management of infectious diseases is built around antimicrobial therapy. However, the development of antimicrobial resistance threatens to create a post-antibiotic era. Antimicrobial stewardship attempts to reduce the development of antimicrobial resistance by improving their appropriate use. Osteopathic manipulative treatment as an adjunctive treatment has the potential for enhancing antimicrobial stewardship by enhancing the human immune system, shortening the duration of antimicrobial therapy, reducing complications, and improving treatment outcomes. The present article reviews the evidence published in the literature since this unique treatment approach was first developed more than 100 years ago. The evidence suggests that adjunctive osteopathic manipulative treatment has great potential for enhancing antimicrobial stewardship and should be further investigated.

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

    Science.gov (United States)

    Herrera, Tania; Sánchez, Sergio

    2014-11-26

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  11. 78 FR 12352 - Notice of Intent To Prepare an Environmental Impact Statement for the Wilderness Stewardship Plan...

    Science.gov (United States)

    2013-02-22

    ... Wilderness Stewardship Plan (WSP) and Environmental Impact Statement (EIS) will be developed to provide... National Park Service Notice of Intent To Prepare an Environmental Impact Statement for the Wilderness Stewardship Plan, Olympic National Park, Clallam, Grays Harbor, Jefferson and Mason County, WA AGENCY...

  12. Individual transferable quota contribution to environmental stewardship: a theory in need of validation

    Directory of Open Access Journals (Sweden)

    Ingrid van Putten

    2014-06-01

    Full Text Available We explored the extent to which (1 individual transferable quotas (ITQs may lead to changes in environmental stewardship and (2 environmental stewardship may in turn contribute to explain the success or otherwise of ITQs in meeting sustainability objectives. ITQs are an example of incentive-based fisheries management in which fishing rights can be privately owned and traded. ITQs are aimed at resolving the problems created by open-access fisheries. ITQs were proposed to promote economic efficiency, and there is growing empirical evidence that ITQs meet a number of economic and social fisheries management objectives. Even though improved stock status arises as a consequence of the total allowable catch levels implemented together with ITQs, the effect is difficult to separate from the improvement attributable to existing and new management changes. However, stock status improvements have also been attributed to increased environmental stewardship resulting from the allocation of individual fishing rights. We defined environmental stewardship as a set of normative values that private individuals may hold, and that entail perceived duties and obligations to carefully manage and use marine resources. We did not debate the success or otherwise of ITQs in meeting sustainability objectives but discussed the premise that this success may in part be a consequence of a change in fishers' environmental stewardship. In particular, because of the absence of empirical literature, we explored the theoretical effects of the introduction of ITQs in conjunction with comanagement on a change in environmental stewardship. Although psychological theory suggests that there may be a relationship, there is insufficient evidence to draw the conclusion that improved environmental outcomes are attributable to changes in stewardship ethics arising from the combined effect of allocating fishing rights and comanagement in ITQ-managed fisheries. Complexity added by the move

  13. Nature connection, outdoor play, and environmental stewardship in residential environmental education

    Science.gov (United States)

    Andrejewski, Robert G.

    A lack of exposure to the natural world has led to a generation of children disconnected from nature. This phenomenon has profound negative implications for the physical and psychological well being of today's youth. Residential environmental education provides one avenue to connect children to nature. One purpose of this study was to investigate the role of Outdoor School, a residential environmental education program, on ecological knowledge, children's connection to nature, school belonging, outdoor play attitude, environmental stewardship attitude, outdoor play behavior, and environmental stewardship behavior, as reported by participants. A quasi-experimental research design was utilized in the study. A total of 228 fifth grade students (156 treatment, 72 control) from central Pennsylvania participated. The results of the program evaluation indicated that Outdoor School was successful in achieving significant, positive gains in the areas of ecological knowledge, connection to nature, outdoor play behavior, and environmental stewardship behavior. No change was found from pretest to post-test in outdoor play attitudes, environmental stewardship attitudes, and school belonging. Additionally, the study addressed gaps in the literature regarding the relationship between connection to nature, environmental stewardship, and outdoor play using two different approaches. An adaptation of the Theory of Planned Behavior (TPB) was used to predict outdoor play behavior in children. In this model, favorable attitudes, subjective norms, and perceived behavioral control lead to intentions to perform a given behavior. Intention to perform the behavior is the best predictor for behavior performance. For this study, participants' feeling of connection to nature was added as an affective independent variable. This model explained 45% of the variance in outdoor play. The hypothesis that a connection to nature would be a significant predictor of both attitudes toward outdoor play was

  14. Impact of CLSI Breakpoint Changes on Microbiology Laboratories and Antimicrobial Stewardship Programs.

    Science.gov (United States)

    Heil, Emily L; Johnson, J Kristie

    2016-04-01

    In 2010, the Clinical and Laboratory Standards Institute (CLSI) lowered the MIC breakpoints for many beta-lactam antibiotics to enhance detection of known resistance amongEnterobacteriaceae The decision to implement these new breakpoints, including the changes announced in both 2010 and 2014, can have a significant impact on both microbiology laboratories and antimicrobial stewardship programs. In this commentary, we discuss the changes and how implementation of these updated CLSI breakpoints requires partnership between antimicrobial stewardship programs and the microbiology laboratory, including data on the impact that the changes had on antibiotic usage at our own institution. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

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

    Science.gov (United States)

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

    2016-11-01

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

  16. Science-based health innovation in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Daar Abdallah S

    2010-12-01

    Full Text Available Abstract In recent years emerging markets such as India, China, and Brazil have developed appropriate business models and lower-cost technological innovations to address health challenges locally and internationally. But it is not well understood what capabilities African countries, with their high disease burden, have in science-based health innovation. This gap in knowledge is addressed by this series in BMC International Health and Human Rights. The series presents the results of extensive on-the-ground research in the form of four country case studies of health and biotechnology innovation, six studies of institutions within Africa involved in health product development, and one study of health venture funds in Africa. To the best of our knowledge it is the first extensive collection of empirical work on African science-based health innovation. The four country cases are Ghana, Rwanda, Tanzania and Uganda. The six case studies of institutions are A to Z Textiles (Tanzania, Acorn Technologies (South Africa, Bioventures venture capital fund (South Africa, the Malagasy Institute of Applied Research (IMRA; Madagascar, the Kenyan Medical Research Institute (KEMRI; Kenya, and Niprisan’s development by Nigeria’s National Institute for Pharmaceutical Research and Development and Xechem (Nigeria. All of the examples highlight pioneering attempts to build technological capacity, create economic opportunities, and retain talent on a continent significantly affected by brain drain. They point to the practical challenges for innovators on the ground, and suggest potentially helpful policies, funding streams, and other support systems. For African nations, health innovation represents an opportunity to increase domestic capacity to solve health challenges; for international funders, it is an opportunity to move beyond foreign aid and dependency. The shared goal is creating self-sustaining innovation that has both health and development impacts. While

  17. Science-based health innovation in sub-Saharan Africa.

    Science.gov (United States)

    Al-Bader, Sara; Masum, Hassan; Simiyu, Ken; Daar, Abdallah S; Singer, Peter A

    2010-12-13

    In recent years emerging markets such as India, China, and Brazil have developed appropriate business models and lower-cost technological innovations to address health challenges locally and internationally. But it is not well understood what capabilities African countries, with their high disease burden, have in science-based health innovation.This gap in knowledge is addressed by this series in BMC International Health and Human Rights. The series presents the results of extensive on-the-ground research in the form of four country case studies of health and biotechnology innovation, six studies of institutions within Africa involved in health product development, and one study of health venture funds in Africa. To the best of our knowledge it is the first extensive collection of empirical work on African science-based health innovation.The four country cases are Ghana, Rwanda, Tanzania and Uganda. The six case studies of institutions are A to Z Textiles (Tanzania), Acorn Technologies (South Africa), Bioventures venture capital fund (South Africa), the Malagasy Institute of Applied Research (IMRA; Madagascar), the Kenyan Medical Research Institute (KEMRI; Kenya), and Niprisan's development by Nigeria's National Institute for Pharmaceutical Research and Development and Xechem (Nigeria).All of the examples highlight pioneering attempts to build technological capacity, create economic opportunities, and retain talent on a continent significantly affected by brain drain. They point to the practical challenges for innovators on the ground, and suggest potentially helpful policies, funding streams, and other support systems.For African nations, health innovation represents an opportunity to increase domestic capacity to solve health challenges; for international funders, it is an opportunity to move beyond foreign aid and dependency. The shared goal is creating self-sustaining innovation that has both health and development impacts. While this is a long-term strategy

  18. The first investigative science-based evidence of Morgellons psychogenesis.

    Science.gov (United States)

    Roncati, Luca; Gatti, Antonietta Morena; Pusiol, Teresa; Piscioli, Francesco; Barbolini, Giuseppe; Maiorana, Antonio

    2016-01-01

    Morgellons disease is an infrequent syndromic condition, that typically affects middle-aged white women, characterized by crawling sensations on and under the skin, associated with itchy rashes, stinging sores, fiber-like filaments emerging from the sores, severe fatigue, concentrating difficulty, and memory loss. The scientific community is prone to believe that Morgellons is the manifestation of various psychiatric syndromes (Munchausen, Munchausen by proxy, Ekbom, Wittmaack-Ekbom). Up until now, no investigative science-based evidence about its psychogenesis has ever been provided. In order to close this gap, we have analyzed the filaments extracted from the skin lesions of a 49-year-old Caucasian female patient, by using a Field Emission Gun-Environmental Electron Scanning Microscope equipped with an X-ray microprobe, for the chemico-elemental characterization of the filaments, comparing them with those collected during a detailed indoor investigation, with careful air monitoring, in her apartment. Our results prove the self-introduction under the epidermis of environmental filaments. For the first time in the literature, we have scientifically demonstrated the self-induced nature of Morgellons disease, thereby wiping out fanciful theories about its etiopathogenesis.

  19. Why does Livermore need LANSCE?

    Energy Technology Data Exchange (ETDEWEB)

    Fortner, R. [Lawrence Livermore National Laboratory, NM (United States)

    1995-10-01

    Five years ago, I was the associate director of the nuclear test program, so I have a really close view of the role of the nuclear testing in the weapons program. My perceptions are strongly driven by the fact that we have lost testing and what that really means. I want to explain to you why I think we really need a science-based stockpile stewardship program and what the issues are interms of having lost nuclear testing.

  20. STOCK-PILED ORGANIC AND MINERAL MIXTURES FOR POT-HOLE REPAIRING OF ASPHALT AND CONCRETE PAVEMENTS

    Directory of Open Access Journals (Sweden)

    A. Yu. Igoshkina

    2007-01-01

    Full Text Available Despite of application of modem materials and methods for construction and repair of asphalt and concrete road pavement, the problem pertaining to removal of surface defects and consequently requirement for effective pot-hole repairing methods still remains an actual one and it is considered as one of the factors that ensures safety traffic conditions.Perspective repairing material has been obtained (cold stock-piled organic and mineral mixtures, which does not require special paving equipment, and which is characterized by a wide range of operational temperatures and excellent thixotropic properties. This allows to solve a problem to prevent asphalt and concrete pavement defects in the seasons of spring and winter. Possibility of long-term storage period and all-year-round application of repairing mixtures increase traffic safety and especially in the period of emergency pot-hole removal on asphalt road pavements.

  1. The future of the past : Towards a better integration of cultural heritage in landscape stewardship

    NARCIS (Netherlands)

    Spek, Mattheus; Bieling, Claudia; Plieninger, Tobias

    In a modern world that seems sometimes too much threatened by oppositions of people, cultures and continents, cultural heritage could reconnect and inspire people by exploring and defining a dynamic and richly varied past that could act as a base for a common future. Therefore, landscape stewardship

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

    Science.gov (United States)

    Sonja Krüger

    2007-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

    Nancy Roeper; Peter Landres; Don Fisher

    2006-01-01

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

  5. 4-H and Forestry Afterschool Clubs: A Collaboration to Foster Stewardship Attitudes and Behaviors in Youth

    Science.gov (United States)

    Gupta, Angela S.; Grant, Samantha; Strauss, Andrea Lorek

    2012-01-01

    The University of Minnesota Extension's 4-H and Forestry Afterschool program combined the 4-H structure and various forestry curricula to foster positive attitudes towards the environment and stewardship-related behaviors as these may serve as precursors to later choices that benefit the environment. Evaluation of third through fifth grade club…

  6. Development and Validation of Two Scales to Measure Elaboration and Behaviors Associated with Stewardship in Children

    Science.gov (United States)

    Vezeau, Susan Lynn; Powell, Robert B.; Stern, Marc J.; Moore, D. DeWayne; Wright, Brett A.

    2017-01-01

    This investigation examines the development of two scales that measure elaboration and behaviors associated with stewardship in children. The scales were developed using confirmatory factor analysis to investigate their construct validity, reliability, and psychometric properties. Results suggest that a second-order factor model structure provides…

  7. A Partnership Model for Training Episodic Environmental Stewardship 4-H Volunteers

    Science.gov (United States)

    Young, Jane Chin; Alexander, Janice; Smith, Martin H.

    2013-01-01

    The Marin Environmental Stewardship pilot project demonstrates the potential for a partnership model that brings together external and internal collaborators to recruit and train episodic 4-H volunteers to meet environmental education needs within a community. The clientele served by the volunteers trained through the project was at-risk, urban…

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

    Science.gov (United States)

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

    2016-02-01

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

  9. Vertically Differentiating Environmental Standards: The Case of the Marine Stewardship Council

    NARCIS (Netherlands)

    Bush, S.R.; Oosterveer, P.J.M.

    2015-01-01

    This paper explores the externally-led vertical differentiation of third-party certification standards using the case of the Marine Stewardship Council (MSC). We analyze this process in two dimensions. First, fisheries employ strategies to capture further market value from fishing practices that go

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

    Science.gov (United States)

    Aspen Institute, 2009

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Science.gov (United States)

    Levine, Jay F

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lora Jean Brake

    2016-03-01

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

  14. 131 Faithful Stewardship (Luke 16:1-15): An Important Part of the ...

    African Journals Online (AJOL)

    Ngozi Ezenwa-Ohaeto

    mismanagement of resources. Luke 16:1-15 was reconstructed to anchor the lessons of proper management of cooperate resources, accountability, fidelity and honesty abhorring of greed for Nigerian leaders. This paper argued that imbibing the culture of faithful stewardship by Nigerian leaders at all spheres of leadership ...

  15. Faithful Stewardship (Luke 16:1-15): An Important Part of the ...

    African Journals Online (AJOL)

    Luke 16:1-15 was reconstructed to anchor the lessons of proper management of cooperate resources, accountability, fidelity and honesty abhorring of greed for Nigerian leaders. This paper argued that imbibing the culture of faithful stewardship by Nigerian leaders at all spheres of leadership can help in the fight against ...

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

    Directory of Open Access Journals (Sweden)

    Georgios Chrysos

    2017-01-01

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

  17. Watershed management contributions to land stewardship: Case studies in the Southeast

    Science.gov (United States)

    Wayne T. Swank; David R. Tilley

    2000-01-01

    We describe three examples of watershed management studies, at different spatial scales, that provide approaches and information useful in enhancing natural resource stewardship in the southern Appalachians. A multiple use “pilot” study, initiated 35 years ago at the Coweeta Hydrologic Laboratory, demonstrates that southern Appalachian forests can be successfully...

  18. Guiding concepts for park and wilderness stewardship in an era of global environmental change

    Science.gov (United States)

    Richard J. Hobbs; David N. Cole; Laurie Yung; Erika S. Zavaleta; Gregory H. Aplet; F. Stuart Chapin; Peter B. Landres; David J. Parsons; Nathan L. Stephenson; Peter S. White; David M. Graber; Eric S. Higgs; Connie Millar; John M. Randall; Kathy A. Tonnessen; Stephen. Woodley

    2010-01-01

    The major challenge to stewardship of protected areas is to decide where, when, and how to intervene in physical and biological processes, to conserve what we value in these places. To make such decisions, planners and managers must articulate more clearly the purposes of parks, what is valued, and what needs to be sustained. A key aim for conservation today is the...

  19. Environmental stewardship footprint research: linking human agency and ecosystem health in the Puget Sound region

    Science.gov (United States)

    Kathleen L. Wolf; Dale J. Blahna; Weston Brinkley; Michele. Romolini

    2013-01-01

    Urbanization processes challenge ecosystem health in many metropolitan areas. New policy and program approaches are needed to restore and sustain natural systems as public agencies and organizations face greater demands and declining budgets. Environmental stewardship is an often overlooked intervention strategy, and the full potential of civic engagement by citizens...

  20. Science and stewardship to protect and sustain wilderness values: Eighth World Wilderness Congress symposium

    Science.gov (United States)

    Alan Watson; Janet Sproull; Liese Dean

    2007-01-01

    The Eighth World Wilderness Congress met in Anchorage, Alaska, in 2005. The symposium on science and stewardship to protect and sustain wilderness values was the largest of multiple symposia held in conjunction with the Congress. The papers contained in this proceedings were generated at this symposium, submitted by the author or authors for consideration for inclusion...

  1. Citizen monitoring and restoration: Volunteers and community involvement in wilderness stewardship

    Science.gov (United States)

    Laurie Yung

    2007-01-01

    Citizen monitoring and restoration is increasingly viewed as a means to involve local communities in wilderness stewardship. This paper examines research on volunteers participating in five monitoring and restoration programs in Western Montana. Volunteers reported that they gained valuable skills, felt more connected with local wilderness areas, and made an important...

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

    Directory of Open Access Journals (Sweden)

    Rodrigo Pereira Medeiros

    2014-12-01

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

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

    Science.gov (United States)

    Susan F. Fox

    2016-01-01

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

  4. Keepers of Our Digital Future: An Assessment of the National Digital Stewardship Residencies, 2013-2016

    Science.gov (United States)

    Mink, Meridith Beck

    2016-01-01

    In September 2015, the Institute of Museum and Library Services (IMLS) awarded the Council on Library and Information Resources (CLIR) a grant to investigate the early impacts of the National Digital Stewardship Residency (NDSR) programs, in order to inform subsequent development of similar programs by others with a vested interest in building…

  5. A review of formal objections to Marine Stewardship Council fisheries certifications

    NARCIS (Netherlands)

    Christian, C.; Ainley, D.; Bailey, M.L.; Dayton, P.; Hocevar, J.; Levine, M.; Nikoloyuk, J.; Nouvian, C.; Velarde, E.; Werner, R.; Jacquet, J.

    2013-01-01

    The Marine Stewardship Council (MSC) was created as a conservation tool – intended to provide “the best environmental choice in seafood” to consumers and to create positive incentives that would improve the status and management of fisheries. During its 15 years, the MSC, which has an annual budget

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  7. Barriers to realizing a stewardship relation between client and vendor: the Best Value approach

    NARCIS (Netherlands)

    Snippert, Tim; Witteveen, Wiebe; Boes, Johan; Voordijk, Johannes T.

    2015-01-01

    This study identifies barriers to realizing a stewardship relation instead of a classic principal–agent relation between client and vendor through implementation of an innovative procurement and risk management method, the Best Value approach. This approach focuses on calculus-based trust

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Antibiotic stewardship and consumption: findings from a pan-European hospital study.

    NARCIS (Netherlands)

    Bruce, J.; MacKenzie, F.M.; Cookson, B.; Mollison, J.; Meer, J.W.M. van der; Krcmery, V.; Gould, I.M.

    2009-01-01

    OBJECTIVES: Much has been written about antibiotic stewardship although less is known about the structure and content of antibiotic policies at hospital level. As part of the European Commission Concerted Action Antibiotic Resistance Prevention And Control (ARPAC) Project, data on antibiotic

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Cassandra Moseley; Susan Charnley

    2014-01-01

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

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

    Science.gov (United States)

    Heather McMillen; Lindsay Campbell; Erika Svendsen; Renae Reynolds

    2016-01-01

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

  13. Original science-based music and student learning

    Science.gov (United States)

    Smolinski, Keith

    American middle school student science scores have been stagnating for several years, demonstrating a need for better learning strategies to aid teachers in instruction and students in content learning. It has also been suggested by researchers that music can be used to aid students in their learning and memory. Employing the theoretical framework of brain-based learning, the purpose of this study was to examine the impact of original, science-based music on student content learning and student perceptions of the music and its impact on learning. Students in the treatment group at a public middle school learned songs with lyrics related to the content of a 4-week cells unit in science; whereas an equally sized control group was taught the same material using existing methods. The content retention and learning experiences of the students in this study were examined using a concurrent triangulation, mixed-methods study. Independent sample t test and ANOVA analyses were employed to determine that the science posttest scores of students in the treatment group (N = 93) were significantly higher than the posttest scores of students in the control group (N = 93), and that the relative gains of the boys in the treatment group exceeded those of the girls. The qualitative analysis of 10 individual interviews and 3 focus group interviews followed Patton's method of a priori coding, cross checking, and thematic analysis to examine the perceptions of the treatment group. These results confirmed that the majority of the students thought the music served as an effective learning tool and enhanced recall. This study promoted social change because students and teachers gained insight into how music can be used in science classrooms to aid in the learning of science content. Researchers could also utilize the findings for continued investigation of the interdisciplinary use of music in educational settings.

  14. New science-based endpoints to accelerate oncology drug development.

    Science.gov (United States)

    Kelloff, Gary J; Sigman, Caroline C

    2005-03-01

    Although several new oncology drugs have reached the market, more than 80% of drugs for all indications entering clinical development do not get marketing approval, with many failing late in development often in Phase III trials, because of unexpected safety issues or difficulty determining efficacy, including confounded outcomes. These factors contribute to the high costs of oncology drug development and clearly show the need for faster, more cost-effective strategies for evaluating oncology drugs and better definition of patients who will benefit from treatment. Remarkable advances in the understanding of neoplastic progression at the cellular and molecular levels have spurred the discovery of molecularly targeted drugs. This progress along with advances in imaging and bioassay technologies are the basis for describing and evaluating new biomarker endpoints as well as for defining other biomarkers for identifying patient populations, potential toxicity, and providing evidence of drug effect and efficacy. Definitions and classifications of these biomarkers for use in oncology drug development are presented in this paper. Science-based and practical criteria for validating biomarkers have been developed including considerations of mechanistic plausibility, available methods and technology, and clinical feasibility. New promising tools for measuring biomarkers have also been developed and are based on genomics and proteomics, direct visualisation by microscopy (e.g., confocal microscopy and computer-assisted image analysis of cellular features), nanotechnologies, and direct and remote imaging (e.g., fluorescence endoscopy and anatomical, functional and molecular imaging techniques). The identification and evaluation of potential surrogate endpoints and other biomarkers require access to and analysis of large amounts of data, new technologies and extensive research resources. Further, there is a requirement for a convergence of research, regulatory and drug developer

  15. Fundamental Science-Based Simulation of Nuclear Waste Forms

    Energy Technology Data Exchange (ETDEWEB)

    Devanathan, Ramaswami; Gao, Fei; Sun, Xin; Khaleel, Mohammad A.

    2010-10-04

    This report presents a hierarchical multiscale modeling scheme based on two-way information exchange. To account for all essential phenomena in waste forms over geological time scales, the models have to span length scales from nanometer to kilometer and time scales from picoseconds to millenia. A single model cannot cover this wide range and a multi-scale approach that integrates a number of different at-scale models is called for. The approach outlined here involves integration of quantum mechanical calculations, classical molecular dynamics simulations, kinetic Monte Carlo and phase field methods at the mesoscale, and continuum models. The ultimate aim is to provide science-based input in the form of constitutive equations to integrated codes. The atomistic component of this scheme is demonstrated in the promising waste form xenotime. Density functional theory calculations have yielded valuable information about defect formation energies. This data can be used to develop interatomic potentials for molecular dynamics simulations of radiation damage. Potentials developed in the present work show a good match for the equilibrium lattice constants, elastic constants and thermal expansion of xenotime. In novel waste forms, such as xenotime, a considerable amount of data needed to validate the models is not available. Integration of multiscale modeling with experimental work is essential to generate missing data needed to validate the modeling scheme and the individual models. Density functional theory can also be used to fill knowledge gaps. Key challenges lie in the areas of uncertainty quantification, verification and validation, which must be performed at each level of the multiscale model and across scales. The approach used to exchange information between different levels must also be rigorously validated. The outlook for multiscale modeling of wasteforms is quite promising.

  16. Can remote sensing help citizen-science based phenological studies?

    Science.gov (United States)

    Delbart, Nicolas; Elisabeth, Beaubien; Laurent, Kergoat; Thuy, Le Toan

    2017-04-01

    Citizen science networks and remote sensing are both efficient to collect massive data related to phenology. However both differ in their advantages and drawbacks for this purpose. Contrarily to remote sensing, citizen science allows distinguishing species-specific phenological responses to climate variability. On the other hand, large portions of territory of a country like Canada are not covered by citizen science networks, and the time series are often incomplete. The main mode of interaction between both types of data consists in validating the maps showing the ecosystem foliage transition times, such as the green-up date, obtained from remote sensing data with field observations, and in particular those collected by citizen scientists. Thus the citizen science phenology data bring confidence to remote sensing based studies. However, one can merely find studies in which remote sensing is used to improve in any way citizen science based study. Here we present bi-directional interactions between both types of data. We first use phenological data from the PlantWatch citizen science network to show that one remote sensing method green-up date relates to the leaf-out date of woody species but also to the whole plant community phenology at the regional level, including flowering phenology. Second we use a remote sensing time series to constrain the analysis of citizen data to overcome the main drawbacks that is the incompleteness of time series. In particular we analyze the interspecies differences in phenology at the scale of so-called "pheno-regions" delineated using remote sensing green-up maps.

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

    Science.gov (United States)

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

    2017-02-01

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

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

    Science.gov (United States)

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

    2017-12-19

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

  19. Antimicrobial stewardship in the Federal Bureau of Prisons: Approaches from the national and local levels.

    Science.gov (United States)

    Long, Michael J; LaPlant, Brian N; McCormick, Justin C

    To determine the impact of national and local antimicrobial stewardship measures on overall antibiotic prescribing in the Federal Bureau of Prisons (BOP). Care was delivered to more than 160,000 inmates in 122 BOP facilities in the United States and Puerto Rico. Medical centers and health services clinics staffed by in-house medical staff, consultants, and specialists. Staffs include a variety of disciplines, including physicians, pharmacists, dentists, nurses, infection control personnel, therapists, health services administrators, and institution executive staff. Innovations occurred on 2 levels: local components were used to reinforce national initiatives. Local institutions used a multidisciplinary team approach including education and focused evaluations of all antibiotic prescriptions before dispensing. National initiatives included the development of a closed formulary, clinical practice guidelines, an antimicrobial stewardship group led by pharmacy, development of tools and strategies for institutions, inclusion in the BOP strategic plan, and a drug utilization evaluation. This was a study of antimicrobial stewardship within BOP and the resultant impact on antibiotic prescriptions. In addition, one institution's antimicrobial stewardship methods were reviewed to determine the impact on antibiotic prescribing practices. The total number of antibiotic prescriptions in BOP-managed institutions in fiscal year (FY) 2010 (October 2009 to September 2010) was 142,907 and progressively decreased to 105,832 in FY2015. The number of antibiotic prescriptions per 1000 inmates correspondingly decreased from 829 in FY2010 to 625 in FY2015. The overall number of antibiotic prescriptions as a percentage of total prescriptions decreased from 7.64% in FY2010 to 5.84% in FY2015. A robust multidisciplinary antimicrobial stewardship program has likely contributed to a decrease in both the total number and the rate of antibiotic prescriptions on a per-1000-patient basis in BOP

  20. Antibiotic stewardship in low- and middle-income countries: the same but different?

    Science.gov (United States)

    Cox, J A; Vlieghe, E; Mendelson, M; Wertheim, H; Ndegwa, L; Villegas, M V; Gould, I; Levy Hara, G

    2017-11-01

    Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low- and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the cornerstones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship programs. We highlight challenges for ABS initiatives in LMICs, give an outline of (inter)national recommendations and demonstrate examples of effective, contextualized stewardship interventions. We searched PubMed for articles on ABS interventions in humans in LMICs. Relevant websites and experts were consulted for additional sources. Evidence on effective and feasible stewardship interventions in LMICs is limited, and challenges for implementation of interventions are numerous. Nevertheless, several initiatives at the international and local levels in Latin America, Africa and Asia have shown that ABS effective interventions are feasible in LMICs, although contextualization is essential. Specific guidance for setting up antimicrobial stewardship programs in LMICs should be developed. Strategic points might need to be progressively addressed in LMICs, such as (a) ensuring availability of diagnostic testing, (b) providing dedicated education in ABR both for healthcare workers and the general public, (c) creating or strengthening (inter)national agencies towards better regulations and audit on production, distribution and dispensing of drugs, (d) strengthening healthcare facilities, (e) exploring a broader synergism between policy makers, academia, professional bodies and civil society and (f) designing and studying easy and scalable ABS interventions for both hospital and community settings. Copyright © 2017. Published by Elsevier Ltd.

  1. The Dual Vulnerability of Transnational, Science-Based Standards in the National Legal Order

    NARCIS (Netherlands)

    Kanetake, Machiko

    2017-01-01

    This paper highlights the scientific and political vulnerability of transnational science-based standards. This paper focuses on radiation standards formulated by the decentralised web of expert committees and inter-governmental forums. Transnational science-based standards are beset with scientific

  2. Venture funding for science-based African health innovation

    Directory of Open Access Journals (Sweden)

    Daar Abdallah S

    2010-12-01

    Full Text Available Abstract Background While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital’s potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. Discussion The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Summary Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social

  3. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-03

    terms of percent ground coverage and plant spread and reproduction). Interestingly, plant growth in all four of the test plots was reduced relative to the lower areas of the roof (the lower area was ca. 2 inches lower than the test plots, due to the space needed for sensors under the plots. The lower roof area uses an aggregate drain layer comparable to that in the third test plot), even when accounting for the north to south differences. The reasons for these differences are not clear and studies are underway to examine the impact of wind scour, drainage rates, temperature, and other factors. This information will be of value to planners of extensive vegetative roof systems in the Philadelphia (and broader) region, since plant growth and roof system overall performance is influenced by local climate, making broad generalizations of performance difficult. Task C: Education and community outreach efforts by the IES involving conferences at SJU, presentations by faculty and students off campus, and educational signage. The Institute for Environmental Stewardship hosted three storm water management workshops on the SJU campus in Philadelphia, in collaboration with the Lower Merion Conservancy, a not-for-profit organization located in Montgomery County, PA. These workshops were free and open to the public. The three workshops (held each year in March) drew more than 200 participants total. The presenters included local and state government agencies, not for profit organizations involved in storm water and open space preservation, designers, engineers, planners and others. Feedback was uniformly positive and we plan to continue the workshops for the foreseeable future. Educational signage has been installed at four locations on campus to explain campus infrastructure related to storm water (rain gardens, vegetative roof and green facades), as well as detailed signage installed on the Science Center roof for the vegetative roof system. More than 100 people (from in and

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  5. A Science-Based Understanding of Cermet Processing.

    Energy Technology Data Exchange (ETDEWEB)

    Cesarano, Joseph; Roach, Robert Allen; Kilgo, Alice C.; Susan, Donald Francis; Van Ornum, David J.; Stuecker, John N.

    2006-04-01

    AbstractThis report is a summary of the work completed in FY01 for science-based characterization of the processes used to fabricate 1) cermet vias in source feedthrus using slurry and paste-filling techniques and 2) cermet powder for dry pressing. Common defects found in cermet vias were characterized based on the ability of subsequent processing techniques (isopressing and firing) to remove the defects. Non-aqueous spray drying and mist granulation techniques were explored as alternative methods of creating CND50, the powder commonly used for dry pressed parts. Compaction and flow characteristics of these techniques were analyzed and compared to standard dry-ball-milled CND50. Due to processing changes, changes in microstructure can occur. A microstructure characterization technique was developed to numerically describe cermet microstructure. Machining and electrical properties of dry pressed parts were also analyzed and related to microstructure using this analytical technique.3 Executive SummaryThis report outlines accomplishments in the science-based understanding of cermet processing up to fiscal year 2002 for Sandia National Laboratories. The three main areas of work are centered on 1) increasing production yields of slurry-filled cermets, 2) evaluating the viability of high-solids-loading pastes for the same cermet components, and 3) optimizing cermet powder used in pressing processes (CND50). An additional development that was created as a result of the effort to fully understand the impacts of alternative processing techniques is the use of analytical methods to relate microstructure to physical properties. Recommendations are suggested at the end of this report. Summaries of these four efforts are as follows:1.Increase Production Yields of Slurry-Filled Cermet Vias Finalized slurry filling criteria were determined based on three designs of experiments where the following factors were analyzed: vacuum time, solids loading, pressure drop across the filter

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

    Science.gov (United States)

    Schotsmans, Paul T

    2003-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  8. Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy

    Directory of Open Access Journals (Sweden)

    Alan P. Johnson

    2015-10-01

    Full Text Available Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation.

  9. Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy.

    Science.gov (United States)

    Johnson, Alan P; Ashiru-Oredope, Diane; Beech, Elizabeth

    2015-10-30

    Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation.

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

    Chen, Justin R; Khan, David A

    2017-06-01

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

  12. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals

    OpenAIRE

    Howard, P; Pulcini, C.; Levy Hara, G.; West, R M; Gould, I. M.; Harbarth, S.; Nathwani, D.

    2017-01-01

    Objectives To report the extent and components of global efforts in antimicrobial stewardship (AMS) in hospitals. Methods An Internet-based survey comprising 43 questions was disseminated worldwide in 2012. Results Responses were received from 660 hospitals in 67 countries: Africa, 44; Asia, 50; Europe, 361; North America, 72; Oceania, 30; and South and Central America, 103. National AMS standards existed in 52% of countries, 4% were planning them and 58% had an AMS programme. The main barrie...

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

    Directory of Open Access Journals (Sweden)

    Vincent Nault

    2008-01-01

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

  14. Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income countries: a Ugandan perspective.

    Science.gov (United States)

    Kamba, Pakoyo Fadhiru; Ireeta, Munanura Edson; Balikuna, Sulah; Kaggwa, Bruhan

    2017-08-01

    In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. In low-income countries like Uganda, many such stockpiles are the result of donations. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. Many low- and middle-income countries need to: (i) strengthen public systems for medicines' management, to improve inventory control and the reliability of procurement forecasts; (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes; (iii) strengthen the regulation of drug donations; (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension; (v) strengthen the enforcement of regulations on safe drug disposal; (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators; and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector.

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

    Science.gov (United States)

    Castro-Sánchez, Enrique; Drumright, Lydia N.; Gharbi, Myriam; Farrell, Susan; Holmes, Alison H.

    2016-01-01

    Objectives To investigate the teaching of antimicrobial stewardship (AS) in undergraduate healthcare educational degree programmes in the United Kingdom (UK). Participants and Methods Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning. Results 80% (112/140) of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%). ‘Adopting necessary infection prevention and control precautions’ was the most frequently taught principle (83/88, 94.3%), followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity’ (73/88, 82.9%) and ‘minimisation of unnecessary antimicrobial prescribing’ (72/88, 81.8%). The ‘use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment’ was reported in ~50% of courses. Only 32/88 (36.3%) programmes included all recommended principles. Discussion Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles. PMID:26928009

  16. Practical Application of the Data Stewardship Maturity Model for NOAA's OneStop Project

    Science.gov (United States)

    Ritchey, N. A.; Peng, G.; Jones, P. R.; Milan, A.; Casey, K. S.

    2016-12-01

    Assessing the current stewardship maturity state of datasets is an important part of ensuring and improving the way datasets are documented, preserved, stewarded, and disseminated to users. It is a critical step towards meeting U.S. federal regulations, organizational requirements, and user needs, especially in the area of data quality.The Data Stewardship Maturity Matrix (DSMM) developed in partnership with NOAA's National Centers of Environmental Information (NCEI) and the Cooperative Institute for Climate and Satellites-North Carolina (CICS-NC) provides a uniform framework for consistent assessment within the context of data management and it includes key components related to data quality and documentation of the quality. This DSMM was used to assess stewardship maturity of datasets archived within NCEI supporting NOAA's OneStop Data Discovery and Access Framework Project. Additionally the DSMM assessment results were implemented in ISO 19115 within the dataset metadata record and will be used for relevancy ranking within OneStop.This presentation will demonstrate the application of the DSMM to NOAA's OneStop datasets including the tools developed to assist the consistent application of the DSMM and communicate the results and an overview of how the DSMM results were implemented in the standard dataset metadata.

  17. Clostridium difficile infection: new approaches to prevention, non-antimicrobial treatment, and stewardship.

    Science.gov (United States)

    Cataldo, Maria Adriana; Granata, Guido; Petrosillo, Nicola

    2017-10-09

    Despite the large amount of scientific publications exploring the epidemiology and the clinical management of Clostridium difficile (CD) infection, some issues remain unsolved or need further studies. The aim of this review is to give an update on the hot topics on CD prevention, including stewardship programs, and on the non-microbiological treatment of CD infection. Areas covered: This article will review the importance of minimizing the CD spore shedding in the healthcare environment for potentially reducing CD transmission. Moreover, antimicrobial stewardship programs aimed to reduce CD incidence will be reviewed. Finally, new strategies for reducing CD infection recurrence will be described. Expert commentary: Besides the basic infection control and prevention practices, including hand hygiene, contact isolation and environmental cleaning, in the prevention of CD infection other issues should be addressed including minimizing the spread of CD in the healthcare setting, and implementing the best strategy for reducing CD infection occurrence, including tailored antimicrobial stewardship programs. Regarding new advancements in treatment and management of CDI episodes, non-antimicrobial approaches seem to be promising in reducing and managing recurrent CD infection.

  18. Costing conservation: an expert appraisal of the pollinator habitat benefits of England's entry level stewardship.

    Science.gov (United States)

    Breeze, T D; Bailey, A P; Balcombe, K G; Potts, S G

    2014-01-01

    Pollination services provided by insects play a key role in English crop production and wider ecology. Despite growing evidence of the negative effects of habitat loss on pollinator populations, limited policy support is available to reverse this pressure. One measure that may provide beneficial habitat to pollinators is England's entry level stewardship agri-environment scheme. This study uses a novel expert survey to develop weights for a range of models which adjust the balance of Entry Level Stewardship options within the current area of spending. The annual costs of establishing and maintaining these option compositions were estimated at £59.3-£12.4 M above current expenditure. Although this produced substantial reduction in private cost:benefit ratios, the benefits of the scheme to pollinator habitat rose by 7-140 %; significantly increasing the public cost:benefit ratio. This study demonstrates that the scheme has significant untapped potential to provide good quality habitat for pollinators across England, even within existing expenditure. The findings should open debate on the costs and benefits of specific entry level stewardship management options and how these can be enhanced to benefit both participants and biodiversity more equitably.

  19. New thoughts on the "forgotten" aspect of antimicrobial stewardship: adverse event reporting.

    Science.gov (United States)

    Hoffmann, Charles; Khadem, Tina; Schweighardt, Anne; Brown, Jack

    2015-01-01

    Antimicrobial stewardship is an activity that optimizes patient care through selection of the most appropriate antimicrobial therapy. Antimicrobial stewardship programs strive to enhance patient care and reduce preventable consequences of antimicrobial use. They are also vital in monitoring for the development of adverse events occurring as a result of antimicrobial therapy, although literature reviews of this activity are scarce. Although randomized controlled trials are considered the gold standard to study the efficacy of a medication, these trials are not designed to test safety end points and often are only able to identify the most commonly occurring and acute adverse events. In addition, prior to a drug going to market, it is difficult to detect rare adverse events because the associated costs are economically untenable given the limited pipeline of novel agents. These limitations in some ways may be resolved with the use of postmarketing surveillance and spontaneous reporting systems such as the United States Food and Drug Administration Adverse Event Reporting System. The focus of this commentary is to highlight the importance of adverse event reporting by antimicrobial stewardship programs to spontaneous reporting systems as a means to improve patient care. © 2015 Pharmacotherapy Publications, Inc.

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

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

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

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

    Science.gov (United States)

    Castro-Sánchez, Enrique; Drumright, Lydia N; Gharbi, Myriam; Farrell, Susan; Holmes, Alison H

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-13

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

  3. A multidimensional antimicrobial stewardship intervention targeting aztreonam use in patients with a reported penicillin allergy.

    Science.gov (United States)

    Swearingen, Sara M; White, Cyle; Weidert, Sara; Hinds, Melisande; Narro, John P; Guarascio, Anthony J

    2016-04-01

    Local antimicrobial susceptibility patterns should be considered for antimicrobial therapy decisions. Antibiogram data can guide beta-lactam antibiotic use in the presence of a penicillin allergy, particularly when allergic cross-reactivity among antibiotic agents is unlikely. To evaluate the effect of a multidimensional antimicrobial stewardship intervention to improve antibiogram-driven antibiotic selection for patients with a reported penicillin allergy receiving aztreonam. This historically controlled, quasi-experimental study compared historical aztreonam use with prospective antibiotic selection following a pharmacist-led intervention in patients with a penicillin allergy. The impact of this intervention on aztreonam use, antimicrobial selection, patient allergy profile updates, length of stay, in-hospital mortality, and antibiotic cost savings was assessed. A significant reduction in median days of aztreonam therapy (4.0 vs. 2.0; p = 0.0001) and median days of therapy per 1000 patient days (14.5 vs. 9.3; p = 0.0001) was found in the intervention group. A pharmacist-led antimicrobial stewardship intervention facilitated antibiogram-driven antibiotic therapy while reducing aztreonam use in patients without an anaphylactic penicillin allergy. Further trials are needed to assess the utility of similar antimicrobial stewardship interventions for patients with penicillin allergy.

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

    Directory of Open Access Journals (Sweden)

    Tania Herrera

    2014-11-01

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

  5. A comparison of readability in science-based texts: Implications for elementary teachers

    National Research Council Canada - National Science Library

    Gallagher, Tiffany; Fazio, Xavier; Ciampa, Katia

    2017-01-01

    .... Online texts were the most disparate with respect to text difficulty. These findings suggest implications for elementary teachers to support students who learn through reading online, science-based resources...

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

    Science.gov (United States)

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

    2016-12-01

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

  7. Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    Full Text Available Objectives: To assess a bundled Antimicrobial Stewardship Program and its effect on mortality. Data:Eight months of clinical electronic medical records and Antimicrobial Stewardship Program registries were used as source of data.Method: This is a historical cohort study conducted in a Brazilian University Hospital. Eligible patients were admitted to general wards or intensive care units and had an antimicrobial therapy prescribed and assessed by different strategies: Bundled Antimicrobial Stewardship Program (bundled intervention consisted of clinical pharmacist chart review, discussion with microbiologist and infectious disease physicians, local education and continuous follow-up or Conventional Antimicrobial Stewardship Program (clinical pharmacist chart review and discussion with infectious disease physician. Primary outcome from this study was 30-day mortality, which was compared between groups, by using Kaplan-Meier survival curve and log-rank test. Other outcomes included Defined Daily Doses per 1000 patient-days and occurrence of resistant bacteria.Results: From 533 patients, 491 were eligible for the study, of which 191 patients were included to Antimicrobial Stewardship Program and 300 to Conventional strategy. In general, they were likely to be male and age was similar in groups (58.9 vs 55.5 years, p= 0.38. Likewise, Charlson Comorbidity Index was not statistically different between groups (2.6 vs 2.7, p= 0.2. Bloodstream site infections were frequently diagnosed in both groups (30.89% vs 26%, p= 0.24. Other less common sites of infections were central nervous system and lungs. The ASP group had higher survival rates (p< 0.01 and the risk difference was 10.8% (95% CI: 2.41-19.14. There were less Defined Daily Doses per 1000 patient-days (417 vs 557.2, p< 0.05 and higher rates of resistant bacteria identified in the ASP group (83% vs 17%.Conclusion: Bundled ASP was the most effective strategy, with reduced mortality and Defined Daily

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

    Directory of Open Access Journals (Sweden)

    Alison J. Duff

    2017-03-01

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

  9. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs.

    Science.gov (United States)

    Morris, Andrew M; Brener, Stacey; Dresser, Linda; Daneman, Nick; Dellit, Timothy H; Avdic, Edina; Bell, Chaim M

    2012-05-01

    Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs. To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts. A multiphase modified Delphi technique. Paper-based survey supplemented with a 1-day consensus meeting. A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts. There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting. We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

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

    Science.gov (United States)

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

    2018-01-10

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

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

    Directory of Open Access Journals (Sweden)

    Steven B. Scyphers

    2014-09-01

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

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

    Science.gov (United States)

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

    2013-02-15

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

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

    DEFF Research Database (Denmark)

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

    regulation aimed at increasing earnings quality from a valuation perspective (earnings persistence) may have a significant impact on how firms rationally respond in terms of allowing accrual discretion in order to alleviate the impact on the stewardship role of earnings. Increasing the precision of more......, as opposed to leaving firms more choice over non-discretionary accrual policies, may lead firms to rationally respond by inducing costly earnings management. More generally, regulating both earnings persistence and the tightness of admissible auditing policies may not result in less equilibrium earnings...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    regulation aimed at increasing earnings quality from a valuation perspective (earnings persistence) may have a significant impact on how firms rationally respond in terms of allowing accrual discretion in order to alleviate the impact on the stewardship role of earnings. Increasing the precision of more......, as opposed to leaving firms more choice over non-discretionary accrual policies, may lead firms to rationally respond by inducing costly earnings management. More generally, regulating both earnings persistence and the tightness of admissible auditing policies may not result in less equilibrium earnings...

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

    Science.gov (United States)

    Ramdeen, S.; Hills, D. J.

    2013-12-01

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

  16. Mitigation of human-pathogenic fungi that exhibit resistance to medical agents: can clinical antifungal stewardship help?

    Science.gov (United States)

    Hull, Claire M; Purdy, Nicola J; Moody, Suzy C

    2014-01-01

    Reducing indiscriminate antimicrobial usage to combat the expansion of multidrug-resistant human-pathogenic bacteria is fundamental to clinical antibiotic stewardship. In contrast to bacteria, fungal resistance traits are not understood to be propagated via mobile genetic elements, and it has been proposed that a global explosion of resistance to medical antifungals is therefore unlikely. Clinical antifungal stewardship has focused instead on reducing the drug toxicity and high costs associated with medical agents. Mitigating the problem of human-pathogenic fungi that exhibit resistance to antimicrobials is an emergent issue. This article addresses the extent to which clinical antifungal stewardship could influence the scale and epidemiology of resistance to medical antifungals both now and in the future. The importance of uncharted selection pressure exerted by agents outside the clinical setting (agricultural pesticides, industrial xenobiotics, biocides, pharmaceutical waste and others) on environmentally ubiquitous spore-forming molds that are lesserstudied but increasingly responsible for drug-refractory infections is considered.

  17. Roadmap to MaRIE January 2015

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, Cris William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-01-15

    After the decision to end nuclear testing and the inception of the Stockpile Stewardship program, the condition of the stockpile was the primary mission driver. During the first two decades of stewardship, the primary program goal could be described as underwriting the Stockpile-to-Target Sequence (STS), the military requirements on the conditions the nuclear warheads needed to survive and still operate.

  18. From Cleanup to Stewardship. A companion report to Accelerating Cleanup: Paths to Closure and background information to support the scoping process required for the 1998 PEIS Settlement Study

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1999-10-01

    Long-term stewardship is expected to be needed at more than 100 DOE sites after DOE's Environmental Management program completes disposal, stabilization, and restoration operations to address waste and contamination resulting from nuclear research and nuclear weapons production conducted over the past 50 years. From Cleanup to stewardship provides background information on the Department of Energy (DOE) long-term stewardship obligations and activities. This document begins to examine the transition from cleanup to long-term stewardship, and it fulfills the Secretary's commitment to the President in the 1999 Performance Agreement to provide a companion report to the Department's Accelerating Cleanup: Paths to Closure report. It also provides background information to support the scoping process required for a study on long-term stewardship required by a 1998 Settlement Agreement.

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

    Directory of Open Access Journals (Sweden)

    Vanessa M Adams

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

  20. Revising Payment for Ecosystem Services in the Light of Stewardship: The Need for a Legal Framework

    Directory of Open Access Journals (Sweden)

    Alessandra Solazzo

    2015-11-01

    Full Text Available Since the Millennium Ecosystem Assessment (MEA highlighted the importance of ecosystem services for human well-being, the payments for such services have increasingly been drawing the attention of governments, the private sector and academia. Nonetheless, there is not yet a specific legal framework which is able to capture the complexity of managing natural resources and, at the same time, deal with the numerous drawbacks that have been identified by critics, who are opposed to using financialisation of the environment as a tool. This paper, after briefly summarizing some of the main features and criticisms of the Payment for Ecosystem Services (PES, will critically assess the understanding of property rights over natural resources as stewardship, rather than as entitlement, because this interpretation is more coherent with the inherent characteristics of natural resources and, consequently, of ecosystem services. The novel usage of a stewardship dimension to property rights underlines the necessity for a legal framework for PES, constituted by “property-liability rules”.

  1. Data Stewardship: Environmental Data Curation and a Web-of-Repositories

    Directory of Open Access Journals (Sweden)

    Karen S. Baker

    2009-10-01

    Full Text Available Scientific researchers today frequently package measurements and associated metadata as digital datasets in anticipation of storage in data repositories. Through the lens of environmental data stewardship, we consider the data repository as an organizational element central to data curation. One aspect of non-commercial repositories, their distance-from-origin of the data, is explored in terms of near and remote categories. Three idealized repository types are distinguished – local, center, and archive - paralleling research, resource, and reference collection categories respectively. Repository type characteristics such as scope, structure, and goals are discussed. Repository similarities in terms of roles, activities and responsibilities are also examined. Data stewardship is related to care of research data and responsible scientific communication supported by an infrastructure that coordinates curation activities; data curation is defined as a set of repeated and repeatable activities focusing on tending data and creating data products within a particular arena. The concept of “sphere-of-context” is introduced as an aid to distinguishing repository types. Conceptualizing a “web-of-repositories” accommodates a variety of repository types and represents an ecologically inclusive approach to data curation.

  2. The role of cooperation for improved stewardship of marine social-ecological systems in Latin America

    Directory of Open Access Journals (Sweden)

    Sebastián Villasante

    2015-03-01

    Full Text Available Latin American and Caribbean (LAC countries are among the worlds' richest in marine biodiversity. Fish stocks in these regions are important for fishing communities, and fishing activities engage several million people. These fisheries depend on the natural services provided by a diverse range of marine social-ecological systems, but many LAC fisheries are in a degraded state, and concerns about overexploitation are widespread. With most fishery resources fully exploited or overexploited, opportunities for development lie primarily in restoring depleted stocks and using stocks more efficiently. The papers published in the Special Feature "Cooperation, Local Communities, and Marine Social-Ecological Systems: New Findings from Latin America" present a range of experiences with ecosystem stewardship in the region and highlight promising perspectives for the future. The Special Feature consists of papers that deal with new findings from case studies which show how cooperation is key for building resilience in LAC fisheries. These case studies illustrate the effects of different types of cooperation and the roles of diverse stakeholders (fishers, scientists, environmental nongovernmental organizations, and national administrations, among others in different countries of the region. Combined, these papers describe social processes, leadership, and institutional and organizational changes of relevance for stewardship of marine social-ecological systems in Latin America. The field of resilience research is still in an explorative phase in the region, and our ambition with this Special Feature is that the new discoveries presented may stimulate additional research in this field, including increased international cooperation with LAC scientists.

  3. Mobile health application to assist doctors in antibiotic prescription - an approach for antibiotic stewardship.

    Science.gov (United States)

    Tuon, Felipe Francisco; Gasparetto, Juliano; Wollmann, Luciana Cristina; Moraes, Thyago Proença de

    Technologies applied to mobile devices can be an important strategy in antibiotic stewardship programs. The aim of this study was to determine the impact of a decision-making application on antibiotic prescription. This was an observational, analytical and longitudinal study on the implementation of an antimicrobial guide for mobile application. This study analyzed the period of 12 months before and 12 months after the app implementation at a university hospital based on local epidemiology, avoiding high cost drugs and reducing the potential for drug resistance including carbapenem. Antimicrobials consumption was evaluated in Daily Defined Dose/1000 patients-day and direct expenses converted into USD. The monthly average consumption of aminoglycosides and cefepime had a statistically significant increase (pantibiotic as a substitute of piperacillin/tazobactam for treating intra-hospital infections. There was a net saving of USD 296,485.90 (pantibiotic protocol in the app can help antibiotic stewardship reducing cost, changing the microbiological profile and antimicrobial consumption. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Use of electronic health records and clinical decision support systems for antimicrobial stewardship.

    Science.gov (United States)

    Forrest, Graeme N; Van Schooneveld, Trevor C; Kullar, Ravina; Schulz, Lucas T; Duong, Phu; Postelnick, Michael

    2014-10-15

    Electronic health records (EHRs) and clinical decision support systems (CDSSs) have the potential to enhance antimicrobial stewardship. Numerous EHRs and CDSSs are available and have the potential to enable all clinicians and antimicrobial stewardship programs (ASPs) to more efficiently review pharmacy, microbiology, and clinical data. Literature evaluating the impact of EHRs and CDSSs on patient outcomes is lacking, although EHRs with integrated CDSSs have demonstrated improvements in clinical and economic outcomes. Both technologies can be used to enhance existing ASPs and their implementation of core ASP strategies. Resolution of administrative, legal, and technical issues will enhance the acceptance and impact of these systems. EHR systems will increase in value when manufacturers include integrated ASP tools and CDSSs that do not require extensive commitment of information technology resources. Further research is needed to determine the true impact of current systems on ASP and the ultimate goal of improved patient outcomes through optimized antimicrobial use. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Between land and sea: divergent data stewardship practices in deep-sea biosphere research

    Science.gov (United States)

    Cummings, R.; Darch, P.

    2013-12-01

    Data in deep-sea biosphere research often live a double life. While the original data generated on IODP expeditions are highly structured, professionally curated, and widely shared, the downstream data practices of deep-sea biosphere laboratories are far more localized and ad hoc. These divergent data practices make it difficult to track the provenance of datasets from the cruise ships to the laboratory or to integrate IODP data with laboratory data. An in-depth study of the divergent data practices in deep-sea biosphere research allows us to: - Better understand the social and technical forces that shape data stewardship throughout the data lifecycle; - Develop policy, infrastructure, and best practices to improve data stewardship in small labs; - Track provenance of datasets from IODP cruises to labs and publications; - Create linkages between laboratory findings, cruise data, and IODP samples. In this paper, we present findings from the first year of a case study of the Center for Dark Energy Biosphere Investigations (C-DEBI), an NSF Science and Technology Center that studies life beneath the seafloor. Our methods include observation in laboratories, interviews, document analysis, and participation in scientific meetings. Our research uncovers the data stewardship norms of geologists, biologists, chemists, and hydrologists conducting multi-disciplinary research. Our research team found that data stewardship on cruises is a clearly defined task performed by an IODP curator, while downstream it is a distributed task that develops in response to local need and to the extent necessary for the immediate research team. IODP data are expensive to collect and challenging to obtain, often costing $50,000/day and requiring researchers to work twelve hours a day onboard the ships. To maximize this research investment, a highly trained IODP data curator controls data stewardship on the cruise and applies best practices such as standardized formats, proper labeling, and

  6. Lessons Learned from Undergraduate Students in Designing a Science-Based Course in Bioethics

    Science.gov (United States)

    Loike, John D.; Rush, Brittany S.; Schweber, Adam; Fischbach, Ruth L.

    2013-01-01

    Columbia University offers two innovative undergraduate science-based bioethics courses for student majoring in biosciences and pre-health studies. The goals of these courses are to introduce future scientists and healthcare professionals to the ethical questions they will confront in their professional lives, thus enabling them to strategically…

  7. Applied Epistemology and Professional Training in a Science-Based Cultural Enterprise

    Science.gov (United States)

    Hoshmand; Lisa Tsoi

    2003-01-01

    Receptiveness toward evidence-based practice such as proposed by Chwalisz (2003) (this issue) is a function of how one defines the discipline and how one views counseling and psychotherapy. By acknowledging the dual nature of therapeutic psychology as a science-based cultural enterprise, one may be able to overcome schisms in the field and related…

  8. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial

    OpenAIRE

    van Vliet, P M; Lincoln, N; Foxall, A

    2005-01-01

    Objectives: Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence.

  9. Winter Grazing in a Grass-Fed System: Effect of Stocking Density and Sequential Use of Autumn-Stockpiled Grassland on Performance of Yearling Steers

    Directory of Open Access Journals (Sweden)

    Domingo J. Mata-Padrino

    2017-01-01

    Full Text Available Winter grazing can help reduce the need for purchased feeds in livestock production systems, when finishing cattle on pasture. Our objective was to evaluate the influence of stocking density and grazing stockpiled forage on performance of yearling steers during winter. Three grasslands were winter grazed for two years: I, naturalized pastureland, and II and III, sown and managed for hay production during the growing season but grazed in winter. Two stocking densities were used: low 7.41 and high 12.35 steers ha−1. Herbage mass was estimated before and after each grazing event, and disappearance (consumption, weathering, and trampling was the difference between both. Forage mass and residual differed by stocking density (SD, year (YR, and grazing interval (GI, and disappearance differed by YR and GI. Grass and dead constituents of botanical composition differed by YR and GI. No differences were found for legumes and forbs. CP differed by YR and GI, and NDF and ADF differed only by YR. Steer average daily gain was 0.15 kg d−1 in 2011 and 0.68 kg d−1 in 2012 and varied by YR and GI. Acceptable gains in 2012 may be a product of environmental conditions that influenced herbage mass and nutritive value during stockpile and animal behavior during winter.

  10. THE BNL ASTD FIELD LAB - NEAR - REAL - TIME CHARACTERIZATION OF BNL STOCKPILED SOILS TO ACCELERATE COMPLETION OF THE EM CHEMICAL HOLES PROJECT.

    Energy Technology Data Exchange (ETDEWEB)

    BOWERMAN,B.S.; ADAMS,J.W.; HEISER,J.; KALB,P.D.; LOCKWOOD,A.

    2003-04-01

    As of October 2001, approximately 7,000 yd{sup 3} of stockpiled soil remained at Brookhaven National Laboratory (BNL) after the remediation of the BNL Chemical/Animal/Glass Pits disposal area. The soils were originally contaminated with radioactive materials and heavy metals, depending on what materials had been interred in the pits, and how the pits were excavated. During the 1997 removal action, the more hazardous/radioactive materials were segregated, along with, chemical liquids and solids, animal carcasses, intact gas cylinders, and a large quantity of metal and glass debris. Nearly all of these materials have been disposed of. In order to ensure that all debris was removed and to characterize the large quantity of heterogeneous soil, BNL initiated an extended sorting, segregation, and characterization project directed at the remaining soil stockpiles. The project was co-funded by the Department of Energy Environmental Management Office (DOE EM) through the BNL Environmental Restoration program and through the DOE EM Office of Science and Technology Accelerated Site Technology Deployment (ASTD) program. The focus was to remove any non-conforming items, and to assure that mercury and radioactive contaminant levels were within acceptable limits for disposal as low-level radioactive waste. Soils with mercury concentrations above allowable levels would be separated for disposal as mixed waste. Sorting and segregation were conducted simultaneously. Large stockpiles (ranging from 150 to 1,200 yd{sup 3}) were subdivided into manageable 20 yd{sup 3} units after powered vibratory screening. The 1/2-inch screen removed almost all non-conforming items (plus some gravel). Non-conforming items were separated for further characterization. Soil that passed through the screen was also visually inspected before being moved to a 20 yd{sup 3} ''subpile.'' Eight samples from each subpile were collected after establishing a grid of four quadrants: north, east

  11. Networked governance and the management of ecosystem services: The case of urban environmental stewardship in New York City

    Science.gov (United States)

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

    2014-01-01

    Urban environmental stewardship groups have become an essential component of the governance structure that regulates ecosystem services in cities. New York City is one example where these groups have grown rapidly in number, size, and visibility since the 1970s. In this article, we combine quantitative survey data with qualitative interview data to examine the...

  12. A national survey of infection control and antimicrobial stewardship structures in Irish long-term care facilities.

    Science.gov (United States)

    Donlon, Sheila; Roche, Fiona; Byrne, Helen; Dowling, Siobhan; Cotter, Meaghan; Fitzpatrick, Fidelma

    2013-06-01

    Information on infection prevention and control (IPC) and antimicrobial stewardship activities in Irish long-term care facilities (LTCFs) is limited. A survey detailing IPC and antimicrobial stewardship activities, including staffing and bed capacity, was circulated to Irish LTCFs. Sixty-nine LTCFs (61 public, 8 private) were surveyed, 56 (81%) of which had an IPC practitioner. Thirty-five (51%) LTCFs had an IPC committee that met on average 5 times (range, 1-10) during the previous year. LTCFs with IPC practitioners based solely in the facility (n = 17) were more likely to have an IPC committee (P = .027). Antimicrobial guidelines were available in 28% (n = 19) and 16% (n = 11) had an antimicrobial stewardship committee in place. Medical care was provided by general practitioners in 51% (n = 35), by physicians employed by the LTCFs in 35% (n = 24), or by both in 14% (n = 10). Medical care and activities were coordinated in 45% (n = 31) of LTCFs. These LTCFs were more likely to have an IPC committee (P IPC and antibiotic stewardship programs and governance structures, highlighting the need for specific LTCF national initiatives. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  13. Application of the “4R” nutrient stewardship concept to horticultural crops: getting nutrients in the “right” place

    Science.gov (United States)

    The 4R nutrient stewardship concept was introduced in 2009 by International Plant Nutrition Institute to define the right source, rate, time, and place to apply fertilizers to produce not only the most economical outcome in any given crop but to also to provide desirable social and environmental ben...

  14. Urban environmental stewardship and changes in vegetative cover and building footprint in New York City neighborhoods (2000-2010)

    Science.gov (United States)

    Dexter H. Locke; Kristen L. King; Erika S. Svendsen; Lindsay K. Campbell; Christopher Small; Nancy F. Sonti; Dana R. Fisher; Jacqueline W.T. Lu

    2014-01-01

    This study explores the connections between vegetation cover change, environmental stewardship, and building footprint change in New York City neighborhoods from the years 2000 to 2010. We use a mixed-methods multidisciplinary approach to analyze spatially explicit social and ecological data. Most neighborhoods lost vegetation during the study period. Neighborhoods...

  15. Generalizable principles for ecosystem stewardship-based management of social-ecological systems: lessons learned from Alaska

    Directory of Open Access Journals (Sweden)

    Winslow D. Hansen

    2014-12-01

    Full Text Available Human pressure could compromise the provision of ecosystem services if we do not implement strategies such as ecosystem stewardship to foster sustainable trajectories. Barriers to managing systems based on ecosystem stewardship principles are pervasive, including institutional constraints and uncertain system dynamics. However, solutions to help managers overcome these barriers are less common. How can we better integrate ecosystem stewardship into natural resource management practices? I draw on examples from the literature and two broadly applicable case studies from Alaska to suggest some generalizable principles that can help managers redirect how people use and view ecosystems. These include (1 accounting for both people and ecosystems in management actions; (2 considering historical and current system dynamics, but managing flexibly for the future; (3 identifying interactions between organizational, temporal, and spatial scales; (4 embracing multiple causes in addition to multiple objectives; and (5 acknowledging that there are no panaceas and that success will be incremental. I also identify next steps to rigorously evaluate the broad utility of these principles and quickly move principles from theory to application. The findings of this study suggest that natural resource managers are poised to overcome the barriers to implementing ecosystem stewardship and to develop innovative adaptations to social-ecological problems.

  16. Supporting Data Stewardship Throughout the Data Life Cycle in the Solid Earth Sciences

    Science.gov (United States)

    Ferrini, V.; Lehnert, K. A.; Carbotte, S. M.; Hsu, L.

    2013-12-01

    Stewardship of scientific data is fundamental to enabling new data-driven research, and ensures preservation, accessibility, and quality of the data, yet researchers, especially in disciplines that typically generate and use small, but complex, heterogeneous, and unstructured datasets are challenged to fulfill increasing demands of properly managing their data. The IEDA Data Facility (www.iedadata.org) provides tools and services that support data stewardship throughout the full life cycle of observational data in the solid earth sciences, with a focus on the data management needs of individual researchers. IEDA builds upon and brings together over a decade of development and experiences of its component data systems, the Marine Geoscience Data System (MGDS, www.marine-geo.org) and EarthChem (www.earthchem.org). IEDA services include domain-focused data curation and synthesis, tools for data discovery, access, visualization and analysis, as well as investigator support services that include tools for data contribution, data publication services, and data compliance support. IEDA data synthesis efforts (e.g. PetDB and Global Multi-Resolution Topography (GMRT) Synthesis) focus on data integration and analysis while emphasizing provenance and attribution. IEDA's domain-focused data catalogs (e.g. MGDS and EarthChem Library) provide access to metadata-rich long-tail data complemented by extensive metadata including attribution information and links to related publications. IEDA's visualization and analysis tools (e.g. GeoMapApp) broaden access to earth science data for domain specialist and non-specialists alike, facilitating both interdisciplinary research and education and outreach efforts. As a disciplinary data repository, a key role IEDA plays is to coordinate with its user community and to bridge the requirements and standards for data curation with both the evolving needs of its science community and emerging technologies. Development of IEDA tools and services

  17. Long-term stewardship of the environmental legacy at restored sites within the Department of Energy nuclear weapons complex.

    Science.gov (United States)

    Wells, James R; Spitz, Henry B

    2003-11-01

    It is readily apparent, as the Department of Energy Office of Environmental Management proceeds in remediating its vast network of contaminated nuclear weapons facilities, that final cleanup at many facilities will not be performed to a level allowing unrestricted use of the facility. Instead, these facilities must rely on engineering, administrative, and institutional controls to ensure the level of cleanup performed at the site remains adequately protective of public health and the environment. In order for these controls to remain effective, however, a plan for long-term stewardship of these sites must be developed that is approved by the U.S. Congress. Although this sounds simple enough for the present, serious questions remain regarding how best to implement a program of stewardship to ensure its effectiveness over time, particularly for sites with residual contamination of radionuclides with half-lives on the order of thousands of years. Individual facilities have attempted to answer these questions at the site-specific level. However, the complexities of the issues require federal support and oversight to ensure the programs implemented at each of the facilities are consistent and effective. The Department of Energy recently submitted a report to Congress outlining the extent of long-term stewardship needs at each of its facilities. As a result, the time is ripe for forward thinking Congressional action to address the relevant issues and ensure the remedy of long-term stewardship successfully carries out its intended purpose and remains protective of public health and the environment. The regulatory elements necessary for the stewardship program to succeed can only be implemented through the plenary powers of the U.S. Congress.

  18. Impact of Penicillin Allergy on Empirical Carbapenem Use in Gram-Negative Bloodstream Infections: An Antimicrobial Stewardship Opportunity.

    Science.gov (United States)

    Al-Hasan, Majdi N; Acker, Emily C; Kohn, Joseph E; Bookstaver, Paul Brandon; Justo, Julie Ann

    2017-11-03

    Retrospective matched-cohort study evaluating association between penicillin allergy and empirical carbapenem use in gram-negative bloodstream infections (BSIs) and utility of antimicrobial stewardship interventions in reducing carbapenem utilization. Hospitalized adults with community-onset gram-negative BSI from January 1, 2010, to June 30, 2015, at two large community hospitals in Columbia, SC, were identified. Antimicrobial stewardship interventions targeting penicillin allergy and carbapenem utilization were fully implemented January 1, 2014. Multivariate logistic regression was used to examine impact of penicillin allergy and antimicrobial stewardship interventions on empirical carbapenem use. Kaplan-Meier analysis was used to evaluate time to carbapenem deescalation in patients with penicillin allergy before and after interventions. Patients with penicillin allergy (n=140) were more likely to receive empirical carbapenem therapy for community-onset gram-negative BSI compared to those without penicillin allergy (n=140) (27% vs 12%, p=0.002). After adjustments in the multivariate model, penicillin allergy (odds ratio [OR] 3.98, 95% confidence interval [CI] 1.98-8.45) and prior β-lactam use (OR 2.72, 95% CI 1.07-6.64) were independently associated with empirical carbapenem use, whereas antimicrobial stewardship interventions were associated with decline in carbapenem utilization (OR 0.41, 95% CI 0.16-0.94). Among patients with penicillin allergy who were prescribed empirical carbapenems, median time to carbapenem deescalation was significantly shorter in the postintervention versus preintervention period (2.0 vs 4.2 days, p=0.004). Penicillin allergy was a significant contributor to carbapenem use in community-onset gram-negative BSI. This was subject to modification by antimicrobial stewardship interventions, which successfully reduced overall carbapenem use and duration of carbapenem therapy in patients with penicillin allergy. © 2017 Pharmacotherapy

  19. Approaches to Modifying the Behavior of Clinicians Who Are Noncompliant With Antimicrobial Stewardship Program Guidelines.

    Science.gov (United States)

    Goldstein, Ellie J C; Goff, Debra A; Reeve, William; Naumovski, Snezana; Epson, Erin; Zenilman, Jonathan; Kaye, Keith S; File, Thomas M

    2016-08-15

    Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier physicians' behavior. One must try to differentiate deviation from ASP norms from all other issues of outliers. Essential elements include identifying and understanding the local problems, planning, and achieving hospital administration and medical staff support. A successful ASP includes effective communication and acceptance of evidence-based recommendations, so that patient clinical outcomes will be optimized. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  20. Reconnecting cities to the biosphere: stewardship of green infrastructure and urban ecosystem services.

    Science.gov (United States)

    Andersson, Erik; Barthel, Stephan; Borgström, Sara; Colding, Johan; Elmqvist, Thomas; Folke, Carl; Gren, Åsa

    2014-05-01

    Within-city green infrastructure can offer opportunities and new contexts for people to become stewards of ecosystem services. We analyze cities as social-ecological systems, synthesize the literature, and provide examples from more than 15 years of research in the Stockholm urban region, Sweden. The social-ecological approach spans from investigating ecosystem properties to the social frameworks and personal values that drive and shape human interactions with nature. Key findings demonstrate that urban ecosystem services are generated by social-ecological systems and that local stewards are critically important. However, land-use planning and management seldom account for their role in the generation of urban ecosystem services. While the small scale patchwork of land uses in cities stimulates intense interactions across borders much focus is still on individual patches. The results highlight the importance and complexity of stewardship of urban biodiversity and ecosystem services and of the planning and governance of urban green infrastructure.

  1. Energy Systems Integration Facility (ESIF): Facility Stewardship Plan, Revision 2.0

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Art [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hannegan, Bryan [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-09-01

    The U.S. Department of Energy (DOE), Office of Energy Efficiency and Renewable Energy, has established the Energy Systems Integration Facility (ESIF) on the campus of the National Renewable Energy Laboratory (NREL) and has designated it as a DOE user facility. This 182,500-sq. ft. research facility provides state-of-the-art laboratory and support infrastructure to optimize the design and performance of electrical, thermal, fuel, and information technologies and systems at scale. This Facility Stewardship Plan serves to provide DOE and other decision makers with information on the existing and expected capabilities of ESIF, and the expected performance metrics to be applied to ESIF operations. This Plan is a living document that will be updated and refined throughout the lifetime of the facility.

  2. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Francis, Arokiasamy J.; Santschi, Peter H.; Honeyman, Bruce D.

    2005-06-01

    The overall objective of this proposed research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation to immobilization) is the role of microorganisms. The hypothesis underlying this proposal is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases, and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  3. Community-based monitoring frameworks: increasing the effectiveness of environmental stewardship.

    Science.gov (United States)

    Conrad, Catherine T; Daoust, Tyson

    2008-03-01

    This article presents an adaptable community-based monitoring (CBM) framework. The investigators used a well-tested conceptual CBM framework developed by the Canadian Community Monitoring Network (CCMN) as a basis from which to work. With the use of feedback from various types of CBM groups in the Province of Nova Scotia, Canada, obtained through surveys and interviews, the CCMN framework was modified into a document that attempts to address current disparities and inefficiencies within most CBM systems. The need for such a framework was underscored by the lack of stewardship groups' use of standardized monitoring protocols and inability to effectively provide information to decision makers. From the information collected through the survey, it was concluded that the proposed framework must be a functional, multiparty form of CBM that addresses the key concerns of a standardized monitoring and communication program and must be able to be fed into the environmental-management system.

  4. Energy Systems Integration Facility (ESIF) Facility Stewardship Plan: Revision 2.1

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Juan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Anderson, Art [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-01-02

    The U.S. Department of Energy (DOE), Office of Energy Efficiency and Renewable Energy (EERE), has established the Energy Systems Integration Facility (ESIF) on the campus of the National Renewable Energy Laboratory (NREL) and has designated it as a DOE user facility. This 182,500-ft2 research facility provides state-of-the-art laboratory and support infrastructure to optimize the design and performance of electrical, thermal, fuel, and information technologies and systems at scale. This Facility Stewardship Plan provides DOE and other decision makers with information about the existing and expected capabilities of the ESIF and the expected performance metrics to be applied to ESIF operations. This plan is a living document that will be updated and refined throughout the lifetime of the facility.

  5. Bedside resource stewardship in disasters: a provider's dilemma practicing in an ethical gap.

    Science.gov (United States)

    Daniel, Michelle

    2012-01-01

    During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future.

  6. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Honeyman, Bruce D.; Francis, A.J.; Gillow, Jeffrey B.; Dodge, Cleveland J.; Santschi, Peter H.; Chin-Chang Hung; Diaz, Angelique; Tinnacher, Ruth; Roberts, Kimberly; Schwehr, Kathy

    2006-04-05

    The overall objective of this research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation and immobilization) is the role of microorganisms. The hypothesis underlying this work is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  7. Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists.

    Science.gov (United States)

    Moody, Julia; Cosgrove, Sara E; Olmsted, Russell; Septimus, Edward; Aureden, Kathy; Oriola, Shannon; Patel, Gita Wasan; Trivedi, Kavita K

    2012-03-01

    It is clear that the widespread and injudicious use of antimicrobials has greatly increased the presence of MDROs that threaten the health of all. There is worldwide acknowledgement that this threat is growing, and that prudent use of antimicrobials combined with infection prevention can prevent harm and improve patient safety. Antimicrobial stewardship programs must harness the talents of all members of the health care team to effectively identify the organism, determine its susceptibility, institute any precautions required, and prescribe the narrowest-acting antibiotic that will destroy it. IPs/HEs play a pivotal role in this approach, by assisting with early organism and infected patient identification, by promoting compliance with standard and transmission-based precautions and other infection prevention strategies such as care bundle practices, hand hygiene, and by educating staff, patients, and visitors.

  8. The state of affairs at primary health care facilities in Pakistan: where is the state's stewardship?

    Science.gov (United States)

    Ahmed, J; Shaikh, B T

    2011-07-01

    Primary health care (PHC) services in Pakistan, particularly in rural areas, are in a dismal state. Inadequacies, unfairness and ignorance about the importance of the basic health care provided by these facilitates have led to a disorganized and poorly performing system. This paper reviews the situation in certain PHC facilities in Sindh province. Inadequate medicines and supplies, underutilized family planning services, lack of human resources, faulty equipment, and absence of a proper referral mechanism were some of the key findings. There is therefore an urgent need for radical improvement in the PHC system in order to maximize the appropriate use of PHC facilities. In order to do this, the paper argues that the stewardship role of the State must be strengthened.

  9. Community Gardens as Contexts for Science, Stewardship,and Civic Action Learning

    Directory of Open Access Journals (Sweden)

    Keith G. Tidball

    2009-01-01

    Full Text Available Community gardens are heterogeneous environments that integrate environmental restoration, community activism, social interactions, cultural expression, and food security. As such, they provide a context for learning that addresses multiple societal goals, including a populace that is scientifically literate, practices environmental stewardship, and participates in civic life. Several theories are useful in describing the learning that occurs in community gardens, including those focusing on learning as acquisition of content by individuals, learning as interaction with other individuals and the environment and as increasingly skilled levels of participation in a community of practice, and social learning among groups of stakeholders leading to concerted action to enhance natural resources. In this paper, we use preliminary evidence from the Garden Mosaics intergenerational education program to suggest the potential for community gardens to foster multiple types of learning.

  10. Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

    Directory of Open Access Journals (Sweden)

    Yeo Chay Leng

    2012-11-01

    Full Text Available Abstract Our prospective-audit-and-feedback antimicrobial stewardship (AS program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. However, process indicators including the number of recommendations and recommendation acceptance rates fell significantly during the year, with accompanying increases in broad-spectrum antibiotic prescription. The trends were reversed only upon reverting to the original setup. Dedicated clinicians play a crucial role in AS programs involving immunocompromised patients. Structured training and adequate succession/contingency planning is critical for sustainability.

  11. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases.

    Science.gov (United States)

    Drees, Marci; Gerber, Jeffrey S; Morgan, Daniel J; Lee, Grace M

    2016-11-01

    Administrative and surveillance data are used frequently in healthcare epidemiology and antimicrobial stewardship (HE&AS) research because of their wide availability and efficiency. However, data quality issues exist, requiring careful consideration and potential validation of data. This methods paper presents key considerations for using administrative and surveillance data in HE&AS, including types of data available and potential use, data limitations, and the importance of validation. After discussing these issues, we review examples of HE&AS research using administrative data with a focus on scenarios when their use may be advantageous. A checklist is provided to help aid study development in HE&AS using administrative data. Infect Control Hosp Epidemiol 2016;1-10.

  12. Optimization of antibiotic use in hospitals--antimicrobial stewardship and the EU project ABS international.

    Science.gov (United States)

    Allerberger, Franz; Lechner, Arno; Wechsler-Fördös, Agnes; Gareis, Roland

    2008-01-01

    The problem of antimicrobial resistance requires common strategies at the European level. We report on an EU initiative fostering antibiotic (AB) stewardship (ABS) in hospitals. The project 'ABS International: implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the EU' started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (AB list, guidelines for AB treatment and surgical prophylaxis, and AB-related organization) and valid process measures as well as quality indicators for AB use were developed. Specific ABS tools are being implemented in up to five health care facilities per country. ABS International is the first EU-funded initiative focusing on the implementation of structural measures in hospitals to promote the prudent use of ABs. (c) 2008 S. Karger AG, Basel.

  13. A cross-sectional survey of antimicrobial stewardship strategies in UK hospitals.

    Science.gov (United States)

    Tonna, A P; Gould, I M; Stewart, D

    2014-10-01

    Antimicrobial stewardship programmes describe strategies to optimize antimicrobial prescribing and utilization, minimize resistance and improve patient outcomes. Strategies in hospitals are usually implemented by multidisciplinary antimicrobial teams (AMTs). The objective of this study was to describe the profile and activities of AMTs within hospitals in the United Kingdom (UK). All hospitals within the UK (n = 836) were included, and a prepiloted questionnaire was mailed to the 'Director of Pharmacy'. Non-respondents were mailed up to two reminder questionnaires at two-weekly intervals. Main outcome measures are as follows: existence and remit of the AMTs; availability of antimicrobial-prescribing policies, aims, scope and methods of dissemination; and monitoring and feedback provided on antimicrobial policy adherence. Response rate was 33% (n = 273). Completed questionnaires analysed were n = 226. Eighty-two (n = 186) of respondents indicated the presence of an AMT within the hospital, with 95% of these (n = 177) reporting an antimicrobial pharmacist as part of the team. All AMTs (n = 186) were involved in development of an antimicrobial policy and almost all (99% n = 184) promoted adherence and restricting use of specific antimicrobials (97% n = 180). Ninety-eight per cent of respondents (n = 222) reported the availability of a local antimicrobial-prescribing policy within the hospital with this disseminated mainly through the hospital intranet (98% n = 217). Adherence to policy was measured mainly through audits measuring the appropriateness of antimicrobial use against the local policy (76% n = 169). Hospitals in England (P = 0·010), tertiary care hospitals (P = 0·021) and bed capacity >500 (P antimicrobial-prescribing policy, less had an AMT. Despite recent government and regional initiatives, further improvements in antimicrobial stewardship are still required. © 2014 John Wiley & Sons Ltd.

  14. The resistance tsunami, antimicrobial stewardship, and the golden age of microbiology.

    Science.gov (United States)

    Prescott, John F

    2014-07-16

    Modern medicine is built on antibiotics. Antibiotics are something that we take for granted. We have however spent over 60 years educating bacteria to become resistant, and the global resistance tsunami has caught everyone unawares. Since bacteria have changed, we also have to change, and to change most of the practices of how we use antibiotics. Because the development of new antibiotics is so expensive, a stewardship approach may help to preserve those that we have now while we work to develop new antibiotics and to develop other approaches to controlling and treating infections. We need to adopt the ethic of Good Stewardship Practice (GSP) as an active and dynamic process of continuous improvement in antibiotic use, a process with many steps of different sizes involving everyone involved in antibiotic use. All antibiotic users have an important role to play in GSP. Although the resistance situation is pessimistic, and the future of antibiotics looks uncertain, we are fortunately entering what may be seen as the golden age of microbiology. This encompasses an astonishing array of technologies for rapid pathogen and resistance gene detection, for clone identification by genome sequencing, for identification of novel bacterial genes and for identification of the Achilles' heels of different pathogens. Future antibiotics may have to be far more targeted to the individual pathogen and the site of infection. A global tax on antibiotics might reduce their use while funding the cost of developing new antibiotics and new approaches to control of infectious diseases. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. The Nature of Scatter at the DARHT Facility and Suggestions for Improved Modeling of DARHT Facility

    Energy Technology Data Exchange (ETDEWEB)

    Morneau, Rachel Anne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-11-09

    This report describes the US Stockpile Stewardship Program which is meant to sustain and evaluate nuclear weapon stockpile with no underground nuclear tests. This research will focus on DARHT, the Dual Axis Radiographic Hydrodynamic Test facility.

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

    Energy Technology Data Exchange (ETDEWEB)

    James S. Tulenko; Carl D. Crane

    2007-12-13

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

  17. Transport of Residual Nitrogen and Carbon through Intact Soil Cores Amended with Stockpiled Feedlot Manure with Wood-Chip or Straw Bedding.

    Science.gov (United States)

    Miller, J J; Beasley, B W; Drury, C F; Hao, X; Larney, F J

    2013-11-01

    The environmental impact of using wood chips instead of straw bedding with feedlot manure on transport and leaching potential from feedlot manure is unknown. Our main objective was to determine if transport of total N, total organic N, NO-N, and nonpurgeable organic C (NPOC) to subsurface soil was lower for soils amended with feedlot manure if combined with wood chips compared with straw. A secondary objective was to compare transport of N and NPOC with organic amendments versus inorganic fertilizer. Stockpiled feedlot manure (SM) with wood chip (SM-WD) or barley straw (SM-ST) bedding at 39 Mg (dry wt.) ha, and inorganic fertilizer (IN) at 100 kg N ha, was applied annually for 13 yr to a clay loam soil in a replicated field experiment in southern Alberta, Canada. Intact soil cores were taken in fall 2011 (0-30 cm depth) from the three treatments, and the residual N and NPOC were eluted from the soil cores. Total N, total organic N, and NPOC were determined on filtered (1.0 μm) effluent samples that are primarily dissolved fraction but may contain some small particulate N and C. Peak concentrations, flow-weighted mean concentrations, and mass loss of total N, total organic N, NO-N, and NPOC were significantly ( ≤ 0.05) lower by 35 to 86% for SM-WD compared with SM-ST. Mean recoveries were also significantly lower for SM-WD than SM-ST by 0.07 to 8% (absolute difference). The transport behavior was similar for SM-WD and IN treatment, but solute transport was greater for SM-ST than for IN. Application of stockpiled feedlot manure with wood chips instead of straw bedding may be a beneficial management practice to reduce transport and leaching potential of N fractions and NPOC. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  18. In the Market But Not of It: Fair Trade Coffee and Forest Stewardship Council Certification as Market-Based Social Change

    National Research Council Canada - National Science Library

    Taylor, Peter Leigh

    2005-01-01

    This paper discusses two well-known market-based social change initiatives, Fair Trade coffee and Forest Stewardship Council certification, which harness market forces to pursue social and environmental objectives...

  19. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy

    NARCIS (Netherlands)

    Hara, G. Levy; Kanj, S.S.; Pagani, L.; Abbo, L.; Endimiani, A.; Wertheim, H.F.L.; Amabile-Cuevas, C.; Tattevin, P.; Mehtar, S.; Cardoso, F.; Unal, S.; Gould, I.

    2016-01-01

    The Antibiotic Stewardship and Resistance Working Groups of the International Society for Chemotherapy propose ten key points for the appropriate use of antibiotics in hospital settings. (i) Get appropriate microbiological samples before antibiotic administration and carefully interpret the results:

  20. Designing Program Roadmaps to Catalyze Community Formation: A Case Study of the Long-Term Stewardship Science and Technology Roadmapword

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Brent; Hanson, Duane; Matthern, Gretchen

    2003-02-27

    A number of broad perspective technology roadmaps have been developed in the last few years as tools for coordinating nation-wide research in targeted areas. These roadmaps share a common characteristic of coalescing the associated stakeholder groups into a special-interest community that is willing to work cooperatively in achieving the roadmap goals. These communities are key to roadmap implementation as they provide the collaborative energy necessary to obtain the political support and funding required for identified science and technology development efforts. This paper discusses the relationship between roadmaps and special-interest communities, using the recently drafted Department of Energy's Long-Term Stewardship Science and Technology Roadmap as a case study. Specific aspects this roadmap's design facilitated the development of a long-term stewardship community while specific realities during roadmap development impacted the realization of the design.

  1. Patient and public understanding and knowledge of antimicrobial resistance and stewardship in a UK hospital: should public campaigns change focus?

    Science.gov (United States)

    Micallef, Christianne; Kildonaviciute, Kornelija; Castro-Sánchez, Enrique; Scibor-Stepien, Aleksandra; Santos, Reem; Aliyu, Sani H; Cooke, Fiona J; Pacey, Sarah; Holmes, Alison H; Enoch, David A

    2017-01-01

    The rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies. A panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room. One hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%). We describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your Fingertips.

    OpenAIRE

    Johnson, A. P.; Muller-Pebody, B.; Budd, E.; Ashiru-Oredope, D.; Ladenheim, D.; Hain, D.; Hope, R.; Bhattacharya, A.; Elgohari, S.; Guy, R.; Henderson, K.; Puleston, R.; Rooney, G.; Thelwall, S.; Wellington, E.

    2017-01-01

    The provision of better access to and use of surveillance data is a key component of the UK 5 Year Antimicrobial Resistance (AMR) Strategy Since April 2016, PHE has made data on practice (infection prevention and control; antimicrobial stewardship) and outcome (prevalence of AMR, antibiotic use and healthcare-associated infections) available through Fingertips, a publicly accessible web tool (https://fingertips.phe.org.uk/profile/amr-local-indicators). Fingertips provides access to a wide ran...

  3. Use of an annual art competition to promote Web site traffic and engage children in antimicrobial stewardship in Pennsylvania.

    Science.gov (United States)

    M'ikanatha, Nkuchia M; Yealy, Courtney; Warrington, Anna-Marie; Reefer, Tabitha; Boktor, Sameh W; Mueller, Natalie; Leonard, Mary; Hackman, Nicole M

    2017-09-08

    We used Google Analytics to assess whether annual kids' art competitions changed traffic to a Web site on appropriate antibiotic use. We found that announcements about kids' art competitions correlated with increased traffic to the Web site, suggesting that this innovation has promise in promoting antimicrobial stewardship efforts. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Impact of a Pharmacist-Driven Respiratory Viral Panel Stewardship Program on Antibiotic Exposure Within a Multicenter Community Health System

    OpenAIRE

    Cubillos, Ashley; Estrada, Sandy; Bachmeier, Harrison; Turner, Edgar

    2017-01-01

    Abstract Background Strategies to ensure optimal use of multiplex polymerase chain reaction (mPCR) testing results for antimicrobial stewardship in acute respiratory infections remain to be elucidated. This study sought to assess the impact of pharmacist intervention (by means of prospective feedback to prescribers) on overall antibiotic exposure in patients with viral-positive mPCR Respiratory Viral Panel (RVP) laboratory test results. Methods This retrospective cohort study included patient...

  5. Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship.

    Science.gov (United States)

    Cai, Tommaso; Verze, Paolo; Brugnolli, Anna; Tiscione, Daniele; Luciani, Lorenzo Giuseppe; Eccher, Cristina; Lanzafame, Paolo; Malossini, Gianni; Wagenlehner, Florian M E; Mirone, Vincenzo; Bjerklund Johansen, Truls E; Pickard, Robert; Bartoletti, Riccardo

    2016-02-01

    The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences. The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (pguidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens. We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical

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

    Directory of Open Access Journals (Sweden)

    Charles G. Curtin

    2014-06-01

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

  7. Antimicrobial stewardship in paediatric oncology: Impact on optimising gentamicin use in febrile neutropenia.

    Science.gov (United States)

    Hennig, Stefanie; Staatz, Christine E; Natanek, Daniel; Bialkowski, Sabina; Consuelo Llanos Paez, Carolina; Lawson, Rachael; Clark, Julia

    2018-02-01

    To evaluate the impact of an antimicrobial stewardship (AMS) intervention, involving introduction of new guidelines on the treatment of febrile neutropenia (FN), on improving the use of gentamicin in paediatric oncology patients. Updated guidelines for gentamicin usage in paediatrics with FN were implemented at a tertiary children's teaching hospital, in Brisbane, Australia. Data on gentamicin usage before and after the guideline change were collected retrospectively from children with cancer admitted to hospital with FN between January 2012 and December 2013. Gentamicin use, duration of gentamicin therapy and therapeutic monitoring practice were compared against bacterial culture status for admissions before and after the guideline change to assess the impact on practice. Data were collected from 227 children corresponding to 453 separate admissions, 195 preguideline and 257 post-guideline change. Following guideline change, the proportion of admissions in which gentamicin was administered reduced from 79.0 to 20.9% (P-value gentamicin was used for >48 hr despite the absence of a confirmed Gram-negative infection decreased from 85.6 to 46.9% (P-value resistance against gentamicin in this cohort. © 2017 Wiley Periodicals, Inc.

  8. New Developments in NOAA's Comprehensive Large Array-Data Stewardship System

    Science.gov (United States)

    Ritchey, N. A.; Morris, J. S.; Carter, D. J.

    2012-12-01

    The Comprehensive Large Array-data Stewardship System (CLASS) is part of the NOAA strategic goal of Climate Adaptation and Mitigation that gives focus to the building and sustaining of key observational assets and data archives critical to maintaining the global climate record. Since 2002, CLASS has been NOAA's enterprise solution for ingesting, storing and providing access to a host of near real-time remote sensing streams such as the Polar and Geostationary Operational Environmental Satellites (POES and GOES) and the Defense Meteorological Satellite Program (DMSP). Since October, 2011 CLASS has also been the dedicated Archive Data Segment (ADS) of the Suomi National Polar-orbiting Partnership (S-NPP). As the ADS, CLASS receives raw and processed S-NPP records for archival and distribution to the broad user community. Moving beyond just remote sensing and model data, NOAA has endorsed a plan to migrate all archive holdings from NOAA's National Data Centers into CLASS while retiring various disparate legacy data storage systems residing at the National Climatic Data Center (NCDC), National Geophysical Data Center (NGDC) and the National Oceanographic Data Center (NODC). In parallel to this data migration, CLASS is evolving to a service-oriented architecture utilizing cloud technologies for dissemination in addition to clearly defined interfaces that allow better collaboration with partners. This evolution will require implementation of standard access protocols and metadata which will lead to cost effective data and information preservation.

  9. Guiding concepts for park and wilderness stewardship in an era of global environmental change

    Science.gov (United States)

    Hobbs, Richard J.; Cole, David N.; Yung, Laurie; Zavaleta, Erika S.; Aplet, Gregory H.; Chapin, F. Stuart; Landres, Peter B.; Parsons, David J.; Stephenson, Nathan L.; White, Peter S.; Graber, David M.; Higgs, Eric S.; Millar, Constance I.; Randall, John M.; Tonnessen, Kathy A.; Woodley, Stephen

    2010-01-01

    The major challenge to stewardship of protected areas is to decide where, when, and how to intervene in physical and biological processes, to conserve what we value in these places. To make such decisions, planners and managers must articulate more clearly the purposes of parks, what is valued, and what needs to be sustained. A key aim for conservation today is the maintenance and restoration of biodiversity, but a broader range of values are also likely to be considered important, including ecological integrity, resilience, historical fidelity (ie the ecosystem appears and functions much as it did in the past), and autonomy of nature. Until recently, the concept of "naturalness" was the guiding principle when making conservation-related decisions in park and wilderness ecosystems. However, this concept is multifaceted and often means different things to different people, including notions of historical fidelity and autonomy from human influence. Achieving the goal of nature conservation intended for such areas requires a clear articulation of management objectives, which must be geared to the realities of the rapid environmental changes currently underway. We advocate a pluralistic approach that incorporates a suite of guiding principles, including historical fidelity, autonomy of nature, ecological integrity, and resilience, as well as managing with humility. The relative importance of these guiding principles will vary, depending on management goals and ecological conditions.

  10. Vertically Differentiating Environmental Standards: The Case of the Marine Stewardship Council

    Directory of Open Access Journals (Sweden)

    Simon R. Bush

    2015-02-01

    Full Text Available This paper explores the externally-led vertical differentiation of third-party certification standards using the case of the Marine Stewardship Council (MSC. We analyze this process in two dimensions. First, fisheries employ strategies to capture further market value from fishing practices that go beyond their initial conditions for certification and seek additional recognition for these activities through co-labelling with, amongst others, international NGOs. Second, fisheries not yet able to meet the requirements of MSC standards are being enrolled in NGO and private sector sponsored Fisheries Improvement Projects (FIPs, providing an alternative route to global markets. In both cases the credibility and authority of the MSC is challenged by new coalitions of market actors opening up new strategies for capturing market value and/or improving the conditions of international market access. Through the lens of global value chains, the results offer new insights on how such standards not only influence trade and markets, but are also starting to change their internal governance in response to threats to their credibility by actors and modes of coordination in global value chains.

  11. Emergence of a global science-business initiative for ocean stewardship.

    Science.gov (United States)

    Österblom, Henrik; Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-08-22

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science-business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well.

  12. Emergence of a global science–business initiative for ocean stewardship

    Science.gov (United States)

    Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-01-01

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science–business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well. PMID:28784792

  13. The intersection of antimicrobial stewardship and microbiology: educating the next generation of health care professionals.

    Science.gov (United States)

    O'Donnell, Lauren A; Guarascio, Anthony J

    2017-01-01

    With the alarming rise of antibiotic resistance, clinical professionals are called upon to manage antibiotic therapies using the most relevant and recent clinical and laboratory data. To this end, antimicrobial stewardship (AMS) programs aim to reduce unnecessary or suboptimal use of antibiotics while maximizing outcomes for the patient. For AMS programs to succeed, the active participation of clinical professionals at all levels of patient care is required. Although programs exist to train established clinicians in AMS, there is a paucity of literature on how and when to integrate AMS concepts and skills in pre-clinical and clinical coursework. Here, we discuss the crucial microbiology concepts and proficiencies that are necessary for building and supporting an AMS program. We provide recommendations for key points to include in clinical curricula in order to develop the necessary microbiology interpretation skills to participate in AMS. The influence of AMS programs on local organism susceptibility patterns is emphasized. The importance of antibiograms, rapid diagnostic testing and the practical interpretations of microbiology laboratory reporting are discussed in regard to prioritization in clinical curricula. We also review the current literature on instructional strategies for introducing AMS into clinical programs, and propose concepts that should be included in didactic coursework in order to provide a foundation for AMS education. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. A Report to Congress on Long-Term Stewardship. Volume I - Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousands of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

  15. Prevalence, Characteristics, and Perception of Nursery Antibiotic Stewardship Coverage in the United States.

    Science.gov (United States)

    Cantey, Joseph B; Vora, Niraj; Sunkara, Mridula

    2017-09-01

    Prolonged or unnecessary antibiotic use is associated with adverse outcomes in infants. Antibiotic stewardship programs (ASPs) aim to prevent these adverse outcomes and optimize antibiotic prescribing. However, data evaluating ASP coverage of nurseries are limited. The objectives of this study were to describe the characteristics of nurseries with and without ASP coverage and to determine perceptions of and barriers to nursery ASP coverage. The 2014 American Hospital Association annual survey was used to randomly select a level III neonatal intensive care unit from all 50 states. A level I and level II nursery from the same city as the level III nursery were then randomly selected. Hospital, nursery, and ASP characteristics were collected. Nursery and ASP providers (pharmacists or infectious disease providers) were interviewed using a semistructured template. Transcribed interviews were analyzed for themes. One hundred forty-six centers responded; 104 (71%) provided nursery ASP coverage. In multivariate analysis, level of nursery, university affiliation, and number of full-time equivalent ASP staff were the main predictors of nursery ASP coverage. Several themes were identified from interviews: unwanted coverage, unnecessary coverage, jurisdiction issues, need for communication, and a focus on outcomes. Most providers had a favorable view of nursery ASP coverage. Larger, higher-acuity nurseries in university-affiliated hospitals are more likely to have ASP coverage. Low ASP staffing and a perceived lack of importance were frequently cited as barriers to nursery coverage. Most nursery ASP coverage is viewed favorably by providers, but nursery providers regard it as less important than ASP providers.

  16. Benefits and unintended consequences of antimicrobial de-escalation: Implications for stewardship programs.

    Directory of Open Access Journals (Sweden)

    Josie Hughes

    Full Text Available Sequential antimicrobial de-escalation aims to minimize resistance to high-value broad-spectrum empiric antimicrobials by switching to alternative drugs when testing confirms susceptibility. Though widely practiced, the effects de-escalation are not well understood. Definitions of interventions and outcomes differ among studies. We use mathematical models of the transmission and evolution of Pseudomonas aeruginosa in an intensive care unit to assess the effect of de-escalation on a broad range of outcomes, and clarify expectations. In these models, de-escalation reduces the use of high-value drugs and preserves the effectiveness of empiric therapy, while also selecting for multidrug-resistant strains and leaving patients vulnerable to colonization and superinfection. The net effect of de-escalation in our models is to increase infection prevalence while also increasing the probability of effective treatment. Changes in mortality are small, and can be either positive or negative. The clinical significance of small changes in outcomes such as infection prevalence and death may exceed more easily detectable changes in drug use and resistance. Integrating harms and benefits into ranked outcomes for each patient may provide a way forward in the analysis of these tradeoffs. Our models provide a conceptual framework for the collection and interpretation of evidence needed to inform antimicrobial stewardship.

  17. On the value of environmental stewardship and sustainability in health administration education.

    Science.gov (United States)

    Verderber, Stephen; Fauerbach, Julia; Walter, Brandon

    2008-01-01

    Global warming, the depletion of the world'snatural resources, and excessive consumer consumption in developed countries are determinants reshaping the way we live our everyday lives. These factors are rapidly giving rise to new ecological paradigms of environmental stewardship and in healthcare environments that express sustainable theories and practices. This has given rise to a systematic system for promoting and assessing the energy performance and efficiency of healthcare facilities known as Leadership in Energy Efficient Environmental Design (LEED), and a parallel certification program, the Green Guide for Heath Care. These developments are examined in direct relation to the functions of managerial ethics. A series of ten sustainability-based ethical dilemmas are presented. Each is examined in relation to the need to inculcate in future healthcare administrators a critical understanding and appreciation of the need to reposition contemporary healthcare organizations at the center--as leading civic participants and role models in relation to the emerging movement towards carbon neutrality in the healthcare industry.

  18. A Report to Congress on Long-Term Stewardship. Volume II, Site Summaries

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousand of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

  19. Male veterans with complicated urinary tract infections: Influence of a patient-centered antimicrobial stewardship program.

    Science.gov (United States)

    Carbo, James F; Ruh, Christine A; Kurtzhalts, Kari E; Ott, Michael C; Sellick, John A; Mergenhagen, Kari A

    2016-12-01

    The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined. This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes. Outcomes before and after implementation of a patient-centered ASP, including duration of antibiotic therapy, length of hospitalization, readmission within 30 days, and Clostridium difficile infection were compared. Interventions resulting from the ASP were categorized. Of the 1,268 patients screened, 241 met criteria for inclusion in the study (n = 118 and n = 123 in the pre-ASP and ASP group, respectively). Duration of antibiotic therapy was significantly shorter in the ASP group (10.32 days vs 11.96 days; P complicated urinary tract infection. Implementation of an ASP was associated with significant decreases in duration of antibiotic therapy and length of hospitalization, without adversely affecting 30-day readmission rates. Published by Elsevier Inc.

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

    Science.gov (United States)

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

    2017-04-01

    Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians. The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  1. Emergence of Global Adaptive Governance for Stewardship of Regional Marine Resources

    Directory of Open Access Journals (Sweden)

    Henrik Österblom

    2013-06-01

    Full Text Available Overfishing has historically caused widespread stock collapses in the Southern Ocean. Until recently, illegal, unreported, and unregulated (IUU fishing threatened to result in the collapse of some of the few remaining valuable fish stocks in the region and vulnerable seabird populations. Currently, this unsustainable fishing has been reduced to less than 10% of former levels. We describe and analyze the emergence of the social-ecological governance system that made it possible to curb the fisheries crisis. For this purpose, we investigated the interplay between actors, social networks, organizations, and institutions in relation to environmental outcomes. We drew on a diversity of methods, including qualitative interviews, quantitative social network and survey data, and literature reviews. We found that the crisis triggered action of an informal group of actors over time, which led to a new organization (ISOFISH that connected two independent networks (nongovermental organizations and the fishing industry, and later (COLTO linked to an international body and convention (CCAMLR. The emergence of the global adaptive governance systems for stewardship of a regional marine resource took place over a 15-year period. We describe in detail the emergence process and illustrate the usefulness of analyzing four features of governance and understanding social-ecological processes, thereby describing structures and functions, and their link to tangible environmental outcomes.

  2. The Economic Impact of Starting, Stopping, and Restarting an Antibiotic Stewardship Program: A 14-Year Experience

    Directory of Open Access Journals (Sweden)

    John A. Bosso

    2013-04-01

    Full Text Available Regions Hospital started a multidisciplinary antibiotic stewardship program (ASP in 1998. The program effectively shut down from 2002–2004 as key personnel departed and was then restarted but without the dedicated pharmacist and infectious diseases physician. Purchasing data (in dollars or dollars/patient/day unadjusted for inflation served as a surrogate marker of antibiotic consumption. These data were reviewed monthly, quarterly, and yearly along with antibiotic susceptibility patterns on a semi-annual basis. Segmented regression analysis was use to compare restricted antibiotic purchases for performance periods of 1998–2001 (construction, 2002–2004 (de-construction, and 2005–2011 (reconstruction. After 4 years (1998–2001 of operation, a number of key participants of the ASP departed. For the following three years (2002–2004 the intensity and focus of the program floundered. This trend was averted when the program was revitalized in early 2005. The construction, deconstruction, and reconstruction of our ASP provided a unique opportunity to statistically examine the financial impact of our ASP or lack thereof in the same institution. We demonstrate a significant economic impact during ASP deconstruction and reconstruction.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-04-24

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

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

    Science.gov (United States)

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

    2013-01-01

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

  5. Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

    Science.gov (United States)

    Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

    2017-08-01

    Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Tate, Susan

    2014-05-01

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

  7. Critical Reading of Science-Based News Reports: Establishing a knowledge, skills and attitudes framework

    Science.gov (United States)

    McClune, Billy; Jarman, Ruth

    2010-04-01

    A recognised aim of science education is to promote critical engagement with science in the media. Evidence would suggest that this is challenging for both teachers and pupils and that science education does not yet adequately prepare young people for this task. Furthermore, in the absence of clear guidance as to what this means and how this may be achieved it is difficult for teachers to develop approaches and resources that address the matter and that systematically promote such critical engagement within their teaching programmes. Twenty-six individuals with recognised expertise or interest in science in the media, drawn from a range of disciplines and areas of practice, constituted a specialist panel in this study. The question this research sought to answer was "what are the elements of knowledge, skill, and attitude which underpin critical reading of science-based news reports?" During in-depth individual interviews the panel were asked to explore what they considered to be essential elements of knowledge, skills, and attitude which people need to enable them to respond critically to news reports with a science component. Analysis of the data revealed 14 fundamental elements which together contribute to an individual's capacity to engage critically with science-based news. These are classified in five categories "knowledge of science", "knowledge of writing and language", "knowledge about news, newspapers and journalism", "skills", and "attitudes". Illustrative profiles of each category along with indicators of critical engagement are presented. The implications for curriculum planning and pedagogy are considered.

  8. Materials science and engineering

    Energy Technology Data Exchange (ETDEWEB)

    Holden, T.M.

    1995-10-01

    The science-based stockpile stewardship program emphasizes a better understanding of how complex components function through advanced computer calculations. Many of the problem areas are in the behavior of materials making up the equipment. The Los Alamos Neutron Science Center (LANSCE) can contribute to solving these problems by providing diagnostic tools to examine parts noninvasively and by providing the experimental tools to understand material behavior in terms of both the atomic structure and the microstructure. Advanced computer codes need experimental information on material behavior in response to stress, temperature, and pressure as input, and they need benchmarking experiments to test the model predictions for the finished part.

  9. Science-based health innovation in Uganda: creative strategies for applying research to development

    Science.gov (United States)

    2010-01-01

    Background Uganda has a long history of health research, but still faces critical health problems. It has made a number of recent moves towards building science and technology capacity which could have an impact on local health, if innovation can be fostered and harnessed. Methods Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 30 people from across the science-based health innovation system, including government officials, researchers in research institutes and universities, entrepreneurs, international donors, and non-governmental organization representatives. Results Uganda has a range of institutions influencing science-based health innovation, with varying degrees of success. However, the country still lacks a coherent mechanism for effectively coordinating STI policy among all the stakeholders. Classified as a least developed country, Uganda has opted for exemptions from the TRIPS intellectual property protection regime that include permitting parallel importation and providing for compulsory licenses for pharmaceuticals. Uganda is unique in Africa in taking part in the Millennium Science Initiative (MSI), an ambitious though early-stage $30m project, funded jointly by the World Bank and Government of Uganda, to build science capacity and encourage entrepreneurship through funding industry-research collaboration. Two universities – Makerere and Mbarara – stand out in terms of health research, though as yet technology development and commercialization is weak. Uganda has several incubators which are producing low-tech products, and is beginning to move into higher-tech ones like diagnostics. Its pharmaceutical industry has started to create partnerships which encourage innovation. Conclusions Science-based health product innovation is in its early stages in Uganda, as are policies for guiding its development

  10. Science-based health innovation in Uganda: creative strategies for applying research to development.

    Science.gov (United States)

    Kamunyori, Sheila; Al-Bader, Sara; Sewankambo, Nelson; Singer, Peter A; Daar, Abdallah S

    2010-12-13

    Uganda has a long history of health research, but still faces critical health problems. It has made a number of recent moves towards building science and technology capacity which could have an impact on local health, if innovation can be fostered and harnessed. Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 30 people from across the science-based health innovation system, including government officials, researchers in research institutes and universities, entrepreneurs, international donors, and non-governmental organization representatives. Uganda has a range of institutions influencing science-based health innovation, with varying degrees of success. However, the country still lacks a coherent mechanism for effectively coordinating STI policy among all the stakeholders. Classified as a least developed country, Uganda has opted for exemptions from the TRIPS intellectual property protection regime that include permitting parallel importation and providing for compulsory licenses for pharmaceuticals. Uganda is unique in Africa in taking part in the Millennium Science Initiative (MSI), an ambitious though early-stage $30m project, funded jointly by the World Bank and Government of Uganda, to build science capacity and encourage entrepreneurship through funding industry-research collaboration. Two universities - Makerere and Mbarara - stand out in terms of health research, though as yet technology development and commercialization is weak. Uganda has several incubators which are producing low-tech products, and is beginning to move into higher-tech ones like diagnostics. Its pharmaceutical industry has started to create partnerships which encourage innovation. Science-based health product innovation is in its early stages in Uganda, as are policies for guiding its development. Nevertheless, there is political will for the

  11. Science-based health innovation in Uganda: creative strategies for applying research to development

    Directory of Open Access Journals (Sweden)

    Daar Abdallah S

    2010-12-01

    Full Text Available Abstract Background Uganda has a long history of health research, but still faces critical health problems. It has made a number of recent moves towards building science and technology capacity which could have an impact on local health, if innovation can be fostered and harnessed. Methods Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 30 people from across the science-based health innovation system, including government officials, researchers in research institutes and universities, entrepreneurs, international donors, and non-governmental organization representatives. Results Uganda has a range of institutions influencing science-based health innovation, with varying degrees of success. However, the country still lacks a coherent mechanism for effectively coordinating STI policy among all the stakeholders. Classified as a least developed country, Uganda has opted for exemptions from the TRIPS intellectual property protection regime that include permitting parallel importation and providing for compulsory licenses for pharmaceuticals. Uganda is unique in Africa in taking part in the Millennium Science Initiative (MSI, an ambitious though early-stage $30m project, funded jointly by the World Bank and Government of Uganda, to build science capacity and encourage entrepreneurship through funding industry-research collaboration. Two universities – Makerere and Mbarara – stand out in terms of health research, though as yet technology development and commercialization is weak. Uganda has several incubators which are producing low-tech products, and is beginning to move into higher-tech ones like diagnostics. Its pharmaceutical industry has started to create partnerships which encourage innovation. Conclusions Science-based health product innovation is in its early stages in Uganda, as are policies for guiding

  12. Perspectives of women of color in science-based education and careers. Summary of the conference on diversity in science

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Research on inequality or stratification in science and engineering tends to concentrate on black/white or male/female difference; very few studies have discussions of both race and gender. Consequently, very little is known about the exact course that women of color take in science-based education and employment or about the course that steers them out of science-based careers. Questions abound: What are the environmental factors that affect the choices in education and science-based careers of women of color? What has influenced women of color who currently are in science-based careers? Is critical mass important and, if so, what are the keys to increasing it? What recommendations can be made to colleges and universities, faculty members, employers, the federal government, women of color themselves, and to improve the conditions and numbers of women of color in science-based careers? These questions prompted the National Research Council`s Committee on Women in Science and Engineering (CWSE) to convene a conference on Diversity in Science: Perspectives on the Retention of Minority Women in Science, Engineering, and Health-Care Professions, held on October 21--23, 1995. Confronting the problem of the lack of knowledge about the journey of women of color in science-based education and career, the conference offered opportunities for these women to describe the paths that they have taken and to identify strategies for success. Their perspectives ground this report. For purposes of this document, women of color include women in the following racial or ethnic groups: Hispanics, African-Americans, Asian and Pacific Islanders, and American Indians and Alaskan Natives. Science-based careers include those in the physical sciences and mathematics, life sciences, social sciences, and engineering.

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

    Science.gov (United States)

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

    2012-12-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  15. Adaptation and Implementation of a Science-Based Prevention System in Colombia: Challenges and Achievements

    Science.gov (United States)

    Pérez-Gómez, Augusto; Mejía-Trujillo, Juliana; Brown, Eric C.; Eisenberg, Nicole

    2016-01-01

    During the last 2 years, the Colombian government and the Nuevos Rumbos Corporation have been implementing an adapted version of the Communities That Care (CTC) prevention system, called Comunidades Que se Cuidan (CQC) in Spanish, for use in Colombia. This brief report presents the process of implementing CQC and identifies some of the main challenges and achievements of implementing the system in eight communities in Colombia. Preliminary results of a pilot study of CQC implementation in Colombia show that prevention system development, including a focus on measuring community risk and protection, can be established successfully in Latin American communities despite a lack of rigorously tested prevention programs and strategies. Moreover, mobilizing community coalitions toward science-based prevention, with a focus on examining local risk and protective factor data, can spur development and evaluation of prevention efforts in Latin America. PMID:28154437

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

    Directory of Open Access Journals (Sweden)

    Stefanie Jane Oliver

    2017-07-01

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

  17. Antimicrobial stewardship: a qualitative study of the development of national guidelines for antibiotic use in hospitals

    Directory of Open Access Journals (Sweden)

    Eli Feiring

    2017-11-01

    Full Text Available Abstract Background As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals’ behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals’ perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Methods Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Results Guideline development was characterized by i broad agreement about scope and purpose, ii broad involvement of stakeholders in the development process, iii use of systematic methods to search for and apply evidence, iv easily identifiable and specific recommendations, v provision of tools on how to put recommendations into practice, and vi editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i diverse perspectives systematically involved in the process, ii accessibility

  18. Antimicrobial stewardship: a qualitative study of the development of national guidelines for antibiotic use in hospitals.

    Science.gov (United States)

    Feiring, Eli; Walter, Anne Berit

    2017-11-21

    As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals' behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals' perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Guideline development was characterized by i) broad agreement about scope and purpose, ii) broad involvement of stakeholders in the development process, iii) use of systematic methods to search for and apply evidence, iv) easily identifiable and specific recommendations, v) provision of tools on how to put recommendations into practice, and vi) editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i) diverse perspectives systematically involved in the process, ii) accessibility and transparency of the rationales for decision

  19. Clinical and Microbiologic Characteristics of Early-Onset Sepsis Among VLBW Infants: Opportunities for Antibiotic Stewardship.

    Science.gov (United States)

    Mukhopadhyay, Sagori; Puopolo, Karen M

    2017-02-09

    Most very-low birth weight (birth weight <1500 grams, VLBW) infants receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years, to identify opportunities for antibiotic stewardship. Retrospective cohort study including VLBW infants admitted from 1990-2015. EOS was defined as isolation of a pathogen in blood or cerebrospinal fluid culture obtained < 72 hours of age. Clinical and microbiologic characteristics of EOS case infants were obtained by review of medical, laboratory and administrative records. Blood culture, antibiotic initiation, and maternal discharge code data was available for all VLBW infants born 1999-2013. 109 EOS cases (20.5/1000 VLBW births) occurred during the study period. Preterm labor, preterm rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of cases. From 1999-2013, 97% of VLBW infants were evaluated for EOS and 90% administered empiric antibiotics; 22% of these infants were born by Cesarean section to mothers with pre-eclampsia and without preterm labor or chorioamnionitis and had a 12-fold lower incidence of EOS compared to the remaining infants. Decisions to initiate and discontinue empiric antibiotics among VLBW infants can be informed by the delivery characteristics of infected infants, and by local microbiologic data.

  20. Antifungal stewardship in a tertiary-care institution: a bedside intervention.

    Science.gov (United States)

    Valerio, M; Muñoz, P; Rodríguez, C G; Caliz, B; Padilla, B; Fernández-Cruz, A; Sánchez-Somolinos, M; Gijón, P; Peral, J; Gayoso, J; Frias, I; Salcedo, M; Sanjurjo, M; Bouza, E

    2015-05-01

    Antifungal stewardship (AFS) programmes are needed in tertiary-care hospitals. Our aim is to describe a bedside non-restrictive AFS programme, and to evaluate its economic impact. During the first year of the AFS a bundle of non-interventional measures were implemented. During the second year an infectious diseases specialist visited 453 patients receiving candins, liposomal amphotericin B, voriconazole or posaconazole. Monthly costs were studied with an interrupted time series (ITS) analysis. The main prescribing departments were haematology (35%), medical departments (23%), and intensive care units (20%). Reasons to start antifungal therapy were: targeted therapy (36%), prophylaxis (32%), empirical therapy (20%) and pre-emptive therapy (12%). At the initial visit, diagnostic advice was provided in 40% of cases. The most common therapeutic recommendations were to de-escalate the antifungal drug (17%) or to suspend it (7%). Annual total antifungal expenditure was reduced from US$3.8 million to US$2.9 million over the first 2 years, generating net savings of US$407,663 and US$824,458 per year after considering the cost of additional staff required. The ITS analyses showed a significant economic impact after the first 12 months of the intervention (p 0.042 at month 13), which was enhanced in the following 24 months (p 0.006 at month 35). The number of defined daily doses decreased from 66.4 to 54.8 per 1000 patient-days. Incidence of candidaemia was reduced from 1.49 to 1.14 (p 0.08) and related mortality was reduced from 28% to 16% (p 0.1). A collaborative and non-compulsory AFS program based on bedside intervention is an efficacious and cost-effective approach that optimizes the use of AF drugs. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  1. The impact of penicillin skin testing on clinical practice and antimicrobial stewardship.

    Science.gov (United States)

    Rimawi, Ramzy H; Cook, Paul P; Gooch, Michael; Kabchi, Badih; Ashraf, Muhammad S; Rimawi, Bassam H; Gebregziabher, Mulugeta; Siraj, Dawd S

    2013-06-01

    Penicillin skin testing (PST) is a simple and reliable way of diagnosing penicillin allergy. After being off the market for 4 years, penicilloyl-polylysine was reintroduced in 2009 as PRE-PEN. We describe the negative predictive value (NPV) of PST and the impact on antibiotic selection in a sample of hospitalized patients with a reported history of penicillin allergy. We introduced a quality improvement process at our 861-bed tertiary care hospital that used PST to guide antibiotic usage in patients with a history consistent with an immunoglobulin E (IgE)-mediated reaction to penicillin. Subjects with a negative PST were then transitioned to a β-lactam agent for the remainder of their therapy. NPV of skin testing was established at 24-hour follow-up. We are reporting the result of 146 patients tested between March 2012 and July 2012. A total of 146 patients with a history of penicillin allergy and negative PST were treated with β-lactam antibiotics. Of these, only 1 subject experienced an allergic reaction to the PST. The remaining 145 patients tolerated a full course of β-lactam therapy without an allergic response, giving the PST a 100% NPV. We estimated that PST-guided antibiotic alteration for these patients resulted in an estimated annual savings of $82,000. Patients with a history of penicillin allergy who have a negative PST result are at a low risk of developing an immediate-type hypersensitivity reaction to β-lactam antibiotics. The increased use of PST may help improve antibiotic stewardship in the hospital setting. Copyright © 2013 Society of Hospital Medicine.

  2. Forest Stewardship Council (FSC) pesticide policy and integrated pest management in certified tropical plantations.

    Science.gov (United States)

    Lemes, Pedro Guilherme; Zanuncio, José Cola; Serrão, José Eduardo; Lawson, Simon A

    2017-01-01

    The Forest Stewardship Council (FSC) was the first non-governmental organization composed of multi-stakeholders to ensure the social, environmental, and economic sustainability of forest resources. FSC prohibits certain chemicals and active ingredients in certified forest plantations. A company seeking certification must discontinue use of products so listed and many face problems to comply with these constraints. The aim of this study was to assess the impacts of certification on pest management from the perspective of Brazilian private forestry sector. Ninety-three percent of Brazilian FSC-certified forest companies rated leaf-cutting ants as "very important" pests. Chemical control was the most important management technique used and considered very important by 82 % of respondents. The main chemical used to control leaf-cutting ants, sulfluramid, is in the derogation process and was classified as very important by 96.5 % of the certified companies. Certified companies were generally satisfied in relation to FSC certification and the integrated management of forest pests, but 27.6 % agreed that the prohibitions of pesticides for leaf-cutting ant and termite control could be considered as a non-tariff barrier on high-productivity Brazilian forest plantations. FSC forest certification has encouraged the implementation of more sustainable techniques and decisions in pest management in forest plantations in Brazil. The prohibition on pesticides like sulfluramid and the use of alternatives without the same efficiency will result in pest mismanagement, production losses, and higher costs. This work has shown that the application of global rules for sustainable forest management needs to adapt to each local reality.

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

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    Jan-Willem H Dik

    2015-06-01

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

  4. Meeting the Challenge of Data Stewardship through Community Partnership and Practice: Examples from the USGS (Invited)

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    Gundersen, L. C.

    2009-12-01

    The collection and maintenance of long-term natural science data is a hallmark of the USGS mission that has become an increasingly complex challenge to meet. Several examples of different aspects of data stewardship illustrate issues and solutions that require community partnerships and agreement on standards and practices to meet the requirements of access, interoperability, and preservation. The USGS National Geologic and Geophysical Data Preservation Program, established 3 years ago, is making important strides in developing and implementing basic data preservation practices and tools across all the geological surveys in the U.S. including preserving data at risk, creating inventories of data, proper curation and cataloguing of data and materials, and creating a universal digital catalogue that will provide discovery and accessibility. For the past 10 years, the National Cooperative Geologic Mapping Program at the USGS has worked with geologic mappers from diverse organizations to establish use of a common map symbology and a community developed geologic map data model. Together these two practices can facilitate the interoperability of this most fundamental but highly individual representation of geologic science. Since 2007, a broad consortium of partners is working together to form the Geosciences Information Network, a virtual network that takes advantage of informatics tools, mark-up languages, web services, and open sources standards to create a potentially unlimited virtual network of information. Using the digital data assets of all the geological surveys across the US and comprising partnerships with ESRI, Microsoft, OneGeology, GEON, and numerous others, this effort strives to use community developed practices and tools and cutting edge technology to bring multi-disciplinary data together while preserving provanance. Finally, the USGS is in the process of developing an Integrated Science Data Environment to preserve and make accessible USGS

  5. Formulary Management and Antimicrobial Stewardship: a 7-year Evaluation at an Integrated Health-System

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    Veve, Michael P; Morin, Amy; Kenney, Rachel M; Makowski, Charles T; Davis, Susan L

    2017-01-01

    Abstract Background The antimicrobial formulary is a key tool in antimicrobial stewardship (ASP). Agents added to formulary typically are those that have been formally reviewed and determined to have a place in therapy in a given facility. Non-formulary (NF) agents generally are those that have not been requested, or were deemed not optimal based on spectrum, formulation, or cost. We evaluated NF antimicrobial orders to identify possible gaps in optimal use and process. Methods IRB-exempt ecological evaluation of NF antimicrobial use in multi-site healthcare system. Anonymous data collected: NF antimicrobial agents ordered between 2010–2017. Drug use characteristics: class, duration, availability of formulary alternatives, and time since FDA approval. Descriptive statistics were used to characterize NF use. Additional formulary processes evaluated: requests, reviews, and decisions. Results 2041 NF antimicrobial were ordered for 44 different agents, representing 14 days. 185 orders were placed for new drugs (within 12 months of FDA-approval), 73% were for HIV agents. 11 of 44 NF agents were subsequently added to the formulary. During the study period, 17 antimicrobial were requested for either inpatient or outpatient formulary addition; all were approved with use criteria or infectious diseases restriction. Of 16 antimicrobial agents FDA-approved during the study period, 6 were requested and added to the inpatient formulary. Fifty-two percent of agents had alternatives in the same class on formulary at the time of use. Potential safety problems identified: dose and duration of therapy. Conclusion Formulary structure provides systematic approach for drug selection, dose, and duration. Monitoring NF antimicrobials use can aid in identification of ASP priorities, with implications for medication safety and patient outcomes. Disclosures S. L. Davis, Allergan: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Merck: Grant Investigator and

  6. Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010

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    Daniel J. Pallin

    2014-05-01

    Full Text Available Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA. The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs and analyze potential quality measures. Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation. Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4% were for skin infection, and 2.7% (2.6-2.9% were first visits for skin infection, with no increase over time (p=0.80. However, anti-CA-MRSA antibiotic use increased, from 61% (56-66% to 74% (71-78% of antibiotic regimens (p<0.001. Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06. Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse. Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse. Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for

  7. Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation.

    Science.gov (United States)

    Trubiano, Jason A; Thursky, Karin A; Stewardson, Andrew J; Urbancic, Karen; Worth, Leon J; Jackson, Cheryl; Stevenson, Wendy; Sutherland, Michael; Slavin, Monica A; Grayson, M Lindsay; Phillips, Elizabeth J

    2017-07-01

    Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions). From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, .09-.29), after adjusting for indication, Charlson comorbidity index, and care setting. An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.

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

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    Marianne E. Krasny

    2014-09-01

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

  9. Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome.

    Science.gov (United States)

    Bedini, Andrea; De Maria, Nicola; Del Buono, Mariagrazia; Bianchini, Marcello; Mancini, Mauro; Binda, Cecilia; Brasacchio, Andrea; Orlando, Gabriella; Franceschini, Erica; Meschiari, Marianna; Sartini, Alessandro; Zona, Stefano; Paioli, Serena; Villa, Erica; Gyssens, Inge C; Mussini, Cristina

    2016-10-01

    A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  10. Marine Stewardship Council certification of fisheries in Russia: a current status and prospects

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    Dmitry Liudvigovich Lajus

    2015-11-01

    Full Text Available Russia supports the sixth largest fisheries worldwide, which grew 25% during the last decade and is forecasted to grow 40% more up to 2020. Such voluminous and fast growing fisheries cause challenges for their sustainability. Marine Stewardship Council (MSC voluntary certification is now the most recognized system aimed to achieve sustainability of fisheries through informed choice of consumers. The certified fisheries benefit through recognition of MSC logo by consumers. The certificate is awarded to fisheries with a good status of target species and limited impact to structure and function of ecosystems, and to protected species. The recent research showed that MSC certified fisheries in average refer to healthier stocks than non-certified ones. Russia entered the program in the second half of the 2000s, and the first certificate was awarded in 2009. Now the MSC process in Russia is very intensive and currently involves thirteen fisheries, seven of them already are certified. The certified fisheries can be subdivided into three groups: (i set net Pacific salmon fisheries of the Far East, (ii bottom trawl codfish fisheries in the Barents Sea, and (iii pelagic trawl Alaska pollock fisheries in the Sea of Okhotsk. The total catch of fisheries involved in the MSC program now is about one-third for Pacific salmon, most of codfish and about a half for Alaska pollock. Process of MSC certifications in Russia faces various problems, caused by differences between western and Russian traditions of fishery management, difficulties of access to scientific information, insufficient support from governmental institutions, illegal fishing, insufficient independent observance, influence of hatcheries on salmon wild stocks and others. We believe that to improve sustainability of Russian fisheries, it is needed to demonstrate economical benefits of certification for those fisheries which are not involved in the program, to involve new fisheries in the process

  11. Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan.

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    Mushtaq, Ammara; Awali, Reda A; Chandramohan, Suganya; Krishna, Amar; Biedron, Caitlin; Jegede, Olufemi; Chopra, Teena

    2017-10-11

    The objective of the study was to assess health care providers' (HCPs) knowledge and attitude toward antimicrobial resistance (AMR) and implement an antimicrobial stewardship program (ASP) in a long-term acute care hospital (LTACH). A questionnaire on antibiotic use and resistance was administered to HCP in an LTACH in Detroit, Michigan, between August 2011 and October 2011. Concurrently, a retrospective review of common antibiotic prescription practices and costs was conducted. Then, a tailored ASP was launched at the LTACH followed by 2-phase postimplementation assessment aiming at evaluating the impact of the ASP on antibiotic expenditure. Of all respondents (N = 26), 65% viewed AMR as a national problem, but only 38% perceived AMR as a problem at their facility. Most respondents were familiar with infections caused by resistant organisms such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase; however, only 35% expressed confidence in treating infected patients. In the preimplementation phase, 15% of antimicrobial doses were inappropriate and 10 of 13 de-escalation opportunities were missed, resulting in additional $23,524.00 expenditure. In the first postimplementation phase, there was a 42% and 58% decrease in the use of daptomycin and tigecycline, respectively, resulting in $55,000 savings. In the second postintervention phase, total antimicrobial cost for treating a cohort of 28 patients in 2016 and 2017 was $26,837.85 and $22,397.15, respectively. Introduction of an ASP in an LTACH improves antimicrobial prescribing practices, reduces cost, and is sustainable. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Deep-sea genetic resources: New frontiers for science and stewardship in areas beyond national jurisdiction

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    Harden-Davies, Harriet

    2017-03-01

    The deep-sea is a large source of marine genetic resources (MGR), which have many potential uses and are a growing area of research. Much of the deep-sea lies in areas beyond national jurisdiction (ABNJ), including 65% of the global ocean. MGR in ABNJ occupy a significant gap in the international legal framework. Access and benefit sharing of MGR is a key issue in the development of a new international legally-binding instrument under the United Nations Convention on the Law of the Sea (UNCLOS) for the conservation and sustainable use of marine biological diversity in ABNJ. This paper examines how this is relevant to deep-sea scientific research and identifies emerging challenges and opportunities. There is no internationally agreed definition of MGR, however, deep-sea genetic resources could incorporate any biological material including genes, proteins and natural products. Deep-sea scientific research is the key actor accessing MGR in ABNJ and sharing benefits such as data, samples and knowledge. UNCLOS provides the international legal framework for marine scientific research, international science cooperation, capacity building and marine technology transfer. Enhanced implementation could support access and benefit sharing of MGR in ABNJ. Deep-sea scientific researchers could play an important role in informing practical new governance solutions for access and benefit sharing of MGR that promote scientific research in ABNJ and support deep-sea stewardship. Advancing knowledge of deep-sea biodiversity in ABNJ, enhancing open-access to data and samples, standardisation and international marine science cooperation are significant potential opportunity areas.

  13. Practical implications of understanding the influence of motivations on commitment to voluntary urban conservation stewardship.

    Science.gov (United States)

    Asah, Stanley T; Blahna, Dale J

    2013-08-01

    -building motivations may help enhance volunteers' commitment to conservation stewardship and address the pressing challenge of retaining urban conservation volunteers. © 2013 Society for Conservation Biology.

  14. [Antibiotic stewardship (ABS). Definition, contents, necessity and practice on examples of current clinical-urological controversies].

    Science.gov (United States)

    Schneidewind, L; Kranz, J; Boehm, K; Spachmann, P; Siegel, F; Huck, N; Fritsche, H M

    2016-04-01

    Infectious diseases caused by multi-resistant pathogens are increasing worldwide and are posing a challenge to German urology as well. Furthermore, there is a limited perspective of new antibiotic developments. One way out of this dilemma is a differentiated handling and use of antibiotics (antibiotic stewardship, ABS). The aim of this review is to identify key issues in modern urological antibiotic therapy, which can be considered as exemplary for the whole topic of ABS. This includes a review of the current data of the individual topics, including thought-provoking impulse for future clinical application and research. The research group "infectious diseases" of GeSRU Academics identified the following central topics: excessive use of fluoroquinolones, diagnosis and treatment of urethritis and perioperative antibiotic prophylaxis. Subsequently, we performed a literature research in MEDLINE to uncover controversies and open questions of the individual topics within the meaning of ABS. The analysis of modern antibiotic therapy in urology shows numerous open questions in all quality dimensions of ABS: structural quality (e.g. through improved training of medical staff in the differentiated use of antibiotics), process quality (e.g. by improved adherence to existing infectiological guidelines, here in particular the perioperative prophylaxis and therapy of urethritis) and outcome (e.g. by detection of resistance rates and infection rates). The overarching and common goal is to avoid a post-antibiotic era. ABS programmes and a 10-point plan of the federal government are considered positive political developments in this area but do not release the individual urologist from a personal responsibility as part of his daily routine. A critical analysis of the topic "antibiotic treatment" is essential.

  15. The Changing Role of Data Stewardship in Creating Trustworthy, Interdisciplinary High Performance Data Platforms for the Future.

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    Richards, C. J.; Evans, B. J. K.; Wyborn, L. A.; Wang, J.; Trenham, C. E.; Druken, K. A.

    2016-12-01

    The Australian National Computational Infrastructure (NCI) has ingested over 10PB of national and international environmental, Earth systems science and geophysics reference data onto a single platform to advance high performance data (HPD) techniques that enable interdisciplinary Data-intensive Science. Improved Data Stewardship is critical to evolve both data and data services that support the increasing need for programmatic usability and that prioritises interoperability rather than just traditional data download or portal access. A data platform designed for programmatic access requires quality checked collections that better utilise interoperable data formats and standards. Achieving this involves strategies to meet both the technical and `social' challenges. Aggregating datasets used by different communities and organisations requires satisfying multiple use cases for the broader research community, whilst addressing existing BAU requirements. For NCI, this requires working with data stewards to manage the process of replicating data to the common platform, community representatives and developers to confirm their requirements, and with international peers to better enable globally integrated data communities. It is particularly important to engage with representatives from each community who can work collaboratively to a common goal, as well as capture their community needs, apply quality assurance, determine any barriers to change and to understand priorities. This is critical when managing the aggregation of data collections from multiple producers with different levels of stewardship maturity, technologies and standards, and where organisational barriers can impact the transformation to interoperable and performant data access. To facilitate the management, development and operation of the HPD platform, NCI coordinates technical and domain committees made up of user representatives, data stewards and informatics experts to provide a forum to discuss

  16. Recreation, values and stewardship: Rethinking why people engage in environmental behaviors in parks and protected areas: Chapter 19

    Science.gov (United States)

    van Riper, Carena J.; Sharp, Ryan; Bagstad, Kenneth J.; Vagias, Wade M.; Kwenye, Jane; Depper, Gina; Freimund, Wayne

    2016-01-01

    Successfully promoting and encouraging the adoption of environmental stewardship behavior is an important responsibility for public land management agencies. Although people increasingly report high levels of concern about environmental issues, widespread patterns of stewardship behavior have not followed suit (Moore 2002). One concept that can be applied in social science research to explain behavior change is that of values. More specifically, held and assigned values lie at the heart of understanding why people around the world continue to live in unsustainable ways that impact parks and protected areas. A held value is an individual psychological orientation defined by Rokeach as “an enduring belief that a specific mode of conduct or endstate of existence is personally and socially preferable” (1973, 550). Held values are at the core of human cognition, and as such, influence attitudes and behavior. Assigned values on the other hand, according to Brown (1984), are the perceived qualities of an environment that are based on and deduced from held values. In other words, assigned values are considered the material and nonmaterial benefits that people believe they obtain from ecosystems. Held and assigned values predict stewardship behaviors (Figure 1). During the 2013 George Wright Society Conference on Parks, Protected Areas, and Cultural Sites, we organized a session to improve our understanding of why individuals and groups choose to engage in stewardship behaviors that benefit the environment. We used held and assigned values as vehicles to explore what people cared about in diverse landscapes, review select case studies from across the globe, and question how best to incorporate visitor perspectives into protected area management decisions and policymaking. In addition to sharing project results, we also discussed the importance of accounting for multiple and often competing value perspectives, potential ways to integrate disciplinary perspectives on

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

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    Nelson, Jody K. [Stoller LMS Team, Contractor to the U.S. Department of Energy Office of Legacy Management, 11025 Dover Street, Suite 1000, Westminster, Colorado 80021 (United States)

    2013-07-01

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

  18. Science-based health innovation in Tanzania: bednets and a base for invention

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    Daar Abdallah S

    2010-12-01

    Full Text Available Abstract Background Tanzania is East Africa’s largest country. Although it is socially diverse, it has experienced general political stability since independence in 1964. Despite gradual economic development and Tanzania’s status as one of the biggest recipients of aid in Africa, health status remains poor. This paper explores Tanzania’s science-based health innovation system, and highlights areas which can be strengthened. Methods Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents, and through open-ended, face-to-face interviews with 52 people from across the science-based health innovation system over two visits to Tanzania from July to October 2007. Results and discussion Tanzania has a rich but complex S&T governance landscape, with the public sector driving the innovation agenda through a series of different bodies which are not well-coordinated. It has some of the leading health research on the continent at the University of Dar es Salaam, Muhimbili University of Health and Applied Sciences, the National Institute for Medical Research and the Ifakara Medical Institute, with strong donor support. Tanzania has found developing an entrepreneurial culture difficult; nevertheless projects such as the clusters initiative at the University of Dar es Salaam are encouraging low-tech innovation and overcoming knowledge-sharing barriers. In the private sector, one generics company has developed a South-South collaboration to enable technology transfer and hence the local production of anti-retrovirals. Local textile company A to Z Textiles is now manufacturing 30 million insecticide impregnated bednets a year. Conclusions To have a coherent vision for innovation, Tanzania may wish to address some key issues: coordination across stakeholders involved with health research, increasing graduates in health-related disciplines, and building capabilities in biological

  19. Science-based health innovation in Rwanda: unlocking the potential of a late bloomer.

    Science.gov (United States)

    Simiyu, Kenneth; Daar, Abdallah S; Hughes, Mike; Singer, Peter A

    2010-12-13

    This paper describes and analyses Rwanda's science-based health product 'innovation system', highlighting examples of indigenous innovation and good practice. We use an innovation systems framework, which takes into account the wide variety of stakeholders and knowledge flows contributing to the innovation process. The study takes into account the destruction of the country's scientific infrastructure and human capital that occurred during the 1994 genocide, and describes government policy, research institutes and universities, the private sector, and NGOs that are involved in health product innovation in Rwanda. Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 38 people from across the science-based health innovation system. Data was collected over two visits to Rwanda between November - December 2007 and in May 2008. A workshop was held in Kigali on May 23rd and May 24th 2009 to validate the findings. A business plan was then developed to operationalize the findings. The results of the study show that Rwanda has strong government will to support health innovation both through its political leadership and through government policy documents. However, it has a very weak scientific base as most of its scientific infrastructure as well as human capital were destroyed during the 1994 genocide. The regulatory agency is weak and its nascent private sector is ill-equipped to drive health innovation. In addition, there are no linkages between the various actors in the country's health innovation system i.e between research institutions, universities, the private sector, and government bureaucrats. Despite the fact that the 1994 genocide destroyed most of the scientific infrastructure and human capital, the country has made remarkable progress towards developing its health innovation system, mainly due to political goodwill. The areas of greatest

  20. Science-based health innovation in Tanzania: bednets and a base for invention.

    Science.gov (United States)

    Shah, Ronak; Singer, Peter A; Daar, Abdallah S

    2010-12-13

    Tanzania is East Africa's largest country. Although it is socially diverse, it has experienced general political stability since independence in 1964. Despite gradual economic development and Tanzania's status as one of the biggest recipients of aid in Africa, health status remains poor. This paper explores Tanzania's science-based health innovation system, and highlights areas which can be strengthened. Qualitative case study research methodology was used. Data were collected through reviews of academic literature and policy documents, and through open-ended, face-to-face interviews with 52 people from across the science-based health innovation system over two visits to Tanzania from July to October 2007. Tanzania has a rich but complex S&T governance landscape, with the public sector driving the innovation agenda through a series of different bodies which are not well-coordinated. It has some of the leading health research on the continent at the University of Dar es Salaam, Muhimbili University of Health and Applied Sciences, the National Institute for Medical Research and the Ifakara Medical Institute, with strong donor support. Tanzania has found developing an entrepreneurial culture difficult; nevertheless projects such as the clusters initiative at the University of Dar es Salaam are encouraging low-tech innovation and overcoming knowledge-sharing barriers. In the private sector, one generics company has developed a South-South collaboration to enable technology transfer and hence the local production of anti-retrovirals. Local textile company A to Z Textiles is now manufacturing 30 million insecticide impregnated bednets a year. To have a coherent vision for innovation, Tanzania may wish to address some key issues: coordination across stakeholders involved with health research, increasing graduates in health-related disciplines, and building capabilities in biological testing, preclinical testing, formulation and standardization, and related areas important

  1. A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

    Directory of Open Access Journals (Sweden)

    Mary Richard Akpan

    2016-01-01

    Full Text Available The growing problem of antimicrobial resistance (AMR has led to calls for antimicrobial stewardship programs (ASP to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI. Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001 higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of

  2. Subdivision design and stewardship affect bird and mammal use of conservation developments.

    Science.gov (United States)

    Farr, Cooper M; Pejchar, Liba; Reed, Sarah E

    2017-06-01

    Developing effective tools for conservation on private lands is increasingly important for global biodiversity conservation; private lands are located in more productive and biologically diverse areas, and they face accelerated rates of land conversion. One strategy is conservation development (CD) subdivisions, which cluster houses in a small portion of a property and preserve the remaining land as protected open space. Despite widespread use, the characteristics that make CD more or less effective at achieving biodiversity conservation are not well understood. We investigated CD's ability to successfully protect animal populations by examining bird and mammal occurrences in 14 CD subdivisions and four undeveloped areas (range: 14-432 ha) in northern Colorado, USA. Using point count and camera trap data in an occupancy modeling framework, we evaluated the relative importance of nine subdivision design factors (e.g., housing density, proportion of CD protected) and 14 stewardship factors (e.g., presence of livestock, percent native vegetation cover) in influencing the overall community composition and the probability of use by 16 birds and six mammals. We found that habitat use by 75% of birds and 83% of mammals was associated with design characteristics that maximized the natural or undisturbed land area both within and near the development (e.g., proportion of CD protected, total area of protected open space, proportion of natural land cover in the surrounding landscape). These factors were also associated with an increasing dominance of human-sensitive bird species, larger-bodied mammals, and mammals with larger home ranges. Habitat use by birds was also influenced by local land use composition and quality, and use by several bird and mammal species decreased with increased localized disturbances. We found few differences in habitat use between sampling sites in undeveloped areas and in CD subdivisions. These similarities indicate that, if CDs are large enough

  3. Participatory eHealth development to support nurses in antimicrobial stewardship.

    Science.gov (United States)

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

    2014-06-05

    Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses' can be supported in ASPs by means of an eHealth intervention that targets their information needs. We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application's functionality, content, and structure to nurse work practice and tasks. By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses') and top-down legislations (medical protocols). Second, it enabled us to fragmentise

  4. Formalization of an antimicrobial stewardship program in a small community hospital.

    Science.gov (United States)

    Lockwood, Alexa R; Bolton, Nicole S; Winton, Mark D; Carter, Jean T

    2017-09-01

    Results of a study to formalize an antimicrobial stewardship program (ASP) in a small community hospital are presented. The formalization process began with a gap analysis of the hospital's antimicrobial services, followed by the development of a fully integrated, multipharmacist ASP. The impact was studied with an institutional review board-approved study design. Retrospective pre-ASP data were pulled from March 1 to June 30, 2012 and 2013 patient records; prospective post-ASP data were collected for March 1 to June 30, 2015. Analyses included descriptive and inferential statistics. No significant differences in age, percent of patients on antimicrobials, or length of stay were found between the 2 groups. The post-ASP period showed a 30.2% decrease in defined daily dose (DDD) per 1,000 patient-days for the 18 most frequently used parenteral antimicrobial agents (p < 0.001). For all nursing units except nursery, the vancomycin and piperacillin-tazobactam DDD per 1,000 patient-days decreased by 63% (p < 0.001) and 36% (p < 0.001), respectively. Mean antibiotic charges per patient-day decreased from $10.44 to $3.09 (p < 0.001) and from $18.04 to $11.29 (p < 0.001) for vancomycin and piperacillin-tazobactam, respectively. Pharmacist interventions increased from 19.3 per 1,000 patients to 104.3 per 1,000 patients. Deescalation of therapy was the most common intervention (46% and 29%) in both time periods. In a small community hospital, a new formalized ASP with pharmacists showed a decrease in the DDD per 1,000 patient-days and average antibiotic charges per patient-day for vancomycin and piperacillin-tazobactam within 4 months of implementation. The approach used to develop a formalized ASP could be used as an example for development in small community hospitals with similar resources. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  5. Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers.

    Science.gov (United States)

    Thern, J; de With, K; Strauss, R; Steib-Bauert, M; Weber, N; Kern, W V

    2014-04-01

    Simple, valid, and evidence-based indicators to measure the quality of antimicrobial prescribing in acute-care hospitals are urgently needed and increasingly requested by policymakers. The aim of this study was to develop new consensus quality indicators (QIs) for hospital antibiotic stewardship (ABS) and infection management which will be further evaluated for internal quality management and external quality assessment in Germany. Based on an extensive literature review, the Austrian-German hospital ABS Guideline Committee and selected members of the German ABS Expert Network discussed and drafted a list of 99 potential indicators for hospitals that reflect structural prerequisites for ABS (35 items), ABS core activities (18 items), additional ABS measures (5 items), and process of care indicators (both generic and disease-specific-12 and 29 items, respectively). Questionnaires were mailed to German ABS experts and healthcare professionals with further education in ABS. Participants scored (on a nine-point Likert scale) relevance (clinical, ecological/resistance, economical/expenses) and presumed practicability (six categories: clarity of definition, effort to collect data, barrier to implementation, verifiability, suitability for external quality assessment, quality gap), taking into account their local work environment. The scores were processed according to the RAND/UCLA appropriateness method, and QIs were judged relevant if the median (clinical + ecological and/or economical) scores were >6. The indicators thus assessed to be potentially relevant were then filtered according to their practicability. Highly relevant QIs with borderline practicability scores and items with disagreements and overlapping areas were re-discussed in a final multidisciplinary panel consensus workshop convened in November 2012. Of the 340 questionnaires that were mailed, 75 questionnaires were completed and returned. Of 99 initially proposed items, 32 were excluded due to

  6. Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle.

    Science.gov (United States)

    Romolini, Michele; Morgan Grove, J; Ventriss, Curtis L; Koliba, Christopher J; Krymkowski, Daniel H

    2016-08-01

    Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

  7. Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control.

    Science.gov (United States)

    Cheon, Shinhye; Kim, Mi-Ja; Yun, Seon-Jin; Moon, Jae Young; Kim, Yeon-Sook

    2016-03-01

    Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center. Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs. The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p baumannii in our ICUs within 1 year.

  8. Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle

    Science.gov (United States)

    Romolini, Michele; Morgan Grove, J.; Ventriss, Curtis L.; Koliba, Christopher J.; Krymkowski, Daniel H.

    2016-08-01

    Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

  9. Policy options to reduce consumer waste to zero: comparing product stewardship and extended producer responsibility for refrigerator waste.

    Science.gov (United States)

    Nicol, Scott; Thompson, Shirley

    2007-06-01

    Today, over-consumption, pollution and resource depletion threaten sustainability. Waste management policies frequently fail to reduce consumption, prevent pollution, conserve resources and foster sustainable products. However, waste policies are changing to focus on lifecycle impacts of products from the cradle to the grave by extending the responsibilities of stakeholders to post-consumer management. Product stewardship and extended producer responsibility are two policies in use, with radically different results when compared for one consumer product, refrigerators. North America has enacted product stewardship policies that fail to require producers to take physical or financial responsibility for recycling or for environmentally sound disposal, so that releases of ozone depleting substances routinely occur, which contribute to the expanding the ozone hole. Conversely, Europe's Waste Electrical and Electronic Equipment (WEEE) Directive requires extended producer responsibility, whereby producers collect and manage their own post-consumer waste products. WEEE has resulted in high recycling rates of greater than 85%, reduced emissions of ozone-depleting substances and other toxins, greener production methods, such as replacing greenhouse gas refrigerants with environmentally friendly hydrocarbons and more reuse of refrigerators in the EU in comparison with North America.

  10. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

    Science.gov (United States)

    Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

    2014-09-01

    An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

  11. Life science-based neuroscience education at large Western Public Universities.

    Science.gov (United States)

    Coskun, Volkan; Carpenter, Ellen M

    2016-12-01

    The last 40 years have seen a remarkable increase in the teaching of neuroscience at the undergraduate level. From its origins as a component of anatomy or physiology departments to its current status as an independent interdisciplinary field, neuroscience has become the chosen field of study for many undergraduate students, particularly for those interested in medical school or graduate school in neuroscience or related fields. We examined how life science-based neuroscience education is offered at large public universities in the Western United States. By examining publicly available materials posted online, we found that neuroscience education may be offered as an independent program, or as a component of biological or physiological sciences at many institutions. Neuroscience programs offer a course of study involving a core series of courses and a collection of topical electives. Many programs provide the opportunity for independent research, or for laboratory-based training in neuroscience. Features of neuroscience programs at Western universities closely matched those seen at the top 25 public universities, as identified by U.S. News & World Report. While neuroscience programs were identified in many Western states, there were several states in which public universities appeared not to provide opportunities to major in neuroscience. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Science-based requirements and operations development for the Maunakea Spectroscopic Explorer

    Science.gov (United States)

    McConnachie, Alan W.; Flagey, Nicolas; Murowinski, Rick; Szeto, Kei; Salmon, Derrick; Withington, Kanoa; Mignot, Shan

    2016-07-01

    MSE is a wide field telescope (1.5 square degree field of view) with an aperture of 11.25m. It is dedicated to multi-object spectroscopy at several different spectral resolutions in the range R 2500 - 40000 over a broad wavelength range (0:36 - 1:8μm). MSE enables transformational science in areas as diverse as exoplanetary host characterization; stellar monitoring campaigns; tomographic mapping of the interstellar and intergalactic media; the in-situ chemical tagging of the distant Galaxy; connecting galaxies to the large scale structure of the Universe; measuring the mass functions of cold dark matter sub-halos in galaxy and cluster-scale hosts; reverberation mapping of supermassive black holes in quasars. Here, we summarize the Observatory and describe the development of the top level science requirements and operational concepts. Specifically, we describe the definition of the Science Requirements to be the set of capabilities that allow certain high impact science programs to be conducted. We cross reference these science cases to the science requirements to illustrate the traceability of this approach. We further discuss the operations model for MSE and describe the development of the Operations Concept Document, one of the foundational documents for the project. We also discuss the next stage in the science based development of MSE, specifically the development of the initial Legacy Survey that will occupy a majority of time on the telescope over the first few years of operation.

  13. Water Hyacinth in China: A Sustainability Science-Based Management Framework

    Science.gov (United States)

    Lu, Jianbo; Wu, Jianguo; Fu, Zhihui; Zhu, Lei

    2007-12-01

    The invasion of water hyacinth ( Eichhornia crassipes) has resulted in enormous ecological and economic consequences worldwide. Although the spread of this weed in Africa, Australia, and North America has been well documented, its invasion in China is yet to be fully documented. Here we report that since its introduction about seven decades ago, water hyacinth has infested many water bodies across almost half of China’s territory, causing a decline of native biodiversity, alteration of ecosystem services, deterioration of aquatic environments, and spread of diseases affecting human health. Water hyacinth infestations have also led to enormous economic losses in China by impeding water flows, paralyzing navigation, and damaging irrigation and hydroelectricity facilities. To effectively control the rampage of water hyacinth in China, we propose a sustainability science-based management framework that explicitly incorporates principles from landscape ecology and Integrated Pest Management. This framework emphasizes multiple-scale long-term monitoring and research, integration among different control techniques, combination of control with utilization, and landscape-level adaptive management. Sustainability science represents a new, transdisciplinary paradigm that integrates scientific research, technological innovation, and socioeconomic development of particular regions. Our proposed management framework is aimed to broaden the currently dominant biological control-centered view in China and to illustrate how sustainability science can be used to guide the research and management of water hyacinth.

  14. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial.

    Science.gov (United States)

    van Vliet, P M; Lincoln, N B; Foxall, A

    2005-04-01

    Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence. A total of 120 patients admitted to a stroke rehabilitation ward were randomised into two treatment groups to receive either BB or MSB treatment. Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale. Secondary measures assessed functional independence, walking speed, arm function, muscle tone, and sensation. Measures were performed by a blinded assessor at baseline, and then at 1, 3, and 6 months after baseline. Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve (AUC) and inserting AUC values into Mann-Whitney U tests. Comparison between groups showed no significant difference for any outcome measures. Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87. There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention. Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients.

  15. Water hyacinth in China: a sustainability science-based management framework.

    Science.gov (United States)

    Lu, Jianbo; Wu, Jianguo; Fu, Zhihui; Zhu, Lei

    2007-12-01

    The invasion of water hyacinth (Eichhornia crassipes) has resulted in enormous ecological and economic consequences worldwide. Although the spread of this weed in Africa, Australia, and North America has been well documented, its invasion in China is yet to be fully documented. Here we report that since its introduction about seven decades ago, water hyacinth has infested many water bodies across almost half of China's territory, causing a decline of native biodiversity, alteration of ecosystem services, deterioration of aquatic environments, and spread of diseases affecting human health. Water hyacinth infestations have also led to enormous economic losses in China by impeding water flows, paralyzing navigation, and damaging irrigation and hydroelectricity facilities. To effectively control the rampage of water hyacinth in China, we propose a sustainability science-based management framework that explicitly incorporates principles from landscape ecology and Integrated Pest Management. This framework emphasizes multiple-scale long-term monitoring and research, integration among different control techniques, combination of control with utilization, and landscape-level adaptive management. Sustainability science represents a new, transdisciplinary paradigm that integrates scientific research, technological innovation, and socioeconomic development of particular regions. Our proposed management framework is aimed to broaden the currently dominant biological control-centered view in China and to illustrate how sustainability science can be used to guide the research and management of water hyacinth.

  16. Aquifer-yield continuum as a guide and typology for science-based groundwater management

    Science.gov (United States)

    Pierce, Suzanne A.; Sharp, John M.; Guillaume, Joseph H. A.; Mace, Robert E.; Eaton, David J.

    2013-03-01

    Groundwater availability is at the core of hydrogeology as a discipline and, simultaneously, the concept is the source of ambiguity for management and policy. Aquifer yield has undergone multiple definitions resulting in a range of scientific methods to calculate and model availability reflecting the complexity of combined scientific, management, policy, and stakeholder processes. The concept of an aquifer-yield continuum provides an approach to classify groundwater yields along a spectrum, from non-use through permissive sustained, sustainable, maximum sustained, safe, permissive mining to maximum mining yields, that builds on existing literature. Additionally, the aquifer-yield continuum provides a systems view of groundwater availability to integrate physical and social aspects in assessing management options across aquifer settings. Operational yield describes the candidate solutions for operational or technical implementation of policy, often relating to a consensus yield that incorporates human dimensions through participatory or adaptive governance processes. The concepts of operational and consensus yield address both the social and the technical nature of science-based groundwater management and governance.

  17. The regional dimension of sectoral innovativeness: An empirical investigation of two specialized suppliers and two science-based industries

    DEFF Research Database (Denmark)

    Buerger, M.; Cantner, U.

    2011-01-01

    , which includes German patent applications from within the period 1995 to 2006. Four industries are considered, two of which are science-based, whereas the remaining two are specialized supplier industries. While diversity is associated with high innovative output in the specialized supplier industries...

  18. Assessment of impact of peptide nucleic acid fluorescence in situ hybridization for rapid identification of coagulase-negative staphylococci in the absence of antimicrobial stewardship intervention.

    Science.gov (United States)

    Holtzman, Carol; Whitney, Dana; Barlam, Tamar; Miller, Nancy S

    2011-04-01

    Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) was instituted at Boston Medical Center for the rapid identification of coagulase-negative staphylococci (CoNS). Without active notification or antimicrobial stewardship intervention, a pre- and postimpact analysis showed no benefit of this assay with respect to the length of hospital stay or vancomycin use.

  19. Private informational governance in Post-Soviet waters: Implications of the Marine Stewardship Council certification in the Russian Barents Sea region

    NARCIS (Netherlands)

    Pristupa, A.O.; Lamers, M.A.J.; Amelung, B.

    2016-01-01

    The Russian Barents Sea represents a celebrated example of sustainable fisheries management owing to effective and stable bilateral cooperation between Norway and Russia. The success of the state regime has not ruled out the emergence of private certification of the Marine Stewardship Council (MSC).

  20. Science and stewardship to protect and sustain wilderness values: Tenth World Wilderness Congress symposium; 2013, 4-10 October, Salamanca, Spain

    Science.gov (United States)

    Alan Watson; Stephen Carver; Zdenka Krenova; Brooke McBride

    2015-01-01

    The Tenth World Wilderness Congress (WILD10) met in Salamanca, Spain in 2013. The symposium on science and stewardship to protect and sustain wilderness values was the largest of multiple symposia held in conjunction with the Congress. This symposium was organized and sponsored by the Aldo Leopold Wilderness Research Institute, the Wildland Research Institute of the...

  1. Participatory action research in antimicrobial stewardship: a novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities

    NARCIS (Netherlands)

    van Buul, L.W.; Sikkens, J.J.; van Agtmael, M.A.; Kramer, M.H.H.; van der Steen, J.T.; Hertogh, C.M.P.M.

    2014-01-01

    It is challenging to change physicians' antimicrobial prescribing behaviour. Although antimicrobial prescribing is determined by contextual (e.g. a lack of guidelines), cultural (e.g. peer practice) and behavioural (e.g. perceived decision making autonomy) factors, most antimicrobial stewardship

  2. Science and stewardship to protect and sustain wilderness values: Ninth World Wilderness Congress symposium; November 6-13, 2009; Merida, Yucatan, Mexico

    Science.gov (United States)

    Alan Watson; Joaquin Murrieta-Saldivar; Brooke McBride

    2011-01-01

    The Ninth World Wilderness Congress (WILD9) met in Merida, Yucatan, Mexico in 2009. The symposium on science and stewardship to protect and sustain wilderness values was the largest of multiple symposia held in conjunction with the Congress. The papers contained in this proceedings were generated at this symposium or submitted by the author or authors for consideration...

  3. Cost-minimization model of a multidisciplinary Antibiotic Stewardship Team based on a successful implementation on a urology ward of an academic hospital

    NARCIS (Netherlands)

    Dik, Jan-Willem H.; Hendrix, Ron; Friedrich, Alex W.; Luttjeboer, Jos; Panday, Prashant Nannan; Wilting, Kasper R.; Lo-Ten-Foe, Jerome R.; Postma, Maarten J.; Sinha, Bhanu

    2015-01-01

    Background In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit,

  4. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.

    Science.gov (United States)

    Baur, David; Gladstone, Beryl Primrose; Burkert, Francesco; Carrara, Elena; Foschi, Federico; Döbele, Stefanie; Tacconelli, Evelina

    2017-09-01

    Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I(2) method. We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; pincidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; pincidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria. German

  5. Stockpiled pre-pandemic H5N1 influenza virus vaccines with AS03 adjuvant provide cross-protection from H5N2 clade 2.3.4.4 virus challenge in ferrets.

    Science.gov (United States)

    Sun, Xiangjie; Belser, Jessica A; Pulit-Penaloza, Joanna A; Creager, Hannah M; Guo, Zhu; Jefferson, Stacie N; Liu, Feng; York, Ian A; Stevens, James; Maines, Taronna R; Jernigan, Daniel B; Katz, Jacqueline M; Levine, Min Z; Tumpey, Terrence M

    2017-08-01

    Avian influenza viruses, notably H5 subtype viruses, pose a continuous threat to public health due to their pandemic potential. In recent years, influenza virus H5 subtype split vaccines with novel oil-in-water emulsion based adjuvants (e.g. AS03, MF59) have been shown to be safe, immunogenic, and able to induce broad immune responses in clinical trials, providing strong scientific support for vaccine stockpiling. However, whether such vaccines can provide protection from infection with emerging, antigenically distinct clades of H5 viruses has not been adequately addressed. Here, we selected two AS03-adjuvanted H5N1 vaccines from the US national pre-pandemic influenza vaccine stockpile and assessed whether the 2004-05 vaccines could provide protection against a 2014 highly pathogenic avian influenza (HPAI) H5N2 virus (A/northern pintail/Washington/40964/2014), a clade 2.3.4.4 virus responsible for mass culling of poultry in North America. Ferrets received two doses of adjuvanted vaccine containing 7.5µg of hemagglutinin (HA) from A/Vietnam/1203/2004 (clade 1) or A/Anhui/1/2005 (clade 2.3.4) virus either in a homologous or heterologous prime-boost vaccination regime. We found that both vaccination regimens elicited robust antibody responses against the 2004-05 vaccine viruses and could reduce virus-induced morbidity and viral replication in the lower respiratory tract upon heterologous challenge despite the low level of cross-reactive antibody titers to the challenge H5N2 virus. This study supports the value of existing stockpiled 2004-05 influenza H5N1 vaccines, combined with AS03-adjuvant for early use in the event of an emerging pandemic with H5N2-like clade 2.3.4.4 viruses. Published by Elsevier Inc.

  6. Network Science Based Quantification of Resilience Demonstrated on the Indian Railways Network.

    Science.gov (United States)

    Bhatia, Udit; Kumar, Devashish; Kodra, Evan; Ganguly, Auroop R

    2015-01-01

    The structure, interdependence, and fragility of systems ranging from power-grids and transportation to ecology, climate, biology and even human communities and the Internet have been examined through network science. While response to perturbations has been quantified, recovery strategies for perturbed networks have usually been either discussed conceptually or through anecdotal case studies. Here we develop a network science based quantitative framework for measuring, comparing and interpreting hazard responses as well as recovery strategies. The framework, motivated by the recently proposed temporal resilience paradigm, is demonstrated with the Indian Railways Network. Simulations inspired by the 2004 Indian Ocean Tsunami and the 2012 North Indian blackout as well as a cyber-physical attack scenario illustrate hazard responses and effectiveness of proposed recovery strategies. Multiple metrics are used to generate various recovery strategies, which are simply sequences in which system components should be recovered after a disruption. Quantitative evaluation of these strategies suggests that faster and more efficient recovery is possible through network centrality measures. Optimal recovery strategies may be different per hazard, per community within a network, and for different measures of partial recovery. In addition, topological characterization provides a means for interpreting the comparative performance of proposed recovery strategies. The methods can be directly extended to other Large-Scale Critical Lifeline Infrastructure Networks including transportation, water, energy and communications systems that are threatened by natural or human-induced hazards, including cascading failures. Furthermore, the quantitative framework developed here can generalize across natural, engineered and human systems, offering an actionable and generalizable approach for emergency management in particular as well as for network resilience in general.

  7. Science-based decision making in a high-risk energy production environment

    Science.gov (United States)

    Weiser, D. A.

    2016-12-01

    Energy production practices that may induce earthquakes require decisions about acceptable risk before projects begin. How much ground shaking, structural damage, infrastructure damage, or delay of geothermal power and other operations is tolerable? I review a few mitigation strategies as well as existing protocol in several U.S. states. Timely and accurate scientific information can assist in determining the costs and benefits of altering production parameters. These issues can also be addressed with probability estimates of adverse effects ("costs"), frequency of earthquakes of different sizes, and associated impacts of different magnitude earthquakes. When risk management decisions based on robust science are well-communicated to stakeholders, mitigation efforts benefit. Effective communications elements include a) the risks and benefits of different actions (e.g. using a traffic light protocol); b) the factors to consider when determining acceptable risk; and c) the probability of different magnitude events. I present a case example for The Geysers geothermal field in California, to discuss locally "acceptable" and "unacceptable" earthquakes and share nearby communities' responses to smaller and larger magnitude earthquakes. I use the USGS's "Did You Feel It?" data archive to sample how often felt events occur, and how many of those are above acceptable magnitudes (to both local residents and operators). Using this information, I develop a science-based decision-making framework, in the case of potentially risky earthquakes, for lessening seismic risk and other negative consequences. This includes assessing future earthquake probabilities based on past earthquake records. One of my goals is to help characterize uncertainties in a way that they can be managed; to this end, I present simple and accessible approaches that can be used in the decision making process.

  8. Self-medication among students in Isfahan University of Medical Sciences based on Health Belief Model.

    Science.gov (United States)

    Pirzadeh, Asiyeh; Mostafavi, Firoozeh

    2014-01-01

    The prevalence of self-medication is high all over the world, especially in Iran. But there is a paucity of studies to explore self-medication activities among the university students. Therefore, the present study was undertaken to determine the self-medication among student in Isfahan University of Medical Sciences, based on Health Belief Model (HBM). This cross-sectional study was conducted in 197 medical students of Isfahan University of Medical Sciences who were randomly chosen by a stratified random sampling method in 2009. The data were collected using a validated and reliable questionnaire based on HBM. Statistical analysis was performed using SPSS software (ver. 16). Descriptive and analytical statistics (independent t-test and test) were used. A two-tailed P value lower than 0.05 was considered statistically significant. The mean and standard deviation of participants' age was 22.00 ± 2.77 years. 67.3% of the sample consisted of females. The mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, and perceived barrier were 80.36 ± 18.29, 40.92 ± 13.89, 61.48 ± 19.03, 59.11 ± 18.46, and 30.36 ± 12.40, respectively. According to the results, 84.98% of students had experienced self-medication at least for one disease during the past 6 months. The prevalence of self-medication in medical students is high and we can consider it as a health problem. So, we need educational interventions for the students, using HBM constructs.

  9. Network Science Based Quantification of Resilience Demonstrated on the Indian Railways Network.

    Directory of Open Access Journals (Sweden)

    Udit Bhatia

    Full Text Available The structure, interdependence, and fragility of systems ranging from power-grids and transportation to ecology, climate, biology and even human communities and the Internet have been examined through network science. While response to perturbations has been quantified, recovery strategies for perturbed networks have usually been either discussed conceptually or through anecdotal case studies. Here we develop a network science based quantitative framework for measuring, comparing and interpreting hazard responses as well as recovery strategies. The framework, motivated by the recently proposed temporal resilience paradigm, is demonstrated with the Indian Railways Network. Simulations inspired by the 2004 Indian Ocean Tsunami and the 2012 North Indian blackout as well as a cyber-physical attack scenario illustrate hazard responses and effectiveness of proposed recovery strategies. Multiple metrics are used to generate various recovery strategies, which are simply sequences in which system components should be recovered after a disruption. Quantitative evaluation of these strategies suggests that faster and more efficient recovery is possible through network centrality measures. Optimal recovery strategies may be different per hazard, per community within a network, and for different measures of partial recovery. In addition, topological characterization provides a means for interpreting the comparative performance of proposed recovery strategies. The methods can be directly extended to other Large-Scale Critical Lifeline Infrastructure Networks including transportation, water, energy and communications systems that are threatened by natural or human-induced hazards, including cascading failures. Furthermore, the quantitative framework developed here can generalize across natural, engineered and human systems, offering an actionable and generalizable approach for emergency management in particular as well as for network resilience in general.

  10. Optimal Stellar Photometry for Multi-conjugate Adaptive Optics Systems Using Science-based Metrics

    Science.gov (United States)

    Turri, P.; McConnachie, A. W.; Stetson, P. B.; Fiorentino, G.; Andersen, D. R.; Bono, G.; Massari, D.; Véran, J.-P.

    2017-04-01

    We present a detailed discussion of how to obtain precise stellar photometry in crowded fields using images from multi-conjugate adaptive optics (MCAO) systems, with the intent of informing the scientific development of this key technology for the Extremely Large Telescopes. We use deep J and K s exposures of NGC 1851 taken with the Gemini Multi-Conjugate Adaptive Optics System (GeMS) on Gemini South to quantify the performance of the instrument and to develop an optimal strategy for stellar photometry using point-spread function (PSF)-fitting techniques. We judge the success of the various methods we employ by using science-based metrics, particularly the width of the main sequence turnoff region. We also compare the GeMS photometry with the exquisite HST data in the visible of the same target. We show that the PSF produced by GeMS possesses significant spatial and temporal variability that must be accounted for during the analysis. We show that the majority of the variation of the PSF occurs within the “control radius” of the MCAO system and that the best photometry is obtained when the PSF radius is chosen to closely match this spatial scale. We identify photometric calibration as a critical issue for next-generation MCAO systems such as those on the Thirty Meter Telescope and European Extremely Large Telescope. Our final CMDs reach K s ˜ 22—below the main sequence knee—making it one of the deepest for a globular cluster available from the ground. Theoretical isochrones are in remarkable agreement with the stellar locus in our data from below the main sequence knee to the upper red giant branch.

  11. "Nuestra Tierra Dinamica" Global Climate Change STEM Education Fostering Environmental Stewardship

    Science.gov (United States)

    La Grave, M.; de Valenzuela, M.; Russell, R.

    2012-12-01

    CLUB ECO LÓGICO is a democratic and participatory program that provides active citizenship in schools and community, placing climate change into context for the Latino Community. The program's objectives focus on: 1. The Environment. Reducing the school and community impact on the environment through environmental footprint through stewardship actions. 2. Empowerment. Engaging participants through project and service learning and make decisions about how to improve their schools, their homes and their community's environment. 3. Community and Research Partnerships. Fostering collaborations with local community, stakeholders, government, universities, research organizations, and businesses that have expertise in environmental research, management, education and climate change. 4. Awareness. Increasing environmental and climate science knowledge of participants through STEM activities and hands-on access to technology. 5. Research and evaluation. Assessing the relevance of program activities through the engagement of the Latino community in planning and the effectiveness and impact of STEM activities through formative and summative evaluation. To address these objectives, the program has several inter related components in an after school setting: SUN EARTH Connections: Elementary (grades K to 2) students learn the basic climate change concepts through inquiry and hands on STEM activities. Bilingual 8 facilitators adapt relevant NASA educational resources for use in inquiry based, hands on activities. Drama and the arts provide unique experiences as well as play a key role in learning, participation and facilitation. GREEN LABS: Elementary students (grades 3 to 5) participate in stations where each Lab is staffed by at least two professionals: a College level fully bilingual Latin American Professional and a stakeholder representing either a research organization or other relevant environmental organization. Our current Green Lab themes include: Air, Soils, Water

  12. Increasing Capacity for Stewardship of Oceans and Coasts: Findings of the National Research Council Report

    Science.gov (United States)

    Roberts, S. J.; Feeley, M. H.

    2008-05-01

    inappropriate evaluation procedures; and, lack of a coordinated and strategic approach among donors. A New Framework Improving ocean stewardship and ending the fragmentation of current capacity building programs will require a new, broadly adopted framework for capacity building that emphasizes cooperation, sustainability, and knowledge transfer within and among communities. The report identifies four specific features of capacity building that would increase the effectiveness and efficiency of future programs: 1. Regional action plans based on periodic program assessments to guide investments in capacity and set realistic milestones and performance measures. 2. Long-term support to establish self-sustaining programs. Sustained capacity building programs require a diversity of sources and coordinated investments from local, regional, and international donors. 3. Development of leadership and political will. One of the most commonly cited reasons for failure and lack of progress in ocean and coastal governance initiatives is lack of political will. One strategy for strengthening support is to identify, develop, mentor, and reward leaders. 4. Establishment of networks and mechanisms for regional collaboration. Networks bring together those working in the same or similar ecosystems with comparable management or governance challenges to share information, pool resources, and learn from one another. The report also recommends the establishment of regional centers to encourage and support collaboration among neighboring countries.

  13. Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study.

    Science.gov (United States)

    Sikkens, Jonne J; van Agtmael, Michiel A; Peters, Edgar J G; Lettinga, Kamilla D; van der Kuip, Martijn; Vandenbroucke-Grauls, Christina M J E; Wagner, Cordula; Kramer, Mark H H

    2017-08-01

    Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531

  14. Defense, basic, and industrial research at the Los Alamos Neutron Science Center: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Longshore, A.; Salgado, K. [comps.

    1995-10-01

    The Workshop on Defense, Basic, and Industrial Research at the Los Alamos Neutron Science Center gathered scientists from Department of Energy national laboratories, other federal institutions, universities, and industry to discuss the use of neutrons in science-based stockpile stewardship, The workshop began with presentations by government officials, senior representatives from the three weapons laboratories, and scientific opinion leaders. Workshop participants then met in breakout sessions on the following topics: materials science and engineering; polymers, complex fluids, and biomaterials; fundamental neutron physics; applied nuclear physics; condensed matter physics and chemistry; and nuclear weapons research. They concluded that neutrons can play an essential role in science-based stockpile stewardship and that there is overlap and synergy between defense and other uses of neutrons in basic, applied, and industrial research from which defense and civilian research can benefit. This proceedings is a collection of talks and papers from the plenary, technical, and breakout session presentations. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

  15. Material Stream Strategy for Lithium and Inorganics (U)

    Energy Technology Data Exchange (ETDEWEB)

    Safarik, Douglas Joseph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Dunn, Paul Stanton [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Korzekwa, Deniece Rochelle [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2018-01-24

    Design Agency Responsibilities: Manufacturing Support to meet Stockpile Stewardship goals for maintaining the nuclear stockpile through experimental and predictive modeling capability. Development and maintenance of Manufacturing Science expertise to assess material specifications and performance boundaries, and their relationship to processing parameters. Production Engineering Evaluations with competence in design requirements, material specifications, and manufacturing controls. Maintenance and enhancement of Aging Science expertise to support Stockpile Stewardship predictive science capability.

  16. Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

    Science.gov (United States)

    Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

    2017-01-01

    Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.

  17. Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians.

    Science.gov (United States)

    Balint, John A; Shelton, Wayne N

    2002-12-01

    There has been growing concern about the effects on the patient-physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called "double agency." Various authors have proposed ways to restore patient centeredness to the patient-physician interaction. We have previously discussed the need to establish a patient-physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug "doctor"; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient-physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.

  18. Expanding Antimicrobial Stewardship to Urgent Care Centers Through a Pharmacist-Led Culture Follow-up Program.

    Science.gov (United States)

    Dumkow, Lisa E; Beuschel, Thomas S; Brandt, Kasey L

    2017-09-01

    Urgent care centers represent a high-volume outpatient setting where antibiotics are prescribed frequently but resources for antimicrobial stewardship may be scarce. In 2015, our pharmacist-led Emergency Department (ED) culture follow-up program was expanded to include two urgent care (UC) sites within the same health system. The UC program is conducted by ED and infectious diseases clinical pharmacists as well as PGY1 pharmacy residents using a collaborative practice agreement (CPA). The purpose of this study was to describe the pharmacist-led UC culture follow-up program and its impact on pharmacist workload. This retrospective, descriptive study included all patients discharged to home from UC with a positive culture from any site resulting between 1 January and 31 December 2016. Data collected included the culture type, presence of intervention, and proportion of interventions made under the CPA. Additionally, pharmacist workload was reported as the number of call attempts made, new prescriptions written, and median time to complete follow-up per patient. Data were reported using descriptive statistics. A total of 1461 positive cultures were reviewed for antibiotic appropriateness as part of the UC culture follow-up program, with 320 (22%) requiring follow-up intervention. Culture types most commonly requiring intervention were urine cultures (25%) and sexually transmitted diseases (25%). A median of 15 min was spent per intervention, with a median of one call (range 1-6 calls) needed to reach each patient. Less than half of patients required a new antimicrobial prescription at follow-up. A pharmacist-led culture follow-up program conducted using a CPA was able to be expanded to UC sites within the same health system using existing clinical pharmacy staff along with PGY1 pharmacy residents. Service expansion resulted in minimal increase in pharmacist workload. Adding UC culture follow-up services to an existing ED program can allow health systems to expand

  19. Risk perception, future land use and stewardship: comparison of attitudes about Hanford Site and Idaho National Engineering and Environmental Laboratory.

    Science.gov (United States)

    Burger, J; Sanchez, J; Roush, D; Gochfeld, M

    2001-04-01

    With the ending of the Cold War, the Department of Energy (DOE) is evaluating mission, future land use and stewardship of departmental facilities. This paper compares the environmental concerns and future use preferences of 351 people interviewed at Lewiston, Idaho, about the Hanford Site and Idaho National Engineering and Environmental Laboratory (INEEL), two of DOE's largest sites. Although most subjects lived closer to Hanford than INEEL, most resided in the same state as INEEL. Therefore their economic interests might be more closely allied with INEEL, while their health concerns might be more related to Hanford. Few lived close enough to either site to be directly affected economically. We test the null hypotheses that there are no differences in environmental concerns and future land-use preferences as a function of DOE site, sex, age and education. When asked to list their major concerns about the sites, more people listed human health and safety, and environmental concerns about Hanford compared to INEEL. When asked to list their preferred future land uses, 49% of subjects did not have any for INEEL, whereas only 35% did not know for Hanford. The highest preferred land uses for both sites were as a National Environmental Research Park (NERP), and for camping, hunting, hiking, and fishing. Except for returning the land to the tribes and increased nuclear storage, subjects rated all future uses as more preferred at INEEL than Hanford. Taken together, these data suggest that the people interviewed know more about Hanford, are more concerned about Hanford, rate recreational uses and NERP as their highest preferred land use, and feel that INEEL is more suited for most land uses than Handford. Overall rankings for future land uses were remarkably similar between the sites, indicating that for these stakeholders, DOE lands should be preserved for research and recreation. These preferences should be taken into account when planning for long-term stewardship at

  20. Population health management in a small health system: Impact of controlled substance stewardship in a patient-centered medical home.

    Science.gov (United States)

    Homsted, Felicity A E; Magee, Chelsea E; Nesin, Noah

    2017-09-15

    The success of a patient-centered medical home in providing population health management (PHM) services through controlled substance stewardship is described. In 2013, Penobscot Community Health Care (PCHC), in Bangor, Maine, was fully engulfed in the prescription opioid crisis. At PCHC, patients' opioid doses were startlingly high. Within the organization, measures to ensure that prescriptions were being used as prescribed, and not diverted, were underutilized. PCHC responded to these challenges by developing a comprehensive approach to controlled substance stewardship, defined as a coordinated effort to promote the appropriate use of controlled substances, improve patient outcomes, reduce misuse and abuse, and decrease patient morbidity and mortality attributed to these high-risk medications. Since the establishment of the program, over 1,300 patient reviews have been conducted. During this time, the number of PCHC patients receiving chronic opioids has decreased by 67.2% and continues to drop, with a corresponding 65.6% decrease in the number of patients receiving benzodiazepines. Premature deaths were reviewed to identify associations with opioids prescribed at the time of death, which revealed a decline of 50% between 2013 and 2015. Since program inception, the reviews conducted based on internal quality-improvement reports have been expanded to include patients on combinations of opioids and benzodiazepines, high-dose opioids, and carisoprodol. Systematic approaches addressing areas of critical need in high-risk populations are integral to PHM efforts in small health systems. The pharmacy team can serve a unique role in identifying, developing, and implementing key PHM services. Coupled with strategic community partnerships, successful PHM integration can assist in the financial survival of small health systems. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  1. Sustained impact of a computer-assisted antimicrobial stewardship intervention on antimicrobial use and length of stay.

    Science.gov (United States)

    Nault, Vincent; Pepin, Jacques; Beaudoin, Mathieu; Perron, Julie; Moutquin, Jean-Marie; Valiquette, Louis

    2017-03-01

    : Prospective audit and feedback interventions are the core components of an antimicrobial stewardship programme. Herein, we describe the sustained impact of an antimicrobial stewardship programme, based on a novel clinical decision-support system (Antimicrobial Prescription Surveillance System; APSS), on antimicrobial use and costs, hospital length of stay (LOS) in days and the proportion of inappropriate antimicrobial prescriptions. A quasi-experimental, retrospective study was conducted using interrupted time series between 2008 and 2013. Data on all hospitalized adults receiving antimicrobials were extracted from the data warehouse of a 677 bed academic centre. The intervention started in August 2010. Prospective audit and feedback interventions, led by a pharmacist, were triggered by APSS based on deviations from published and local guidelines. Changes in outcomes before and after the intervention were compared using segmented regression analysis. APSS reviewed 40 605 hospitalizations for 35 778 patients who received antimicrobials. The intervention was associated with a decrease in the average LOS (level change -0.92, P  antimicrobial consumption in DDDs/1000 inpatient days (level change -32.4, P  antimicrobial spending in Canadian dollars (level change -19 649, P  = 0.01; trend -1881, P  antimicrobials (level change -2.3, P  = 0.04; intercept 41%). The implementation of the APSS-initiated strategy was associated with a positive impact on antimicrobial use and spending, LOS and inappropriate prescriptions. The high rate of accepted interventions may have contributed to these results.

  2. Standardizing Benchmark Dose Calculations to Improve Science-Based Decisions in Human Health Assessments

    Science.gov (United States)

    Wignall, Jessica A.; Shapiro, Andrew J.; Wright, Fred A.; Woodruff, Tracey J.; Chiu, Weihsueh A.; Guyton, Kathryn Z.

    2014-01-01

    Background: Benchmark dose (BMD) modeling computes the dose associated with a prespecified response level. While offering advantages over traditional points of departure (PODs), such as no-observed-adverse-effect-levels (NOAELs), BMD methods have lacked consistency and transparency in application, interpretation, and reporting in human health assessments of chemicals. Objectives: We aimed to apply a standardized process for conducting BMD modeling to reduce inconsistencies in model fitting and selection. Methods: We evaluated 880 dose–response data sets for 352 environmental chemicals with existing human health assessments. We calculated benchmark doses and their lower limits [10% extra risk, or change in the mean equal to 1 SD (BMD/L10/1SD)] for each chemical in a standardized way with prespecified criteria for model fit acceptance. We identified study design features associated with acceptable model fits. Results: We derived values for 255 (72%) of the chemicals. Batch-calculated BMD/L10/1SD values were significantly and highly correlated (R2 of 0.95 and 0.83, respectively, n = 42) with PODs previously used in human health assessments, with values similar to reported NOAELs. Specifically, the median ratio of BMDs10/1SD:NOAELs was 1.96, and the median ratio of BMDLs10/1SD:NOAELs was 0.89. We also observed a significant trend of increasing model viability with increasing number of dose groups. Conclusions: BMD/L10/1SD values can be calculated in a standardized way for use in health assessments on a large number of chemicals and critical effects. This facilitates the exploration of health effects across multiple studies of a given chemical or, when chemicals need to be compared, providing greater transparency and efficiency than current approaches. Citation: Wignall JA, Shapiro AJ, Wright FA, Woodruff TJ, Chiu WA, Guyton KZ, Rusyn I. 2014. Standardizing benchmark dose calculations to improve science-based decisions in human health assessments. Environ Health

  3. Public stewardship of private for-profit healthcare providers in low- and middle-income countries

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-01-01

    Background Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. Objectives To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. Search methods For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant

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

    Directory of Open Access Journals (Sweden)

    François Kidd

    2016-03-01

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

  5. Advances in rapid identification and susceptibility testing of bacteria in the clinical microbiology laboratory: implications for patient care and antimicrobial stewardship programs

    Directory of Open Access Journals (Sweden)

    Florian P. Maurer

    2017-03-01

    Full Text Available Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e.g. for susceptibility testing, DNA amplification assays, and introduction of novel technologies (e.g. MALDI-TOF has fundamentally changed approaches towards pathogen identification and characterization. Importantly, these techniques offer increased diagnostic resolution while at the same time shorten the time-to-result, and are thus of obvious importance for antimicrobial stewardship. In this review, we will discuss recent advances in medical microbiology with special emphasis on the impact of novel techniques on antimicrobial stewardship programs.

  6. Advances in Rapid Identification and Susceptibility Testing of Bacteria in the Clinical Microbiology Laboratory: Implications for Patient Care and Antimicrobial Stewardship Programs.

    Science.gov (United States)

    Maurer, Florian P; Christner, Martin; Hentschke, Moritz; Rohde, Holger

    2017-03-30

    Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e.g. for susceptibility testing, DNA amplification assays), and introduction of novel technologies (e.g. MALDI-TOF) has fundamentally changed approaches towards pathogen identification and characterization. Importantly, these techniques offer increased diagnostic resolution while at the same time shorten the time-to-result, and are thus of obvious importance for antimicrobial stewardship. In this review, we will discuss recent advances in medical microbiology with special emphasis on the impact of novel techniques on antimicrobial stewardship programs.

  7. Strategic plan 1994

    Energy Technology Data Exchange (ETDEWEB)

    1995-03-01

    Sandia National Laboratories faces institutional challenges that are unique in its history. Never before have the national laboratories been viewed so critically, and never before has their role been the subject of such study and debate. At the same time, the opporunities to render `exceptional service in the national interest` have never been greater. The business of Sandia today and into the foreseeable future will rely on a strong, integrated technical foundation, represented most fundamentally by its core competencies. While is is impossible to foresee precisely what missions Sandia will pursue many years from now, one thing is clear: Central to its service to the nation will be the application of science-based engineering skills to the stewardship of the nuclear weapons stockpile. Whether on not the nation ever builds a new nuclear weapon, those that remain in stockpile will require continuous stewardship based on the integration of scientific understanding with experienced systems engineering. Sandia`s steadfast commitment to DOE`s stockpile stewardship mission will also be evident in the production of limited numbers of certain vital weapon components as the weapons production complex is realigned. Complementing this enduring responsibility will be expanded missions in energy, environment, and economic competitiveness. The work for other federal agencies will be jointly sponsored under high-level agreements with DOE. Multi-institutional teams will become a common way of doing business. The multiprogram laboratory model will evolve toward a new model of multi-laboratory programs addressing major national needs. Sandia will be a distinct and important component of an integrated system of national laboratories.

  8. Correction to: Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy.

    Science.gov (United States)

    Giacobbe, Daniele Roberto; Del Bono, Valerio; Mikulska, Malgorzata; Gustinetti, Giulia; Marchese, Anna; Mina, Federica; Signori, Alessio; Orsi, Andrea; Rudello, Fulvio; Alicino, Cristiano; Bonalumi, Beatrice; Morando, Alessandra; Icardi, Giancarlo; Beltramini, Sabrina; Viscoli, Claudio

    2017-12-01

    A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: Daniele Roberto Giacobbe 1 , Valerio Del Bono 1 , Malgorzata Mikulska 1 , Giulia Gustinetti 1 , Anna Marchese 2 , Federica Mina 3 , Alessio Signori 4 , Andrea Orsi 5 , Fulvio Rudello 6 , Cristiano Alicino 5 , Beatrice Bonalumi 3 , Alessandra Morando 7 , Giancarlo Icardi 5 , Sabrina Beltramini 3 , Claudio Viscoli 1 ; On behalf of the San Martino Antimicrobial Stewardship Group.

  9. Evaluation of the short-term effects of antimicrobial stewardship in the intensive care unit at a tertiary hospital in China.

    Directory of Open Access Journals (Sweden)

    Dapeng Hou

    Full Text Available Antibiotic abuse can lead to antibiotic resistance, which is a severe problem in China. The purpose of this study is to evaluate the short-term effects of antimicrobial stewardship strategies, including formulary restriction, preauthorization, perioperative quinolone restriction, and control of total antibiotic consumption in the ICU at a tertiary hospital in China. After implementation of antimicrobial stewardship, the total antibiotic consumption in the ICU significantly decreased. The defined daily doses (DDDs per 100 patient-days decreased from 197.65 to 143.41; however, the consumption of cephalosporins increased from 53.65 to 63.17 DDDs. Significant improvements in resistance to amikacin, gentamicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, and piperacillin in Enterobacteriaceae and resistance to ceftazidime, imipenem, and meropenem in non-fermenting Gram-negative rods were observed. In addition, the initial use of no antibiotics or of a single antibiotic significantly increased (P<0.001 and the use of two antibiotics in combination significantly decreased (P<0.001. Our results demonstrate that implementation of antimicrobial stewardship in a short period in the ICU dramatically reduced antibiotic consumption and significantly improved antibiotic resistance, which leads to more reasonable antibiotic selections by ICU physicians.

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

    Science.gov (United States)

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

    2015-12-01

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

  11. Developing a Science-based River Basin Management Plan for the Kharaa River Basin, Mongolia

    Science.gov (United States)

    Karthe, Daniel

    2013-04-01

    management. In the past, shared and unclear responsibilities, a spatial mismatch between administrative and river basin boundaries, the lack of relevant information, financial resources and implementation capacity resulted in an uncoordinated and partially uncontrolled exploitation of water resources (Livingstone et al. 2009; Horlemann et al. 2012). The recent decision of the Mongolian government to develop river basin management plans and to provide for their implementation through river basin councils and administrations, and the comparatively good data availability resulting from the R&D project, resulted in the decision to jointly develop a science-based river basin management plan for the KRB as a model region for other river basins of the country. References: Hartwig, M.; Theuring, P.; Rode, M. & Borchardt, D. (2012): Suspended sediments in the Kharaa River catchment (Mongolia) and its impact on hyporheic zone functions. Environmental Earth Sciences 65(5):1535-1546. Hofmann, J.; Venohr, M.; Behrendt, H. & Opitz, D. (2010): Integrated Water Resources Management in Central Asia: Nutrient and heavy metal emissions and their relevance for the Kharaa River Basin, Mongolia. Water Science and Technology 62(2):353-363. Horlemann, L. & Dombrowsky, I. (2012): Institutionalising IWRM in developing and transition countries: the case of Mongolia. Environmental Earth Sciences 65(5):1547-1559. Karthe, D.; Borchardt, D. & Hufert, F. (2012a): Implementing IWRM: Experiences from a Central Asian Model Region. In: Pandya, A.B. (Ed.) (2012): India Water Week 2012. Water, Energy and Food Security: Call for Solutions, Part A3, pp. 1-15. Delhi: Ministry of Water Resources, Government of India. Karthe, D.; Sigel, K.; Scharaw, B. et al. (2012b): Towards an integrated concept for monitoring and improvements in water supply, sanitation and hygiene (WASH) in urban Mongolia. Water & Risk 20:1-5. Karthe, D.; Malsy, M.; Kopp, B. & Minderlein, S. (2013): Assessing Water Availibility and its Drivers in

  12. Assessing the Predictors of Intention and Behavior in Using Virtual Social Networks Among Students of the Yazd University of Medical Sciences Based on the Theory of Planned Behavior

    National Research Council Canada - National Science Library

    Zahra Khazir; Morad ali Zareipour; Mahdi Abdolkarimi; Arefeh Dehghani tafti; Tahereh Rahimi

    2017-01-01

    .... The present study was to determine predictive factors of virtual social networks among students of Yazd university of medical sciences based on the constructs of the Theory of Planned Behavior. Methods...

  13. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel.

    Science.gov (United States)

    Pardo, Joe; Klinker, Kenneth P; Borgert, Samuel J; Butler, Brittany M; Giglio, Patricia G; Rand, Kenneth H

    2016-02-01

    The purpose of this study was to evaluate the impact of the FilmArray Blood Culture Identification (BCID) Panel on the management of patients with blood cultures growing gram positive cocci and Candida. We retrospectively compared clinical and economic outcomes between patients during the BCID testing period and a matched historical control group before BCID testing was introduced. A total of 84 BCID patients were matched to 252 historical controls. BCID identification of coagulase negative staphylococci contaminants resulted in shorter post-culture length of stay (P < 0.008) and saved roughly $30,000 per 100 patients tested. The BCID led to shorter duration of empirical vancomycin for patients with contaminated blood cultures (P = 0.005) and methicillin-susceptible Staphylococcus aureus bacteremia (P < 0.001). Patients with vancomycin-resistant enterococcal bacteremia received active therapy earlier than historical controls (P = 0.047). The BCID, coupled with antimicrobial stewardship intervention, was a cost effective tool to improve patient care. Published by Elsevier Inc.

  14. Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists.

    Science.gov (United States)

    Hand, Kieran S; Cumming, Debbie; Hopkins, Susan; Ewings, Sean; Fox, Andy; Theminimulle, Sandya; Porter, Robert J; Parker, Natalie; Munns, Joanne; Sheikh, Adel; Keyser, Taryn; Puleston, Richard

    2017-04-01

    The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test. Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P  antimicrobial resistance and drug expenditure. The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS.

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

    Science.gov (United States)

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

    2017-08-01

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

  16. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital.

    Science.gov (United States)

    Teo, J; Kwa, A L H; Loh, J; Chlebicki, M P; Lee, W

    2012-06-01

    Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a "whole-system" approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients' cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A "whole-system" ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.

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

    Science.gov (United States)

    Chavada, Ruchir; Walker, Harry N.; Tong, Deborah; Murray, Amy

    2017-01-01

    The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs. PMID:29071048

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

    Directory of Open Access Journals (Sweden)

    Ruchir Chavada

    2017-10-01

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

  19. Fenticonazole: an effective topical treatment for superficial mycoses as the first-step of antifungal stewardship program.

    Science.gov (United States)

    Tumietto, F; Giacomelli, L

    2017-06-01

    The resistance of microorganisms to antimicrobial drugs is a major issue for public health, with important consequences in terms of morbidity, mortality and resource use. The phenomenon is so serious that in some areas of the world resistant strains to all available drugs have been selected. Many conditions may result in the development of resistance: they include the indiscriminate or inappropriate (e.g., for viral infection or colonization) use of antibiotics, the excessive duration of the prescribed treatment regimens, as well as inadequate dosing or administration routes. Resistance is well-known, but less studied, also for infections caused by fungi. In the last decade, an impressive outbreak of candidiasis due to non-albicans strains (with variable patterns of resistance to azoles) was observed. This outbreak was likely associated with inappropriate use of oral azoles for the treatment of non-complicated candidiasis, such as vulvovaginal candidiasis or Candida dermatitis. In this setting, fenticonazole may represent an effective topical drug for the treatment of mycotic infections of skin and mucosa. Topical treatment of superficial mycoses still holds a major importance as it helps reduce the exposure to oral systemic azoles - mainly fluconazole and itraconazole - of intestinal microbiota, which represents the main human reservoir of yeasts. This strategy can contribute to reduce the selection of resistant strains of Candida, within the context of a really-effective antifungal stewardship program.

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

    Science.gov (United States)

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

    2017-08-01

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

  1. Overall welfare assessment of laying hens: comparing science-based, environment-based and animal-based assessments.

    Science.gov (United States)

    Shimmura, Tsuyoshi; Bracke, Marc B M; De Mol, Rudi M; Hirahara, Satoshi; Uetake, Katsuji; Tanaka, Toshio

    2011-02-01

    To increase the validity of evaluations and facilitate expansion and maintenance of assessment systems, we constructed a database of studies on the welfare of laying hens around the world. On the basis of this database, we devised a science-based welfare assessment model. Our model includes measurements, levels and weightings based on the scientific studies in the database, and can clarify the advantages and disadvantages of housing systems for laying hens from the viewpoint of the five freedoms. We also evaluated the usefulness of our model by comparing it with environment-based Animal Needs Index (ANI), another science-based model called FOWEL, and animal-based measurements. Our model showed that freedom from injury, pain and disease, and freedom from discomfort were more secure in the cage system, while non-cage systems scored better for natural behavior and freedom from fear and distress. A significant strong-positive correlation was found between the animal-based assessment and the total scores of ANI (rs = 0.94, P Animal Science.

  2. Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants: Opportunities for Antibiotic Stewardship.

    Science.gov (United States)

    Mukhopadhyay, Sagori; Puopolo, Karen M

    2017-05-01

    Most very low birth weight (VLBW, birth weight <1500 g) infants receive empiric antibiotics for risk of early-onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years and to identify opportunities for antibiotic stewardship. Retrospective cohort study includes VLBW infants admitted from 1990 to 2015. EOS was defined as isolation of a pathogen in blood or cerebrospinal fluid culture obtained at <72 hours of age. Clinical and microbiologic characteristics of EOS case infants were obtained by review of medical, laboratory and administrative records. Blood culture, antibiotic initiation and maternal discharge code data were available for all VLBW infants born between 1999 and 2013. One-hundred nine EOS cases (20.5/1000 VLBW births) occurred during the study period. Preterm labor, preterm rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of cases. From 1999 to 2013, 97% of VLBW infants were evaluated for EOS and 90% administered empiric antibiotics; 22% of these infants were born by cesarean section to mothers with preeclampsia and without preterm labor or chorioamnionitis and had a 12-fold lower incidence of EOS compared with the remaining infants. Decisions to initiate and discontinue empiric antibiotics among VLBW infants can be informed by the delivery characteristics of infected infants and by local microbiologic data.

  3. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your Fingertips.

    Science.gov (United States)

    Johnson, Alan P; Muller-Pebody, Berit; Budd, Emma; Ashiru-Oredope, Diane; Ladenheim, David; Hain, Doris; Hope, Russell; Bhattacharya, Alex; Elgohari, Suzanne; Guy, Rebecca; Henderson, Katherine; Puleston, Richard; Rooney, Graeme; Thelwall, Simon; Wellington, Edgar; Lamagni, Theresa; Hopkins, Susan

    2017-04-01

    The provision of better access to and use of surveillance data is a key component of the UK 5 Year Antimicrobial Resistance (AMR) Strategy. Since April 2016, PHE has made data on practice (infection prevention and control; antimicrobial stewardship) and outcome (prevalence of AMR, antibiotic use and healthcare-associated infections) available through Fingertips, a publicly accessible web tool (https://fingertips.phe.org.uk/profile/amr-local-indicators). Fingertips provides access to a wide range of public health data presented as thematic profiles, with the above data being available through the 'AMR local indicators' profile. Local data on a range of indicators can be viewed at the level of National Health Service acute trusts, Clinical Commissioning Groups or general practitioner practices, all of which can be compared with the corresponding aggregate values for England to allow benchmarking. The data can be viewed in a range of formats including an overview showing counts and rates, interactive maps, spine charts and graphs that show temporal trends over a range of time scales or allow correlations between pairs of indicators. The aim of the AMR local indicators profile on Fingertips is to support the development of local action plans to optimize antibiotic prescribing and reduce AMR and healthcare-associated infections. Provision of access to relevant information in an easy to use format will help local stakeholders, including healthcare staff, commissioners, Directors of Public Health, academics and the public, to benchmark relevant local AMR data and to monitor the impact of local initiatives to tackle AMR over time. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Environmental management: integrating ecological evaluation, remediation, restoration, natural resource damage assessment and long-term stewardship on contaminated lands.

    Science.gov (United States)

    Burger, Joanna

    2008-08-01

    Ecological evaluation is essential for remediation, restoration, and Natural Resource Damage Assessment (NRDA), and forms the basis for many management practices. These include determining status and trends of biological, physical, or chemical/radiological conditions, conducting environmental impact assessments, performing remedial actions should remediation fail, managing ecosystems and wildlife, and assessing the efficacy of remediation, restoration, and long-term stewardship. The objective of this paper is to explore the meanings of these assessments, examine the relationships among them, and suggest methods of integration that will move environmental management forward. While remediation, restoration, and NRDA, among others, are often conducted separately, it is important to integrate them for contaminated land where the risks to ecoreceptors (including humans) can be high, and the potential damage to functioning ecosystems great. Ecological evaluations can range from inventories of local plants and animals, determinations of reproductive success of particular species, levels of contaminants in organisms, kinds and levels of effects, and environmental impact assessments, to very formal ecological risk assessments for a chemical or other stressor. Such evaluations can range from the individual species to populations, communities, ecosystems or the landscape scale. Ecological evaluations serve as the basis for making decisions about the levels and kinds of remediation, the levels and kinds of restoration possible, and the degree and kinds of natural resource injuries that have occurred because of contamination. Many different disciplines are involved in ecological evaluation, including biologists, conservationists, foresters, restoration ecologists, ecological engineers, economists, hydrologist, and geologists. Since ecological evaluation forms the basis for so many different types of environmental management, it seems reasonable to integrate management options

  5. Coral reefs and residents of the U.S. Virgin Islands: A relationship of knowledge, outdoor activities and stewardship

    Directory of Open Access Journals (Sweden)

    Christine Settar

    2010-10-01

    Full Text Available To test the hypotheses that U.S. Virgin Islanders’ knowledge about local coral reefs is correlated with behavior, and that different sociological groups of residents have different patterns of knowledge and behavior, a mixed approach to surveying residents was used: (1 personal interviews were held in public locations and (2 an online version of the survey was administered to residents of the U.S. Virgin Islands. From July-October 2008, 462 residents over 18 years old were surveyed. Results indicate that people who engaged in outdoor activities knew significantly more about coral reefs (Spearman p<0.01, r2=0.128. Those more knowledgeable about coral reefs engaged in more positive stewardship activities (e.g. beach clean-ups (Spearman p<0.01, r2=0.127. Negative behaviors (e.g. anchoring on reef were not significantly correlated with increased knowledge of coral reefs (Spearman p=0.911, r2=-0.000025. Fishers did not have greater ability in identifying Acropora palmate coral than non-fishers (χ2=4.138, p=0.126; however, swimmers, snorkelers and divers (as a class were moreable to identify A. palmata than non-swimmers (χ2 =9.764, p=0.002. Most residents identified sea turtle species as endangered (hawksbill turtle, 78.9% but only 48.2% of the responses included Acropora spp. as threatened. Resident attitudes towards conservation of local resources were overwhelmingly positive. Rev. Biol. Trop. 58 (Suppl. 3: 197-212. Epub 2010 October 01.

  6. Impact of Antimicrobial Stewardship program on Hospitalized Patients at the Intensive Care Unit: A prospective Audit and feedback Study.

    Science.gov (United States)

    Khdour, Maher R; Hallak, Hussein O; Al-Deyab, Mamoon; Nasif, Mowafq A; Khalili, Aliaa M; Dallashi, Ahamad A; Khofash, Mohammad B; Scott, Michael G

    2017-12-13

    Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of Antimicrobial Stewardship Program (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. A prospective audit with intervention and feedback by ASP team within 48-72h of antibiotic administration began in Sep, 2015. Four months of pre-ASP data with 4-months of post-ASP data were compared. Data collected included clinical and demographic data; utilization of antimicrobials measured by Define Daily Doses, duration of therapy, length of stay, readmission and all-cause mortality. Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial utilization by 24.3% (87.3 DDD/100 bed. vs 66.1 DDD/100 bed p<0.001). The median (IQR) of length of stay was significantly reduced post ASP (11 (3-21) vs. 7 (4-19) days; p <0.01). Also, the median (IQR) of duration of therapy was significantly reduced post-ASP (8 (5-12) days vs. 5 (3-9); p=0.01). There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; p=0.1) and (26.1% vs. 24.6%; p=0.54) respectively. Our prospective audit and feedback program was associated with positive impact on antimicrobial utilization, duration of therapy and length of stay. This article is protected by copyright. All rights reserved.

  7. Earth Science Keyword Stewardship: Access and Management through NASA's Global Change Master Directory (GCMD) Keyword Management System (KMS)

    Science.gov (United States)

    Stevens, T.; Olsen, L. M.; Ritz, S.; Morahan, M.; Aleman, A.; Cepero, L.; Gokey, C.; Holland, M.; Cordova, R.; Areu, S.; Cherry, T.; Tran-Ho, H.

    2012-12-01

    Discovering Earth science data can be complex if the catalog holding the data lacks structure. Controlled keyword vocabularies within metadata catalogues can improve data discovery. NASA's Global Change Master Directory's (GCMD) Keyword Management System (KMS) is a recently released a RESTful web service for managing and providing access to controlled keywords (science keywords, service keywords, platforms, instruments, providers, locations, projects, data resolution, etc.). The KMS introduces a completely new paradigm for the use and management of the keywords and allows access to these keywords as SKOS Concepts (RDF), OWL, standard XML, and CSV. A universally unique identifier (UUID) is automatically assigned to each keyword, which uniquely identifies each concept and its associated information. A component of the KMS is the keyword manager, an internal tool that allows GCMD science coordinators to manage concepts. This includes adding, modifying, and deleting broader, narrower, or related concepts and associated definitions. The controlled keyword vocabulary represents over 20 years of effort and collaboration with the Earth science community. The maintenance, stability, and ongoing vigilance in maintaining mutually exclusive and parallel keyword lists is important for a "normalized" search and discovery, and provides a unique advantage for the science community. Modifications and additions are made based on community suggestions and internal review. To help maintain keyword integrity, science keyword rules and procedures for modification of keywords were developed. This poster will highlight the use of the KMS as a beneficial service for the stewardship and access of the GCMD keywords. Users will learn how to access the KMS and utilize the keywords. Best practices for managing an extensive keyword hierarchy will also be discussed. Participants will learn the process for making keyword suggestions, which subsequently help in building a controlled keyword

  8. ICStatus and progress of the National Ignition Facility as ICF and HED user facility

    Science.gov (United States)

    Van Wonterghem, B. M.; Kauffman, R. L.; Larson, D. W.; Herrmann, M. C.

    2016-05-01

    Since its completion in 2009, the National Ignition Facility has been operated in support of NNSA's Stockpile Stewardship mission, providing unique experimental data in the high energy density regime. We will describe the progress made by the National Ignition facility in the user office and management, facility capabilities, target diagnostics and diagnostics development. We will also discuss the results of a major effort to increase the shot rate on NIF. An extensive set of projects, developed in conjunction with the HED community and drawing on best practices at other facilities, improved shot rate by over 80% and recently enabled us to deliver 356 target experiments in FY15 in support of the users. Through an updated experimental set-up and review process, computer controlled set-up of the laser and diagnostics and disciplined operations, NIF also continued to deliver experimental reliability, precision and repeatability. New and complex platforms are introduced with a high success rate. Finally we discuss how new capabilities and further efficiency improvements will enable the successful execution of ICF and HED experimental programs required to support the quest for Ignition and the broader Science Based Stockpile Stewardship mission

  9. Development and case study of a science-based software platform to support policy making on air quality.

    Science.gov (United States)

    Zhu, Yun; Lao, Yanwen; Jang, Carey; Lin, Chen-Jen; Xing, Jia; Wang, Shuxiao; Fu, Joshua S; Deng, Shuang; Xie, Junping; Long, Shicheng

    2015-01-01

    This article describes the development and implementations of a novel software platform that supports real-time, science-based policy making on air quality through a user-friendly interface. The software, RSM-VAT, uses a response surface modeling (RSM) methodology and serves as a visualization and analysis tool (VAT) for three-dimensional air quality data obtained by atmospheric models. The software features a number of powerful and intuitive data visualization functions for illustrating the complex nonlinear relationship between emission reductions and air quality benefits. The case study of contiguous U.S. demonstrates that the enhanced RSM-VAT is capable of reproducing the air quality model results with Normalized Mean Bias quality policy making in near real time. Copyright © 2014. Published by Elsevier B.V.

  10. Creating nurturing environments: a science-based framework for promoting child health and development within high-poverty neighborhoods.

    Science.gov (United States)

    Komro, Kelli A; Flay, Brian R; Biglan, Anthony

    2011-06-01

    Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities.

  11. Sharing our data—An overview of current (2016) USGS policies and practices for publishing data on ScienceBase and an example interactive mapping application

    Science.gov (United States)

    Chase, Katherine J.; Bock, Andrew R.; Sando, Roy

    2017-01-05

    This report provides an overview of current (2016) U.S. Geological Survey policies and practices related to publishing data on ScienceBase, and an example interactive mapping application to display those data. ScienceBase is an integrated data sharing platform managed by the U.S. Geological Survey. This report describes resources that U.S. Geological Survey Scientists can use for writing data management plans, formatting data, and creating metadata, as well as for data and metadata review, uploading data and metadata to ScienceBase, and sharing metadata through the U.S. Geological Survey Science Data Catalog. Because data publishing policies and practices are evolving, scientists should consult the resources cited in this paper for definitive policy information.An example is provided where, using the content of a published ScienceBase data release that is associated with an interpretive product, a simple user interface is constructed to demonstrate how the open source capabilities of the R programming language and environment can interact with the properties and objects of the ScienceBase item and be used to generate interactive maps.

  12. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions.

    Science.gov (United States)

    Daughton, Christian G

    2003-05-01

    Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. The growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite a paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented for reducing or minimizing the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment--additional, collateral benefits could automatically accrue, including the lessening of medication expense for the consumer and improving patient health and consumer safety. In this article (the second of two parts describing the "green pharmacy") I focus on those actions and activities tied more closely to the end user (e.g., the patient) and issues associated with drug disposal/recycling that could prove useful in minimizing the environmental disposition of PPCPs. I also outline some recommendations and suggestions for further research and pose some considerations regarding the future. In this mini-monograph I attempt to capture cohesively for the first time the wide spectrum of actions available for minimizing the release of PPCPs to the environment. A major objective is to generate an active dialog or debate across the many disciplines that must become actively involved to design and implement a successful approach to life-cycle stewardship of PPCPs.

  13. Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship.

    Directory of Open Access Journals (Sweden)

    Young Kyung Yoon

    Full Text Available OBJECTIVE: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. METHODS: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18; Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36; and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54. RESULTS: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD: 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028 and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001. The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB (P = 0.031. CONCLUSIONS: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

  14. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy.

    Science.gov (United States)

    Daughton, Christian G

    2003-05-01

    Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. Although PPCPs typically have been identified in surface and ground waters, some are also undoubtedly associated with solid phases such as suspended particulates, sediments, and sewage sludges, despite their relatively high affinity for water. Often amenable to degradation, their continual introduction to waste-receiving waters results from their widespread, continuous, combined use by individuals and domestic animals, giving PPCPs a "pseudo-persistence" in the environment. Little is known about the environmental or human health hazards that might be posed by chronic, subtherapeutic levels of these bioactive substances or their transformation products. The continually growing, worldwide importance of freshwater resources, however, underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite the paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented to reduce or minimize the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment; additional, collateral benefits could automatically accrue, including reducing consumers' medication expenses and improving patient health and consumer safety. In this article, the first of a two-part mini-monograph describing the "green pharmacy," I focus initially on the background behind the imperative for an ecologically oriented stewardship program for PPCPs

  15. Long-Term Stewardship at a Former Uranium Mill Tailings Site in Riverton, Wyoming WM2017-17090

    Energy Technology Data Exchange (ETDEWEB)

    Dam, William [USDOE Office of Legacy Management, Washington, DC (United States); Gil, Dr. April [USDOE Office of Legacy Management, Washington, DC (United States); Johnson, Raymond H. [Navarro Research and Engineering, Oak Ridge, TN (United States); Campbell, Sam [Navarro Research and Engineering, Oak Ridge, TN (United States)

    2017-03-01

    The US Department of Energy Office of Legacy Management (LM) is responsible for maintaining protective public health and environmental conditions at former uranium mill tailings sites nationwide via long-term stewardship. One of these sites, a former uranium mill near Riverton, Wyoming, is within the boundary of the Wind River Indian Reservation and operated from 1958 to 1963. Tailings and contaminated material associated with mill operations were removed and transported to an offsite disposal cell in 1989. The remedial action was completed under Title I of the Uranium Mill Tailings Radiation Control Act of 1978. Milling operations, which included an unlined tailings impoundment and an unlined evaporation pond, contaminated the shallow groundwater, resulting in a downgradient groundwater plume that discharges to the Little Wind River. A natural flushing compliance strategy was implemented in 1998. This strategy allows contaminants of concern to naturally flush from the groundwater, provided that contaminants flush below US Environmental Protection Agency maximum concentration limits within 100 years. As part of the compliance strategy, LM has implemented a groundwater monitoring program along with institutional controls that include the installation of an alternate water supply, continued sampling of private wells, and restrictions on well drilling and gravel pit construction. LM works closely with local stakeholders and community members to ensure that these institutional controls are in place and maintained. The Riverton site provides an interesting case study where contaminant remobilization due to river flooding prompted a reevaluation of the conceptual site model to verify if the current compliance strategy would remain protective of human health and the environment. Concentrations of groundwater contaminants, which include sulfate, molybdenum, and uranium, were transiently elevated following flooding of the Little Wind River in 2010 and 2016. These flood

  16. Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path

    Science.gov (United States)

    2010-01-01

    Background Science, technology and innovation have long played a role in Ghana’s vision for development, including in improving its health outcomes. However, so far little research has been conducted on Ghana’s capacity for health innovation to address local diseases. This research aims to fill that gap, mapping out the key actors involved, highlighting examples of indigenous innovation, setting out the challenges ahead and outlining recommendations for strengthening Ghana’s health innovation system. Methods Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 48 people from across the science-based health innovation system. Data was collected over three visits to Ghana from February 2007 to August 2008, and stakeholders engaged subsequently. Results Ghana has strengths which could underpin science-based health innovation in the future, including health and biosciences research institutions with strong foreign linkages and donor support; a relatively strong regulatory system which is building capacity in other West African countries; the beginnings of new funding forms such as venture capital; and the return of professionals from the diaspora, bringing expertise and contacts. Some health products and services are already being developed in Ghana by individual entrepreneurs, which are innovative in the sense of being new to the country and, in some cases, the continent. They include essential medicines, raw pharmaceutical materials, new formulations for pediatric use and plant medicines at various stages of development. Conclusions While Ghana has many institutions concerned with health research and its commercialization, their ability to work together to address clear health goals is low. If Ghana is to capitalize on its assets, including political and macroeconomic stability which underpin investment in health enterprises, it needs to

  17. Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path.

    Science.gov (United States)

    Al-Bader, Sara; Daar, Abdallah S; Singer, Peter A

    2010-12-13

    Science, technology and innovation have long played a role in Ghana's vision for development, including in improving its health outcomes. However, so far little research has been conducted on Ghana's capacity for health innovation to address local diseases. This research aims to fill that gap, mapping out the key actors involved, highlighting examples of indigenous innovation, setting out the challenges ahead and outlining recommendations for strengthening Ghana's health innovation system. Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 48 people from across the science-based health innovation system. Data was collected over three visits to Ghana from February 2007 to August 2008, and stakeholders engaged subsequently. Ghana has strengths which could underpin science-based health innovation in the future, including health and biosciences research institutions with strong foreign linkages and donor support; a relatively strong regulatory system which is building capacity in other West African countries; the beginnings of new funding forms such as venture capital; and the return of professionals from the diaspora, bringing expertise and contacts. Some health products and services are already being developed in Ghana by individual entrepreneurs, which are innovative in the sense of being new to the country and, in some cases, the continent. They include essential medicines, raw pharmaceutical materials, new formulations for pediatric use and plant medicines at various stages of development. While Ghana has many institutions concerned with health research and its commercialization, their ability to work together to address clear health goals is low. If Ghana is to capitalize on its assets, including political and macroeconomic stability which underpin investment in health enterprises, it needs to improve the health innovation environment

  18. Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2010-12-01

    Full Text Available Abstract Background Science, technology and innovation have long played a role in Ghana’s vision for development, including in improving its health outcomes. However, so far little research has been conducted on Ghana’s capacity for health innovation to address local diseases. This research aims to fill that gap, mapping out the key actors involved, highlighting examples of indigenous innovation, setting out the challenges ahead and outlining recommendations for strengthening Ghana’s health innovation system. Methods Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 48 people from across the science-based health innovation system. Data was collected over three visits to Ghana from February 2007 to August 2008, and stakeholders engaged subsequently. Results Ghana has strengths which could underpin science-based health innovation in the future, including health and biosciences research institutions with strong foreign linkages and donor support; a relatively strong regulatory system which is building capacity in other West African countries; the beginnings of new funding forms such as venture capital; and the return of professionals from the diaspora, bringing expertise and contacts. Some health products and services are already being developed in Ghana by individual entrepreneurs, which are innovative in the sense of being new to the country and, in some cases, the continent. They include essential medicines, raw pharmaceutical materials, new formulations for pediatric use and plant medicines at various stages of development. Conclusions While Ghana has many institutions concerned with health research and its commercialization, their ability to work together to address clear health goals is low. If Ghana is to capitalize on its assets, including political and macroeconomic stability which underpin investment in health

  19. Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009-2013).

    Science.gov (United States)

    Zou, Y M; Ma, Y; Liu, J H; Shi, J; Fan, T; Shan, Y Y; Yao, H P; Dong, Y L

    2015-04-01

    The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (β = -10.504, p resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (β = 34.94, p antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

  20. Time for action-Improving the design and reporting of behaviour change interventions for antimicrobial stewardship in hospitals: Early findings from a systematic review.

    Science.gov (United States)

    Davey, Peter; Peden, Claire; Charani, Esmita; Marwick, Charis; Michie, Susan

    2015-03-01

    There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information. We identified 116 studies reporting 123 interventions. Reporting of BCTs was poor, with little detail of BCT characteristics. Feedback was only reported for 17 (13.8%) of the interventions, and self-monitoring was used in only 1 intervention. Goals were reported for all interventions but were poorly specified, with only three of the nine characteristics reported for ≥50% of interventions. A goal threshold and timescale were specified for just 1 of the 123 interventions. Only 29 authors (25.0%) responded to the request for additional information. In conclusion, both the content and reporting of interventions for antimicrobial stewardship fell short of scientific principles and practices. There is a strong evidence base regarding BCTs in other contexts that should be applied to antimicrobial stewardship now if we are to further our understanding of what works, for whom, why and in what contexts. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.