Increasing Research Productivity and Professional Development in Psychology With a Writing Retreat.

Science.gov (United States)

Stanley, Ian H; Hom, Melanie A; Chu, Carol; Joiner, Thomas E

2017-09-01

Writing is a core feature of the training requirements and career demands of psychology faculty members and graduate students. Within academic psychology, specifically, writing is vital for the generation of scientific knowledge through manuscripts and grant applications. Although resources exist regarding how to improve one's writing skills, few models have been described regarding how to promote a culture of writing productivity that realizes tangible deliverables, such as manuscripts and grant applications. In this article, we discuss the rationale, model, and initial outcome data of a writing retreat developed and implemented to increase research productivity among psychology faculty and trainees. We also review best practices for conducting writing retreats and identify key areas for future SoTL on advancing writing.

Staffing in Radiotherapy: An Activity Based Approach

International Nuclear Information System (INIS)

2015-01-01

Radiotherapy requires competent professional staff to ensure safe and effective patient treatment and management. There is a need to provide guidelines that recommend appropriate staffing levels to support the initiation of new services as well as the expansion or upgrade of existing services as even simple upgrades or replacement of existing equipment may have a significant impact on staffing needs. Similarly, the introduction of education and training programmes will require staffing adjustments. A calculation algorithm was developed to predict staffing levels based on the inputs that are known or can be easily estimated. This publication complements other IAEA publications used to support the initiation of basic radiation medicine services including Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects, published in 2008

Staffing and job satisfaction: nurses and nursing assistants.

Science.gov (United States)

Kalisch, Beatrice; Lee, Kyung Hee

2014-05-01

The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses. This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units. Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction. Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff. Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career. © 2012 John Wiley & Sons Ltd.

New law on staffing levels will save lives.

Science.gov (United States)

2016-02-17

Good news about nurse staffing levels can be hard to find, so how fantastic that a protracted campaign in Wales finally paid off last week with the passage of legislation to ensure hospital wards are staffed safely. Next month, the Queen will give royal assent to the Safe Nurse Staffing Levels (Wales) Bill, which will save lives, produce better outcomes and enhance the patient experience of care.

Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy.

Science.gov (United States)

Soliman, Ahmed M; Du, Ella Xiaoyan; Yang, Hongbo; Wu, Eric Q; Haley, Jane C

2017-06-01

Hysterectomy and laparoscopy are the two most common surgical options used to treat women with endometriosis, yet the disease may still recur. This study aimed to determine the long-term retreatment rates among endometriosis patients in the United States who received either hysterectomy or laparoscopy. Patients aged 18-49 years with endometriosis who underwent hysterectomy or laparoscopy were identified in the Truven Health MarketScan claims database (2004-2013). The retreatment rate up to 8 years after the initial surgery was estimated using Kaplan-Meier survival analysis. The relative risk of retreatment among patients with hysterectomy versus laparoscopy was assessed using a Cox proportional hazard model. A total of 24,915 patients with endometriosis who underwent hysterectomy and 37,308 patients with endometriosis who underwent laparoscopy were identified. The estimated retreatment rates were 3.3%, 4.7%, and 5.4% in the 2nd, 5th, and 8th year following hysterectomy, respectively, while the rates following laparoscopy were 15.8%, 27.5%, and 35.2%, respectively. The hazard ratio of retreatment was 0.157 (95% confidence interval [CI]: 0.146-0.169) comparing hysterectomy to laparoscopy. In the sensitivity analysis, which expanded the definition of retreatment by including medical treatments, the retreatment rate increased by a factor of 11-14 for the hysterectomy cohort and by a factor of 2-4 for the laparoscopy cohort, and the hazard ratio of retreatment rate for hysterectomy versus laparoscopy was 0.490 (95% CI: 0.477-0.502). Our study results indicated that the disease retreatment rate after laparoscopy is high among patients with endometriosis; even hysterectomy does not guarantee freedom from retreatment.

Cooperative Spatial Retreat for Resilient Drone Networks.

Science.gov (United States)

Kang, Jin-Hyeok; Kwon, Young-Min; Park, Kyung-Joon

2017-05-03

Drones are broadening their scope to various applications such as networking, package delivery, agriculture, rescue, and many more. For proper operation of drones, reliable communication should be guaranteed because drones are remotely controlled. When drones experience communication failure due to bad channel condition, interference, or jamming in a certain area, one existing solution is to exploit mobility or so-called spatial retreat to evacuate them from the communication failure area. However, the conventional spatial retreat scheme moves drones in random directions, which results in inefficient movement with significant evacuation time and waste of battery lifetime. In this paper, we propose a novel spatial retreat technique that takes advantage of cooperation between drones for resilient networking, which is called cooperative spatial retreat (CSR). Our performance evaluation shows that the proposed CSR significantly outperforms existing schemes.

Efficacy of ProTaper universal retreatment files in removing filling materials during root canal retreatment.

Science.gov (United States)

Giuliani, Valentina; Cocchetti, Roberto; Pagavino, Gabriella

2008-11-01

The aim of this study was to evaluate the efficacy of the ProTaper Universal System rotary retreatment system and of Profile 0.06 and hand instruments (K-file) in the removal of root filling materials. Forty-two extracted single-rooted anterior teeth were selected. The root canals were enlarged with nickel-titanium (NiTi) rotary files, filled with gutta-percha and sealer, and randomly divided into 3 experimental groups. The filling materials were removed with solvent in conjunction with one of the following devices and techniques: the ProTaper Universal System for retreatment, ProFile 0.06, and hand instruments (K-file). The roots were longitudinally sectioned, and the image of the root surface was photographed. The images were captured in JPEG format; the areas of the remaining filling materials and the time required for removing the gutta-percha and sealer were calculated by using the nonparametric one-way Kruskal-Wallis test and Tukey-Kramer tests, respectively. The group that showed better results for removing filling materials was the ProTaper Universal System for retreatment files, whereas the group of ProFile rotary instruments yielded better root canal cleanliness than the hand instruments, even though there was no statistically significant difference. The ProTaper Universal System for retreatment and ProFile rotary instruments worked significantly faster than the K-file. The ProTaper Universal System for retreatment files left cleaner root canal walls than the K-file hand instruments and the ProFile Rotary instruments, although none of the devices used guaranteed complete removal of the filling materials. The rotary NiTi system proved to be faster than hand instruments in removing root filling materials.

Technical basis for staffing levels at nuclear power plants

Energy Technology Data Exchange (ETDEWEB)

Shurberg, D.A.; Haber, S.B. [Brookhaven National Lab., Upton, NY (United States); Morisseau, D. [Nuclear Regulatory Commission, Washington, DC (United States)] [and others

1995-04-01

The objective of this project is to provide a technical basis for the establishment of criteria for minimum staffing levels of licensed and non-licensed NPP shift personnel. Minimum staffing levels for the purpose of this study, are defined as those necessary for successful accomplishment of all safety and additional functions that must be performed in order for the licensee to meet applicable regulatory requirements. This project involves a multi-faceted approach to the investigation of the issue. Relevant NRC documentation was identified and reviewed. Using the information obtained from this documentation review, a test plan was developed to aid in the collection of further information regarding the adequacy of current shift staffing levels. The test plan addresses three different activities to be conducted to provide information to the NRC for use in the assessment of current minimum staffing levels. The first activity is collection of data related to industry shift staffing practices through site visits to seven nuclear power plants. The second activity is a simulator study, which will use licensed operator crews responding to a simulated event, under two different staffing levels. Finally, workload models will be constructed for both licensed and non-licensed personnel, using a priori knowledge of the simulator scenarios with data resulting from one of the staffing levels studied in the simulator, and the data collected from the site visits. The model will then be validated against the data obtained from the second staffing level studied in the simulator. The validated model can then be used to study the impact of changing staffing-related variables on the plant shift crew`s ability to effectively mitigate an event.

Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.

Science.gov (United States)

West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin

2014-05-01

To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

Science.gov (United States)

Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.

2016-01-01

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819

Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort

DEFF Research Database (Denmark)

Chatzidionysiou, Katerina; Lie, Elisabeth; Lukina, Galina

2017-01-01

of 800 patients qualified for the second analysis: 616 were retreated on flare and 184 at fixed interval. For the first retreatment, the fixed-interval retreatment group yielded significantly better results than the on-flare group (estimated marginal mean DAS28 = 3.8, 95% CI 3.6-4.1 vs 4.6, 95% CI 4.......5-4.7, p leads to further clinical improvement after the first course of RTX. A fixed-interval retreatment strategy seems to be more effective than on-flare retreatment....

STAF: A Powerful and Sophisticated CAI System.

Science.gov (United States)

Loach, Ken

1982-01-01

Describes the STAF (Science Teacher's Authoring Facility) computer-assisted instruction system developed at Leeds University (England), focusing on STAF language and major program features. Although programs for the system emphasize physical chemistry and organic spectroscopy, the system and language are general purpose and can be used in any…

Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

Science.gov (United States)

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

2008-01-01

We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

The Efficacy of the WaveOne Reciprocating File System versus the ProTaper Retreatment System in Endodontic Retreatment of Two Different Obturating Techniques.

Science.gov (United States)

Jorgensen, Ben; Williamson, Anne; Chu, Rene; Qian, Fang

2017-06-01

This ex vivo study aimed to evaluate the efficacy of retreating GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) and warm vertically condensed gutta-percha in moderately curved canals with 2 different systems: ProTaper Universal Retreatment (Dentsply Tulsa Dental) and WaveOne (Dentsply Tulsa Dental). Eighty mesial roots of mandibular molars were used in this study. The mesiobuccal canals in each sample were prepared to length with the WaveOne Primary file (Dentsply Tulsa Dental). The canals were obturated with either a warm vertical approach or with GuttaCore and divided into 4 retreatment groups with the same mean root curvature: warm vertical retreated with ProTaper, warm vertical retreated with WaveOne, GuttaCore retreated with ProTaper, and GuttaCore retreated with WaveOne. The warm vertical groups were obturated using a continuous-wave technique of gutta-percha compaction, and the GuttaCore groups were obturated according to the manufacturer's instructions. After allowing sealer to set, each specimen was retreated with either the ProTaper Universal Retreatment files D1, D2, or D3 or with the WaveOne Primary file to the predetermined working length. The time taken to reach the working length was recorded. Instrument fatigue and failure were also evaluated. The post hoc 2-sample t tests showed that the overall mean total time taken to reach the working length for the warm vertical groups was significantly greater than that observed for the GuttaCore groups (mean = 87.11 vs 60.16 seconds, respectively), and the overall mean total time taken to reach the working length for WaveOne was significantly greater than that observed for ProTaper (99.09 vs 48.18 seconds, respectively). Two-way analysis of variance showed a significant main effect for both the type of experiment groups (F 1,76  = 15.32, P = .0002) and the type of retreatments (F 1,76  = 54.67, P file underwent more separations than the ProTaper files. The WaveOne Primary file underwent

Staffing and structure of infection prevention and control programs.

Science.gov (United States)

Stone, Patricia W; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C; Furuya, E Yoko; Larson, Elaine

2009-06-01

The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.

Cooperative Spatial Retreat for Resilient Drone Networks †

Science.gov (United States)

Kang, Jin-Hyeok; Kwon, Young-Min; Park, Kyung-Joon

2017-01-01

Drones are broadening their scope to various applications such as networking, package delivery, agriculture, rescue, and many more. For proper operation of drones, reliable communication should be guaranteed because drones are remotely controlled. When drones experience communication failure due to bad channel condition, interference, or jamming in a certain area, one existing solution is to exploit mobility or so-called spatial retreat to evacuate them from the communication failure area. However, the conventional spatial retreat scheme moves drones in random directions, which results in inefficient movement with significant evacuation time and waste of battery lifetime. In this paper, we propose a novel spatial retreat technique that takes advantage of cooperation between drones for resilient networking, which is called cooperative spatial retreat (CSR). Our performance evaluation shows that the proposed CSR significantly outperforms existing schemes. PMID:28467390

Comparison of the amount of apical debris extrusion associated with different retreatment systems and supplementary file application during retreatment process.

Science.gov (United States)

Çiçek, Ersan; Koçak, Mustafa Murat; Koçak, Sibel; Sağlam, Baran Can

2016-01-01

The type of instrument affects the amount of debris extruded. The aim of this study was to compare the effect of retreatment systems and supplementary file application on the amount of apical debris extrusion. Forty-eight extracted mandibular premolars with a single canal and similar length were selected. The root canals were prepared with the ProTaper Universal system with a torque-controlled engine. The root canals were dried and were obturated using Gutta-percha and sealer. The specimens were randomly divided into four equal groups according to the retreatment procedures (Group 1, Mtwo retreatment files; Group 2, Mtwo retreatment files + Mtwo rotary file #30 supplementary file; Group 3, ProTaper Universal retreatment (PTUR) files; and Group 4, PTUR files + ProTaper F3 supplementary file). The extruded debris during instrumentation were collected into preweighed Eppendorf tubes. The amount of apically extruded debris was calculated by subtracting the initial weight of the tube from the final weight. Three consecutive weights were obtained for each tube. No statistically significant difference was found in the amount of apically extruded debris between Groups 1 and 3 (P = 0.590). A significant difference was observed between Groups 1 and 2 (P file significantly increased the amount of apically extruded debris.

Library/Media Centers in U.S. Public Schools: Growth, Staffing, and Resources. Full Report

Science.gov (United States)

Tuck, Kathy D.; Holmes, Dwight R.

2016-01-01

At the request of New Business Item: 89 (NBI: 89) adopted at the 2015 NEA Representative Assembly, this study examines the extent to which students have access to public school library/media centers with qualified staff and up-to-date resources. The study explores trends in library/media center openings and closings as well as staffing patterns…

Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material.

Science.gov (United States)

Marques da Silva, B; Baratto-Filho, F; Leonardi, D P; Henrique Borges, A; Volpato, L; Branco Barletta, F

2012-10-01

To assess the efficacy of different retreatment rotary files in removing gutta-percha and endodontic sealer from canals. Ninety straight single-rooted premolars were prepared up to a size 30 and filled with gutta-percha and sealer and then randomly assigned to six retreatment groups (n = 15). Groups I, III, and V were retreated using rotary systems ProTaper Universal Retreatment (PTUR), D-RaCe, and Mtwo Retreatment, respectively. Groups II, IV, and VI were retreated using the additional instruments F4, size 40, .04 taper RaCe, and size 40, .04 taper Mtwo, respectively. The roots were split vertically, and images of the halves were obtained using a high-resolution scanner and evaluated with AutoCAD software to calculate the percentage of residual material. Data were analyzed with Kruskal-Wallis and Student-Newman-Keuls tests using a 5% significance cutoff (P 0.05) between groups when additional instruments were used. The percentage of residual material was lowest in the PTUR group and was statistically significant only when compared to the D-RaCe system (P = 0.0038). All root canals had residual filling material after retreatment even when additional instruments were used. © 2012 International Endodontic Journal.

Staff Assist: A Resource to Improve Nursing Home Quality and Staffing

Science.gov (United States)

Castle, Nicholas G.

2011-01-01

Purpose: This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Design and Methods: Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g.,…

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

Science.gov (United States)

Park, Claire Su-Yeon

2017-08-01

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

Cost analysis of nursing home registered nurse staffing times.

Science.gov (United States)

Dorr, David A; Horn, Susan D; Smout, Randall J

2005-05-01

To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

Science.gov (United States)

Bowblis, John R; Roberts, Amy Restorick

2018-06-01

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Development, Validation, and Implementation of a Clinic Nurse Staffing Guideline.

Science.gov (United States)

Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar

2017-10-01

Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.

Formation and interpretation of eskers beneath retreating ice sheets

Science.gov (United States)

Creyts, T. T.; Hewitt, I.

2017-12-01

The retreat of the ice sheets during the Pleistocene left large and spectacular subglacial features exposed. Understanding these features gives us insight into how the ice sheets retreated, how meltwater influenced retreat, and can help inform our understanding of potential future rates of ice sheet retreat. Among these features, eskers, long sinuous ridges primarily composed of clastic sediments, lack a detailed explanation of how surface melt rates and ice sheet retreat rates influence their growth and spatial distribution. Here, we develop a theory for esker formation based on the initial work of Rothlisberger modified for sediment transport and inclusion of surface meltwater forcing. The primary subglacial ingredients include water flow through subglacial tunnels with the addition of mass balances for sediment transport. We show how eskers when water flow slows below a critical stress for sediment motion. This implies that eskers are deposited in a localized region near the snout of the ice sheet. Our findings suggest that very long eskers form sequentially as the ice front retreats. The position of the esker follows the path of the channel mouth through time, which does not necessarily coincide with the instantaneous route of the feeding channel. However, in most cases, we expect those locations to be similar. The role of surface meltwater and the climatology associated with the forcing is crucial to the lateral spacing of the eskers. We predict that high surface melt rates lead to narrower catchments but that the greater extent of the ablation area means that channels are likely larger. At the same time, for a given channel size (and hence sediment flux), the size of a deposited esker depends on a margin retreat rate. Hence, the size of the eskers is related delicately to the balance between surface melt rates and margin retreat rates. We discuss how our theory can be combined with observed esker distributions to infer the relationship between these two rates

Improving Staffing and Nurse Engagement in a Neuroscience Intermediate Unit.

Science.gov (United States)

Nadolski, Charles; Britt, Pheraby; Ramos, Leah C

2017-06-01

The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.

2017 Rapid Retreat Of Thwaites Glacier

Science.gov (United States)

Milillo, P.; Rignot, E. J.; Mouginot, J.; Scheuchl, B.

2017-12-01

We employ data from the second generation of SAR systems e.g. the Italian COSMO- SkyMed (CSK) constellation and the German TanDEM-X (TDX) formation to monitor grounding line retreat using short repeat-time interferometry and accurate InSAR DEM on Thwaites glacier in the Amundsen Sea Embayment (ASE), West Antarctica. The ASE is a marine-based ice sheet with a retrograde bed containing enough ice to raise global sea level by 120 cm. Several studies have inferred the mechanical properties of portions of ASE using observationally constrained numerical models, but these studies offer only temporal snapshots of basal mechanics owing to a dearth of observational time series. Prior attempts of grounding lines mapping have been limited because few space-borne SAR missions offer the short-term repeat pass capability required to map the differential vertical displacement of floating ice at tidal frequencies with sufficient detail to resolve grounding line boundaries in areas of fast ice deformation. Using 1-day CSK repeat pass data and TDX DEMs, we collected frequent, high-resolution grounding line measurements of Thwaites glaciers spanning 2015-2017. We compare the results with ERS data spanning 1996-2011, and Sentinel-1a 2014-2015 data. Between 2011 and 2017 we observe a maximum retreat of 5-7 km across the main Thwaites glacier tongue and Thwaites Eastern ice shelf (TEIS) corresponding to an increased retreat rate of 0.5 km/yr. Grounding line retreat has been fueled by the enhanced intrusion of warm, salty, subsurface ocean water of circumpolar deep water origin onto the continental shelf, beneath the floating ice shelf, to reach the glacier grounding zone and melt it from below at rates varying from 50 to 150 m/yr. The retreat rate varies depending on the magnitude of ice melt by the ocean, the rate of ice thinning and the shape of the glacier surface and bed topography.

Nurse dose: linking staffing variables to adverse patient outcomes.

Science.gov (United States)

Manojlovich, Milisa; Sidani, Souraya; Covell, Christine L; Antonakos, Cathy L

2011-01-01

Inconsistent findings in more than 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. The aim of this study was to examine the construct validity of nurse dose by determining its association with methicillin-resistant Staphylococcus aureus (MRSA) infections and reported patient falls on a sample of inpatient adult acute care units. Staffing data came from 26 units in Ontario, Canada, and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from infection control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were associated significantly with both outcomes. Active ingredient (education, experience, skill mix) and intensity (full-time employees, registered nurse [RN]:patient ratio, RN hours per patient day) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls, and coefficients were again negative, but coefficient sizes differed. By conceptualizing nurse and staffing variables (education, experience, skill mix, full-time employees, RN:patient ratio, RN hours per patient day) as attributes of nurse dose and by including these in the same analysis, it is possible to determine their relative influence on MRSA infections and reported patient falls.

Comparative evaluation of debris extruded apically by using, Protaper retreatment file, K3 file and H-file with solvent in endodontic retreatment

Directory of Open Access Journals (Sweden)

Chetna Arora

2012-01-01

Full Text Available Aim: The aim of this study was to evaluate the apical extrusion of debris comparing 2 engine driven systems and hand instrumentation technique during root canal retreatment. Materials and Methods: Forty five human permanent mandibular premolars were prepared using the step-back technique, obturated with gutta-percha/zinc oxide eugenol sealer and cold lateral condensation technique. The teeth were divided into three groups: Group A: Protaper retreatment file, Group B: K3, file Group C: H-file with tetrachloroethylene. All the canals were irrigated with 20ml distilled water during instrumentation. Debris extruded along with the irrigating solution during retreatment procedure was carefully collected in preweighed Eppendorf tubes. The tubes were stored in an incubator for 5 days, placed in a desiccator and then re-weighed. Weight of dry debris was calculated by subtracting the weight of the tube before instrumentation and from the weight of the tube after instrumentation. Data was analyzed using Two Way ANOVA and Post Hoc test. Results : There was statistically significant difference in the apical extrusion of debris between hand instrumentation and protaper retreatment file and K3 file. The amount of extruded debris caused by protaper retreatment file and K3 file instrumentation technique was not statistically significant. All the three instrumentation techniques produced apically extruded debris and irrigant. Conclusion: The best way to minimize the extrusion of debris is by adapting crown down technique therefore the use of rotary technique (Protaper retreatment file, K3 file is recommended.

Wage, Work Environment, and Staffing: Effects on Nurse Outcomes

Science.gov (United States)

McHugh, Matthew D.; Ma, Chenjuan

2015-01-01

Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes. PMID:25121923

Efficacy of two rotary retreatment systems in removing Gutta-percha and sealer during endodontic retreatment with or without solvent: A comparative in vitro study.

Science.gov (United States)

Bhagavaldas, Moushmi Chalakkarayil; Diwan, Abhinav; Kusumvalli, S; Pasha, Shiraz; Devale, Madhuri; Chava, Deepak Chowdary

2017-01-01

The aim of this in vitro study was to compare the efficacy of two retreatment rotary systems in the removal of Gutta-percha (GP) and sealer from the root canal walls with or without solvent. Forty-eight extracted human mandibular first premolars were prepared and obturated with GP and AH Plus sealer. Samples were then randomly divided into four groups. Group I was retreated with MtwoR rotary system without solvent, Group II was retreated with MtwoR rotary system with Endosolv R as the solvent, Group III with D-RaCe rotary system without solvent, and Group IV with D-RaCe rotary system and Endosolv R solvent. The cleanliness of canal walls was determined by stereomicroscope (×20) and AutoCAD software. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the data. Results showed that none of the retreatment systems used in this study was able to completely remove the root canal filling material. D-RaCe with or without solvent showed significantly ( P > 0.05) less filling material at all levels compared to MtwoR with/without solvent. Within the limitation of the current study, D-RaCe rotary retreatment system is more effective in removing filling material from root canal walls when compared to MtwoR rotary retreatment system.

The health impact of residential retreats: a systematic review.

Science.gov (United States)

Naidoo, Dhevaksha; Schembri, Adrian; Cohen, Marc

2018-01-10

Unhealthy lifestyles are a major factor in the development and exacerbation of many chronic diseases. Improving lifestyles though immersive residential experiences that promote healthy behaviours is a focus of the health retreat industry. This systematic review aims to identify and explore published studies on the health, wellbeing and economic impact of retreat experiences. MEDLINE, CINAHL and PsychINFO databases were searched for residential retreat studies in English published prior to February 2017. Studies were included if they were written in English, involved an intervention program in a residential setting of one or more nights, and included before-and-after data related to the health of participants. Studies that did not meet the above criteria or contained only descriptive data from interviews or case studies were excluded. A total of 23 studies including eight randomised controlled trials, six non-randomised controlled trials and nine longitudinal cohort studies met the inclusion criteria. These studies included a total of 2592 participants from diverse geographical and demographic populations and a great heterogeneity of outcome measures, with seven studies examining objective outcomes such as blood pressure or biological makers of disease, and 16 studies examining subjective outcomes that mostly involved self-reported questionnaires on psychological and spiritual measures. All studies reported post-retreat health benefits ranging from immediately after to five-years post-retreat. Study populations varied widely and most studies had small sample sizes, poorly described methodology and little follow-up data, and no studies reported on health economic outcomes or adverse effects, making it difficult to make definite conclusions about specific conditions, safety or return on investment. Health retreat experiences appear to have health benefits that include benefits for people with chronic diseases such as multiple sclerosis, various cancers, HIV

Stability of therapeutic retreatment of corneal wavefront customized ablation with the SCHWIND CAM: 4-year data.

Science.gov (United States)

Aslanides, Ioannis M; Kolli, Sai; Padroni, Sara; Padron, Sara; Arba Mosquera, Samuel

2012-05-01

To evaluate the long-term outcomes of aspheric corneal wavefront ablation profiles for excimer laser retreatment. Eighteen eyes that had previously undergone LASIK or photorefractive keratectomy (PRK) were retreated with LASIK using the corneal wavefront ablation profile. Custom Ablation Manager (SCHWIND eye-tech-solutions, Kleinostheim, Germany) software and the ESIRIS flying spot excimer laser system (SCHWIND) were used to perform the ablations. Refractive outcomes and wavefront data are reported up to 4 years after retreatment. Pre- and postoperative data were compared with Student t tests and (multivariate) correlation tests. P<.05 was considered statistically significant. A bilinear correlation of various postoperative wavefront aberrations versus planned correction and preoperative aberration was performed. Mean manifest refraction spherical equivalent (MRSE) before retreatment was -0.38±1.85 diopters (D) and -0.09±0.22 D at 6 months and -0.10±0.38 D at 4 years postoperatively. The reduction in MRSE was statistically significant at both postoperative time points (P<.005). Postoperative aberrations were statistically lower (spherical aberration P<.05; coma P<.005; root-mean-square higher order aberration P<.0001) at 4 years postoperatively. Distribution of the postoperative uncorrected distance visual acuity (P<.0001) and corrected distance visual acuity (P<.01) were statistically better than preoperative values. Aspheric corneal wavefront customization with the ESIRIS yields visual, optical, and refractive results comparable to those of other wavefront-guided customized techniques for the correction of myopia and myopic astigmatism. The corneal wavefront customized approach shows its strength in cases where abnormal optical systems are expected. Systematic wavefront customized corneal ablation appears safe and efficacious for retreatment cases. Copyright 2012, SLACK Incorporated.

Rostering from staffing levels: a branch-and-price approach

NARCIS (Netherlands)

van der Veen, Egbert; Veltman, Bart

Many rostering methods first create shifts from some given staffing levels, and after that create rosters from the set of created shifts. Although such a method has some nice properties, it also has some bad ones. In this paper we outline a method that creates rosters directly from staffing levels.

Spiral computed tomography assessment of the efficacy of different rotary versus hand retreatment system.

Science.gov (United States)

Mittal, Neelam; Jain, Jyoti

2014-01-01

The purpose of this study was to evaluate the efficacy of nickel-titanium rotary retreatment systems versus stainless steel hand retreatment system with or without solvent for gutta-percha removal during retreatment. Sixty extracted human mandibular molar teeth with single canal in a distal root was prepared with ProTaper rotary nickel-titanium files and obturated with gutta-percha and sealer. The teeth were randomly divided into six groups of 10 specimens in each groups. The volume of filling material before and after retreatment were evaluated in cm(3) using the computed tomography (CT) scanner proprietary software. Maximum amount of filling material removed during retreatment with ProTaper retreatment system with solvent and minimum with hand retreatment system with solvent. None of the technique was 100% effective in removing the filling materials, but the ProTaper retreatment system with solvent was better.

Support sought for petition on safer staffing levels in Wales.

Science.gov (United States)

2014-11-01

RCN WALES is urging the public to sign an e-petition supporting draft legislation on safe staffing. The petition calls for support for the Safe Nursing Staffing Levels (Wales) Bill, drawn up by Welsh Liberal Democrat leader Kirsty Williams.

Staffing decision processes and issues: Case studies of seven US Nuclear Power Plants

International Nuclear Information System (INIS)

Melber, B.; Roussel, A.; Baker, K.; Durbin, N.; Hunt, P.; Hauth, J.; Forslund, C.; Terrill, E.; Gore, B.

1994-03-01

The objective of this report is to identify how decisions are made regarding staffing levels and positions for a sample of U.S. nuclear power plants. In this report, a framework is provided for understanding the major forces driving staffing and the implications of staffing decisions for plant safety. The focus of this report is on driving forces that have led to changes in staffing levels and to the establishment of new positions between the mid-1980s and the early 1990s. Processes used at utilities and nuclear power plants to make and implement these staffing decisions are also discussed in the report. While general trends affecting the plant as a whole are presented, the major emphasis of this report is on staffing changes and practices in the operations department, including the operations shift crew. The findings in this report are based on interviews conducted at seven nuclear power plants and their parent utilities. A discussion of the key findings is followed by a summary of the implications of staffing issues for plant safety

Fabulous award for staffing app.

Science.gov (United States)

2015-12-02

A safe staffing app giving up-to-date information on the number of nurses on the wards at Nottingham University Hospitals NHS Trust scooped top prize at the inaugural Academy of Fabulous NHS Stuffawards in London last week.

Development of the staffing evaluation technique for mental tasks of the advanced main control room

International Nuclear Information System (INIS)

Hsieh Tsungling; Yang Chihwei; Lin Chiuhsiangjoe

2011-01-01

The key goals of staffing and qualifications review element are to ensure that the right numbers of people with the appropriate skills and abilities are available to support plant operations and events. If the staffing level is too few, excessive stress that caused human errors possibly will be placed on the operators. Accordingly, this study developed a staffing evaluation technique based on CPM-GOMS for the mental tasks such as operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation technique. The results indicated the performance of evaluated staffing level via the staffing evaluation technique was significantly higher than that of non-evaluated staffing level; thus, validity of the staffing evaluation technique can be accepted. Finally, the implications for managerial practice on the findings of this study were discussed. (author)

Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.

Science.gov (United States)

Bowblis, John R; Hyer, Kathryn

2013-08-01

To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

The relationship of California's Medicaid reimbursement system to nurse staffing levels.

Science.gov (United States)

Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

2012-10-01

Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

Treatment philosophy and retreatment rates following piezoelectric lithotripsy.

Science.gov (United States)

Fegan, J; Camp, L A; Wilson, W T; Miller, G L; Preminger, G M

1993-01-01

Second generation lithotriptors offer the advantage of anesthesia-free fragmentation of renal and ureteral calculi but they frequently require multiple treatments to attain a stone-free status. However, excessive single lithotripsy sessions or multiple treatments may be associated with significant damage to the kidney. For some clinicians a common treatment philosophy involves evaluation of serial plain abdominal films every 24 hours after lithotripsy and immediate retreatment of all patients with incomplete fragmentation. To avoid unnecessary retreatments and, thus, minimize potential renal damage, we prospectively evaluated 100 patients undergoing lithotripsy on a Wolf Piezolith 2300 device. Patients were routinely treated with 4,000 shocks at 1,100 bar. Serial plain abdominal films were obtained at 1 day and 2 weeks after lithotripsy. The need for retreatment was determined by the plain abdominal film results. Additional therapy was considered necessary if there was no stone fragmentation or if residual fragments measured greater than 4 mm. Of the patients whose plain abdominal film at 24 hours indicated the need for a repeat treatment 43% were stone-free on the 2-week film. Thus, these patients were spared an unnecessary treatment by allowing adequate time for the stone fragments to pass spontaneously. Our data suggest that repeat treatments on second generation lithotriptors should not be performed within 24 hours. Rather, the patient should be reevaluated at least 1 to 2 weeks later to avoid unnecessary retreatment with the attendant potential for renal injury. In addition, when comparing the retreatment rates of various lithotriptors, one should also consider the treatment philosophy used at the particular institution and the timing of the radiographic studies used to determine the stone-free status.

Exceptional retreat of Novaya Zemlya's marine-terminating outlet glaciers between 2000 and 2013

Directory of Open Access Journals (Sweden)

J. R. Carr

2017-09-01

Full Text Available Novaya Zemlya (NVZ has experienced rapid ice loss and accelerated marine-terminating glacier retreat during the past 2 decades. However, it is unknown whether this retreat is exceptional longer term and/or whether it has persisted since 2010. Investigating this is vital, as dynamic thinning may contribute substantially to ice loss from NVZ, but is not currently included in sea level rise predictions. Here, we use remotely sensed data to assess controls on NVZ glacier retreat between 1973/76 and 2015. Glaciers that terminate into lakes or the ocean receded 3.5 times faster than those that terminate on land. Between 2000 and 2013, retreat rates were significantly higher on marine-terminating outlet glaciers than during the previous 27 years, and we observe widespread slowdown in retreat, and even advance, between 2013 and 2015. There were some common patterns in the timing of glacier retreat, but the magnitude varied between individual glaciers. Rapid retreat between 2000 and 2013 corresponds to a period of significantly warmer air temperatures and reduced sea ice concentrations, and to changes in the North Atlantic Oscillation (NAO and Atlantic Multidecadal Oscillation (AMO. We need to assess the impact of this accelerated retreat on dynamic ice losses from NVZ to accurately quantify its future sea level rise contribution.

Preparing emergency personnel in dialysis: a just-in-time training program for additional staffing during disasters.

Science.gov (United States)

Stoler, Genevieve B; Johnston, James R; Stevenson, Judy A; Suyama, Joe

2013-06-01

There are 341 000 patients in the United States who are dependent on routine dialysis for survival. Recent large-scale disasters have emphasized the importance of disaster preparedness, including supporting dialysis units, for people with chronic disease. Contingency plans for staffing are important for providing continuity of care for a technically challenging procedure such as dialysis. PReparing Emergency Personnel in Dialysis (PREP-D) is a just-in-time training program designed to train individuals having minimum familiarity with the basic steps of dialysis to support routine dialysis staff during a disaster. A 5-module educational program was developed through a collaborative, multidisciplinary effort. A pilot study testing the program was performed using 20 nontechnician dialysis facility employees and 20 clinical-year medical students as subjects. When comparing pretest and posttest scores, the entire study population showed a mean improvement of 28.9%, with dialysis facility employees and medical students showing improvements of 21.8% and 36.4%, respectively (P just-in-time training format. The knowledge gained by using the PREP-D program during a staffing shortage may allow for continuity of care for critical services such as dialysis during a disaster.

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

Science.gov (United States)

Gabbay, Uri; Bukchin, Michael

2009-01-01

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

Murdoch Retreats from China

Institute of Scientific and Technical Information of China (English)

Jessy Zhang

2006-01-01

@@ News Corp's Asian flagship enterprise Star Group announced in early June it would sell a 19.9 percent stake in Phoenix Satellite Television to China Mobile. This move is widely interpreted as a signal that Rudolf Murdoch, the helmsman of News Corp,might have lost his patience and could eventually retreat from the Chinese media market.

Consequences of Inadequate Staffing Include Missed Care, Potential Failure to Rescue, and Job Stress and Dissatisfaction.

Science.gov (United States)

Simpson, Kathleen Rice; Lyndon, Audrey; Ruhl, Catherine

2016-01-01

To evaluate responses of registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to a survey that sought their recommendations for staffing guidelines and their perceptions of the consequences of inadequate nurse staffing. The goal was to use these member data to inform the work of the AWHONN nurse staffing research team. Secondary analysis of responses to the 2010 AWHONN nurse staffing survey. Online. AWHONN members (N = 884). Review of data from an online survey of AWHONN members through the use of thematic analysis for descriptions of the consequences of inadequate nurse staffing during the childbirth process. Three main themes emerged as consequences of inadequate staffing or being short-staffed: Missed Care, Potential for Failure to Rescue, and Job-Related Stress and Dissatisfaction. These themes are consistent with those previously identified in the literature related to inadequate nurse staffing. Based on the responses from participants in the 2010 AWHONN nurse staffing survey, consequences of inadequate staffing can be quite serious and may put patients at risk for preventable harm. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Wastewater retreatment and reuse system for agricultural irrigation in rural villages.

Science.gov (United States)

Kim, Minyoung; Lee, Hyejin; Kim, Minkyeong; Kang, Donghyeon; Kim, Dongeok; Kim, YoungJin; Lee, Sangbong

2014-01-01

Climate changes and continuous population growth increase water demands that will not be met by traditional water resources, like surface and ground water. To handle increased water demand, treated municipal wastewater is offered to farmers for agricultural irrigation. This study aimed to enhance the effluent quality from worn-out sewage treatment facilities in rural villages, retreat effluent to meet water quality criteria for irrigation, and assess any health-related and environmental impacts from using retreated wastewater irrigation on crops and in soil. We developed the compact wastewater retreatment and reuse system (WRRS), equipped with filters, ultraviolet light, and bubble elements. A pilot greenhouse experiment was conducted to evaluate lettuce growth patterns and quantify the heavy metal concentration and pathogenic microorganisms on lettuce and in soil after irrigating with tap water, treated wastewater, and WRRS retreated wastewater. The purification performance of each WRRS component was also assessed. The study findings revealed that existing worn-out sewage treatment facilities in rural villages could meet the water quality criteria for treated effluent and also reuse retreated wastewater for crop growth and other miscellaneous agricultural purposes.

Spent Nuclear Fuel Project operational staffing plan

International Nuclear Information System (INIS)

Debban, B.L.

1996-03-01

Using the Spent Nuclear Fuel (SNF) Project's current process flow concepts and knowledge from cognizant engineering and operational personnel, an initial assessment of the SNF Project radiological exposure and resource requirements was completed. A small project team completed a step by step analysis of fuel movement in the K Basins to the new interim storage location, the Canister Storage Building (CSB). This analysis looked at fuel retrieval, conditioning of the fuel, and transportation of the fuel. This plan describes the staffing structure for fuel processing, fuel movement, and the maintenance and operation (M ampersand O) staffing requirements of the facilities. This initial draft does not identify the support function resources required for M ampersand O, i.e., administrative and engineering (technical support). These will be included in future revisions to the plan. This plan looks at the resource requirements for the SNF subprojects, specifically, the operations of the facilities, balances resources where applicable, rotates crews where applicable, and attempts to use individuals in multi-task assignments. This plan does not apply to the construction phase of planned projects that affect staffing levels of K Basins

Impact of staffing parameters on operational reliability

International Nuclear Information System (INIS)

Hahn, H.A.; Houghton, F.K.

1993-01-01

This paper reports on a project related to human resource management of the Department of Energy's (DOE's) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment safety, and health concerns. For the of the current paper, human resource management activities are identified as ''Staffing'' and include the of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability. The work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development

Impact of staffing parameters on operational reliability

International Nuclear Information System (INIS)

Hahn, H.A.; Houghton, F.K.

1993-01-01

This paper reports on a project related to human resource management of the Department of Energy (DOEs) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment, safety, and health concerns. For the purposes of the current paper, human resource management activities are identified as 'Staffing' and include the process of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability, the work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that, although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development

Patients' perceptions, treatment need, and complexity of orthodontic re-treatment

NARCIS (Netherlands)

Ren, Yijin; Boxum, Christo; Sandham, John

The aim of the present study was to investigate the subjective perception and objective treatment need and complexity of patients seeking orthodontic re-treatment. One hundred subjects (66 females, 34 males, age 26.7+/-8.2 years) seeking re-treatment were asked to complete a questionnaire which was

Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada

Science.gov (United States)

Battista, Jerry J.; Patterson, Michael S.; Beaulieu, Luc; Sharpe, Michael B.; Schreiner, L. John; MacPherson, Miller S.; Van Dyk, Jacob

2012-01-01

The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively. PACS numbers: 87.55.N‐, 87.55.Qr PMID:22231223

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco.

Science.gov (United States)

Dooley, Kelly E; Lahlou, Ouafae; Ghali, Iraqi; Knudsen, Janine; Elmessaoudi, My Driss; Cherkaoui, Imad; El Aouad, Rajae

2011-02-28

Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1

Staffing and Workflow of a Maturing Institutional Repository

Directory of Open Access Journals (Sweden)

Debora L. Madsen

2013-02-01

Full Text Available Institutional repositories (IRs have become established components of many academic libraries. As an IR matures it will face the challenge of how to scale up its operations to increase the amount and types of content archived. These challenges involve staffing, systems, workflows, and promotion. In the past eight years, Kansas State University's IR (K-REx has grown from a platform for student theses, dissertations, and reports to also include faculty works. The initial workforce of a single faculty member was expanded as a part of a library-wide reorganization, resulting in a cross-departmental team that is better able to accommodate the expansion of the IR. The resultant need to define staff responsibilities and develop resources to manage the workflows has led to the innovations described here, which may prove useful to the greater library community as other IRs mature.

Effects of Medicare payment changes on nursing home staffing and deficiencies.

Science.gov (United States)

Konetzka, R Tamara; Yi, Deokhee; Norton, Edward C; Kilpatrick, Kerry E

2004-06-01

To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. Online Survey, Certification and Reporting (OSCAR) data from 1996-2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.

Twenty years of staffing, practice environment, and outcomes research in military nursing.

Science.gov (United States)

Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S; Swiger, Pauline; Breckenridge-Sproat, Sara; Brosch, Laura Ruse; Jennings, Bonnie Mowinski

Two decades ago, findings from an Institute of Medicine (IOM) report sparked the urgent need for evidence supporting relationships between nurse staffing and patient outcomes. This article provides an overview of nurse staffing, practice environment, and patient outcomes research, with an emphasis on findings from military studies. Lessons learned also are enumerated. This study is a review of the entire Military Nursing Outcomes Database (MilNOD) program of research. The MilNOD, in combination with evidence from other health care studies, provides nurses and leaders with information about the associations between staffing, patient outcomes, and the professional practice environment of nursing in the military. Leaders, therefore, have useful empirical evidence to make data-driven decisions. The MilNOD studies are the basis for the current Army nursing dashboard, and care delivery framework, called the Patent CaringTouch System. Future research is needed to identify ideal staffing based on workload demands, and provide leaders with factors to consider when operationalizing staffing recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

Staffing, overtime, and shift scheduling project

International Nuclear Information System (INIS)

Lewis, P.M.

1989-01-01

Recent events at the Peach Bottom nuclear power plant have demonstrated the need to establish a quantifiable basis for assessing the safety significance of long work hours on nuclear power plant operators. The incidents at TMI-2, Chernobyl, and Bhopal, which all occurred during the late evening/night shift, further highlight the importance of the relationship between shift scheduling and performance. The objective of this project is to estimate, using statistical analysis on data from the nuclear industry, the effects on safety of staffing levels, overtime, and shift scheduling for operators and maintenance personnel. Regarding staffing levels, the Nuclear Regulatory Commission (NRC) currently has no explicit regulation concerning the minimum acceptable levels of staffing in a plant that has an operating license. The NRC has no systematic method for collecting data on the number of licensed operators on the operating crews. In 1982 the NRC recommended that plants write into their technical specifications a model policy on overtime. Currently, 77 nuclear power plant units have the model policy or a modification of it written into their technical specifications; 33 units have no policy on overtime. The model policy sets limits on overtime for safety related personnel, although these limits can be exceeded with plant manger approval. The US nuclear power industry has three types of shift schedules: (1) forward-rotating 8-hour/day shift schedules, (2) backward-rotating 8-hour/day schedules, and (3) 12-hour/day schedules

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

Science.gov (United States)

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Extension Staffing Models to Serve 4-H Clientele in Changing Times

Directory of Open Access Journals (Sweden)

Donna R. Gillespie

2010-03-01

Full Text Available In response to budget cuts in 2002, 4-H staffing models were restructured. The response by University of Idaho Extension was intended to continue meeting the needs of Idaho’s citizens with fewer UI Extension faculty. This staffing reorganization led to the formation of the District III 4-H Team who united to bring stronger 4-H programs to south central Idaho and expand programs to underserved audiences. Information from surveys and interviews over the past seven years reflects the effectiveness, challenges and successes of the District III 4-H Team. In Making the Best Better: 4-H Staffing Patterns and Trends in the Largest Professional Network in the Nation (2007, author Kirk A. Astroth notes a nationwide change in 4-H leadership at the county level from 4-H faculty to program assistants or coordinators. The information gathered in our research may help other states determine staffing models to meet the needs of clientele in these changing times.

Radiotherapy staffing in the European countries

DEFF Research Database (Denmark)

Lievens, Yolande; Defourny, Noémie; Coffey, Mary

2014-01-01

includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40...... of countries can be distinguished on the basis of available personnel resources and socio-economic status. CONCLUSIONS: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such......, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants...

The Implications of Flexible Staffing Arrangements for Job Stability

OpenAIRE

Houseman, Susan N.; Polivka, Anne E.

1999-01-01

In this paper, we examine the job stability of workers in a wide range of flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. We draw upon two data sources in our analysis. The first is a nationwide survey of employers on their use of flexible staffing arrangements conducted by the Upjohn Institute for Employment Research. This survey provides evidence on why employers use various types of flex...

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

Staffing Patterns in Public School Systems: Current Status and Trends, Update 2001. Research Snapshot.

Science.gov (United States)

Williams, Alicia D.; Protheroe, Nancy; Parks, Michael C.

Staffing patterns in American public-school systems are presented in this report of the 2000-01 school year. The report addresses the following: why information about staffing ratios is important; how many people currently work in public schools; what proportion of these are teachers, administrators, and support staff; current staffing patterns in…

Incidence, outcomes, and risk factors for retreatment after wavefront-optimized ablations with PRK and LASIK.

Science.gov (United States)

Randleman, J Bradley; White, Alfred J; Lynn, Michael J; Hu, Michelle H; Stulting, R Doyle

2009-03-01

To analyze and compare retreatment rates after wavefront-optimized photorefractive keratectomy (PRK) and LASIK and determine risk factors for retreatment. A retrospective chart review was performed to identify patients undergoing PRK or LASIK with the wavefront-optimized WaveLight platform from January 2005 through December 2006 targeted for a piano outcome and to determine the rate and risk factors for retreatment surgery in this population. Eight hundred fifty-five eyes were analyzed, including 70 (8.2%) eyes with hyperopic refractions and 785 (91.8%) eyes with myopic refractions. After initial treatment, 72% of eyes were 20/20 or better and 99.5% were 20/40 or better. To improve uncorrected visual acuity, 54 (6.3%) eyes had retreatments performed. No significant differences in retreatment rates were noted based on age (P = .15), sex (P = .8), eye (P = .3), PRK versus LASIK (P = 1.0), room temperature (P = .1) or humidity (P = .9), and no correlation between retreatment rate and month or season of primary surgery (P = .4). There was no correlation between degree of myopia and retreatment rate. Eyes were significantly more likely to undergo retreatment if they were hyperopic (12.8% vs 6.0%, P = .006) or had astigmatism > or = 1.00 diopter (D) (9.1% vs 5.3%, P = .04). Retreatment rate was 6.3% with the WaveLight ALLEGRETTO WAVE excimer laser. This rate was not influenced by age, sex, corneal characteristics, or environmental factors. Eyes with hyperopic refractions or astigmatism > or = 1.00 D were more likely to undergo retreatment.

The association between nurse staffing and omissions in nursing care: A systematic review.

Science.gov (United States)

Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane

2018-03-08

To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia

DEFF Research Database (Denmark)

Krüger, A J; Lossius, H M; Mikkelsen, S

2013-01-01

All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...

Modeling Antarctic Ice Sheet retreat in warm climates: a historical perspective.

Science.gov (United States)

Pollard, D.; Deconto, R. M.; Gasson, E.

2016-12-01

Early modeling of Antarctic Ice Sheet size vs. climate focused on asymmetry between retreat and growth, with much greater warming needed to cause retreat from full ice cover, due to Height Mass Balance Feedback and albedo feedback. This led to a long-standing model-data conflict, with models needing 1000 to2000 ppmv atmospheric CO2 to produce retreat from full size, vs. proxy data of large ice fluctuations despite much lower CO2 since the Miocene.Subsequent modeling with marine ice physics found that the West Antarctic Ice Sheet could undergo repeated warm-period collapses with realistic past forcing. However, that yields only 3 to 7 m equivalent sea-level rise above modern, compared to 10 to 20 m or more suggested by some geologic data. Large subglacial basins in East Antarctica could be vulnerable to the same processes,but did not retreat in most models due to narrower and shallower sills.After recent modifications, some ice sheet models were able to produce warm-period collapse of major East Antarctic basins, with sea-level rise of up to 15 m. The modifications are (i) hydrofracturing by surface melt, and structural failure of ice cliffs, or (ii) numerical treatment at the grounding line. In these models, large retreat occurs both for past warmintervals, and also for future business-as-usual scenarios.Some interpretations of data in the late Oligocene and Miocene suggest yet larger fluctuations, between 50 to 100% of modern Antarctic size. That would require surface-melt driven retreat of some terrestrial East Antarctic ice, despite the hysteresis issue raised above. A recent study using a coupled climate-ice sheet model found that with a finer climate gridand more frequent coupling exchange, substantial retreat of terrestrial Antarctica can occur with 500 to 840 ppmv CO2, much lower than in earlier models. This will allow meaningful interactions between modeling and deeper-time geologic interpretations since the late Oligocene.

Enhancing the research and publication efforts of health sciences librarians via an academic writing retreat.

Science.gov (United States)

Bullion, John W; Brower, Stewart M

2017-10-01

This case study describes the South Central Chapter of the Medical Library Association (SCC/MLA) initiative to develop an academic writing retreat for members who sought the necessary time and support to advance their research projects toward publication. SCC/MLA staged a dedicated writing retreat to coincide with the organization's 2012, 2013, and 2014 annual meetings. Each cohort met over two days to write and to workshop their peers' manuscripts. Organizers distributed an online survey one month after each retreat to evaluate attendees' perceptions. Three years' worth of writing retreats yielded fourteen peer-reviewed articles and one book chapter. Participants indicated that the retreat helped them meet or exceed their writing goals by offering protected time and a setting conducive to productivity. The format of the retreat is cost effective and easily adaptable for fellow professionals who wish to organize a formal event as a conference offering or simply support a writing group at their home institutions. In SCC/MLA, the retreat revitalized interest in writing and demystified the scholarly publication process.

Nuclear power plant organization and staffing for improved performance: Lessons learned

International Nuclear Information System (INIS)

1998-11-01

Experience from well operated nuclear power plants (NPPs) around the world indicates that an organizational structure which efficiently supports plant operation is essential in economically achieving both high level of safety and operational performance. At the same time energy markets are being opened to competition in many Member States. It is in consideration of this new competitive energy market that the overall objective of this document is to provide NPP managers information on lessons learned on improving the organization and staffing of NPP activities. Within this overall objective, specific objectives are to: Identify organisational design and staffing principles, Provide examples of how NPPs implement these principles, Identify typical NPP staffing levels, Factors affecting these levels, and staffing trends among various NPP types. Although it is not expected that any particular utility or NPP manager would consider all of the suggestions provided here to be appropriate, it is anticipated that nearly every NPP manager in IAEA Member States would find some ideas useful in improving the efficiency and effectiveness of NPP activities

Nursing teamwork, staff characteristics, work schedules, and staffing.

Science.gov (United States)

Kalisch, Beatrice J; Lee, Hyunhwa

2009-01-01

This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.

Reliable Refuge: Two Sky Island Scorpion Species Select Larger, Thermally Stable Retreat Sites.

Science.gov (United States)

Becker, Jamie E; Brown, Christopher A

2016-01-01

Sky island scorpions shelter under rocks and other surface debris, but, as with other scorpions, it is unclear whether these species select retreat sites randomly. Furthermore, little is known about the thermal preferences of scorpions, and no research has been done to identify whether reproductive condition might influence retreat site selection. The objectives were to (1) identify physical or thermal characteristics for retreat sites occupied by two sky island scorpions (Vaejovis cashi Graham 2007 and V. electrum Hughes 2011) and those not occupied; (2) determine whether retreat site selection differs between the two study species; and (3) identify whether thermal selection differs between species and between gravid and non-gravid females of the same species. Within each scorpion's habitat, maximum dimensions of rocks along a transect line were measured and compared to occupied rocks to determine whether retreat site selection occurred randomly. Temperature loggers were placed under a subset of occupied and unoccupied rocks for 48 hours to compare the thermal characteristics of these rocks. Thermal gradient trials were conducted before parturition and after dispersal of young in order to identify whether gravidity influences thermal preference. Vaejovis cashi and V. electrum both selected larger retreat sites that had more stable thermal profiles. Neither species appeared to have thermal preferences influenced by reproductive condition. However, while thermal selection did not differ among non-gravid individuals, gravid V. electrum selected warmer temperatures than its gravid congener. Sky island scorpions appear to select large retreat sites to maintain thermal stability, although biotic factors (e.g., competition) could also be involved in this choice. Future studies should focus on identifying the various biotic or abiotic factors that could influence retreat site selection in scorpions, as well as determining whether reproductive condition affects thermal

Scientific retreats with 'speed dating': networking to stimulate new interdisciplinary translational research collaborations and team science.

Science.gov (United States)

Ranwala, Damayanthi; Alberg, Anthony J; Brady, Kathleen T; Obeid, Jihad S; Davis, Randal; Halushka, Perry V

2017-02-01

To stimulate the formation of new interdisciplinary translational research teams and innovative pilot projects, the South Carolina Clinical and Translational Research (SCTR) Institute (South Carolina Clinical and Translational Science Award, CTSA) initiated biannual scientific retreats with 'speed dating' networking sessions. Retreat themes were prioritized based on the following criteria; cross-cutting topic, unmet medical need, generation of novel technologies and methodologies. Each retreat begins with an external keynote speaker followed by a series of brief research presentations by local researchers focused on the retreat theme, articulating potential areas for new collaborations. After each session of presentations, there is a 30 min scientific 'speed dating' period during which the presenters meet with interested attendees to exchange ideas and discuss collaborations. Retreat attendees are eligible to compete for pilot project funds on the topic of the retreat theme. The 10 retreats held have had a total of 1004 participants, resulted in 61 pilot projects with new interdisciplinary teams, and 14 funded projects. The retreat format has been a successful mechanism to stimulate novel interdisciplinary research teams and innovative translational research projects. Future retreats will continue to target topics of cross-cutting importance to biomedical and public health research. Copyright © 2016 American Federation for Medical Research.

The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets.

Science.gov (United States)

Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

2013-01-01

Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets. In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.

A comparison of current Naval Facilities Engineering Command field office staffing methods, state staffing methods and the construction industry institutes owner contractor work structure

OpenAIRE

Monreal, Michael

2001-01-01

CIVINS (Civilian Institutions) Thesis document This report was generated by accepting a report topic contained in a list of topics on the Civil Engineer Corps Graduate School Information web page. The topic request and description is noted as follows: Topic. How to Measure Staffing Requirements in ROICC offices and Other Acquisition Functions with a description. Description: We base current staffing requirements on history and only adjust from what we have used in the past years. It is sus...

Little Ice Age advance and retreat of Glaciar Jorge Montt, Chilean Patagonia

Directory of Open Access Journals (Sweden)

A. Rivera

2012-03-01

Full Text Available Glaciar Jorge Montt (48°20' S/73°30' W, one of the main tidewater glaciers of the Southern Patagonian Icefield (SPI, has experienced the greatest terminal retreat observed in Patagonia during the past century, with a recession of 19.5 km between 1898 and 2011. This retreat has revealed trees laying subglacially until 2003. These trees were dated using radiocarbon, yielding burial ages between 460 and 250 cal yrs BP. The presence of old growth forest during those dates indicates that Glaciar Jorge Montt was upvalley of its present position before the commonly recognized Little Ice Age (LIA period in Patagonia. The post-LIA retreat was most likely triggered by climatically induced changes during the 20th century; however, Glaciar Jorge Montt has responded more dramatically than its neighbours. The retreat of Jorge Montt opened a 19.5 km long fjord since 1898, which reaches depths in excess of 390 m. The bathymetry is well correlated with glacier retreat rates, suggesting that dynamic responses of the glacier are at least partially connected to near buoyancy conditions at the ice front, resulting in high calving fluxes, accelerating thinning rates and rapid ice velocities.

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn.

Science.gov (United States)

Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie

2015-04-01

This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.

Improvements in nuclear plant staffing resulting from the AP600 design programme

International Nuclear Information System (INIS)

Mycoff, C.

2001-01-01

The staffing for a single-unit AP600 is estimated to require a staff for operation and maintenance about 32% smaller than current generation power plants of similar size. These staffing reductions are driven primarily by various features incorporated into the AP600 plant design. (author)

Leadership, staffing and quality of care in nursing homes

Science.gov (United States)

2011-01-01

Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

Leadership, staffing and quality of care in nursing homes

Directory of Open Access Journals (Sweden)

Havig Anders

2011-11-01

Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses

42 CFR 9.9 - Facility staffing.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Facility staffing. 9.9 Section 9.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR... Biosafety Officer must have experience in developing and monitoring biohazards and dealing with biosafety...

Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

Science.gov (United States)

Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

2016-11-01

Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

Scientific Retreats with ‘Speed Dating’: Networking to Stimulate New Interdisciplinary Translational Research Collaborations and Team Science

Science.gov (United States)

Alberg, Anthony J.; Brady, Kathleen T.; Obeid, Jihad S.; Davis, Randal; Halushka, Perry V.

2016-01-01

To stimulate the formation of new interdisciplinary translational research teams and innovative pilot projects, the South Carolina Clinical & Translational Research (SCTR) Institute (South Carolina Clinical and Translational Science Award, CTSA) initiated biannual scientific retreats with “speed dating” networking sessions. Retreat themes were prioritized based on the following criteria; cross-cutting topic, unmet medical need, generation of novel technologies and methodologies. Each retreat commences with an external keynote speaker followed by a series of brief research presentations by local researchers focused on the retreat theme, articulating potential areas for new collaborations. After each session of presentations, there is a 30 minute scientific “speed dating” period during which the presenters meet with interested attendees to exchange ideas and discuss collaborations. Retreat attendees are eligible to compete for pilot project funds on the topic of the retreat theme. The 10 retreats held have had a total of 1004 participants, resulted in 61 pilot projects with new interdisciplinary teams, and 14 funded projects. The retreat format has been a successful mechanism to stimulate novel interdisciplinary research teams and innovative translational research projects. Future retreats will continue to target topics of cross-cutting importance to biomedical and public health research. PMID:27807146

STAFFING DALAM ALQURAN DAN HADIS DITINJAU DARI MANAJEMEN PENDIDIKAN

Directory of Open Access Journals (Sweden)

Tuti Andriani

2016-08-01

Full Text Available Staffing in an organization can be defined as a series of processes and efforts to acquire, develop, motivate, and evaluate the overall human resources. It is required within the organization in achieving its goals. In staffing, putting a person in a work should be in accordance with his capabilities and expertise so that all are expected to be achieved. Job placement principle is the principle of humanity, democracy, the right man on the right place, equal pay for equal work, unity of direction, the principle of unity of purpose, unity of command, Efficiency and Productivity Work. The concept is the placement, promotion, transfer and demotion. Staffing in the Qur'an and Hadith seen from education management is an employee must complete properly, responsibility, trust, has the capability and expertise, serve, work ethic, strong and trustworthy, honest, sincere, true and trustful, physical and mental strength, and high manners. Professionalism in view of sharia is characterized by three things, namely ahliyah (expertise, himmatul 'charity (high work ethic, trustworthy (reliable.

The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets

Science.gov (United States)

Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

2013-01-01

Background Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets Purpose In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. Methodology/Approach By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Findings Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Practice Implications Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost cutting measures may be inefficient and negatively affect financial performance. PMID:22543824

77 FR 40638 - Syniverse Technologies, Inc., Including On-Site Leased Workers From Insight Global Stone Staffing...

Science.gov (United States)

2012-07-10

..., Inc., Including On-Site Leased Workers From Insight Global Stone Staffing, and Randstad Formerly Known..., Massachusetts, including on-site leased workers from Insight Global, Stone Staffing, Randstad formerly known as... Insight Global, Stone Staffing, Randstad, formerly known as Sapphire Technologies, were employed on-site...

Staffing to Maximize Profit for Call Centers with Impatient and Repeat-Calling Customers

Directory of Open Access Journals (Sweden)

Jun Gong

2015-01-01

Full Text Available Motivated by call center practice, we study the optimal staffing of many-server queues with impatient and repeat-calling customers. A call center is modeled as an M/M/s+M queue, which is developed to a behavioral queuing model in which customers come and go based on their satisfaction with waiting time. We explicitly take into account customer repeat behavior, which implies that satisfied customers might return and have an impact on the arrival rate. Optimality is defined as the number of agents that maximize revenues net of staffing costs, and we account for the characteristic that revenues are a direct function of staffing. Finally, we use numerical experiments to make certain comparisons with traditional models that do not consider customer repeat behavior. Furthermore, we indicate how managers might allocate staffing optimally with various customer behavior mechanisms.

Retreatment of Exudative Age-Related Macular Degeneration after Loading 3-Monthly Intravitreal Ranibizumab.

Science.gov (United States)

Sugiyama, Atsushi; Sakurada, Yoichi; Honda, Shigeru; Miki, Akiko; Matsumiya, Wataru; Yoneyama, Seigo; Kikushima, Wataru; Iijima, Hiroyuki

2018-01-01

The aim of this study was to investigate the clinical implications of required retreatment after 3-monthly intravitreal ranibizumab (IVR) injections followed by as-needed reinjections up to 5 years in eyes with exudative age-related macular degeneration (AMD). A retrospective cohort study was conducted for 165 treatment-naïve eyes from 165 patients with exudative AMD. Visual changes were investigated in terms of the required retreatments. Retreatment-free proportions were 37.0, 23.7, 16.6, 12.1, and 10.5% at 12, 24, 36, 48, and 60 months, respectively. Visual changes were significantly better in eyes which did not require retreatment at every yearly checkpoint within the 5 years. A multivariate logistic regression analysis revealed that requirement of additional IVR treatments in the first 12-24 months was associated with the T allele (risk allele) of ARMS2 A69S (p = 0.010 and 0.015, respectively). Cox regression analysis revealed that older age (p = 0.046) and the T allele of ARMS2 A69S (p = 0.036) were associated with required retreatment within the 5-year follow-up period. Age and the T allele of ARMS2 A69S are the risk factors requiring retreatments, leading to poor visual change in eyes with exudative AMD following the initial 3-monthly IVR. © 2017 S. Karger AG, Basel.

The impact of HMO penetration on the relationship between nurse staffing and quality.

Science.gov (United States)

Mark, Barbara A; Harless, David W; McCue, Michael

2005-07-01

While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.

[Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications].

Science.gov (United States)

Kim, Yunmi; You, Sunju; Kim, Jinhyun

2017-12-01

This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future. © 2017 Korean Society of Nursing Science

77 FR 63872 - Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc...

Science.gov (United States)

2012-10-17

... Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc...., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc., Select Staffing, and... follows: ''All workers of Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time...

Staffing the Global Organization: "Cultural Nomads"

Science.gov (United States)

McPhail, Ruth; Fisher, Ron; Harvey, Michael; Moeller, Miriam

2012-01-01

This article explores the evolution of international staffing in an increasingly globalized and hypercompetitive marketplace. As the issue of staff retention becomes critical in global organizations, it is important to understand the types of managers that may be on or assigned to overseas assignments. The purpose of this article is to present a…

Nurse Staffing and Quality of Care of Nursing Home Residents in Korea.

Science.gov (United States)

Shin, Juh Hyun; Hyun, Ta Kyung

2015-11-01

To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea. We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately

Development of Staffing Patterns in Six New Medical Schools Established 1952-1960.

Science.gov (United States)

National Institutes of Health (DHEW), Bethesda, MD. Resources Analysis Branch.

This summary report of staffing patterns in 6 medical schools established between 1952 and 1960 is the first phase of a proposed study of biomedical staffing requirements in institutions of higher education, 1965-1975. The 6 schools are: the University of Miami, Albert Einstein College of medicine at Yeshiva University, the University of Florida,…

Worthy Work, Unlivable Wages: The National Child Care Staffing Study, 1988-1997.

Science.gov (United States)

Whitebook, Marcy; Howes, Carollee; Phillips, Deborah

In 1988, the National Child Care Staffing Study first gathered information on staffing and quality from a sample of child care centers in five metropolitan areas--Atlanta, Boston, Detroit, Phoenix, and Seattle--and returned for updated information in 1992. In 1997, directors of the original sample of centers still in operation were contacted again…

A century of ice retreat on Kilimanjaro: the mapping reloaded

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N. J. Cullen

2013-03-01

Full Text Available A new and consistent time series of glacier retreat on Kilimanjaro over the last century has been established by re-interpreting two historical maps and processing nine satellite images, which removes uncertainty about the location and extent of past and present ice bodies. Three-dimensional visualization techniques were used in conjunction with aerial and ground-based photography to facilitate the interpretation of ice boundaries over eight epochs between 1912 and 2011. The glaciers have retreated from their former extent of 11.40 km2 in 1912 to 1.76 km2 in 2011, which represents a total loss of about 85% of the ice cover over the last 100 yr. The total loss of ice cover is in broad agreement with previous estimates, but to further characterize the spatial and temporal variability of glacier retreat a cluster analysis using topographical information (elevation, slope and aspect was performed to segment the ice cover as observed in 1912, which resulted in three glacier zones being identified. Linear extrapolation of the retreat in each of the three identified glacier assemblages implies the ice cover on the western slopes of Kilimanjaro will be gone before 2020, while the remaining ice bodies on the plateau and southern slopes will most likely disappear by 2040. It is highly unlikely that any body of ice will be present on Kilimanjaro after 2060 if present-day climatological conditions are maintained. Importantly, the geo-statistical approach developed in this study provides us with an additional tool to characterize the physical processes governing glacier retreat on Kilimanjaro. It remains clear that, to use glacier response to unravel past climatic conditions on Kilimanjaro, the transition from growth to decay of the plateau glaciers must be further resolved, in particular the mechanisms responsible for vertical cliff development.

Continuing evidence for poorer treatment outcomes for single male patients: Retreatment data from RTOG 97-14

International Nuclear Information System (INIS)

Konski, Andre; DeSilvio, Michelle; Hartsell, William; Watkins-Bruner, Deborah; Coyne, James; Scarantino, Charles; JanJan, Nora

2006-01-01

Purpose: The specific aim of this study was to evaluate outcome differences by gender and partner status for patients treated on Radiation Therapy Oncology Group (RTOG) protocol 97-14. Methods and Materials: RTOG 97-14 randomized patients with metastatic breast or prostate cancer to bone to receive 8 Gy in 1 fraction or 30 Gy in 10 fractions. Retreatment rates and overall survival were made based upon gender, marital status, and Karnofsky Performance Status (KPS). The cumulative incidence method was used to estimate retreatment time at 36 months from enrollment, and Gray's test was used to test for treatment differences within the same groupings. Marital status, gender, KPS, and treatment were variables tested in a univariate Cox model evaluating the time to retreatment. Results: Married men and women and single women receiving 30 Gy had significantly longer time to retreatment, p = 0.0067, p = 0.0052, and p = 0.0009 respectively. We failed to show a difference in retreatment rates over time in single men receiving either 30 Gy or 8 Gy. Univariate analysis of the entire group determined patients receiving 30 Gy in 10 fractions significantly less likely to receive retreatment, p < 0.0001, with a trend toward single patients less likely to be re-treated, p = 0.07. Conclusion: Non-disease-related variables, such as social support, might influence the results of clinical trials with subjective endpoints such as retreatment rates. The statistically nonsignificant difference in the 36-month retreatment rates observed in single male patients receiving 8 Gy may be a result of inadequate social support systems in place to facilitate additional care. Patients receiving 8 Gy in a single fraction had significantly higher retreatment rates compared with patients receiving 30 Gy in 10 fractions

Development of staffing evaluation principle for advanced main control room and the effect on situation awareness and mental workload

International Nuclear Information System (INIS)

Lin, Chiuhsiang Joe; Hsieh, Tsung-Ling; Lin, Shiau-Feng

2013-01-01

Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed

Development of staffing evaluation principle for advanced main control room and the effect on situation awareness and mental workload

Energy Technology Data Exchange (ETDEWEB)

Lin, Chiuhsiang Joe, E-mail: cjoelin@mail.ntust.edu.tw [Department of Industrial Management, National Taiwan University of Science and Technology, 43, Section 4, Keelung Road, Taipei 10607, Taiwan (China); Hsieh, Tsung-Ling, E-mail: bm1129@gmail.com [Institute of Nuclear Energy Research, 1000, Wenhua Road, Chiaan Village, Lungtan 32546, Taiwan (China); Lin, Shiau-Feng, E-mail: g9602411@cycu.edu.tw [Department of Industrial Engineering, Chung-Yuan Christian University, 200, Chung Pei Road, Chung-Li 32023, Taiwan (China)

2013-12-15

Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed.

Effectiveness of ProTaper Universal retreatment instruments used with rotary or reciprocating adaptive motion in the removal of root canal filling material.

Science.gov (United States)

Capar, I D; Arslan, H; Ertas, H; Gök, T; Saygılı, G

2015-01-01

To compare the effectiveness of ProTaper Universal retreatment instruments with continuous rotation and adaptive motion (AM; a modified reciprocating motion that combines rotational and reciprocating motion) in the removal of filling material. Mesiobuccal root canals in 36 mandibular first molars were instrumented up to size F2 with the ProTaper Universal instrument (Dentsply Maillefer, Ballaigues, Switzerland) and filled using sealer and ProTaper Universal F2 gutta-percha cones. Gutta-percha was then down-packed and the root canal backfilled using the extruder hand-piece of the Elements Obturation System (SybronEndo, Orange, CA, USA). The teeth were assigned to two groups (n = 18), and removal of the root fillings was performed using one of the following techniques: group 1) ProTaper Universal retreatment files used with rotational motion (RM) and group 2) ProTaper Universal retreatment files used with adaptive motion (AM) (600° clockwise/0° counter-clockwise to 370° clockwise/50° counter-clockwise). The teeth were sectioned, and both halves were analysed at 8 × magnification. The percentage of remaining filling material was recorded. The data were analysed statistically using the Student's t-test at a 95% confidence level (P ProTaper Universal retreatment files with adaptive motion removed more filling materials from root canals than the rotational movement. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

The Role of Silence at the Retreats of a Buddhist Community

Directory of Open Access Journals (Sweden)

Orsolya Huszár

2016-12-01

Full Text Available The purpose of the study is to establish that the definition of silence as simply an absence of something or as the background of communication proves to be inadequate in a number of communicative instances. The interpretation of silence is culturally determined, and the underappreciation of its role is typical in low-context Western cultures; this is also evinced by the neglect of the topic in the literature. The present study will describe the communicative functions of silence through the findings of field work conducted at the retreats of a Buddhist community in Hungary, providing empirical input for the relevant theoretical constructs. The research findings show that silence is accorded a central role in essentially every component of the retreat (meditations, relaxation, ceremonies, teachings, small-group sharings, meals and rest; and while each event at the retreat focuses primarily on a different specific function of communication, the entire retreat does involve the linkage, affecting, revelational and – to a certain extent – activating functions (to follow the five-element typology of J. Vernon Jensen, as well as – to a lesser extent – the judgmental function. The research also shows that it requires time for individuals in a low-context culture to recognize the “point” of silence – something that the retreats provide the right opportunity for. In fact, the insights the individuals arrived at through these occasions could be put to use in their daily lives, helping their problem-solving and social relationships and in general improving their quality of life.

Transcending Gender: Female Non-Buddhists’ Experiences of the Vipassanā Meditation Retreat

Directory of Open Access Journals (Sweden)

Brooke Schedneck

2018-03-01

Full Text Available Female non-Buddhists have been writing detailed descriptions of their personal experiences in vipassanā meditation retreats since the 1960s. These memoirists relate to the English-speaking world their experience of the retreat process and self-transformations. Early memoirists traveled Asia in order to learn and practice vipassanā meditation. These memoirs are as much about the meditation practice itself as living in an Asian culture. The mindfulness craze, beginning in the late 2000s, brought with it increased awareness of vipassanā practice. At this time we see a renewed interest in recording vipassanā retreat experiences, but these are even more personal and not concerned with travel, as many vipassanā meditation retreats are now available outside of Asia. I consider four female memoirists: Marie Byles and Jane Hamilton-Smith, writing in the 1960s and 1970s, and Raji Lukkoor, and Jennifer Howd, whose memoirs appeared in 2010 and 2014, respectively. These women’s writings demonstrate that, although non-Buddhist female meditators understand vipassanā meditation as a nongendered practice, it is still an embodied, gendered experience. Each of these women has different reactions to the female gender on the retreat, from outrage at gender discrimination to acceptance of it, from judgment of female teachers and meditators to revealing a more feminine self.

Assessment of Apical Extrusion of Debris during Endodontic Retreatment with 3 Rotary Nickel-Titanium Retreatment Systems and Hand Files

Directory of Open Access Journals (Sweden)

Gkampesi S.

2016-03-01

Full Text Available Aim: to evaluate the amount of debris extruded apically as well as the time needed for removal of root canal filling material using ProTaper, MTwo, REndo NiTi rotary retreatment systems and hand files.

Extreme beach retreat history inferred from cut-and-fill beach deposits at Moruya, SE Australia

Science.gov (United States)

Tamura, T.; Woodroffe, C. D.; Oliver, T.; Cunningham, A. C.

2017-12-01

A sequence of beach ridges often records a `cut and fill', where the fair-weather swash accretion of beach sand is punctuated by storm erosion. The detailed chronology of the sequence is thus a clue to decipher past storm events and associated beach erosion, but has not been explored much. Here we explore the potential of such a sequence to detect past extreme retreats in Bengello Beach at Moruya, southeastern Australia. Beach monitoring since 1972 reveals that Bengello beach has shown a typical cut and fill, in which the beach retreats several tens of meters in relation to storms and recovers within a following few years. A storm event caused extreme retreat up to 50 m in 1974. Since then, no retreat exceeded 30 m. The beach monitoring highlights the sporadic nature of the prograded beach deposits; they can only be preserved as stratigraphic records during rapid beach recovery following a large retreat deeper than the beach profile envelope. Thus, ages of the preserved beach deposits roughly correspond to timings of large retreat. Optically-stimulated luminescence (OSL) ages were determined for beach deposits at 5-10 m intervals along a shore-normal transect from the modern foredune to beach ridge 120 m inland. The most landward sample was dated as 510 yr, indicating that the net progradation rate is 0.24 m/yr, concordant with both the long- and short-term rates since the mid Holocene and 1972, respectively. Other ages show four events of retreat around 350, 180, 130 and 90 yr, and also reflect the beach scarp resulting from the 1974 event. The retreat of each event is given by the distance between the shoreline position prior to storm erosion and relevant gap in OSL age. The position of the pre-storm shoreline is estimated by assuming a constant rate of the net progradation of 0.24 m/yr, as with long- and short-term rates. The retreat of the four events is then determined as 45-55 m, similar to the 1974 event. In summary, extreme beach retreats, including that in

Spiral computed tomography assessment of the efficacy of different rotary versus hand retreatment system

OpenAIRE

Neelam Mittal; Jyoti Jain

2014-01-01

Aims: The purpose of this study was to evaluate the efficacy of nickel-titanium rotary retreatment systems versus stainless steel hand retreatment system with or without solvent for gutta-percha removal during retreatment. Materials and Methods: Sixty extracted human mandibular molar teeth with single canal in a distal root was prepared with ProTaper rotary nickel-titanium files and obturated with gutta-percha and sealer. The teeth were randomly divided into six groups of 10 specimens in ...

Nurse burnout in China: a questionnaire survey on staffing, job satisfaction, and quality of care.

Science.gov (United States)

Lu, Minmin; Ruan, Hui; Xing, Weijie; Hu, Yan

2015-05-01

The investigators examined how nurse staffing affects nurse job satisfaction and quality of care. Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China. A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care. The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82). Nurse staffing is associated with job dissatisfaction and quality of care. Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects. © 2013 John Wiley & Sons Ltd.

Using a complex audit tool to measure workload, staffing and quality in district nursing.

Science.gov (United States)

Kirby, Esther; Hurst, Keith

2014-05-01

This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.

Evaluation of apically extruded debris during root canal retreatment with two different rotary systems followed by a self-adjusting file.

Science.gov (United States)

Cakici, Fatih; Cakici, Elif B; Küçükekenci, Funda Fundaoglu

2016-02-01

To compare the amount of apically extruded debris during root canal retreatment using ProTaper retreatment system (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper retreatment system with Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel), Mtwo retreatment system (VDW, Munich, Germany), Mtwo retreatment system with SAF instruments. In total, 72 extracted human mandibular incisor teeth were used. All root canals were prepared with ProTaper universal (Dentsply Maillefer) up to F2 file and filled with gutta percha and AH plus sealer using cold lateral condensation before being assembled randomly into 4 groups (n = 18 each). Root canal filling materials were removed using the ProTaper retreatment system, the ProTaper retreatment system followed by SAF system, Mtwo retreatment system and Mtwo retreatment system followed by SAF system. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using Kruskal-Wallis test. All retreatment techniques caused the apical extrusion of debris. There was no significant difference between the groups statistically (p>0.05). The results of this study showed that SAF system after Mtwo retreatment system and ProTaper retreatment system for improving retreatment has no significant effect on the amount of debris extruded apically.

Impact of a physician-staffed helicopter on a regional trauma system

DEFF Research Database (Denmark)

Hesselfeldt, R; Steinmetz, J; Jans, H

2013-01-01

This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients.......This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients....

Safety of BTZ retreatment for patients with low-grade peripheral neuropathy during the initial treatment.

Science.gov (United States)

Vidisheva, Aleksandra P; Wang, James; Spektor, Tanya M; Bitran, Jacob D; Lutzky, Jose; Tabbara, Imad A; Ye, Joseph Z; Ailawadhi, Sikander; Stampleman, Laura V; Steis, Ronald G; Moezi, Mehdi M; Swift, Regina A; Maluso, Tina M; Udd, Kyle A; Eshaghian, Shahrooz; Nassir, Youram; Berenson, James R

2017-10-01

Neuropathy is an important complication that may limit treatment options for patients with multiple myeloma. Previous studies have focused on treatment efficacy and have shown that retreatment with bortezomib (BTZ) is an effective treatment option. The goal of this study was to focus on the clinical manifestations of peripheral neuropathy (PN) and to retrospectively compare the incidence and severity of PN between the initial BTZ regimen and upon retreatment. Furthermore, this study evaluated how certain factors affect BIPN, which will help determine what conditions should be considered prior to retreatment. Charts were reviewed from 93 patients who were retreated with a BTZ-containing regimen after previously being treated with this drug. Among the patients who developed PN, most patients in the study had low-grade neuropathy during the initial BTZ treatment (n = 52, 68%). The results showed no evidence of cumulative toxicity, and there was no significant difference in the incidence and severity of PN upon retreatment. Factors such as the presence of baseline PN, number of prior treatments, dose of BTZ, and comorbidities did not increase the severity of PN upon retreatment. The lapse of time between the two regimens also did not affect the severity of PN. The results suggest that retreatment with BTZ may be a feasible option, without additional risks of PN, for MM patients even with peripheral neuropathy during their initial treatment with this drug.

Requirements for SSC central computing staffing (conceptual)

International Nuclear Information System (INIS)

Pfister, J.

1985-01-01

Given a computation center with --10,000 MIPS supporting --1,000 users, what are the staffing requirements? The attempt in this paper is to list the functions and staff size required in a central computing or centrally supported computing complex. The organization assumes that although considerable computing power would exist (mostly for online) in the four interaction regions (IR) that there are functions/capabilities better performed outside the IR and in this model at a ''central computing facility.'' What follows is one staffing approach, not necessarily optimal, with certain assumptions about numbers of computer systems, media, networks and system controls, that is, one would get the best technology available. Thus, it is speculation about what the technology may bring and what it takes to operate it. From an end user support standpoint it is less clear, given the geography of an SSC, where and what the consulting support should look like and its location

Nurses' perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units.

Science.gov (United States)

Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine

2012-01-01

To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions.

Science.gov (United States)

Ms, Suzie Aparicio; Welch Bacon, Cailee E; Parsons, John T; Bay, R Curtis; Cohen, Randy P; DeZeeuw, Terry; McLeod, Tamara C Valovich

2015-12-01

The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Cross-sectional study. Web-based survey. Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured

Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions

Science.gov (United States)

MS, Suzie Aparicio; Welch Bacon, Cailee E.; Parsons, John T.; Bay, R. Curtis; Cohen, Randy P.; DeZeeuw, Terry; McLeod, Tamara C. Valovich

2015-01-01

Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their

Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing

NARCIS (Netherlands)

van Oostveen, Catharina J.; Mathijssen, Elke; Vermeulen, Hester

2015-01-01

To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing

Contrasting evidence of Holocene ice margin retreat, south-western Greenland

DEFF Research Database (Denmark)

Levy, L. B.; Larsen, N. K.; Davidson, T. A.

2017-01-01

Constraining the Greenland Ice Sheet's (GrIS) response to Holocene climate change provides calibrations for ice sheet models that hindcast past ice margin fluctuations. Ice sheet models predict enhanced ice retreat in south-western Greenland during the middle Holocene; however, few geological...... observations corroborating the extensive retreat are available. We present new data from lake sediment cores from the Isua region, south-western Greenland, which provide constraints on Holocene fluctuations of the GrIS margins. Our data indicate that the main GrIS margin was 30 km west of its present...

Measuring Surface Deformation in Glacier Retreated Areas Based on Ps-Insar - Geladandong Glacier as a Case Study

Science.gov (United States)

Mohamadi, B.; Balz, T.

2018-04-01

Glaciers are retreating in many parts of the world as a result of global warming. Many researchers consider Qinghai-Tibetan Plateau as a reference for climate change by measuring glaciers retreat on the plateau. This retreat resulted in some topographic changes in retreated areas, and in some cases can lead to geohazards as landslides, and rock avalanches, which is known in glacier retreated areas as paraglacial slope failure (PSF). In this study, Geladandong biggest and main glacier mass was selected to estimate surface deformation on its glacier retreated areas and define potential future PSF based on PS-InSAR technique. 56 ascending and 49 descending images were used to fulfill this aim. Geladandong glacier retreated areas were defined based on the maximum extent of the glacier in the little ice age. Results revealed a general uplift in the glacier retreated areas with velocity less than 5mm/year. Obvious surface motion was revealed in seven parts surround glacier retreated areas with high relative velocity reached ±60mm/year in some parts. Four parts were considered as PSF potential motion, and two of them showed potential damage for the main road in the study area in case of rock avalanche into recent glacier lakes that could result in glacier lake outburst flooding heading directly to the road. Finally, further analysis and field investigations are needed to define the main reasons for different types of deformation and estimate future risks of these types of surface motion in the Qinghai-Tibetan Plateau.

An international comparison of commercial nuclear power plant staffing regulations and practice, 1980--1990

International Nuclear Information System (INIS)

Melber, B.; Hauth, J.; Terrill, E.; Berk, B.; Gore, B.

1994-03-01

In this report an international review of regulatory and industry practices is provided in the area of nuclear power plant staffing during the 1980s in Canada, France, Germany, Japan, Sweden, and the United Kingdom. The objective of this review is to highlight trends in staffing regulatory approaches, industry practices, and issues of concern in other countries that have potential relevance to nuclear power plant staffing issues in the United States. The decade of the 1980s was marked by a great deal of growth in nuclear power operations internationally; however, growth of nuclear power is not expected to continue in the 1990s except in France and Japan. A continuum of regulatory approaches to staffing was identified, ranging from prescribed regulations that are applied to all licensees (Germany is most similar to the United States in this regard), to indirect staffing regulations where the regulatory authority oversees plant operating practices that are agreed to in the plant operating license (most notably, France and the United Kingdom). Most of the changes observed in staffing regulations and practices in the early 1980s were made in response to the accident at the Three Mile Island Unit 2 nuclear power plant (TMI) in 1979. These changes included the widespread issuance of new operator and licensing requirements and the establishment of national training centers. After the post-TMI changes were implemented, a period of relative stability followed. Changes in the latter half of the 1980s have focused on continuing improvements and additions to training curricula and methods, most notably increased reliance on simulator training

Structure and staffing of radiotherapy physics in the UK

International Nuclear Information System (INIS)

Thwaites, D I

1995-01-01

In 1989 IPSM brought out a policy document on the role of the physical scientist in radiotherapy. At roughly the same time IPSM also produced recommended minimum staffing levels for the medical physics support of radiotherapy, which drew heavily on comprehensive reviews of both physicist and physics technician staffing carried out by the Scottish Radiotherapy Physicists Group in 1980 (updated in 1989). The IPSM figures remain professional recommendations and have not been taken up by any official body. However some of the Scottish figures were included in a SHHD Planning Council Scientific Advisory report and so have some measure of official endorsement. All these figures were derived specifically for the UK situation of essentially regional oncology centres, where generally medium to large radiotherapy departments are the norm, to concentrate equipment, expertise and experience. Thus there are approximately 60 centres for a population of 55 million. In addition the recommendations reflect the typical structure of UK departments, in terms of professional roles and relationships. The current situation regarding physicist and physics technician numbers is reviewed, using evidence from recent surveys. The UK and other recommendations are applied to a number of representative centres and the figures obtained are compared to each other and to the actual staffing levels

Benthic Trophic Interactions in an Antarctic Shallow Water Ecosystem Affected by Recent Glacier Retreat.

Directory of Open Access Journals (Sweden)

Francesca Pasotti

Full Text Available The western Antarctic Peninsula is experiencing strong environmental changes as a consequence of ongoing regional warming. Glaciers in the area are retreating rapidly and increased sediment-laden meltwater runoff threatens the benthic biodiversity at shallow depths. We identified three sites with a distinct glacier-retreat related history and different levels of glacial influence in the inner part of Potter Cove (King George Island, South Shetland Islands, a fjord-like embayment impacted since the 1950s by a tidewater glacier retreat. We compared the soft sediment meio- and macrofauna isotopic niche widths (δ13C and δ15N stable isotope analysis at the three sites to investigate possible glacier retreat-related influences on benthic trophic interactions. The isotopic niches were locally shaped by the different degrees of glacier retreat-related disturbance within the Cove. Wider isotopic niche widths were found at the site that has become ice-free most recently, and narrower niches at the older ice-free sites. At an intermediate state of glacier retreat-related disturbance (e.g. via ice-growler scouring species with different strategies could settle. The site at the earliest stage of post-retreat development was characterized by an assemblage with lower trophic redundancy. Generally, the isotopic niche widths increased with increasing size spectra of organisms within the community, excepting the youngest assemblage, where the pioneer colonizer meiofauna size class displayed the highest isotopic niche width. Meiofauna at all sites generally occupied positions in the isotopic space that suggested a detrital-pool food source and/or the presence of predatory taxa. In general ice scour and glacial impact appeared to play a two-fold role within the Cove: i either stimulating trophic diversity by allowing continuous re-colonization of meiofaunal species or, ii over time driving the benthic assemblages into a more compact trophic structure with

Benthic Trophic Interactions in an Antarctic Shallow Water Ecosystem Affected by Recent Glacier Retreat.

Science.gov (United States)

Pasotti, Francesca; Saravia, Leonardo Ariel; De Troch, Marleen; Tarantelli, Maria Soledad; Sahade, Ricardo; Vanreusel, Ann

2015-01-01

The western Antarctic Peninsula is experiencing strong environmental changes as a consequence of ongoing regional warming. Glaciers in the area are retreating rapidly and increased sediment-laden meltwater runoff threatens the benthic biodiversity at shallow depths. We identified three sites with a distinct glacier-retreat related history and different levels of glacial influence in the inner part of Potter Cove (King George Island, South Shetland Islands), a fjord-like embayment impacted since the 1950s by a tidewater glacier retreat. We compared the soft sediment meio- and macrofauna isotopic niche widths (δ13C and δ15N stable isotope analysis) at the three sites to investigate possible glacier retreat-related influences on benthic trophic interactions. The isotopic niches were locally shaped by the different degrees of glacier retreat-related disturbance within the Cove. Wider isotopic niche widths were found at the site that has become ice-free most recently, and narrower niches at the older ice-free sites. At an intermediate state of glacier retreat-related disturbance (e.g. via ice-growler scouring) species with different strategies could settle. The site at the earliest stage of post-retreat development was characterized by an assemblage with lower trophic redundancy. Generally, the isotopic niche widths increased with increasing size spectra of organisms within the community, excepting the youngest assemblage, where the pioneer colonizer meiofauna size class displayed the highest isotopic niche width. Meiofauna at all sites generally occupied positions in the isotopic space that suggested a detrital-pool food source and/or the presence of predatory taxa. In general ice scour and glacial impact appeared to play a two-fold role within the Cove: i) either stimulating trophic diversity by allowing continuous re-colonization of meiofaunal species or, ii) over time driving the benthic assemblages into a more compact trophic structure with increased

Can shrubs help to reconstruct historical glacier retreats?

International Nuclear Information System (INIS)

Buras, Allan; Hallinger, Martin; Wilmking, Martin

2012-01-01

In the 21st century, most of the world’s glaciers are expected to retreat due to further global warming. The range of this predicted retreat varies widely as a result of uncertainties in climate and glacier models. To calibrate and validate glacier models, past records of glacier mass balance are necessary, which often only span several decades. Long-term reconstructions of glacier mass balance could increase the precision of glacier models by providing the required calibration data. Here we show the possibility of applying shrub growth increments as an on-site proxy for glacier summer mass balance, exemplified by Salix shrubs in Finse, Norway. We further discuss the challenges which this method needs to meet and address the high potential of shrub growth increments for reconstructing glacier summer mass balance in remote areas. (letter)

Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction.

Science.gov (United States)

Halm, Margo; Peterson, Michelle; Kandels, Mary; Sabo, Julie; Blalock, Miriam; Braden, Rebecca; Gryczman, Anna; Krisko-Hagel, Kathryn; Larson, Dave; Lemay, Diane; Sisler, Bette; Strom, Linda; Topham, Debra

2005-01-01

To conduct an investigation similar to a landmark study that investigated the association between nurse-to-patient ratio and patient mortality, failure-to-rescue, emotional exhaustion and job satisfaction of nurses. Cross-sectional analysis of 2709 general, orthopedic, and vascular surgery patients, and 140 staff nurses (42% response rate) caring for these patients in a large Midwestern institution. The main outcome measures were mortality, failure-to-rescue, emotional exhaustion, and job dissatisfaction. Staffing was not a significant predictor of mortality or failure-to-rescue, nor did clinical specialty predict emotional exhaustion or job dissatisfaction. Although these findings reinforce adequate staffing ratios at this institution, programs that support nurses in their daily practice and positively impact job satisfaction need to be explored. The Nursing Research Council not only has heightened awareness of how staffing ratios affect patient and nurse outcomes, but also a broader understanding of how the research process can be used to effectively shape nurse's practice and work environments.

Variability, trends, and predictability of seasonal sea ice retreat and advance in the Chukchi Sea

Science.gov (United States)

Serreze, Mark C.; Crawford, Alex D.; Stroeve, Julienne C.; Barrett, Andrew P.; Woodgate, Rebecca A.

2016-10-01

As assessed over the period 1979-2014, the date that sea ice retreats to the shelf break (150 m contour) of the Chukchi Sea has a linear trend of -0.7 days per year. The date of seasonal ice advance back to the shelf break has a steeper trend of about +1.5 days per year, together yielding an increase in the open water period of 80 days. Based on detrended time series, we ask how interannual variability in advance and retreat dates relate to various forcing parameters including radiation fluxes, temperature and wind (from numerical reanalyses), and the oceanic heat inflow through the Bering Strait (from in situ moorings). Of all variables considered, the retreat date is most strongly correlated (r ˜ 0.8) with the April through June Bering Strait heat inflow. After testing a suite of statistical linear models using several potential predictors, the best model for predicting the date of retreat includes only the April through June Bering Strait heat inflow, which explains 68% of retreat date variance. The best model predicting the ice advance date includes the July through September inflow and the date of retreat, explaining 67% of advance date variance. We address these relationships by discussing heat balances within the Chukchi Sea, and the hypothesis of oceanic heat transport triggering ocean heat uptake and ice-albedo feedback. Developing an operational prediction scheme for seasonal retreat and advance would require timely acquisition of Bering Strait heat inflow data. Predictability will likely always be limited by the chaotic nature of atmospheric circulation patterns.

Staffing Policy for Solving the Information Security

Directory of Open Access Journals (Sweden)

A. I. Tolstoy

2012-06-01

Full Text Available Determining staffing policy implementation of information security tasks is given. The basic requirements that must be taken into account when developing policies are defined. The policy framework is determined and recommendations for the design of such policies are formulated. Requirements for the implementation of the policy are defined.

Re-treatment tuberculosis cases categorised as "other": are they properly managed?

Directory of Open Access Journals (Sweden)

Hannock Tweya

Full Text Available BACKGROUND: Although the World Health Organization (WHO provides information on the number of TB patients categorised as "other", there is limited information on treatment regimens or treatment outcomes for "other". Such information is important, as inappropriate treatment can lead to patients remaining infectious and becoming a potential source of drug resistance. Therefore, using a cohort of TB patients from a large registration centre in Lilongwe, Malawi, our study determined the proportion of all TB re-treatment patients who were registered as "other", and described their characteristics and treatment outcomes. METHODS: This retrospective observational study used routine program data to determine the proportion of all TB re-treatment patients who were registered as "other" and describe their characteristics and treatment outcomes between January 2006 and December 2008. RESULTS: 1,384 (12% of 11,663 TB cases were registered as re-treatment cases. Of these, 898 (65% were categorised as "other": 707 (79% had sputum smear-negative pulmonary TB and 191 (21% had extra pulmonary TB. Compared to the smear-positive relapse, re-treatment after default (RAD and failure cases, smear-negative "other" cases were older than 34 years and less likely to have their HIV status ascertained. Among those with known HIV status, "other" TB cases were more likely to be HIV positive. Of TB patients categorised as "other", 462 (51% were managed on the first-line regimen with a treatment success rate of 63%. CONCLUSION: A large proportion of re-treatment patients were categorised as "other". Many of these patients were HIV-infected and over half were treated with a first-line regimen, contrary to national guidelines. Treatment success was low. More attention to recording, diagnosis and management of these patients is warranted as incorrect treatment regimen and poor outcomes could lead to the development of drug resistant forms of TB.

High School Administrative Staffing in Washington State: Principal Perspectives on Resource Needs and Utilization

Science.gov (United States)

Steach, John C.

2011-01-01

This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…

Creating pharmacy staffing-to-demand models: predictive tools used at two institutions.

Science.gov (United States)

Krogh, Paul; Ernster, Jason; Knoer, Scott

2012-09-15

The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

Damage to root dentin during retreatment procedures

NARCIS (Netherlands)

Shemesh, H.; Roeleveld, A.C.; Wesselink, P.R.; Wu, M.K.

2011-01-01

Introduction: The aim of this study was to explore the influence of retreatment procedures on the appearance of defects on the root canal walls. Methods: Two hundred mandibular premolars were divided into 4 groups. One group was left unprepared. The rest of the teeth were prepared with ProTaper

Retreating academics: creating spaces for the scholarship of ...

African Journals Online (AJOL)

, this paper explores particular spaces created to support academic engagement in the scholarship of teaching and learning: the space of writing retreats. The metaphor of 'tapestry' is used to capture the development of a complex conceptual ...

Risk Factors for Retreatment Following Myopic LASIK with Femtosecond Laser and Custom Ablation for the Treatment of Myopia.

Science.gov (United States)

Kruh, Jonathan N; Garrett, Kenneth A; Huntington, Brian; Robinson, Steve; Melki, Samir A

2017-01-01

To identify risks factors for retreatment post-laser in situ keratomeliusis (LASIK). A retrospective chart review from December 2008 to September 2012 identified 1,402 patients (2,581 eyes) that underwent LASIK treatment for myopia with the Intralase™ FS, STAR S4 IR™ Excimer Laser, and WaveScan WaveFront™ technology. In this group, 83 patients were retreated. All charts were reviewed for preoperative age, gender, initial manifest refraction spherical equivalent (MRSE), total astigmatism, and iris registration. Increased incidence rates of retreatment post-LASIK were preoperative age >40 years (p -3.0 D (p = 0.02), and astigmatism >1D (p = 0.001). Iris registration capture did not significantly reduce the retreatment rate (p = 0.12). Risk factors for retreatment included preoperative age >40 years, initial MRSE > -3.0 D, and astigmatism >1D. There was no difference in retreatment rate for patients based on gender or iris registration capture.

Investigations into localized re-treatment of the retina with a 3-nanosecond laser.

Science.gov (United States)

Chidlow, Glyn; Plunkett, Malcolm; Casson, Robert J; Wood, John P M

2016-08-01

Subvisual retinal lasers necessarily cause clinically invisible lesions, hence, they could intentionally or inadvertently be targeted at precisely the same or an overlapping location during repeat laser treatment. Herein, we investigated the structural integrity and cellular responses of localized re-treatment using a nanosecond laser (2RT) currently in trials for early age-related macular degeneration. Rats were randomly assigned to one of five groups: sham, subvisual 2RT, subvisual 2RT re-treatment, visual effect 2RT, visual effect 2RT re-treatment. Re-treatment groups were lasered on days 0 and 21; single laser groups were only lasered on day 21. All rats were euthanized at day 28 and eyes were then dissected and processed for immunohistochemistry. For re-treatment, the laser was targeted at precisely the same locations on both delivery occasions. Analytical endpoints included monitoring of retinal vascular integrity overlying lesions, investigation into any potential choroidal neovascularization, assessment of the RPE, quantification of collateral injury to photoreceptors or other neuronal classes, and delineation of glial reactivity. Repeat laser administration to rats caused ostensibly identical retinal-RPE-choroid responses to those obtained in age-matched rats that received only a single application. Specifically, 7 days after treatment, RPE cells were re-populating lesion sites. No obvious consistent differences were evident between the single and repeat laser groups. Moreover, repeat laser caused no (measurable) additive injury to photoreceptors or other retinal neuronal classes from single laser treatment. In re-lasered animals, there was no increase in microglial activity overlying and adjacent to lesion sites relative to single lasered rats. Finally, there was no evidence of choroidal neovascularization after repeat laser treatment. The overall results provide a measure of confidence that re-treatment of patients with 2RT should not provide any

Counseling, Psychological, and Social Services Staffing: Policies in U.S. School Districts.

Science.gov (United States)

Brener, Nancy; Demissie, Zewditu

2018-06-01

Schools are in a unique position to meet the mental and behavioral health needs of children and adolescents because approximately 95% of young people aged 7-17 years attend school. Little is known, however, about policies related to counseling, psychological, and social services staffing in school districts. This study analyzed the prevalence of such policies in public school districts in the U.S. Data from four cycles (2000, 2006, 2012, and 2016) of the School Health Policies and Practices Study, a national survey periodically conducted to assess policies and practices for ten components of school health, were analyzed in 2017. The survey collected data related to counseling, psychological, and social services among nationally representative samples of school districts using online or mailed questionnaires. Sampled districts identified respondents responsible for or most knowledgeable about the content of each questionnaire. The percentage of districts with a district-level counseling, psychological, and social services coordinator increased significantly from 62.6% in 2000 to 79.5% in 2016. In 2016, 56.3% of districts required each school to have someone to coordinate counseling, psychological, and social services at the school. Fewer districts required schools at each level to have a specified ratio of counselors to students (16.2% for elementary schools, 16.8% for middle schools, and 19.8% for high schools), and the percentage of districts with these requirements has decreased significantly since 2012. Increases in the prevalence of district-level staffing policies could help increase the quantity and quality of counseling, psychological, and social services staff in schools nationwide, which in turn could improve mental and behavioral health outcomes for students. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration

MEASURING SURFACE DEFORMATION IN GLACIER RETREATED AREAS BASED ON PS-INSAR – GELADANDONG GLACIER AS A CASE STUDY

Directory of Open Access Journals (Sweden)

B. Mohamadi

2018-04-01

Full Text Available Glaciers are retreating in many parts of the world as a result of global warming. Many researchers consider Qinghai-Tibetan Plateau as a reference for climate change by measuring glaciers retreat on the plateau. This retreat resulted in some topographic changes in retreated areas, and in some cases can lead to geohazards as landslides, and rock avalanches, which is known in glacier retreated areas as paraglacial slope failure (PSF. In this study, Geladandong biggest and main glacier mass was selected to estimate surface deformation on its glacier retreated areas and define potential future PSF based on PS-InSAR technique. 56 ascending and 49 descending images were used to fulfill this aim. Geladandong glacier retreated areas were defined based on the maximum extent of the glacier in the little ice age. Results revealed a general uplift in the glacier retreated areas with velocity less than 5mm/year. Obvious surface motion was revealed in seven parts surround glacier retreated areas with high relative velocity reached ±60mm/year in some parts. Four parts were considered as PSF potential motion, and two of them showed potential damage for the main road in the study area in case of rock avalanche into recent glacier lakes that could result in glacier lake outburst flooding heading directly to the road. Finally, further analysis and field investigations are needed to define the main reasons for different types of deformation and estimate future risks of these types of surface motion in the Qinghai-Tibetan Plateau.

NURSE STAFFING AND RENAL ANAEMIA OUTCOMES IN HAEMODIALYSIS CARE.

Science.gov (United States)

Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus

2016-09-01

Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Orthograde endodontic retreatment of teeth with individual cast posts: Report of two cases

Directory of Open Access Journals (Sweden)

Ramić Bojana

2012-01-01

Full Text Available Introduction. The failure of primary endodontic treatment is manifested by various clinical symptoms following endodontic therapy or, more frequently, by the development of chronic inflammatory process in the apex region without any subjective symptoms. In case of unfavorable outcome of the primary endodontic treatment, orthograde endodontic retreatment is the method of choice for a prolonged therapy. Outline of Cases. Two female patients, 47 and 44 years old, were presented at the Dental Clinic of Vojvodina for endodontic retreatment of teeth 22, 23 and 13, within the repeated prosthetic restoration. Intraradicular individual cast posts were removed using ultrasonic instruments. Remains of gutta-percha were removed by engine driven rotary re-treatment files, root canals were shaped and cleaned using the crown-down technique, and obturated with gutta-percha and epoxy-resin-based sealer using the lateral compaction technique. Conclusion. When there are metal posts or broken instruments in the root canal, the use of ultrasonic instruments is considered a safe method characterized by negligible tooth substance loss and minimal root damage causing fractures and perforations, and the entire procedure is effective and predictable. Non-surgical orthograde endodontic retreatment, when properly performed in accessible and penetrable root canals, achieves a high cure rate, good and lasting results and eliminates the need for radical procedures, such as apical surgery or tooth extraction. When nonsurgical endodontic retreatment is done, treated teeth must be restored by full coronal coverage as soon as possible, to prevent coronal leakage or fracture.

75 FR 28295 - Cummins Filtration, Including On-Site Leased Workers From Manpower and Spherion Staffing...

Science.gov (United States)

2010-05-20

.... The Department has determined that workers from Spherion Staffing were sufficiently under the control..., Including On-Site Leased Workers From Manpower and Spherion Staffing, Including On-Site Workers From Hagemeyer North America, Lake Mills, IA; Amended Certification Regarding Eligibility To Apply for Worker...

20 CFR 653.111 - State agency staffing requirements.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... ethnic characteristics in the work force shall be distributed in substantially the same proportion among...

Means of Slope Retreat on the Na Pali Cliffs, Kauai, Hawaii

Science.gov (United States)

Osborn, G.; Sheardown, A.; Blay, C.

2016-12-01

The spectacular, 500 to 600 m high, deeply grooved escarpment referred to as the Na Pali cliffs, on the northwest coast of Kauai, requires a substrate competent enough to hold up high steep cliffs yet erodible enough to allow generation of wide, deep grooves. These opposing tendencies are afforded by weathering of originally strong basalt that keeps pace with erosion. The fluted cliffs maintain a rather consistent slope angle, generally 50-60°, whether they are close to the shoreline or have retreated some distance from it, indicating that the slopes are retreating parallel to themselves. Previous literature promotes groundwater sapping or waterfall-plunge-pool erosion as the chief means of valley-head retreat, but there is no evidence that either concept provides a general explanation for retreat of the fluted cliffs. The eroding cliffs maintain steepness because as much rock is eroded at the base as at the top, and transported sediment is washed completely out of the gully system. The thin-bedded basalts exposed in the steep flutes are decomposed into irregularly alternating fine sediment of low to moderate cohesion and thoroughly fractured beds or lenses of solid but chemically weathered rock, and covered with a veneer of sparse grass. Erosion proceeds by episodic removal of thin grass-covered surficial sheets of the weathering products. Some of this process may be facilitated by shallow mass movement, but probably most of the work is done by overland and channelized flow during intense rainstorms. The Na Pali coast experiences one-hour rainfalls of 2-2.5 inches (1 year recurrence interval) and 5-6 inches (100 year recurrence interval); experiments by others on basaltic soils in Molokai suggest such rain is more than enough to generate erosion-inducing overland flow. Between the deep grooves and the shoreline are slopes with lesser drainage densities and lesser slope angles. The rocks here are not distinguished from the rocks above in previous literature, and

Climate Change and Glacier Retreat: Scientific Fact and Artistic Opportunity

Science.gov (United States)

Fagre, D. B.

2008-12-01

Mountain glaciers continue to retreat rapidly over most of the globe. In North America, at Glacier National Park, Montana, recent research results from Sperry Glacier (2005-2007) indicate negative mass balances are now 3-4 times greater than in the 1950s. A geospatial model of glacier retreat in the Blackfoot-Jackson basin suggested all glaciers would be gone by 2030 but has proved too conservative. Accelerated glacier shrinkage since the model was developed has mirrored an increase in actual annual temperature that is almost twice the rate used in the model. The glaciers in Glacier National Park are likely to be gone well before 2030. A variety of media, curricula, and educational strategies have been employed to communicate the disappearance of the glaciers as a consequence of global warming. These have included everything from print media and television coverage to podcasts and wayside exhibits along roads in the park. However, a new thrust is to partner with artists to communicate climate change issues to new audiences and through different channels. A scientist-artist retreat was convened to explore the tension between keeping artistic products grounded in factually-based reality while providing for freedom to express artistic creativity. Individual artists and scientists have worked to create aesthetic and emotional images, using painting, poetry, music and photography, to convey core messages from research on mountain ecosystems. Finally, a traveling art exhibit was developed to highlight the photography that systematically documents glacier change through time. The aim was to select photographs that provide the most compelling visual experience for an art-oriented viewer and also accurately reflect the research on glacier retreat. The exhibit opens on January 11, 2009

Nurses experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng South Africa

Directory of Open Access Journals (Sweden)

Moloko Malatji

2017-12-01

Purpose: The purpose of this study was to explore and describe nurses' experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng in order to develop recommendations for staffing patterns in these wards. Methodology: A qualitative, exploratory, descriptive and contextual research design was used. Data was collected by means of in-depth semi structured individual interviews from a purposive sample of professional nurses working in the surgical wards of this hospital. Data was analysed using Tesch's method of qualitative thematic analysis. Principles of trustworthiness and ethical principles to ensure the protection of human rights were applied throughout the study. Results: The findings of the study revealed one central theme which reflected that participants experienced the staffing patterns of the surgical wards negatively. Two main themes emerged as, nurses had negative experiences in the surgical wards as well as negative emotional experiences related to the staffing patterns. Conclusion: It is evident from the findings of the study that nurses are experiencing staffing patterns negatively.

Psychological effects of a one-month meditation retreat on experienced meditators: the role of nonattachment

Directory of Open Access Journals (Sweden)

Jesus Montero-Marin

2016-12-01

Full Text Available Background. There are few studies devoted to assessing the impact of meditation-intensive retreats on the well-being, positive psychology and personality of experienced meditators. We aimed to assess whether a 1-month Vipassana retreat: a would increase mindfulness and well-being; b would increase prosocial personality traits; and c whether psychological changes would be mediated and/or moderated by non-attachment.Method. A controlled, non-randomized, pre-post-intervention trial was used. The intervention group was a convenience sample (n=19 of experienced meditators who participated in a 1-month Vipassana meditation retreat. The control group (n=19 comprised matched experienced meditators who did not take part in the retreat. During the retreat, the mean duration of daily practice was 8-9 hours, the diet was vegetarian and silence was compulsory. The Experiences Questionnaire (EQ, Non-Attachment Scale (NAS, Positive and Negative Affect Schedule (PANAS, Satisfaction With Life Scale (SWLS, Temperament Character Inventory Revised (TCI-R-67, Five Facets Mindfulness Questionnaire (FFMQ, Self-Other Four Immeasurables (SOFI and the MINDSENS Composite Index were administered. ANCOVAs and linear regression models were used to assess pre-post changes and mediation/moderation effects.Results. Compared to controls, retreatants showed increases in non-attachment, observing, MINDSENS, positive-affect, balance-affect and cooperativeness; and decreases in describing, negative-others, reward-dependence and self-directedness. Non-attachment had a mediating role in decentring, acting aware, non-reactivity, negative-affect, balance-affect and self-directedness; and a moderating role in describing and positive others, with both mediating and moderating effects on satisfaction with life.Conclusions. A 1-month Vipassana meditation retreat seems to yield improvements in mindfulness, well-being and personality, even in experienced meditators. Non-attachment might

A staffing decision support methodology using a quality loss function : a cross-disciplinary quantitative study

NARCIS (Netherlands)

Mincsovics, G.Z.

2009-01-01

Background Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget. Objectives For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and

Sub-ice-shelf sediments record history of twentieth-century retreat of Pine Island Glacier.

Science.gov (United States)

Smith, J A; Andersen, T J; Shortt, M; Gaffney, A M; Truffer, M; Stanton, T P; Bindschadler, R; Dutrieux, P; Jenkins, A; Hillenbrand, C-D; Ehrmann, W; Corr, H F J; Farley, N; Crowhurst, S; Vaughan, D G

2017-01-05

The West Antarctic Ice Sheet is one of the largest potential sources of rising sea levels. Over the past 40 years, glaciers flowing into the Amundsen Sea sector of the ice sheet have thinned at an accelerating rate, and several numerical models suggest that unstable and irreversible retreat of the grounding line-which marks the boundary between grounded ice and floating ice shelf-is underway. Understanding this recent retreat requires a detailed knowledge of grounding-line history, but the locations of the grounding line before the advent of satellite monitoring in the 1990s are poorly dated. In particular, a history of grounding-line retreat is required to understand the relative roles of contemporaneous ocean-forced change and of ongoing glacier response to an earlier perturbation in driving ice-sheet loss. Here we show that the present thinning and retreat of Pine Island Glacier in West Antarctica is part of a climatically forced trend that was triggered in the 1940s. Our conclusions arise from analysis of sediment cores recovered beneath the floating Pine Island Glacier ice shelf, and constrain the date at which the grounding line retreated from a prominent seafloor ridge. We find that incursion of marine water beyond the crest of this ridge, forming an ocean cavity beneath the ice shelf, occurred in 1945 (±12 years); final ungrounding of the ice shelf from the ridge occurred in 1970 (±4 years). The initial opening of this ocean cavity followed a period of strong warming of West Antarctica, associated with El Niño activity. Thus our results suggest that, even when climate forcing weakened, ice-sheet retreat continued.

Capacity Adjustment through Contingent Staffing Outsourcing

OpenAIRE

Neubert , Gilles; Adjadj , Philippe

2009-01-01

International audience; For a long time, contingent staffing was considered as the responsability of the Human Resource department. The high needs of workforce flexibility combined with disseminated agencies have led some companies to a great number of labor suppliers. This situation has produced important cost variation, poor quality of service, and important risk due to the mistunderstanding by local managers of legal considerations. To face this situation, companies have started to move fr...

Medical staffing in Ontario neonatal intensive care units.

Science.gov (United States)

Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D

1989-06-01

Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

The effect of investor-owned chain acquisitions on hospital expenses and staffing.

Science.gov (United States)

Manheim, L M; Shortell, S M; McFall, S

1989-01-01

Much concern has been raised about the effect of "corporatization" of health through the expansion of investor-owned hospital chains. One method of expansion is through hospital acquisition. At issue is the question of the effect of acquisitions on expenses and on such patient care inputs as staffing levels. In this article, we examine the effect of acquisition by one investor-owned chain on hospital costs and staffing. Subsequent to acquisition, hospital costs increase and staffing decreases, relative to competitor hospitals. However, since investor-owned hospitals not recently acquired do not have higher cost levels than their competitors, the increase in costs appears to be due to factors associated with the acquisition itself rather than factors associated with being an investor-owned hospital. Under the retrospective payment system in effect at the time, revenues also were higher for acquired hospitals. Under prospective payment, increasing revenues has been more difficult, decreasing acquisition incentives. PMID:2807933

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

Science.gov (United States)

Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2013-12-01

The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

Power grid control in retreat

International Nuclear Information System (INIS)

Morch, Stein

2000-01-01

Bilateral grid control that obstructs free trade of electricity is in retreat. Negotiations on opening the Skagerrak cables are in progress. The EU, national authorities, network companies with system responsibility, market actors, electricity exchanges all push for quick opening of the grid. At present, free trade of electricity is hindered not so much by physical bottlenecks in the grid as by market actors possessing control and bilateral agreements. The article discusses current bilateral agreements and how they might affect the possibility of a free trade of electricity in Europe

Retreat of Stephenson Glacier, Heard Island, from Remote Sensing and Field Observations

Science.gov (United States)

Mitchell, W.; Schmieder, R.

2017-12-01

Heard Island (Australian sub-Antarctic territory, 53 S, 73.5 E) is a volcanic island mantled in glaciers, and a UNESCO World Heritage Site both for its geology and ecology. Lying to the south of the Antarctic Convergence, the changes in response to climate seen on Heard Island are likely to be a bellwether for areas further south. Beginning in 1999, American satellites (Landsat 7, EO-1, and Landsat 8) have produced images of the island on a roughly weekly basis. Although the island is often shrouded in clouds, clear images of at least portions of the island are plentiful enough to create a nearly-annual record of the toe of Stephenson Glacier. During this period, Stephenson Glacier retreated by nearly 5 km, and lost 50% of its area. As a result of this retreat, a portion of the glacier now could be classified as a separate glacier. Additionally, in 2016, terrestrial photographs of Stephenson Glacier were taken during a three-week expedition to Heard Island, which accessed the Stephenson Glacier area by boat via the proglacial Stephenson Lagoon. During that work, sonar indicated some depths in the lagoon exceeding 100 m. Much of the loss in glacier length and area occurred during the mid- and late-2000s, with retreat rates slowing toward 2017. At this time, the glacier has retreated so that the main toe is not far from the base of a tall ice falls, while another toe—perhaps now a separate glacier—is land-based. This type of retreat pattern, fast over water and slower on land, is typical of other tidewater glaciers. Further monitoring of Stephenson Glacier and other glaciers on Heard Island will continue using Landsat 8.

Staffing for Cyberspace Operations: Summary of Analysis

Science.gov (United States)

2016-08-01

military-unique knowledge or skills required; (2) military incumbency is required by law, Executive Order, treaty or international agreement (e.g., DPH...civilian employment . 1 Thomas H. Barth et al., “(U) Staffing for Cyberspace Operations,” IDA Paper P...DoD cyberspace strategies, doctrine, and current concepts of operation and employment for CMF. Additionally, the team conducted interviews with

Efficacy of protaper next and protaper universal retreatment systems in removing gutta-percha in curved root canals during root canal retreatment.

Science.gov (United States)

Ozyurek, Taha; Ozsezer-Demiryurek, Ebru

2017-01-01

The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) nickel-titanium (NiTi) systems and Hedström hand files in curved mesial canals of mandibular molar teeth and the time required for gutta-percha and sealer removal. Ninety mandibular molar teeth with curved mesial roots were instrumented up to #35.04 with Mtwo NiTi rotary instruments and obturated using the continuous wave of condensation technique. Removal of gutta-percha and sealer was performed using one of the following: PTN and PTR NiTi systems and Hedström hand files. Samples were placed on the VistaScan phosphor plates in the mesio-distal direction and the radiographs were taken. The digital radiographs were analyzed using AutoCAD software. Also, the total time required for gutta-percha removal was calculated by a chronometer. The total retreatment time was significantly shorter in the PTN and PTR groups compared with the manual group (p<0.05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (p<0.05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the manual group (p<0.001). Within the limitations of this study, the PTN and PTR groups showed less residual gutta-percha and sealer than the manual group. The NiTi rotary systems were significantly faster than the manual group in the time required for gutta-percha and sealer removal.

Interim results of the study of control room crew staffing for advanced passive reactor plants

International Nuclear Information System (INIS)

Hallbert, B.P.; Sebok, A.; Haugset, K.

1996-01-01

Differences in the ways in which vendors expect the operations staff to interact with advanced passive plants by vendors have led to a need for reconsideration of the minimum shift staffing requirements of licensed Reactor Operators and Senior Reactor Operators contained in current federal regulations (i.e., 10 CFR 50.54(m)). A research project is being carried out to evaluate the impact(s) of advanced passive plant design and staffing of control room crews on operator and team performance. The purpose of the project is to contribute to the understanding of potential safety issues and provide data to support the development of design review guidance. Two factors are being evaluated across a range of plant operating conditions: control room crew staffing; and characteristics of the operating facility itself, whether it employs conventional or advanced, passive features. This paper presents the results of the first phase of the study conducted at the Loviisa nuclear power station earlier this year. Loviisa served as the conventional plant in this study. Data collection from four crews were collected from a series of design basis scenarios, each crew serving in either a normal or minimum staffing configuration. Results of data analyses show that crews participating in the minimum shift staffing configuration experienced significantly higher workload, had lower situation awareness, demonstrated significantly less effective team performance, and performed more poorly as a crew than the crews participating in the normal shift staffing configuration. The baseline data on crew configurations from the conventional plant setting will be compared with similar data to be collected from the advanced plant setting, and a report prepared providing the results of the entire study

Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

Directory of Open Access Journals (Sweden)

Ying Song

Full Text Available The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs after stent assisted coiling (SAC has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years. The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months. Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be

To evaluate and compare the efficacy, cleaning ability of hand and two rotary systems in root canal retreatment.

Science.gov (United States)

Shivanand, Sunita; Patil, Chetan R; Thangala, Venugopal; Kumar, Pabbati Ravi; Sachdeva, Jyoti; Krishna, Akash

2013-05-01

To evaluate and compare the efficacy, cleaning ability of hand and two rotary systems in root canal retreatment. Sixty extracted premolars were retreated with following systems: Group -ProTaper Universal retreatment files, Group 2-ProFile system, Group 3-H-file. Specimens were split longitudinally and amount of remaining gutta-percha on the canal walls was assessed using direct visual scoring with the aid of stereomicroscope. Results were statistically analyzed using ANOVA test. Completely clean root canal walls were not achieved with any of the techniques investigated. However, all three systems proved to be effective for gutta-percha removal. Significant difference was found between ProTaper universal retreatment file and H-file, and also between ProFile and H-file. Under the conditions of the present study, ProTaper Universal retreatment files left significantly less guttapercha and sealer than ProFile and H-file. Rotary systems in combination with gutta-percha solvents can perform superiorly as compared to the time tested traditional hand instrumentation in root canal retreatment.

Efficacy of Different Methods for Removing Root Canal Filling Material in Retreatment - An In-vitro Study.

Science.gov (United States)

Kasam, Swetha; Mariswamy, Annapoorna Ballagere

2016-06-01

Although success of endodontic therapy has significantly improved in the last few decades due to the introduction of novel materials and techniques, failures of endodontic therapy requiring re-treatment still comprise a significant percentage of patients requiring root canal treatment. To evaluate and compare the effective removal of gutta percha and sealer, amount of apical debris extrusion and time required for gutta percha removal using various endodontic files. Total 48 extracted mandibular premolars were mounted on acrylic blocks and endodontic procedure was carried out using size 40 K file and obturated using guttapercha and zinc oxide eugenol sealer. After one month storage, samples were decoronated, mounted on screw capped vials and subjected to removal of obturated material by four instruments: H files, safe sided H files, protaper universal retreatment rotary system and ultrasonic retreatment tip, grouped as 1, 2, 3, and 4 respectively. Only 2mm of obturated material from the coronal part was removed using no. 3 Gates Glidden drill, guttapercha was softened with a drop of xylene for 2 mins for each canal and retreatment was performed. The retreatment procedure was said to be complete when no visible debris were observed on the instrument flutes. The samples split into two halves and examined under stereomicroscope, photographed, assessed using AUTOCAD software and percentage of remaining filling material in coronal, middle, apical thirds of the canal was calculated in mm(2). Retreatment time was recorded in seconds and apically extruded debris was assessed by microbalance in grams for each tooth. The data was analyzed by using descriptive statistics, ANOVA and Scheffe's post hoc test through SPSS for windows (v 16.0). The ultrasonic retreatment tip had less percentage of residual guttapercha/sealer, shorter mean operating time and little apical extrusion with a significant difference (p<0.05) between the other groups. All techniques retained guttapercha

Efficacy of reciprocating and rotary NiTi instruments for retreatment of curved root canals assessed by micro-CT.

Science.gov (United States)

Rödig, T; Reicherts, P; Konietschke, F; Dullin, C; Hahn, W; Hülsmann, M

2014-10-01

To compare the efficacy of reciprocating and rotary NiTi-instruments in removing filling material from curved root canals using micro-computed tomography. Sixty curved root canals were prepared and filled with gutta-percha and sealer. After determination of root canal curvatures and radii in two directions as well as volumes of filling material, the teeth were assigned to three comparable groups (n = 20). Retreatment was performed using Reciproc, ProTaper Universal Retreatment or Hedström files. Percentages of residual filling material and dentine removal were assessed using micro-CT imaging. Working time and procedural errors were recorded. Statistical analysis was performed by variance procedures. No significant differences amongst the three retreatment techniques concerning residual filling material were detected (P > 0.05). Hedström files removed significantly more dentine than ProTaper Universal Retreatment (P  0.05). Reciproc and ProTaper Universal Retreatment were significantly faster than Hedström files (P = 0.0001). No procedural errors such as instrument fracture, blockage, ledging or perforation were detected for Hedström files. Three perforations were recorded for ProTaper Universal Retreatment, and in both NiTi groups, one instrument fracture occured. Remnants of filling material were observed in all samples with no significant differences between the three techniques. Hedström files removed significantly more dentine than ProTaper Universal Retreatment, but no significant differences between both NiTi systems were detected. Procedural errors were observed with ProTaper Universal Retreatment and Reciproc. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Do Wellness Tourists Get Well? An Observational Study of Multiple Dimensions of Health and Well-Being After a Week-Long Retreat.

Science.gov (United States)

Cohen, Marc M; Elliott, Fiona; Oates, Liza; Schembri, Adrian; Mantri, Nitin

2017-02-01

Wellness retreats use many complementary and alternative therapies within a holistic residential setting, yet few studies have evaluated the effect of retreat experiences on multiple dimensions of health and well-being, and no published studies have reported health outcomes in wellness tourists. To assess the effect of a week-long wellness-retreat experience in wellness tourists. A longitudinal observational study with outcomes assessed upon arrival and departure and 6 weeks after the retreat. A rural health retreat in Queensland, Australia. A holistic, 1-week, residential, retreat experience that included many educational, therapeutic, and leisure activities and an organic, mostly plant-based diet. Multiple outcome measures were performed upon arrival and departure and 6 weeks after the retreat. These included anthropometric measures, urinary pesticide metabolites, a food and health symptom questionnaire, the Five Factor Wellness Inventory, the General Self Efficacy questionnaire, the Pittsburgh Insomnia Rating Scale, the Depression Anxiety Stress Scale, the Profile of Mood States, and the Cogstate cognitive function test battery. Statistically significant improvements (p effects and assess the value and relevance of retreat experiences to clinicians and health insurers.

Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes.

Science.gov (United States)

North, Nicola; Leung, William; Ashton, Toni; Rasmussen, Erling; Hughes, Frances; Finlayson, Mary

2013-04-01

To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers. © 2012 Blackwell Publishing Ltd.

Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients?

Science.gov (United States)

Horstmann, S; Rizos, T; Güntner, J; Hug, A; Jenetzky, E; Krumsdorf, U; Veltkamp, R

2013-01-01

Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population. Consecutive patients admitted to our stroke unit with acute ischaemic stroke were prospectively enrolled. The diagnostic work-up included neuroimaging, neuroultrasound, baseline 12-channel electrocardiogram (ECG), 24-h Holter ECG, continuous ECG monitoring, and echocardiography. Presence of AF was documented according to the medical history of each patient and after review of 12-lead ECG, 24-h Holter ECG, or continuous ECG monitoring performed during the stay on the ward. Additionally, a telephone follow-up visit was conducted for each patient after 3 months to inquire about newly diagnosed AF. Items for each patient-age, baseline NIHSS, left atrial dilatation, and stroke etiology according to the TOAST criteria - were assessed to calculate the STAF score. Overall, 584 patients were enrolled in our analysis. AF was documented in 183 (31.3%) patients. In multivariable analysis, age, NIHSS, left atrial dilatation, and absence of vascular etiology were independent predictors for AF. The logistic AF-prediction model of the STAF score revealed fair classification accuracy in receiver operating characteristic curve analysis with an area under the curve of 0.84. STAF scores of ≥5 had a sensitivity of 79% and a specificity of 74% for predicting AF. The value of the STAF score for predicting the risk of pAF in stroke patients is limited. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

Psychological Effects of a 1-Month Meditation Retreat on Experienced Meditators: The Role of Non-attachment.

Science.gov (United States)

Montero-Marin, Jesus; Puebla-Guedea, Marta; Herrera-Mercadal, Paola; Cebolla, Ausias; Soler, Joaquim; Demarzo, Marcelo; Vazquez, Carmelo; Rodríguez-Bornaetxea, Fernando; García-Campayo, Javier

2016-01-01

Background: There are few studies devoted to assessing the impact of meditation-intensive retreats on the well-being, positive psychology, and personality of experienced meditators. We aimed to assess whether a 1-month Vipassana retreat: (a) would increase mindfulness and well-being; (b) would increase prosocial personality traits; and (c) whether psychological changes would be mediated and/or moderated by non-attachment. Method: A controlled, non-randomized, pre-post-intervention trial was used. The intervention group was a convenience sample ( n = 19) of experienced meditators who participated in a 1-month Vipassana meditation retreat. The control group ( n = 19) comprised matched experienced meditators who did not take part in the retreat. During the retreat, the mean duration of daily practice was 8-9 h, the diet was vegetarian and silence was compulsory. The Experiences Questionnaire (EQ), Non-attachment Scale (NAS), Positive and Negative Affect Schedule (PANAS), Satisfaction With Life Scale (SWLS), Temperament Character Inventory Revised (TCI-R-67), Five Facets Mindfulness Questionnaire (FFMQ), Self-Other Four Immeasurables (SOFI) and the MINDSENS Composite Index were administered. ANCOVAs and linear regression models were used to assess pre-post changes and mediation/moderation effects. Results: Compared to controls, retreatants showed increases in non-attachment, observing, MINDSENS, positive-affect, balance-affect, and cooperativeness; and decreases in describing, negative-others, reward-dependence and self-directedness. Non-attachment had a mediating role in decentring, acting aware, non-reactivity, negative-affect, balance-affect and self-directedness; and a moderating role in describing and positive others, with both mediating and moderating effects on satisfaction with life. Conclusions: A 1-month Vipassana meditation retreat seems to yield improvements in mindfulness, well-being, and personality, even in experienced meditators. Non-attachment might

The effects of staffing and training on firm productivity and profit growth before, during, and after the Great Recession.

Science.gov (United States)

Kim, Youngsang; Ployhart, Robert E

2014-05-01

This study integrates research from strategy, economics, and applied psychology to examine how organizations may leverage their human resources to enhance firm performance and competitive advantage. Staffing and training are key human resource management practices used to achieve firm performance through acquiring and developing human capital resources. However, little research has examined whether and why staffing and training influence firm-level financial performance (profit) growth under different environmental (economic) conditions. Using 359 firms with over 12 years of longitudinal firm-level profit data, we suggest that selective staffing and internal training directly and interactively influence firm profit growth through their effects on firm labor productivity, implying that staffing and training contribute to the generation of slack resources that help buffer and then recover from the effects of the Great Recession. Further, internal training that creates specific human capital resources is more beneficial for prerecession profitability, but staffing is more beneficial for postrecession recovery, apparently because staffing creates generic human capital resources that enable firm flexibility and adaptation. Thus, the theory and findings presented in this article have implications for the way staffing and training may be used strategically to weather economic uncertainty (recession effects). They also have important practical implications by demonstrating that firms that more effectively staff and train will outperform competitors throughout all pre- and postrecessionary periods, even after controlling for prior profitability. (c) 2014 APA, all rights reserved.

EFFICACY OF PROTAPER NEXT AND PROTAPER UNIVERSAL RETREATMENT SYSTEMS IN REMOVING GUTTA-PERCHA IN CURVED ROOT CANALS DURING ROOT CANAL RETREATMENT

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Taha ÖZYÜREK

2017-04-01

Full Text Available Purpose: The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN, ProTaper Universal Retreatment (PTR nickel-titanium (NiTi systems and Hedström hand files in curved mesial canals of mandibular molar teeth and the time required for gutta-percha and sealer removal. Materials and Methods: Ninety mandibular molar teeth with curved mesial roots were instrumented up to #35.04 with Mtwo NiTi rotary instruments and obturated using the continuous wave of condensation technique. Removal of gutta-percha and sealer was performed using one of the following: PTN and PTR NiTi systems and Hedström hand files. Samples were placed on the VistaScan phosphor plates in the mesio-distal direction and the radiographs were taken. The digital radiographs were analyzed using AutoCAD software. Also, the total time required for gutta-percha removal was calculated by a chronometer. Results: The total retreatment time was significantly shorter in the PTN and PTR groups compared with the manual group (p<0.05. There was a significant difference between the groups according to the total residual gutta-percha and sealer (p<0.05. The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the manual group (p<0.001. Conclusion: Within the limitations of this study, the PTN and PTR groups showed less residual gutta-percha and sealer than the manual group. The NiTi rotary systems were significantly faster than the manual group in the time required for gutta-percha and sealer removal.

Efficacy and safety of bortezomib-based retreatment at the first relapse in multiple myeloma patients: A retrospective study.

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Oriol, Albert; Giraldo, Pilar; Kotsianidis, Ioannis; Couturier, Catherine; Olie, Robert; Angermund, Ralf; Corso, Alessandro

2015-08-01

Multiple myeloma remains incurable and retreatment with available therapies is of substantial interest. This retrospective observational study included data from 35 patients treated initially and at the first relapse with bortezomib-containing regimens. Bortezomib retreatment provided a similar depth and time to response as first-line therapy; however, as could be expected, the duration of response was shorter with retreatment. The tolerability profile was similar with bortezomib as the first- and second-line therapy, with no evidence of cumulative toxicity. These findings support bortezomib retreatment after a treatment-free interval of ≥6 months in patients who achieved at least a partial response to the first-line bortezomib-based therapy.

Habitat selection in a rocky landscape: experimentally decoupling the influence of retreat site attributes from that of landscape features.

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Benjamin M Croak

Full Text Available Organisms selecting retreat sites may evaluate not only the quality of the specific shelter, but also the proximity of that site to resources in the surrounding area. Distinguishing between habitat selection at these two spatial scales is complicated by co-variation among microhabitat factors (i.e., the attributes of individual retreat sites often correlate with their proximity to landscape features. Disentangling this co-variation may facilitate the restoration or conservation of threatened systems. To experimentally examine the role of landscape attributes in determining retreat-site quality for saxicolous ectotherms, we deployed 198 identical artificial rocks in open (sun-exposed sites on sandstone outcrops in southeastern Australia, and recorded faunal usage of those retreat sites over the next 29 months. Several landscape-scale attributes were associated with occupancy of experimental rocks, but different features were important for different species. For example, endangered broad-headed snakes (Hoplocephalus bungaroides preferred retreat sites close to cliff edges, flat rock spiders (Hemicloea major preferred small outcrops, and velvet geckos (Oedura lesueurii preferred rocks close to the cliff edge with higher-than-average sun exposure. Standardized retreat sites can provide robust experimental data on the effects of landscape-scale attributes on retreat site selection, revealing interspecific divergences among sympatric taxa that use similar habitats.

Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes.

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Leary, Alison; Cook, Rob; Jones, Sarahjane; Smith, Judith; Gough, Malcolm; Maxwell, Elaine; Punshon, Geoffrey; Radford, Mark

2016-12-16

Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses. The data were obtained from 1 large acute National Health Service hospital trust in England. Routinely collected physiological, signs and symptom data from a clinical database were extracted, imported and mined alongside a bespoke staffing and outcomes database using Mathmatica V.10. The physiological data consisted of 120 million patient entries over 6 years, the bespoke database consisted of 9 years of daily data on staffing levels and safety factors such as falls. To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. After mining, 40 correlations (pdata (such as the presence or absence of nausea) and staffing factors. Several inter-related factors demonstrated step changes where registered nurse availability appeared to relate to physiological parameters or outcomes such as falls and the management of symptoms. Data extraction proved challenging as some commercial databases were not built for extraction of the massive data sets they contain. The relationship between staffing and outcomes appears to exist. It appears to be non-linear but calculable and a data-driven model appears possible. These findings could be used to build an initial mathematical model for acute staffing which could be further tested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Prevention and management of "do not return" notices: a quality improvement process for supplemental staffing nursing agencies.

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Ade-Oshifogun, Jochebed Bosede; Dufelmeier, Thaddeus

2012-01-01

This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research. © 2012 Wiley Periodicals, Inc.

The effect of physician staffing model on patient outcomes in a medical progressive care unit.

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Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

2016-04-01

Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

Flexible nurse staffing based on hourly bed census predictions

NARCIS (Netherlands)

Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.

2012-01-01

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method

Flexible nurse staffing based on hourly bed census predictions

NARCIS (Netherlands)

Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.

Workloads in nursing wards depend highly on patient arrivals and lengths of stay, both of which are inherently variable. Predicting these workloads and staffing nurses accordingly are essential for guaranteeing quality of care in a cost-effective manner. This paper introduces a stochastic method

A comparative evaluation of efficacy of protaper universal rotary retreatment system for gutta-percha removal with or without a solvent.

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Kumar, M Sita Ram; Sajjan, Girija S; Satish, Kalyan; Varma, K Madhu

2012-09-01

The aim was to evaluate and compare the efficacy of ProTaper Universal rotary retreatment system with or without solvent and stainless steel hand files for endodontic filling removal from root canals and also to compare retreatment time for each system. Thirty extracted mandibular premolars with single straight canals were endodontically treated. Teeth were divided into three major groups, having 10 specimens each. Removal of obturating material in group 1 by stainless steel hand files with RC Solve, group 2 by ProTaper Universal retreatment instruments and group 3 by ProTaper Universal retreatment instruments along with RC solve was done. Retreatment was considered complete for all groups when no filling material was observed on the instruments. The retreatment time was recorded for each tooth. All specimens were grooved longitudinally in a buccolingual direction. The split halves were examined under a stereomicroscope and images were captured and analyzed. The remaining filling debris area ratios were considered for statistical analysis. With ANOVA test, statistical analysis showed that there was statistically no significant difference regarding the amount of filling remnants between the groups (P ProTaper Universal retreatment system files alone proved to be faster than the other experimental groups.

Why Employers Use Flexible Staffing Arrangements: Evidence from an Establishment Survey. Upjohn Institute Staff Working Paper.

Science.gov (United States)

Houseman, Susan N.

Use of flexible staffing arrangements--including temporary help agency, short-term, on-call, regular part-time, and contract workers--is widespread and two-thirds of employers believe this trend will increase in the near future. A study examined which employers use flexible staffing arrangements, why they use these arrangements, and their…

Reconceptualizing Leadership in Migrant Communities: Latina/o Parent Leadership Retreats as Sites of Community Cultural Wealth

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Nava, Pedro E.; Lara, Argelia

2016-01-01

This article examines how the Education Leadership Foundation (a leadership development community based organization) in partnership with the Migrant Education Program use parent retreats for building leadership, and skill development of migrant farm-working families. Utilizing cooperative and community responsive practices, these retreats build…

Staffing UK University Campuses Overseas: Lessons from MNE Practice

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Salt, John; Wood, Peter

2014-01-01

This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…

Effect of Topography on Subglacial Discharge and Submarine Melting During Tidewater Glacier Retreat

Science.gov (United States)

Amundson, J. M.; Carroll, D.

2018-01-01

To first order, subglacial discharge depends on climate, which determines precipitation fluxes and glacier mass balance, and the rate of glacier volume change. For tidewater glaciers, large and rapid changes in glacier volume can occur independent of climate change due to strong glacier dynamic feedbacks. Using an idealized tidewater glacier model, we show that these feedbacks produce secular variations in subglacial discharge that are influenced by subglacial topography. Retreat along retrograde bed slopes (into deep water) results in rapid surface lowering and coincident increases in subglacial discharge. Consequently, submarine melting of glacier termini, which depends on subglacial discharge and ocean thermal forcing, also increases during retreat into deep water. Both subglacial discharge and submarine melting subsequently decrease as glacier termini retreat out of deep water and approach new steady state equilibria. In our simulations, subglacial discharge reached peaks that were 6-17% higher than preretreat values, with the highest values occurring during retreat from narrow sills, and submarine melting increased by 14% for unstratified fjords and 51% for highly stratified fjords. Our results therefore indicate that submarine melting acts in concert with iceberg calving to cause tidewater glacier termini to be unstable on retrograde beds. The full impact of submarine melting on tidewater glacier stability remains uncertain, however, due to poor understanding of the coupling between submarine melting and iceberg calving.

Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment

International Nuclear Information System (INIS)

Bedard, Gillian; Hoskin, Peter; Chow, Edward

2014-01-01

Introduction: Radiation therapy has been shown to successfully palliate bone metastases. A number of systematic reviews and large clinical trials have reported response rates for initial treatment and retreatment. Objective: To determine overall response rates of patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Methods: Intent-to-treat and evaluable patient statistics from a systematic review of palliative radiotherapy trials for initial treatment of bone metastases and a randomized clinical trial of retreatment were pooled and analyzed to determine the overall response rates for patients receiving initial treatment and retreatment. Results: In the intent-to-treat calculation, 71–73% of patients had an overall response to radiation treatment and in the evaluable patient population; 85–87% of patients did so. Response rates varied slightly whether patients underwent single or multiple fractions in initial treatment or retreatment. Conclusions: Single and multiple fraction radiation treatment yielded very similar overall response rates. Patients treated with a single fraction for both initial and repeat radiation experience almost identical overall response to those patients treated with multiple fraction treatment. It is therefore recommended that patients with uncomplicated painful bone metastases be treated with a single 8 Gy fraction of radiation at both the initial treatment and retreatment

The Impact of Part-Time Staff on Art & Design Students' Ratings of Their Programmes

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Yorke, Mantz

2014-01-01

Art & Design receives ratings on a number of scales of the UK's National Student Survey (NSS) that are less strong than those for some other subject areas. Art & Design, along with performing arts, is characterised by a relatively high level of part-time (PT) staffing. PT staffing data are set against NSS ratings for post-92 universities…

Salt Marshes as Monitors of Late Holocene Outlet Glacier Retreat

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Wake, L. M.; Woodroffe, S.; Long, A. J.; Milne, G. A.

2014-12-01

New proxy sea-level records extracted from salt marshes in the vicinity of Jakobshavn Isbrae (Pakitsoq; 69.51°N, 50.74°W) and at previous sites in central western Greenland (Sisimiut; 66.47°N, 53.61°W and Aasiaat; 68.69°N, 52.88°W) are analyzed with respect to their ability to act as proximal tide gauges detecting mass balance changes in nearby outlet glaciers associated with the transition from the Little Ice Age ("LIA", 1400-1850AD) to the Industrial Period (>1850AD). Data at Pakitsoq demonstrate that sea-level rose at a rate of 3.5 ±1.7 mm/yr prior to 1850AD and slowed to 0.3 ±0.6mm/yr thereafter, producing a slowdown in sea level of 3.2 ± 1.8 mm/yr. A similar slowdown, occurring at 1600AD, is observed at Aasiaat and Sisimiut. We interpret these observed changes using a glacial isostatic adjustment model of sea-level change truncated at degree and order 4096, with an aim to determine if the sea-level data can be used to place constraints on changes in Jakobshavn Isbrae and/or Kangiata Nunaata Sermia (Nuuk fjord) during this period. Modelled sea level at Pakitsoq is insensitive to the location of thickening (thinning) associated with grounding line advance (retreat) and the rate of advance and retreat but is sensitive to the change point in time between periods of growth associated with LIA expansion (sea level rise) and the onset of 19th century recession (sea level fall) of Jakobshavn Isbrae. We conclude that the change in sea-level rate observed at Pakitsoq circa 1850AD marks the onset of post LIA retreat of this outlet glacier. Conversely, the modelled sea-level response to the retreat of Kangiata Nunaata Sermia from its LIA maximum at ca. 1761AD is below the detection threshold of the salt marsh record at Sisimiut.

A comparative evaluation of efficacy of protaper universal rotary retreatment system for gutta-percha removal with or without a solvent

Directory of Open Access Journals (Sweden)

M Sita Ram Kumar

2012-01-01

Full Text Available Aim: The aim was to evaluate and compare the efficacy of ProTaper Universal rotary retreatment system with or without solvent and stainless steel hand files for endodontic filling removal from root canals and also to compare retreatment time for each system. Materials and Methods: Thirty extracted mandibular premolars with single straight canals were endodontically treated. Teeth were divided into three major groups, having 10 specimens each. Removal of obturating material in group 1 by stainless steel hand files with RC Solve, group 2 by ProTaper Universal retreatment instruments and group 3 by ProTaper Universal retreatment instruments along with RC solve was done. Retreatment was considered complete for all groups when no filling material was observed on the instruments. The retreatment time was recorded for each tooth. All specimens were grooved longitudinally in a buccolingual direction. The split halves were examined under a stereomicroscope and images were captured and analyzed. The remaining filling debris area ratios were considered for statistical analysis. Results: With ANOVA test, statistical analysis showed that there was statistically no significant difference regarding the amount of filling remnants between the groups (P < 0.05. Differences between the means of groups are statistically significant regarding the retreatment time. Conclusion: Irrespective of the technique used, all the specimens had some remnants on the root canal wall. ProTaper Universal retreatment system files alone proved to be faster than the other experimental groups.

Differences in the clinical-epidemiological profile between new cases of tuberculosis and retreatment cases after default

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Aylana de Souza Belchior

Full Text Available Abstract OBJECTIVE To identify the socioeconomic and clinical-epidemiological factors related to tuberculosis in new cases and retreatment cases. METHOD Comparative study with 126 patients, of which 42 were retreatment cases after default attended in a reference center, and 84 were new cases completing the first treatment and treated in Basic Health Units. The collection of primary data was through interview, and of secondary data by records of the Notifiable Diseases Information System. Comparative analysis between the two groups. RESULTS The new cases differ from retreatment cases regarding educational level. The clinical-epidemiological profile shows a significant difference in relation to performance of the tuberculin skin test, and the HIV test result (positive in favor of new cases. In relation to performance of sputum culture and the result (positive of the first sputum smear of the first and second samples, in favor of retreatment cases. CONCLUSION The two groups are significantly different in clinical and epidemiological characteristics that show the access to exams.

Staffing an Academic Reference Desk with Librarians is not Cost-effective. A Review of: Ryan, Susan M. “Reference Transactions Analysis: The Cost-effectiveness of Staffing a Traditional Academic Reference Desk.” Journal of Academic Librarianship 34.5 (2008: 389-99.

Directory of Open Access Journals (Sweden)

Cari Merkley

2009-06-01

categories derived by the researcher: look-up (a search for a known item, directional (library-specific orientation to the space and collections, technology (assistance with using library technology and electronic resources, and reference. The category of reference was further subdivided into eight additional categories: catalogue search, citation help, database help, “guide to correct databases,” “personal knowledge or referral,” “quick internet search,” research, and Serials Solutions (392. “Guide to correct databases” referred to advice on the appropriate database to answer a question and serials solutions included questions that could be answered using the Serials Solutions product, such as the availability of a particular journal or article in the collection (392. Questions were assigned to the single most appropriate category by the researcher. Question categories were then mapped to “suggested staffing levels” (396. This determination was made by the researcher, and no details were given as to how the decision was made for each category. The three levels of staffing discussed were librarian, “trained student or staff,” and “well-trained staff/occasional librarian referral” (396. The cost of staffing the reference desk during the eight months captured in this study was calculated by multiplying the hours worked by each librarian by his/her individual average rate of pay across the four data collection periods. Indirect staff costs such as benefits were not included in this calculation. The average cost per reference transaction was determined by dividing the total salary costs by the total number of reference queries during the periods of study. Costs for those categories of questions best addressed by a librarian could then be determined. The actual number of librarians who participated in the study is unclear. The methodology refers to four full-time and two part-time librarians (391. However, later in the article there is reference to

A model ensemble for projecting multi‐decadal coastal cliff retreat during the 21st century

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Limber, Patrick; Barnard, Patrick; Vitousek, Sean; Erikson, Li

2018-01-01

Sea cliff retreat rates are expected to accelerate with rising sea levels during the 21st century. Here we develop an approach for a multi‐model ensemble that efficiently projects time‐averaged sea cliff retreat over multi‐decadal time scales and large (>50 km) spatial scales. The ensemble consists of five simple 1‐D models adapted from the literature that relate sea cliff retreat to wave impacts, sea level rise (SLR), historical cliff behavior, and cross‐shore profile geometry. Ensemble predictions are based on Monte Carlo simulations of each individual model, which account for the uncertainty of model parameters. The consensus of the individual models also weights uncertainty, such that uncertainty is greater when predictions from different models do not agree. A calibrated, but unvalidated, ensemble was applied to the 475 km‐long coastline of Southern California (USA), with 4 SLR scenarios of 0.5, 0.93, 1.5, and 2 m by 2100. Results suggest that future retreat rates could increase relative to mean historical rates by more than two‐fold for the higher SLR scenarios, causing an average total land loss of 19 – 41 m by 2100. However, model uncertainty ranges from +/‐ 5 – 15 m, reflecting the inherent difficulties of projecting cliff retreat over multiple decades. To enhance ensemble performance, future work could include weighting each model by its skill in matching observations in different morphological settings

75 FR 45166 - Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing...

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2010-08-02

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-71,014] Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing, Hawkins, WI; Notice of Negative...., Hawkins Window Division, including on-site leased workers of Nicolet Staffing, Hawkins, Wisconsin. Signed...

Comparison of the amount of apically extruded debris produced by four retreatment techniques: an ex vivo study

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Cristiane Ferreira Alfenas

2017-12-01

Full Text Available Objective: the aim of this study was to compare the amount of apically extruded debris during the removal of root canal filling material using nickel-titanium rotary retreatment instruments and Hedström files. Material and Methods: sixty mandibular incisors with a single canal were instrumented and obturated by cold lateral compaction. For retreatment, specimens were randomly divided into four groups (n = 15: Hedström files with or without solvent; D-RaCe system and Mtwo retreatment system. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The mean weights of extruded material were analyzed by one-way ANOVA. Results: the results showed that all retreatment techniques caused apical extrusion of debris, but no statistically significant difference was observed between groups (p>0.05. Conclusion: under the conditions of this study, all retreatment techniques caused apical debris extrusion.

Incidence of flare-ups and evaluation of quality after retreatment of resorcinol-formaldehyde resin ("Russian Red Cement") endodontic therapy.

Science.gov (United States)

Gound, Tom G; Marx, David; Schwandt, Nathan A

2003-10-01

The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.

Treatment and retreatment with omalizumab in chronic spontaneous urticaria: Real life experience with twenty-five patients.

Science.gov (United States)

Türk, Murat; Yılmaz, İnsu; Bahçecioğlu, Sakine Nazik

2018-01-01

Previous data have shown the high efficacy of omalizumab in chronic spontaneous urticaria (CSU). However, factors that may be effective on the response to therapy, relapse rates after drug discontinuation, and efficacy of retreatment remain unclear. This study aimed to determine the efficacy of omalizumab in CSU refractory to conventional therapy, to identify possible factors affecting treatment response and relapse, and also to evaluate the efficacy of retreatment on relapsed disease. The data of CSU patients treated with 300 mg/month omalizumab for at least 3 months were retrospectively analyzed. In order to evaluate the efficacy of treatment and retreatment, baseline and follow-up concomitant medication score (CMS) and urticaria activity score (UAS) were calculated. Possible factors affecting treatment response and relapse were identified. Twenty-five patients were included. The median duration of omalizumab therapy was 6 (6-12) months. Of the patients with baseline UAS 6 (5.5-6) and CMS 13 (10-15), 8 (32%) had complete response (UAS = 0) and 2 (8%) were non-responders after 3 months of therapy. None of the complete responders were positive for IgG-anti-TPO. After discontinuation of omalizumab therapy, 11 (61%) patients experienced relapse and 10 of them received retreatment with omalizumab. Half of the patients had complete response, and half had partial response (UAS = 1-4) after retreatment. No treatment related adverse events were documented. Omalizumab has high efficacy in both the treatment and retreatment of CSU; however, relapse rates after discontinuation are high. Autoimmune markers may be helpful in predicting treatment response and relapse. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Comparison of retreatment ability of full-sequence reciprocating instrumentation and 360° rotary instrumentation.

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Capar, Ismail Davut; Gok, Tuba; Orhan, Ezgi

2015-12-01

The purpose of the present study was to investigate the amount of root canal filling material after root canal filling removal with 360° rotary instrumentation or reciprocating motion with the same file sequence. Root canals of the 36 mandibular premolars were shaped with ProTaper Universal instruments up to size F2 and filled with corresponding single gutta-percha cone and sealer. The teeth were assigned to two retreatment groups (n = 18): group 1 360° rotational motion and group 2 reciprocating motion of ATR Tecnika motors (1310° clockwise and 578° counterclockwise). Retreatment procedure was performed with ProTaper Universal retreatment files with a sequence of D1-3 and ProTaper Universal F3 instruments. Total time required to remove filling material were recorded. Remaining filling material was examined under stereomicroscope at ×8 magnification. The data were analysed statistically using the Mann-Whitney U test, and testing was performed at 95 % confidence level (p  0.05) in terms of remaining filling material. The total time required for retreatment was shorter in 360° rotational motion group compared to reciprocating motion group (p instruments with reciprocating motion of ATR motor and conventional rotary motion have similar efficacy in root canal filling removal.

The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members.

Science.gov (United States)

Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M

2017-07-01

Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

Flexible Training Strategy (National Task Force on Medical Staffing)

OpenAIRE

Department of Health (Ireland)

2003-01-01

Flexible Training Strategy (National Task Force on Medical Staffing) The Flexible Training Strategy, while endorsing flexible/part-time options recognises that the preferred option for the majority of doctors-in-training and consultants is most likely to continue to be full-time training and work. Click here to download PDF

New Directions for Academic Libraries in Research Staffing: A Case Study at National University of Ireland Galway

Science.gov (United States)

Cox, John

2017-01-01

New research needs, global developments and local shifts in emphasis are demanding a broader range of interactions by librarians with researchers and are challenging previous staffing structures. Research has a higher institutional profile and academic libraries have responded by creating new roles and staffing models, with stronger linkage across…

Registered Nurse Staffing in Pennsylvania Nursing Homes: Comparison before and after Implementation of Medicare's Prospective Payment System.

Science.gov (United States)

Kanda, Katsuya; Mezey, Mathy

1991-01-01

Examined changes in resident acuity and registered nurse staffing in all nursing homes in Pennsylvania before and after introduction of Medicare Prospective Payment System (PPS) in 1983. Found that acuity of nursing home residents increased significantly since introduction of PPS, full-time registered nurse staffing remained unchanged, and…

Postoperative pain after endodontic retreatment: single- versus two-visit treatment.

Science.gov (United States)

Yoldas, Oguz; Topuz, Aysin; Isçi, A Sehnaz; Oztunc, Haluk

2004-10-01

The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.

Staffing the Principalship: Finding, Coaching, and Mentoring School Leaders

Science.gov (United States)

Lovely, Suzette

2004-01-01

"Help Wanted" signs are springing up outside schools. The shortage of school administrators is not coming, it is here. To thwart the shortage and keep schools on the cutting edge, diligence in cultivating, training, and inspiring a new generation of school leaders--especially for the principalship, must be exercised. Staffing the Principalship…

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

Directory of Open Access Journals (Sweden)

Sachin Logani

2011-01-01

Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

Healthcare security staffing for smaller facilities: where science meets art.

Science.gov (United States)

Warren, Bryan

2013-01-01

Obtaining effective security resourcing and staffing for smaller healthcare facilities presents many difficulties, according to the author In this article, he provides guidance to security practitioners on taking existing data and translating it into a language that administration will understand and appreciate.

45 CFR 1336.65 - Staffing and organization of the Revolving Loan Fund: Responsibilities of the Loan Administrator.

Science.gov (United States)

2010-10-01

... organization table, including: (a) The structure and composition of the Board of Directors of the RLF; (b) The... 45 Public Welfare 4 2010-10-01 2010-10-01 false Staffing and organization of the Revolving Loan... Hawaiian Revolving Loan Fund Demonstration Project § 1336.65 Staffing and organization of the Revolving...

Timing, cause and impact of the late Eocene stepwise sea retreat from the Tarim Basin (west China)

NARCIS (Netherlands)

Bosboom, R.|info:eu-repo/dai/nl/322947359; Dupont-Nivet, G.|info:eu-repo/dai/nl/313092559; Grothe, A.|info:eu-repo/dai/nl/338017712; Brinkhuis, H.|info:eu-repo/dai/nl/095046097; Villa, G.; Mandic, O.; Stoica, M.; Kouwenhoven, T.J.|info:eu-repo/dai/nl/191377406; Huang, W.; Yang, W.; Guo, Z.

2014-01-01

A vast shallow epicontinental sea extended across Eurasia and was well-connected to the Western Tethys before it retreated westward and became isolated as the Paratethys Sea. However, the palaeogeography and the timing of this westward retreat are too poorly constrained to determine potential wider

Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes.

Science.gov (United States)

Roberts, Amy Restorick; Bowblis, John R

2017-02-01

Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.

Evaluation of apically extruded debris during root canal retreatment with several NiTi systems.

Science.gov (United States)

Dincer, A N; Er, O; Canakci, B C

2015-12-01

To compare the amount of debris extruded apically during root canal retreatment using ProTaper, Mtwo and Reciproc instruments with hand H-files. In total, 60 freshly extracted human mandibular incisor teeth were used. All root canals were prepared with a Reciproc R25 file than filled with Gutta-percha and AH Plus sealer using cold lateral condensation before being assigned randomly to four groups (n = 15 each). In group 1, root fillings were removed with the Protaper Universal retreatment system; ProTaper Universal F3 and F4 instruments were used for the final preparation. In group 2, root fillings were removed with the Mtwo retreatment system; Mtwo size 30, .06 taper, size 35, .06 taper and size 40, .06 taper files were used for the final preparation. In group 3, root fillings were removed with Reciproc R25 instruments; Reciproc R40 instruments were used for the final preparation. In group 4, the root fillings were removed with Gates Glidden burs and sizes 35, 30 and 25 H-files; for final preparation, a size 40 H-file was used. Glass vials were used for debris collection. The vials were weighed before and after Gutta-percha removal. Additionally, the times required for the retreatment procedures were recorded. Data were analysed statistically using one-way analysis of variance. The Reciproc system produced significantly smaller amounts of apical extruded debris than the other groups (P ProTaper groups. The ProTaper and Reciproc groups required significantly less time than the Mtwo and H-file groups (P hand filing. Use of the ProTaper and Reciproc instruments required less time for retreatment procedures than use of the Mtwo or H-file. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Extensive Holocene ice sheet grounding line retreat and uplift-driven readvance in West Antarctica

Science.gov (United States)

Kingslake, J.; Scherer, R. P.; Albrecht, T.; Coenen, J. J.; Powell, R. D.; Reese, R.; Stansell, N.; Tulaczyk, S. M.; Whitehouse, P. L.

2017-12-01

The West Antarctic Ice Sheet (WAIS) reached its Last Glacial Maximum (LGM) extent 29-14 kyr before present. Numerical models used to project future ice-sheet contributions to sea-level rise exploit reconstructions of post-LGM ice mass loss to tune model parameterizations. Ice-sheet reconstructions are poorly constrained in areas where floating ice shelves or a lack of exposed geology obstruct conventional glacial-geological techniques. In the Weddell and Ross Sea sectors, ice-sheet reconstructions have traditionally assumed progressive grounding line (GL) retreat throughout the Holocene. Contrasting this view, using three distinct lines of evidence, we show that the GL retreated hundreds of kilometers inland of its present position, before glacial isostatic rebound during the Mid to Late Holocene caused the GL to readvance to its current position. Evidence for retreat and readvance during the last glacial termination includes (1) widespread radiocarbon in sediment cores recovered from beneath ice streams along the Siple and Gould Coasts, indicating marine exposure at least 200 km inland of the current GL, (2) ice-penetrating radar observations of relic crevasses and other englacial structures preserved in slow-moving grounded ice, indicating ice-shelf grounding and (3) an ensemble of new ice-sheet simulations showing widespread post-LGM retreat of the GL inland of its current location and later readvance. The model indicates that GL readvance across low slope ice-stream troughs requires uplift-driven grounding of the ice shelf on topographic highs (ice rises). Our findings highlight ice-shelf pinning points and lithospheric response to unloading as drivers of major ice-sheet fluctuations. Full WAIS collapse likely requires GL retreat well beyond its current position in the Ronne and Ross Sectors and linkage via Amundsen Sea sector glaciers.

Landmark Study Reveals Antarctic Glacier's Long History of Retreat

OpenAIRE

Kuska, Dale M.

2016-01-01

Faculty Showcase Archive Article Approved for public release; distribution is unlimited. A major study, released in late November in the journal “Nature,” reveals the history of retreat of the massive Pine Island Glacier (PIG) in western Antarctica, widely considered one of the largest contributors to global sea-level rise.

From Retreat to Re-engagement: The New American Foreign Policy ...

African Journals Online (AJOL)

From Retreat to Re-engagement: The New American Foreign Policy for ... that the re-engagement with Sub-Saharan Africa, is based on US perception of threats ... in the subordination of the region to the world's only superpower and its allies.

Organization and staffing of the regulatory body for nuclear facilities. Safety guide

International Nuclear Information System (INIS)

2005-01-01

The purpose of this safety guide is to provide recommendations for national authorities on the appropriate management system, organization and staffing for the regulatory body responsible for the regulation of nuclear facilities in order to achieve compliance with the applicable safety requirements. This safety guide covers the organization and staffing in relation to nuclear facilities such as: enrichment and fuel manufacturing plants. Nuclear power plants. Other reactors such as research reactors and critical assemblies. Spent fuel reprocessing plants. And radioactive waste management facilities such as treatment, storage and disposal facilities. This safety guide also covers issues related to the decommissioning of nuclear facilities, the closure of waste disposal facilities and site rehabilitation

Long-term cliff retreat and erosion hotspots along the central shores of the Monterey Bay National Marine Sanctuary

Science.gov (United States)

Moore, Laura J.; Griggs, Gary B.

2002-01-01

Quantification of cliff retreat rates for the southern half of Santa Cruz County, CA, USA, located within the Monterey Bay National Marine Sanctuary, using the softcopy/geographic information system (GIS) methodology results in average cliff retreat rates of 7–15 cm/yr between 1953 and 1994. The coastal dunes at the southern end of Santa Cruz County migrate seaward and landward through time and display net accretion between 1953 and 1994, which is partially due to development. In addition, three critically eroding segments of coastline with high average erosion rates ranging from 20 to 63 cm/yr are identified as erosion ‘hotspots’. These locations include: Opal Cliffs, Depot Hill and Manresa. Although cliff retreat is episodic, spatially variable at the scale of meters, and the factors affecting cliff retreat vary along the Santa Cruz County coastline, there is a compensation between factors affecting retreat such that over the long-term the coastline maintains a relatively smooth configuration. The softcopy/GIS methodology significantly reduces errors inherent in the calculation of retreat rates in high-relief areas (e.g. erosion rates generated in this study are generally correct to within 10 cm) by removing errors due to relief displacement. Although the resulting root mean squared error for erosion rates is relatively small, simple projections of past erosion rates are inadequate to provide predictions of future cliff position. Improved predictions can be made for individual coastal segments by using a mean erosion rate and the standard deviation as guides to future cliff behavior in combination with an understanding of processes acting along the coastal segments in question. This methodology can be applied on any high-relief coast where retreat rates can be measured.

Non-surgical retreatment of a failed apicoectomy without retrofilling using white mineral trioxide aggregate as an apical barrier.

Science.gov (United States)

Stefopoulos, Spyridon; Tzanetakis, Giorgos N; Kontakiotis, Evangelos G

2012-01-01

Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.

[Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

Science.gov (United States)

Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

2014-02-01

This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

Science.gov (United States)

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Summary of the RHIC Retreat 2008

International Nuclear Information System (INIS)

Pilat, F.; Brennan, M.; Brown, K.; Fischer, W.; Montag, C.

2008-01-01

The main goal of the RHIC Retreat is to review last run's performance and prepare for the next. As always though we also discussed the longer term goals and plans for the facility to put the work in perspective and in the right priority. A straw-man plan for the facility was prepared for the DOE that assumes 30 cryoweek and running 2 species per year. The plan outlines RHIC operations for 2008-2012 and integrates well accelerator and detector upgrades to optimize the physics output with high luminosities. The plans includes guidance from the PAC and has been reviewed by DOE

A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

DEFF Research Database (Denmark)

Kruger, Andreas J; Lockey, David; Kurola, Jouni

2011-01-01

-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....

Implementing an inclusive staffing model for today's reference services a practical guide for librarians

CERN Document Server

Nims, Julia K; Stevens, Robert

2013-01-01

Reference service remains a core function of modern libraries. However, how and where we provide assistance has evolved with changing technologies and the shifting habits and preferences of our users. One way libraries can provide the on-demand, in-person assistance while managing and developing new services and resources that will benefit current and future users is to reconsider how their reference points and services are staffed and adopt a staff-based reference model. In Implementing an Inclusive Staffing Model for Today's Reference Services, Nims, Storm, and Stevens describe step-by-step

Observations and modeling of fjord sedimentation during the 30 year retreat of Columbia Glacier, AK

Science.gov (United States)

Love, Katherine B; Hallet, Bernard; Pratt, Thomas L.; O'Neel, Shad

2016-01-01

To explore links between glacier dynamics, sediment yields and the accumulation of glacial sediments in a temperate setting, we use extensive glaciological observations for Columbia Glacier, Alaska, and new oceanographic data from the fjord exposed during its retreat. High-resolution seismic data indicate that 3.2 × 108 m3 of sediment has accumulated in Columbia Fjord over the past three decades, which corresponds to ~5 mm a−1 of erosion averaged over the glaciated area. We develop a general model to infer the sediment-flux history from the glacier that is compatible with the observed retreat history, and the thickness and architecture of the fjord sediment deposits. Results reveal a fivefold increase in sediment flux from 1997 to 2000, which is not correlated with concurrent changes in ice flux or retreat rate. We suggest the flux increase resulted from an increase in the sediment transport capacity of the subglacial hydraulic system due to the retreat-related steepening of the glacier surface over a known subglacial deep basin. Because variations in subglacial sediment storage can impact glacial sediment flux, in addition to changes in climate, erosion rate and glacier dynamics, the interpretation of climatic changes based on the sediment record is more complex than generally assumed.

Nurse staffing patterns and hospital efficiency in the United States.

Science.gov (United States)

Bloom, J R; Alexander, J A; Nuchols, B A

1997-01-01

The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.

Prehospital interventions before and after implementation of a physician-staffed helicopter

DEFF Research Database (Denmark)

Sonne, Asger; Wulffeld, Sandra; Steinmetz, Jacob

2017-01-01

INTRODUCTION: Implementation of a physician-staffed helicopter emergency medical service (HEMS) in eastern Denmark was associated with increased survival for severely injured patients. This study aimed to assess the potential impact of advanced prehospital interventions by comparing the proportion...

Retreatment of recanalized aneurysms after Y-stent-assisted coil embolization with double enterprise stents: case report and systematic review of the literature.

Science.gov (United States)

Kono, Kenichi; Shintani, Aki; Terada, Tomoaki

2014-01-01

It is necessary to consider possibility of recanalization and retreatment after coil embolization for cerebral aneurysms. There is concern that retreatment for recanalized aneurysms after Y-stent-assisted coil embolization may be difficult because of double stents, especially in Y-stents with double closed-cell stents owing to narrowed structures. However, no detailed reports of retreatment after Y-stent have been reported. Between July 2010 and June 2013, we treated four aneurysms with Y-stent-assisted coil embolization using Enterprise closed-cell stents. Recanalization occurred in one case (25%), and retreatment was performed. We easily navigated a microcatheter into the target portions of the aneurysm through the Y-stent and occluded the aneurysm with coils. Additionally, by systematically searching in PubMed, we found 105 cases of Y-stent-assisted coil embolization using Enterprise stents or Neuroform stents with more than 6 months of follow-up. Among them, retreatment was performed in 10 cases (9.5%). There were no significant differences in retreatment rates among different stent combinations (P=0.91; Fisher's exact test). In conclusion, navigation of a microcatheter into the aneurysm through the Y-stent with double Enterprise stents was feasible, and retreatment rates after Y-stent-assisted coiling may not depend on stent combinations.

Hillslope failure and paraglacial reworking of sediments in response to glacier retreat, Fox Valley, New Zealand.

Science.gov (United States)

McColl, Samuel T.; Fuller, Ian C.; Anderson, Brian; Tate, Rosie

2017-04-01

Climate and glacier fluctuations influence sediment supply to glacier forelands, which in turn influences down-valley hazards to infrastructure and tourism within glacier forelands. At Fox Glacier, one of New Zealand's most iconic and popular glaciers, rapid retreat has initiated a range of hillslope and valley floor responses, that present a cascade of hazards and changes that need to be carefully managed. Fox Glacier has retreated many kilometres historically, with 2.6 km of retreat since the mid-20th century, and a phase of rapid retreat of 50-340 m per year since 2009. To study the system response to past and ongoing glacial retreat at the Fox valley, morphological changes are being observed using time-lapse photography and the annual collection of high-resolution digital elevation models (DEMs) and orthophoto mosaics. The DEMs are being produced using Structure from Motion photogrammetry from UAV/RPAS and helicopter platforms, and are being used, along with manual ground surveying, to produce ground surface change models (DoDs; DEMs of Difference) and sediment budgets for the valley. Results from time-lapse photography and DoDs show that glacial retreat has initiated destabilisation and (mostly chronic) mass movement of surficial glacial sediments on the valley slopes near the glacier terminus. Alluvial fans farther down valley are actively growing, reworking glacial and landslide sediments from tributary catchments. These paraglacial sediments being delivered to the proglacial river from the glacier terminus and alluvial fans are driving aggradation of the valley floor of decimetres to metres per year and maintaining a highly dynamic braid plain. Valley floor changes also include the melting of buried dead ice, which are causing localised subsidence at the carpark and one of the alluvial fans. The unstable slopes and active debris fans, aggrading and highly active river channel, ground subsidence, add to the spectacle but also the hazards of the Fox valley

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units.

Science.gov (United States)

Weiss, Manfred; Marx, Gernot; Iber, Thomas

2017-08-04

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

Processes controlling the retreat of the Isles Dernieres, a Louisiana barrier-island chain

Science.gov (United States)

Dingler, John R.; Reiss, Thomas E.

1991-01-01

The Isles Dernieres is a low-lying, transgressive barrier-island chain situated about 150 km west of the modern Mississippi delta. Much of the Isles Dernieres consists of highly dissected salt-marsh muds that lie at or slightly above sea level and are covered by a veneer of sand along the shoreline facing the Gulf of Mexico. Maximum berm elevations are generally less than 1.5 m above mean sea level. Since the mid-1800s, the initial island has been fragmented into four islands, and the beach face has retreated landward at a rate of more than 10 m/yr. The dominant processes controlling degradation of the chain are cold fronts that pass through the area several times each year and occasional hurricanes. Beach surveys over a 2-year period on the Isles Dernieres document irreversible beach-face retreat in conjunction with multiple cold fronts and one major hurricane (Gilbert). Although both the hurricane and the cold fronts caused the island to erode, the erosional patterns of the two storm types differed from each other. During the two years, over 60 cold fronts collectively caused about 37 m of beach-face retreat, whereas Gilbert itself produced more than 40 m of retreat. A major difference between the two storm types was in the percentage of washover sand produced by each. Commonly, the cold fronts did not create enough of a storm surge to overtop the berm, so most of the material removed from the beach face must have moved offshore or alongshore. Gilbert, in contrast, inundated the study site, and essentially all the sand removed from the beach face moved to the backshore.

Quality of life following trauma before and after implementation of a physician-staffed helicopter

DEFF Research Database (Denmark)

Funder, Kamilia S; Rasmussen, L.S.; Hesselfeldt, R

2017-01-01

BACKGROUND: Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might...... be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. METHODS: Prospective, observational study including trauma patients who survived at least 3 years...

Summary of the RHIC Retreat 2008

Energy Technology Data Exchange (ETDEWEB)

Pilat,F.; Brennan, M.; Brown, K.; Fischer, W.; Montag, C.

2008-08-01

The main goal of the RHIC Retreat is to review last run's performance and prepare for the next. As always though we also discussed the longer term goals and plans for the facility to put the work in perspective and in the right priority. A straw-man plan for the facility was prepared for the DOE that assumes 30 cryoweek and running 2 species per year. The plan outlines RHIC operations for 2008-2012 and integrates well accelerator and detector upgrades to optimize the physics output with high luminosities. The plans includes guidance from the PAC and has been reviewed by DOE.

Obesity and intensive staffing needs of nursing home residents.

Science.gov (United States)

Harris, John Alexander; Engberg, John; Castle, Nicholas George

2018-06-05

The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.

Dynamic Staffing and Rescheduling in Software Project Management: A Hybrid Approach.

Directory of Open Access Journals (Sweden)

Yujia Ge

Full Text Available Resource allocation could be influenced by various dynamic elements, such as the skills of engineers and the growth of skills, which requires managers to find an effective and efficient tool to support their staffing decision-making processes. Rescheduling happens commonly and frequently during the project execution. Control options have to be made when new resources are added or tasks are changed. In this paper we propose a software project staffing model considering dynamic elements of staff productivity with a Genetic Algorithm (GA and Hill Climbing (HC based optimizer. Since a newly generated reschedule dramatically different from the initial schedule could cause an obvious shifting cost increase, our rescheduling strategies consider both efficiency and stability. The results of real world case studies and extensive simulation experiments show that our proposed method is effective and could achieve comparable performance to other heuristic algorithms in most cases.

Variability of onset and retreat of the rainy season in mainland China and associations with atmospheric circulation and sea surface temperature

Science.gov (United States)

Cao, Qing; Hao, Zhenchun; Shao, Quanxi; Hao, Jie; Nyima, Tsring

2018-02-01

Precipitation plays an important role in both environment and human society and is a significant factor in many scientific researches such as water resources, agriculture and climate impact studies. The onset and retreat of rainy season are useful features to understand the variability of precipitation under the influence of climate change. In this study, the characteristics of onset and retreat in mainland China are investigated. The multi-scale moving t-test was applied to determine rainy season and K-means cluster analysis was used to divide China into sub-regions to better investigate rainy season features. The possible linkage of changing characteristics of onset and retreat to climate factors were also explored. Results show that: (1) the onset started from middle March in the southeast of China to early June in the northwest and rainy season ended earliest in the northwest and southeast while the central China had the latest retreat; (2) Delayed onset and advanced retreat over time were observed in many parts of China, together with overall stable or increased rainy-season precipitation, would likely lead to higher probability of flooding; (3) The onset (retreat) was associated with the increased (decreased) number of cyclones in eastern China and anticyclone near the South China Sea. Delayed onset, and advanced retreat were likely related to cold and warm sea surface temperature (SST) in the conventional El Niño-Southern Oscillation (ENSO) regions, respectively. These results suggest that predictability of rainy season can be improved through the atmospheric circulation and SST, and help water resources management and agricultural planning.

Radial Flow Effects On A Retreating Rotor Blade

Science.gov (United States)

2014-05-01

birds , marine life and even insect wings. In some cases such as helicopters, wind turbines and compres- sors, dynamic stall becomes the primary...on dynamic stall and reverse flow as applied to a helicopter rotor in forward flight and a wind turbine operating at a yaw angle. While great...occurring on a retreating blade with a focus on dynamic stall and reverse flow as applied to a helicopter rotor in forward flight and a wind turbine

Temperature under the Tongue: A paleotemperature record of the Drygalksi Ice Tongue with improved chronology of ice retreat

Science.gov (United States)

Subt, C.; Rosenheim, B. E.; Lee, J. I.; Yoo, K. C.; Browne, I. M.; Shevenell, A.

2017-12-01

The Ross Embayment is among the most well-studied regions in Antarctica. Despite the relative abundance of data, the style and forcing of deglaciation of the Ross Sea sector following the Last Glacial Maximum (LGM; 23-19 ka) is challenging due to the region's considerable size, complex geometry, and the difficulties in dating Antarctic glaciomarine sedimentary sequences. Ross Sea sediments indicate a dynamic glacial retreat in the western Ross Sea, whereas regional glacial systems may have retreated and advanced multiple times during the last deglaciation. Two marine sediment cores collected near the Drygalski Ice Tongue in the western Ross Sea during 2012 and 2015 Korea Polar Research Institute (KOPRI) expeditions reveal a sequence of alternating diatomaceous muds and oozes interbedded with diamict, which suggest dynamic post-LGM grounded ice retreat in the Ross Sea. Dynamic retreat is hypothesized to have been driven by rising sea levels and warmer ocean waters on the continental shelf, thus a record of upper ocean temperatures should reflect this. Here we present the first post-LGM upper ocean temperature record from the Ross Sea, developed using the TEX86 (tetraether index of lipids consisting of 86 carbons) paleothermometer. To overcome the difficulties of dating these sediments using traditional methods, we apply specialized Ramped PyrOx 14C dating for sediments with high proportions of relict carbon . This technique is particularly well-suited for the post-LGM retreat sedimentary sequences from Antarctic margins because it allows for separation of autochthonous and relict material for dating. By combining organic paleothermometry and state-of-the-art chronologic techniques, we gain a more thorough understanding of upper ocean temperatures in the Ross Sea during the last deglaciation, and their implications for ice retreat.

Effect of Endodontic Retreatment on Push-out Bond Strength and Quality of Fiber Postbonding Interface of Resin Cements.

Science.gov (United States)

Pelegrine, Rina Andréa; Paulillo, Luís Alexandre Maffei Sartini; Kato, Augusto Shoji; Fontana, Carlos Eduardo; Pinheiro, Sérgio Luiz; De Martin, Alexandre Sigrist; Bueno, Carlos Eduardo da Silveira

2016-01-01

The aim of this study is to evaluate the impact of endodontic retreatment on push-out bond strength and dentin interface of two resin cements used for fiber postcementation during endodontic retreatment. The root canals of 40 extracted human canines were prepared, obturated and divided into four groups (n = 10). Gutta-percha was partially removed and fiber posts were immediately cemented in groups 1 and 2 using Panavia F with ED Primer and RelyX™ U200, respectively. In groups 3 and 4, the root canal access was sealed with temporary restorative cement, specimens were stored for 30 days, endodontically retreated, and fiber posts were cemented using the resin cements applied to groups 1 and 2, respectively. Push-out tests and scanning electron microscopy analyses of different areas were performed. Data from push-out bond strengths were analyzed by one-way analysis of variance and Tukey's tests. Higher bond strength values were detected in the apical third for group 1 than group 3 (p 0.05). Comparisons between different thirds in the same group revealed a higher bond strength in the apical third for group 1. Scanning electron microscopy showed formation of hybrid layer and extensive resin tags in group 1. No hybrid layer was observed in groups 2 and 4. Endodontic retreatment had adverse effects on the push-out bond strength and dentinal interface of Panavia F with ED Primer when used for fiber postcementation specifically in the apical third, but not on RelyX™ U200. A significant interaction was detected between endodontic retreatment and resin cement, which indicated that endodontic retreatment might adversely affect the push-out bond strength and dentinal interface of Panavia F with ED Primer when used for fiber postcementation specifically in the apical third.

Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay.

Science.gov (United States)

de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W

2014-04-01

In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.

Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap.

Science.gov (United States)

Ortega-Usobiaga, J; Llovet-Osuna, F; Katz, T; Djodeyre, M R; Druchkiv, V; Bilbao-Calabuig, R; Baviera, J

2018-02-01

To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing (P=.01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

[Staffing levels in medical radiation physics in radiation therapy in Germany. Summary of a questionnaire].

Science.gov (United States)

Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus

2003-10-01

To get a general idea of the actual staffing level situation in medical radiation physics in 1999 a survey was carried out by the task-group "Personalbedarf" of Deutsche Gesellschaft für Medizinische Physik (DGMP) among all DGMP-members who are active in this field. Main components for equipment and activities are defined in Report 8 and 10 of DGMP for staffing requirements in medical radiation physics. 322 forms were sent out, 173 of them have been evaluated. From the answers regarding equipment and activities numbers for staff are calculated by the methods given in Report 8 and 10 for this spot check target and compared with effective staffing levels. The data of the spot check are then extrapolated on total Germany. The result is a calculated deficit of 865 medical physicists for the whole physics staff, 166 of them in radiation therapy. From the age distribution of DGMP-members and the calculated deficit resulted a training capacity of about 100 medical physicists at all per year (19 in radiation therapy) if the deficit shall be cut back in 10 years.

Comparison of cyclic fatigue resistance of three different rotary nickel-titanium instruments designed for retreatment.

Science.gov (United States)

Inan, Ugur; Aydin, Cumhur

2012-01-01

A number of rotary nickel-titanium (NiTi) systems have been developed to provide better, faster, and easier cleaning and shaping of the root canal system, and recently, rotary NiTi systems designed for root canal retreatment have been introduced. Because the main problem with the rotary NiTi files is fracture, the aim of this study was to compare the cyclic fatigue resistance of 3 different rotary NiTi systems designed for root canal retreatment. Total of 60 instruments of 3 different rotary NiTi systems designed for root canal retreatment were used in this study. Twenty R-Endo R3, 20 ProTaper D3, and 20 Mtwo R (Retreatment) 25.05 instruments were tested. Cyclic fatigue testing of instruments was performed by using a device that allowed the instruments to rotate freely inside an artificial canal. Each instrument was rotated until fracture occurred, and the number of cycles to fracture for each instrument was calculated. Representative samples were also evaluated under a scanning electron microscope to confirm the fracture was flexural. Data were analyzed by using 1-way analysis of variance test. R-Endo R3 instruments showed better cyclic fatigue resistance than ProTaper D3 and Mtwo R 25.05 instruments, and the difference was statistically significant (P instruments were more resistant to fatigue failure than ProTaper D3 and Mtwo R 25.05. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Recent glacier retreat and climate trends in Cordillera Huaytapallana, Peru

Science.gov (United States)

López-Moreno, J. I.; Fontaneda, S.; Bazo, J.; Revuelto, J.; Azorin-Molina, C.; Valero-Garcés, B.; Morán-Tejeda, E.; Vicente-Serrano, S. M.; Zubieta, R.; Alejo-Cochachín, J.

2014-01-01

We analyzed 19 annual Landsat Thematic Mapper images from 1984 to 2011 to determine changes of the glaciated surface and snow line elevation in six mountain areas of the Cordillera Huaytapallana range in Peru. In contrast to other Peruvian mountains, glacier retreat in these mountains has been poorly documented, even though this is a heavily glaciated area. These glaciers are the main source of water for the surrounding lowlands, and melting of these glaciers has triggered several outburst floods. During the 28-year study period, there was a 55% decrease in the surface covered by glaciers and the snowline moved upward in different regions by 93 to 157 m. Moreover, several new lakes formed in the recently deglaciated areas. There was an increase in precipitation during the wet season (October-April) over the 28-year study period. The significant increase in maximum temperatures may be related to the significant glacier retreat in the study area. There were significant differences in the wet season temperatures during El Niño (warmer) and La Niña (colder) years. Although La Niña years were generally more humid than El Niño years, these differences were not statistically significant. Thus, glaciers tended to retreat at a high rate during El Niño years, but tended to be stable or increase during La Niña years, although there were some notable deviations from this general pattern. Climate simulations for 2021 to 2050, based on the most optimistic assumptions of greenhouse gas concentrations, forecast a continuation of climate warming at the same rate as documented here. Such changes in temperature might lead to a critical situation for the glaciers of the Cordillera Huaytapallana, and may significantly impact the water resources, ecology, and natural hazards of the surrounding areas.

Westinghouse, DOE see apples, oranges in IG staffing report

International Nuclear Information System (INIS)

Lobsenz, G.

1994-01-01

The operator of the Energy Department's Savannah River weapons plant has at least 1,800 more employees than it needs, and could save $400 million over a five-year period by cutting its staff accordingly, a DOE inspector general study says. Most of the boat - 1,206 employees - was attributed to excessive numbers of managers, with the inspector general concluding that Westinghouse Savannah River Co. had roughly twice as many layers of management than two other DOE weapons contractors. The study also concluded that Westinghouse in fiscal year 1992 significantly understated its actual staffing levels in reports to DOE, failing to disclose 1,765 full-time employees or the equivalent hours worked. Through such underreporting Westinghouse was able to open-quotes circumvent staffing ceilings established by the department,close quotes the study added. Overall, DOE Inspector General John Layton said Westinghouse's staff levels substantially exceeded those needed for efficient operation of the South Carolina nuclear weapons facility. Layton based his analysis on efficiency standards attained by other DOE weapons plant contractors, such as Martin Marietta Energy Systems at DOE's Oak Ridge, Tenn., plant and EG ampersand G Rocky Flats, as well as widely utilized worker performance requirements used by the Navy and private sector companies that perform work similar to that done at Savannah River

Postoperative Pain after Endodontic Retreatment Using Rotary or Reciprocating Instruments: A Randomized Clinical Trial.

Science.gov (United States)

Comparin, Daniel; Moreira, Edson Jorge Lima; Souza, Erick M; De-Deus, Gustavo; Arias, Ana; Silva, Emmanuel João Nogueira Leal

2017-07-01

The aim of this randomized clinical trial was to evaluate the influence of rotary or reciprocating retreatment techniques on the incidence, intensity, duration of postoperative pain, and medication intake. After power analysis calculations, 65 patients who needed endodontic retreatment were randomly assigned to 1 of 2 groups according to the instrumentation system used: Mtwo (VDW, Munich, Germany) or Reciproc (VDW). Retreatments were performed in a single visit by an endodontic specialist. Participants were asked to rate the incidence and intensity of the postoperative pain on a verbal rating scale 24, 48, and 72 hours after treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (ibuprofen 400 mg) taken. A logistic regression analysis was used to assess both the incidence and duration of pain. Differences in the intensity of pain were analyzed using the ordinal (linear) chi-square test, and the Mann-Whitney U test was used to assess differences in the intake of analgesic medication between groups. No statistically significant difference was found among the 2 groups in relation to postoperative pain or analgesic medication intake at the 3 time points assessed (P > .05). Multivariate analysis showed a significantly higher incidence of pain after 24 hours when preoperative pain was present and a significantly longer duration of pain for men than women independently of the retreatment technique used. The reciprocating system and the continuous rotary system were found to be equivalent regarding the incidence, intensity, duration of postoperative pain, and intake of analgesic medication. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

How Pennsylvania School Libraries Pay Off: Investments in Student Achievement and Academic Standards

Science.gov (United States)

Lance, Keith Curry; Schwarz, Bill

2012-01-01

The purpose of this study was to examine the impact of Pennsylvania school library programs on student learning--specifically, the infrastructure (staffing, budgets, collections, technology, and access hours) that contributes most to student achievement, the costs and benefits associated with them, and the gap between current Pennsylvania school…

From networking to next-working: how an academic department "retreated" and advanced at the same time.

Science.gov (United States)

Yager, Joel; Kenna, Heather; Hantke, Mindy

2015-04-01

Department-wide retreats conducted at periods of transition can enrich and benefit academic departments in several ways. Here, the authors describe the organization, conduct, and immediate outcomes of a department-wide retreat in a university department of psychiatry intended to (1) foster networking and communication among faculty who often work in "silos" and (2) invite the faculty to provide "internal consultations" regarding aspirational strategic goals and recommendations for short-term actionable tactics to address these goals. The retreat featured an evening networking and socializing poster session followed by a day-long event consisting of small group and large group interactive sessions. Participants were 120 faculty members including 44 new and younger faculty members who prepared and presented posters about themselves and their work. A variety of aspirational goals and specific recommendations for follow-up emerged from small groups were discussed in plenary sessions and were subsequently summarized and distributed to the faculty to be addressed by ongoing workgroups. Immediate informal feedback suggests that conducting and acting on recommendations ensuing from academic department retreats can foster at least a short-term sense of shared community and purpose, network faculty, identify commonly held values and aspirational goals, and potentially stimulate formation of innovative affinity groups and collaborations. Longer-term workgroup efforts and outcome assessments are required to assess the enduring results and value of such undertakings.

Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

Science.gov (United States)

Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H

2015-02-01

While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.

Glacier retreat and associated sediment dynamics in proglacial areas: a case study from the Silvretta Alps, Austria

Science.gov (United States)

Felbauer, Lucia; Pöppl, Ronald

2016-04-01

Global warming results in an ongoing retreat of glaciers in the Alps, leaving behind large amounts of easily erodible sediments. In addition, the debuttressing of rock-walls and the decay of permafrost in the high mountain regions facilitates mass movements of potential disastrous consequences, such as rock falls, landslides and debris flows. Therefore, it is highly important to quantify the amount of sediments that are supplied from the different compartments and to investigate how glacial retreat influences sediment dynamics in proglacial areas. In the presented work glacier retreat and associated sediment dynamics were investigated in the Kromer valley (Silvretta Alps, Austria) by analyzing remote sensing data. Glacial retreat from the period of 1950 to 2012 was documented by interpreting aerial photographs. By digitizing the different stages of the glaciers for six time frames, changes in glacier area and length were mapped and quantified. In order to identify, characterize and quantify sediment dynamics in the proglacial areas a high resolution DEM of difference (DoD) between 2007 and 2012 was created and analyzed, further differentiating between different zones (e.g. valley bottom, hillslope) and types of geomorphic processes (e.g. fluvial, gravitational). First results will be presented at the EGU General Assembly 2016.

Radioiodine uptake following iodine-131 therapy for Graves' disease: an early indicator of need for retreatment

International Nuclear Information System (INIS)

Carpentier, W.R.; Gilliland, P.F.; Piziak, V.K.; Petty, F.C.; McConnell, B.G.; Verdonk, C.A.; Ibarra, J.D.; Thompson, J.Q.

1989-01-01

Forty-five patients with Graves' disease were studied prospectively to determine if 24-hour I-131 uptake measurements alone or in combination with serum thyroid hormone levels at six weeks would determine the necessity for retreatment of the thyrotoxicosis. All patients with an I-131 uptake greater than 30% at six weeks required retreatment. No patient with an I-131 uptake of less than 15% required retreatment. Patients with uptakes between 15% and 30% were variable. An elevated free thyroxin index at 6 weeks is not helpful to determine which patients will remain thyrotoxic. Patients with a free thyroxin index within the normal range at six weeks can be predicted to be euthyroid by 12 weeks if their 24-hour I-131 uptake is between 15% and 30% and to be hypothyroid if their 24-hour I-131 uptake is below 15%. There was no difference between patient groups treated initially with antithyroid medication and those who were not

Incidence of apical crack initiation and propagation during the removal of root canal filling material with ProTaper and Mtwo rotary nickel-titanium retreatment instruments and hand files.

Science.gov (United States)

Topçuoğlu, Hüseyin Sinan; Düzgün, Salih; Kesim, Bertan; Tuncay, Oznur

2014-07-01

The aim of this study was to determine the incidence of crack initiation and propagation in apical root dentin after retreatment procedures performed by using 2 rotary retreatment systems and hand files with additional instrumentation. Eighty extracted mandibular premolars with single canals were selected. One millimeter from the apex of each tooth was ground perpendicular to the long axis of the tooth, and the apical surface was polished. Twenty teeth served as the control group, and no preparation was performed. The remaining 60 teeth were prepared to size 35 with rotary files and filled with gutta-percha and AH Plus sealer. Specimens were then divided into 3 groups (n = 20), and retreatment procedures were performed with the following devices and techniques: ProTaper Universal retreatment files, Mtwo retreatment files, and hand files. After retreatment, the additional instrumentation was performed by using size 40 ProTaper, Mtwo, and hand files. Digital images of the apical root surface were recorded before preparation, after instrumentation, after filling, after retreatment, and after additional instrumentation. The images were then inspected for the presence of any new apical cracks and propagation. Data were analyzed with the logistic regression and Fisher exact tests. All experimental groups caused crack initiation and propagation after use of retreatment instruments. The ProTaper and Mtwo retreatment groups caused greater crack initiation and propagation than the hand instrument group (P ProTaper and Mtwo instruments after the use of retreatment instruments caused crack initiation and propagation, whereas hand files caused neither crack initiation nor propagation (P < .05). This study showed that retreatment procedures and additional instrumentation after the use of retreatment files may cause crack initiation and propagation in apical dentin. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

California's minimum-nurse-staffing legislation and nurses' wages.

Science.gov (United States)

Mark, Barbara; Harless, David W; Spetz, Joanne

2009-01-01

In 2004, California became the first state to implement minimum-nurse-staffing ratios in acute care hospitals. We examined the wages of registered nurses (RNs) before and after the legislation was enacted. Using four data sets-the National Sample Survey of Registered Nurses, the Current Population Survey, the National Compensation Survey, and the Occupational Employment Statistics Survey-we found that from 2000 through 2006, RNs in California metropolitan areas experienced real wage growth as much as twelve percentage points higher than the growth in the wages of nurses employed in metropolitan areas outside of California.

In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for gutta-percha removal with or without a solvent.

Science.gov (United States)

Takahashi, Cristiane Midori; Cunha, Rodrigo Sanches; de Martin, Alexandre Sigrist; Fontana, Carlos Eduardo; Silveira, Cláudia Fernandes M; da Silveira Bueno, Carlos Eduardo

2009-11-01

Effective removal of gutta-percha in endodontic retreatment is a significant factor to ensure a favorable outcome from failed procedures. The purpose of this study was to evaluate the efficacy of a nickel-titanium rotary instrument system with or without a solvent versus stainless steel hand files for gutta-percha removal. Forty extracted human maxillary anterior teeth were prepared and filled. They were divided into 4 groups: Gates-Glidden and K-files, Gates-Glidden and K-files with chloroform, ProTaper Universal rotary retreatment system, and ProTaper Universal rotary retreatment system with chloroform. The operating time was recorded. The teeth were longitudinally sectioned and photographed. The images were analyzed and the filling remnants were quantified by using the IMAGE TOOL software. With Kruskall-Wallis test, statistical analysis showed that there was no significant difference between the techniques in regard to the amount of the endodontic filling remnants (P ProTaper Universal rotary retreatment system was faster than the hand files (P ProTaper Universal rotary retreatment system without chloroform was faster.

Efficacy of ProTaper Retreatment System in Root Canals Obturated with Gutta-Percha Using Two Different Sealers and GuttaFlow

Science.gov (United States)

Siotia, Jaya; Acharya, Shashi Rashmi; Gupta, Sunil Kumar

2011-01-01

Objective. To compare the efficacy of ProTaper retreatment files in removing three different obturating materials. Study Design. Forty-five human, single-rooted premolars were divided into three experimental groups. Group 1 was obturated with gutta-percha and AH Plus sealer, Group 2 was obturated with gutta-percha and zinc oxide eugenol sealer, and Group 3 was obturated with GuttaFlow. Retreatment was done using the ProTaper universal rotary retreatment files. Root halves were visualized using magnifying loops at 3X magnification and optical stereomicroscope at 10X magnification. Images were analyzed using AutoCAD 2004 software to calculate area of the remaining debris in the canal. For statistical analysis were used variance test and ANOVA. Results. Total debris/canal area ratio between the three groups showed a statistically significant difference (P < 0.001). Conclusion. ProTaper retreatment system did not produce completely clean canals in any of the groups. However, it had the best efficacy towards removing silicon based obturating material GuttaFlow. PMID:22114598

A scientific model to determine the optimal radiographer staffing component in a nuclear medicine department

International Nuclear Information System (INIS)

Shipanga, A.N.; Ellmann, A.

2004-01-01

Full text: Introduction: Nuclear medicine in South Africa is developing fast. Much has changed since the constitution of a scientific model for determining an optimum number of radiographer posts in a Nuclear Medicine department in the late 1980's. Aim: The aim of this study was to ascertain whether the number of radiographers required by a Nuclear Medicine department can still be determined according to the norms established in 1988. Methods: A quantitative study using non-experimental evaluation design was conducted to determine the ratios between current radiographer workload and staffing norms. The workload ratios were analysed using the procedures statistics of the Nuclear Medicine department at Tygerberg Hospital. Radiographers provided data about their activities related to patient procedures, including information about the condition of the patients, activities in the radiopharmaceutical laboratory, and patient related administrative tasks. These were factored into an equation relating this data to working hours, including vacation and sick leave. The calculation of Activity Standards and an annual Standard Workload was used to finally calculate the staffing requirements for a Nuclear Medicine department. Results: Preliminary data confirmed that old staffing norms cannot be used in a modern Nuclear Medicine department. Protocols for several types of study have changed, including the additional acquisition of tomographic studies. Interest in the use of time-consuming non-imaging studies has been revived and should be factored Into the equation. Conclusions: All Nuclear Medicine departments In South Africa, where the types of studies performed have changed over the past years, should look carefully at their radiographer staffing ratio to ascertain whether the number of radiographers needed is adequate for the current workload. (author)

Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings

International Nuclear Information System (INIS)

Frank, Albert; Lefkowitz, David; Jaeger, Stanley; Gobar, Lisa; Sunderland, John; Gupta, Naresh; Scott, Walter; Mailliard, James; Lynch, Henry; Bishop, John; Thorpe, Patricia; Dewan, Naresh

1995-01-01

Purpose: The purpose of the study was to determine if Positron emission tomography (PET) 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) imaging could detect subclinical local lung cancer recurrence and whether retreatment of such recurrence was feasible and beneficial. Methods and Materials: Twenty patients with biopsy proven lung cancer were studied with Positron emission tomography for the purpose of detecting subclinical lung cancer recurrence over a period of 4.25 years. All patients were treated with external radiation as part or all of their therapy. Twenty patients had baseline PET and computed tomography (CT) studies for comparison with later studies. Surviving patients had a total of 40 sequential PET scans and 35 CT scans. The follow-up interval ranged from 5 to 40 months posttreatment. The differential uptake ratio (DUR) was determined for regions of interest of increased FDG uptake. Results: The median DUR value of the 20 baseline PET studies was 5.59. The DUR value of greater than 3 was empirically selected as being positive for tumor detection. On baseline studies, PET had a 100% correlation with the CT findings in regard to detection of the site of primary tumor involvement. Four of 20 patients showed areas of discordance in the mediastinal and hilar areas on initial PET and CT studies. Seven of 17 patients showed discordant posttreatment PET-CT findings. Two false positive PET studies were due to radiation pneumonitis and one to macrophage glycolysis in tumor necrosis. For detection of asymptomatic tumor recurrence, analysis of sequential PET and CT studies, biopsy results, and the patient's clinical course suggested that PET had a sensitivity of 100%, specificity of 89.3%, and accuracy of 92.5%. Computerized Tomography was found to have a sensitivity of 67%, specificity of 85%, and accuracy of 82% for detection of such early-stage recurrence. Five patients went on to have retreatment with external irradiation based upon the PET evidence. Four retreated

Comparing the staffing models of outsourcing in selected companies

OpenAIRE

Chaloupková, Věra

2010-01-01

This thesis deals with problems of takeover of employees in outsourcing. The capital purpose is to compare the staffing model of outsourcing in selected companies. To compare in selected companies I chose multi-criteria analysis. This thesis is dividend into six chapters. The first charter is devoted to the theoretical part. In this charter describes the basic concepts as outsourcing, personal aspects, phase of the outsourcing projects, communications and culture. The rest of thesis is devote...

Endodontic retreatment: clinical comparison of reciprocating systems versus rotary system in disinfecting root canals.

Science.gov (United States)

Martinho, Frederico C; Freitas, Lilian F; Nascimento, Gustavo G; Fernandes, Aleteia M; Leite, Fabio R M; Gomes, Ana P M; Camões, Izabel C G

2015-07-01

This clinical study was conducted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and cultivable bacteria in endodontic retreatment. Thirty endodontically treated teeth with post-treatment apical periodontitis were selected. The specimens were divided into three groups according to the system used: WaveOne (n = 10), Reciproc instrument (n = 10), and ProTaper Universal Retreatment system (n = 10). Samples were collected before and after chemomechanical preparation. The irrigation was performed by using 2.5% sodium hypochlorite. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial colony-forming unit counts. At baseline, endotoxins and cultivable bacteria were recovered from 100% of the root canal samples in a median value of 5.84 EU/mL and 4.98 × 10(3) CFU/mL, respectively. After CMP, no differences were found in the median percentage values of endotoxin reduction achieved with reciprocating systems-WaveOne [94.11%] and Reciproc [93.29%] and with rotary systems-ProTaper [94.98%] (P > 0.05). Both single-file reciprocating systems [WaveOne (98.27%) and Reciproc (99.54%)] and rotary system [ProTaper (98.73%)] were effective in reducing bacterial load (P > 0.05). Moreover, no differences were found among the systems tested. The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper system for removal of endotoxins and bacteria in endodontic retreatment. All systems tested were effective to remove cultivable bacteria and endotoxin in endodontic retreatment. As no differences among systems were observed, it is possible to suggest that clinicians should choose the preferred technique to perform endodontic.

Bathymetry and retreat of Southeast Greenland glaciers from Operation IceBridge and Ocean Melting Greenland data

Science.gov (United States)

Millan, R.; Rignot, E. J.; Morlighem, M.; Bjork, A. A.; Mouginot, J.; Wood, M.

2017-12-01

Southeast Greenland has been one of the largest contributors to ice mass loss in Greenland in part because of significant changes in glacier dynamics. The leading hypothesis for the changes in glacier dynamics is that enhanced thermal forcing from the ocean has dislodged a number of glaciers from their anchoring positions and some of them retreated rapidly along a reverse bed. The glaciers response has been observed to vary significantly from one fjord to the next, but until now there was not enough data to understand or interpret these changes. In particular, there was no data on glacier bed topography and seafloor bathymetry in the fjords. Here we present the results of new fjord mapping by the NASA Ocean Melting Greenland mission combined with a recent high-resolution airborne gravity survey by NASA Operation IceBridge. We combine these data with a reconstruction of the bed using a mass conservation approach upstream extending into the glacial fjords for the first time. In the fjord and along the ice-ocean transition, we employ a 3D inversion of gravity data to infer the bed elevation along a set of 9 survey boxes spanning south of Helheim Glacier to the southern tip of Southeast Greenland. We combine the results with an analysis of the glacier front history since the 1930's and Conductivity Temperature Depth data obtained in the fjord by OMG in 2016. The data reveals bed elevations several 100-m deeper than previously thought, for almost all the glaciers, up to 500 m for some of them. For many glaciers, the bed profiles help to completely understand the history of retreat of the glaciers. For instance, glaciers stranded on sills have been stable; glaciers on a reverse slope have retreated rapidly; and glaciers with a normal slope have retreated slowly. The mapping also helps document the extent of the marine portion of the glacier basins. In many of the fjords, we document the presence of warm, salty Atlantic Water which fuels large melt rates. We employ

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Directory of Open Access Journals (Sweden)

Célia Regina Farias de Araújo Lucena

2013-02-01

Full Text Available PURPOSE: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. METHODS: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group. In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2, and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-µm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection. Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums. RESULTS: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM was 4.7 ± 2.1 and was significantly lower (p<0.0001 than mean panretinal photocoagulation pain (60.8 ± 7.8. Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. CONCLUSION: In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment

Root Canal Retreatment menggunakan Kombinasi Kalsium Hidroksida dan Chlorhexidine sebagai Medikamen Intra Kanal Insisivus Sentral Kiri Maksila

Directory of Open Access Journals (Sweden)

Andina Novita Sari

2014-12-01

retreatment dengan cleaning dan shaping ulang yang baik dengan menggunakan medikasi intrakanal berupa kombinasi kalsium hidroksida dan chlorhexidine 2% diharapkan mempunyai efek antimikroba yang sinergis untuk mencapai kesuksesan root canal retreatment.   Root Canal Retreatment Using Calcium Hydroxide as Intra Canal Medicament On The Maxillary Left Incisor. Enterococcus faecalis bacteria is most abundant in the root canal infection treated endodontically. Chlorhexidine has a broad antibacterial spectrum and has been used as an endodontic irrigant and intracanal medication. Chlorhexidine has a bactericidal and fungicidal effect as chlorhexidine absorbed into the bacterial cell surface and cause damage to the integrity of the cell membrane. Calcium hydroxide is a biocompatible, antimicrobial agents with high pH effects and stimulates hard tissue formation. A mixture of calcium hydroxide and chlorhexidine is used to control bacteria Enterococcus faecalis alternative. The purpose of this case report is to report on the success of root canal treatment in the left maxillary central incisor with acute periapical periodontitis using a combination of calcium hydroxide and chlorhexidine as intracanal A 24 years old female patient presents with left upper central incisor tooth ache since 4 years ago. The tooth was hurt to percussion, but normal to pulpation as well as the mobility. The tooth has a history of previous trauma and broken 6 years ago and has performed endodontic treatment. Radiographic examination showed obturation teeth 21 are not hermetic with periapical radiolucency in diffuse boundaries, widening of the periodontal ligament and the dissolution of the lamina dura. Root canal re-treatment using a combination of calcium hydroxide and chlorhexidine as intracanal medicaments were performed. In conclussion, the root canal cleaning and shaping retreatment can be performed using a combination of calcium hydroxide and chlorhexidine as intracanal

The Multitrophic Effects of Climate Change and Glacier Retreat in Mountain Rivers.

Science.gov (United States)

Fell, Sarah C; Carrivick, Jonathan L; Brown, Lee E

2017-10-01

Climate change is driving the thinning and retreat of many glaciers globally. Reductions of ice-melt inputs to mountain rivers are changing their physicochemical characteristics and, in turn, aquatic communities. Glacier-fed rivers can serve as model systems for investigations of climate-change effects on ecosystems because of their strong atmospheric-cryospheric links, high biodiversity of multiple taxonomic groups, and significant conservation interest concerning endemic species. From a synthesis of existing knowledge, we develop a new conceptual understanding of how reducing glacier cover affects organisms spanning multiple trophic groups. Although the response of macroinvertebrates to glacier retreat has been well described, we show that there remains a relative paucity of information for biofilm, microinvertebrate, and vertebrate taxa. Enhanced understanding of whole river food webs will improve the prediction of river-ecosystem responses to deglaciation while offering the potential to identify and protect a wider range of sensitive and threatened species.

The retreat of the world's mountain glaciers during recent decades

International Nuclear Information System (INIS)

Francou, B.; Vincent, Ch.

2009-01-01

Glaciers have become essential tools for measuring changes in the global environment. Here, we analyze glacier evolution during the last few decades and we wonder whether the observed retreat remains in the range of glacier fluctuations since the mid-Holocene. The main fluctuations experienced by glaciers during the last millenniums, and particularly during the Little Ice Age (-1300 A.D. to ∼1860 A.D.), are presented succinctly. The recent 1960-2005 period, well documented both by ground and remote sensing observations, shows important disparities between different massifs concerning the timing and the magnitude of glacier fluctuations, which depend on regional climatic conditions. The links between glacier mass balance evolution and climate is clear when approached from an energy balance but the variables commonly considered are only temperature and precipitation. The strong correlation existing between these variables and the mass balance evolution makes it possible to simulate glaciers in the future in function of distinct climatic scenarios. Modeling glacier retreat for the 21. century is an important goal because it will allow the impacts on water resource and sea level to be assessed. (authors)

Skin-deep diagnosis: affective bias and zebra retreat complicating the diagnosis of systemic sclerosis.

Science.gov (United States)

Miller, Chad S

2013-01-01

Nearly half of medical errors can be attributed to an error of clinical reasoning or decision making. It is estimated that the correct diagnosis is missed or delayed in between 5% and 14% of acute hospital admissions. Through understanding why and how physicians make these errors, it is hoped that strategies can be developed to decrease the number of these errors. In the present case, a patient presented with dyspnea, gastrointestinal symptoms and weight loss; the diagnosis was initially missed when the treating physicians took mental short cuts and used heuristics as in this case. Heuristics have an inherent bias that can lead to faulty reasoning or conclusions, especially in complex or difficult cases. Affective bias, which is the overinvolvement of emotion in clinical decision making, limited the available information for diagnosis because of the hesitancy to acquire a full history and perform a complete physical examination in this patient. Zebra retreat, another type of bias, is when a rare diagnosis figures prominently on the differential diagnosis but the physician retreats for various reasons. Zebra retreat also factored in the delayed diagnosis. Through the description of these clinical reasoning errors in an actual case, it is hoped that future errors can be prevented or inspiration for additional research in this area will develop.

Improved age constraints for the retreat of the Irish Sea Ice Stream

Science.gov (United States)

Smedley, Rachel; Chiverrell, Richard; Duller, Geoff; Scourse, James; Small, David; Fabel, Derek; Burke, Matthew; Clarke, Chris; McCarroll, Danny; McCarron, Stephen; O'Cofaigh, Colm; Roberts, David

2016-04-01

BRITICE-CHRONO is a large (> 45 researchers) consortium project working to provide an extensive geochronological dataset constraining the rate of retreat of a number of ice streams of the British-Irish Ice Sheet following the Last Glacial Maximum. When complete, the large empirical dataset produced by BRITICE-CHRONO will be integrated into model simulations to better understand the behaviour of the British-Irish Ice Sheet in response to past climate change, and provide an analogue for contemporary ice sheets. A major feature of the British-Irish Ice Sheet was the dynamic Irish Sea Ice Stream, which drained a large proportion of the ice sheet and extended to the proposed southern limit of glaciation upon the Isles of Scilly (Scourse, 1991). This study will focus on a large suite of terrestrial samples that were collected along a transect of the Irish Sea basin, covering the line of ice retreat from the Isles of Scilly (50°N) in the south, to the Isle of Man (54°N) in the north; a distance of 500 km. Ages are determined for both the eastern and western margins of the Irish Sea using single-grain luminescence dating (39 samples) and terrestrial cosmogenic nuclide dating (10 samples). A Bayesian sequence model is then used in combination with the prior information determined for deglaciation to integrate the geochronological datasets, and assess retreat rates for the Irish Sea Ice Stream. Scourse, J.D., 1991. Late Pleistocene stratigraphy and palaeobotany of the Isles of Scilly. Philosophical Transactions of the Royal Society of London B334, 405 - 448.

Staffing Levels and Inpatient Outcomes at Military Health Care Facilities: A Resource-Based View

National Research Council Canada - National Science Library

Yap, Glenn

2004-01-01

Using a Resource-Based Theory/View of the firm, this study examined if increased inpatient staffing levels at military hospitals can generate a competitive advantage based on better patient quality outcomes...

Modelling Waterfall Retreat in Heterogenous Bedrock

Science.gov (United States)

Attal, M.; Hodge, R. A.; Williams, R.; Baynes, E.

2016-12-01

Bedrock rivers are the mediators of environmental change through mountainous landscapes. In response to an increase in uplift rate for example, a "knickpoint" (often materialised as a waterfall) will propagate upstream, separating a domain downstream where the river and its adjacent hillslopes have steepened in response to the change from a "relict" domain upstream which is adjusted to the conditions before the change (Crosby and Whipple 2006). Many studies assume that knickpoint propagation rate scales with drainage area, based on the stream power theory. However, recent studies in a range of locations have found no obvious relationship between knickpoint retreat rate and drainage area, potentially resulting from the stream power law neglecting (i) the influence of sediment on the processes associated with waterfall migration and (ii) thresholds for bedrock detachment (Cook et al. 2013; Mackey et al. 2014; DiBiase et al. 2015; Baynes et al. 2015; Brocard et al. 2016). In this study, we develop a 1D model of waterfall retreat in horizontally bedded bedrock with varying joint spacing. In the model, knickpoint migration is based on two rules: a waterfall will start migrating once the threshold flow depth (a function of knickpoint height and joint spacing) has been exceeded (Lamb and Dietrich 2009), and the migration rate will then be a function of the water-depth-to-waterfall-height ratio, based on experimental results by Baynes (2015). Using a hydrograph based on a Poisson rectangular pulse rainfall simulator (Tucker and Bras 2001), we demonstrate the importance of structure in controlling the speed at which waterfalls migrate but also their number and the length over which they are distributed (Fig. 1). The model is applied to the Jökulsá á Fjöllum, NE Iceland, where rapid migration of waterfalls as a result of discrete events has been identified (Baynes et al. 2015), using new constraints on joint spacing derived from high resolution lidar survey of the gorge

ACL Research Retreat VI : An update on ACL injury risk and prevention

NARCIS (Netherlands)

R.J. Schmitz; M. Collins; D.A. Padua; Anne Benjaminse; A.M. Chaudhari; S.J. Schultz

2012-01-01

It has been well recognized that multiple factors, whether individually or in combination, contribute to noncontact anterior cruciate ligament (ACL) injury. The ongoing mission of the ACL Research Retreat is to bring clinicians and researchers together to present and discuss the most recent advances

Probabilistic estimation of dune retreat on the Gold Coast, Australia

Science.gov (United States)

Palmsten, Margaret L.; Splinter, Kristen D.; Plant, Nathaniel G.; Stockdon, Hilary F.

2014-01-01

Sand dunes are an important natural buffer between storm impacts and development backing the beach on the Gold Coast of Queensland, Australia. The ability to forecast dune erosion at a prediction horizon of days to a week would allow efficient and timely response to dune erosion in this highly populated area. Towards this goal, we modified an existing probabilistic dune erosion model for use on the Gold Coast. The original model was trained using observations of dune response from Hurricane Ivan on Santa Rosa Island, Florida, USA (Plant and Stockdon 2012. Probabilistic prediction of barrier-island response to hurricanes, Journal of Geophysical Research, 117(F3), F03015). The model relates dune position change to pre-storm dune elevations, dune widths, and beach widths, along with storm surge and run-up using a Bayesian network. The Bayesian approach captures the uncertainty of inputs and predictions through the conditional probabilities between variables. Three versions of the barrier island response Bayesian network were tested for use on the Gold Coast. One network has the same structure as the original and was trained with the Santa Rosa Island data. The second network has a modified design and was trained using only pre- and post-storm data from 1988-2009 for the Gold Coast. The third version of the network has the same design as the second version of the network and was trained with the combined data from the Gold Coast and Santa Rosa Island. The two networks modified for use on the Gold Coast hindcast dune retreat with equal accuracy. Both networks explained 60% of the observed dune retreat variance, which is comparable to the skill observed by Plant and Stockdon (2012) in the initial Bayesian network application at Santa Rosa Island. The new networks improved predictions relative to application of the original network on the Gold Coast. Dune width was the most important morphologic variable in hindcasting dune retreat, while hydrodynamic variables, surge and

Healing the heart: a randomized pilot study of a spiritual retreat for depression in acute coronary syndrome patients.

Science.gov (United States)

Warber, Sara L; Ingerman, Sandra; Moura, Vera L; Wunder, Jenna; Northrop, Alyssa; Gillespie, Brenda W; Durda, Kate; Smith, Katherine; Rhodes, Katherine S; Rubenfire, Melvyn

2011-01-01

Depression is associated with increased risk of cardiovascular morbidity and mortality in coronary heart disease. Numerous conventional and complementary therapies may address depression. Few involving spirituality have been tested. The aim of this study was to compare the effects of a nondenominational spiritual retreat, Medicine for the Earth (MFTE), on depression and other measures of well-being six- to 18-months post acute coronary syndrome (ACS). A randomized controlled pilot study of MFTE, Lifestyle Change Program (LCP), or usual cardiac care (control) was conducted in Southeastern Michigan. ACS patients were recruited via local and national advertising (n = 58 enrolled, 41 completed). The four-day MFTE intervention included guided imagery, meditation, drumming, journal writing, and nature-based activities. The four-day LCP included nutrition education, exercise, and stress management. Both retreat groups received follow-up phone coaching biweekly for three months. Validated self-report scales of depression, spiritual well-being, perceived stress, and hope were collected at baseline, immediately post-retreat, and at three and six months. Depression was not significantly different among groups (P = .21). However, the MFTE group had the highest depression scores at baseline and had significantly lower scores at all postintervention time points (P ≤ .002). Hope significantly improved among MFTE participants, an effect that persisted at three- and six-month follow-up (P = .014). Although several measures showed improvement in all groups by six months, the MFTE group had immediate improvement post-retreat, which was maintained. This pilot study shows that a nondenominational spiritual retreat, MFTE, can be used to increase hope while reducing depression in patients with ACS. Copyright © 2011 Elsevier Inc. All rights reserved.

Radioiodine uptake following iodine-131 therapy for Graves' disease: an early indicator of need for retreatment

Energy Technology Data Exchange (ETDEWEB)

Carpentier, W.R.; Gilliland, P.F.; Piziak, V.K.; Petty, F.C.; McConnell, B.G.; Verdonk, C.A.; Ibarra, J.D.; Thompson, J.Q.

1989-01-01

Forty-five patients with Graves' disease were studied prospectively to determine if 24-hour I-131 uptake measurements alone or in combination with serum thyroid hormone levels at six weeks would determine the necessity for retreatment of the thyrotoxicosis. All patients with an I-131 uptake greater than 30% at six weeks required retreatment. No patient with an I-131 uptake of less than 15% required retreatment. Patients with uptakes between 15% and 30% were variable. An elevated free thyroxin index at 6 weeks is not helpful to determine which patients will remain thyrotoxic. Patients with a free thyroxin index within the normal range at six weeks can be predicted to be euthyroid by 12 weeks if their 24-hour I-131 uptake is between 15% and 30% and to be hypothyroid if their 24-hour I-131 uptake is below 15%. There was no difference between patient groups treated initially with antithyroid medication and those who were not.

Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review.

Science.gov (United States)

Goryakin, Yevgeniy; Griffiths, Peter; Maben, Jill

2011-04-01

Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future

Risk factors for treatment default among re-treatment tuberculosis patients in India, 2006.

Science.gov (United States)

Jha, Ugra Mohan; Satyanarayana, Srinath; Dewan, Puneet K; Chadha, Sarabjit; Wares, Fraser; Sahu, Suvanand; Gupta, Devesh; Chauhan, L S

2010-01-25

Under India's Revised National Tuberculosis Control Programme (RNTCP), >15% of previously-treated patients in the reported 2006 patient cohort defaulted from anti-tuberculosis treatment. To assess the timing, characteristics, and risk factors for default amongst re-treatment TB patients. For this case-control study, in 90 randomly-selected programme units treatment records were abstracted from all 2006 defaulters from the RNTCP re-treatment regimen (cases), with one consecutively-selected non-defaulter per case. Patients who interrupted anti-tuberculosis treatment for >2 months were classified as defaulters. 1,141 defaulters and 1,189 non-defaulters were included. The median duration of treatment prior to default was 81 days (25%-75% interquartile range 44-117 days) and documented retrieval efforts after treatment interruption were inadequate. Defaulters were more likely to have been male (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.2-1.7), have previously defaulted anti-tuberculosis treatment (aOR 1.3 95%CI 1.1-1.6], have previous treatment from non-RNTCP providers (AOR 1.3, 95%CI 1.0-1.6], or have public health facility-based treatment observation (aOR 1.3, 95%CI 1.1-1.6). Amongst the large number of re-treatment patients in India, default occurs early and often. Improved pre-treatment counseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening.

Daddy's Gone to Colorado: Male-Staffed Child Care for Father-Absent Boys.

Science.gov (United States)

Brody, Steve

1978-01-01

The article presents the goals, methods, and case examples of The Nutury, a predominantly male-staffed child care center serving single-parent children. The primary goal is to provide consistent relationships with men for children without a male model in their home. Clinical observations reveal positive life-styles and attitudes. (LPG)

Staffing a call center with uncertain non-stationary arrival rate and flexibility

NARCIS (Netherlands)

Liao, S.; van Delft, C.; Jouini, O.; Koole, G.M.

2012-01-01

We consider a multi-period staffing problem in a single-shift call center. The call center handles inbound calls, as well as some alternative back-office jobs. The call arrival process is assumed to follow a doubly non-stationary stochastic process with a random mean arrival rate. The inbound calls

Is Theory Applied in Practice?A Stady of Linkage between Swedish MNC's Strategies and Húman Resource Staffing Policies

OpenAIRE

Ivinger, Linnea; Lindvetter, Lisa

2006-01-01

Theory suggests that there is a linkage between strategies and human resource staffing policies. Our aim with the dissertation was to test if such a linkage could be proven in Swedish MNCs. Also, indications spoke for ethnocentric tendencies in MNCs. We wanted to test if this was the reality for Swedish companies. In order to test the linkage we had to categorise the companies’ strategies and human resource staffing policies. By a survey we concluded that there was not full consistency in the...

Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

Directory of Open Access Journals (Sweden)

Karien Jooste

2013-03-01

Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

Directory of Open Access Journals (Sweden)

Karien Jooste

2013-01-01

Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

Synthesis of the project leadership staffing needs for successful development of alternative delivery programs.

Science.gov (United States)

2017-08-01

This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

Linking Backbarrier Lacustrine Stratigraphy with Spatial Dynamics of Shoreline Retreat in a Rapidly Subsiding Region of the Mississippi River Delta

Science.gov (United States)

Dietz, M.; Liu, K. B.; Bianchette, T. A.; Yao, Q.

2017-12-01

The shoreline along the northern Gulf of Mexico is rapidly retreating as coastal features of abandoned Mississippi River delta complexes erode and subside. Bay Champagne is located in the Caminada-Moreau headland, a region of shoreline west of the currently active delta that has one of the highest rates of retreat and land loss. As a result, this site has transitioned from a stable, circular inland lake several kilometers from the shore to a frequently perturbed, semi-circular backbarrier lagoon, making it ideal to study the environmental effects of progressive land loss. Analyses of clastic layers in a series of sediment cores collected at this site over the past decade indicate the lake was less perturbed in the past and has become increasingly more sensitive to marine incursion events caused by tropical cyclones. Geochemical and pollen analyses of these cores also reveal profound changes in environmental and chemical conditions in Bay Champagne over the past century as the shoreline has retreated. Through relating stratigraphy to spatial changes observed from satellite imagery, this study attempts to identify the tipping point at which Bay Champagne began the transition from an inland lake to a backbarrier environment, and to determine the rate at which this transition occurred. Results will be used to develop a model of the environmental transition experienced by a rapidly retreating coastline and to predict how other regions of the Mississippi River deltaic system could respond to future shoreline retreat.

The use of social Stegodyphus spider retreats as nest-lining by pale ...

African Journals Online (AJOL)

The pale chanting-goshawk (Melierax canorus) incorporates silk nests (hereafter 'retreats') of the social spider Stegodyphus dumicola (Araneae: Eresidae) in the construction of the nest-lining of their own nests. This study investigates whether pale chanting-goshawks in the Little Karoo, South Africa, show a preference for ...

Running Head: Evaluation of Contract Versus VA-Staffed CBOCs. Evaluating Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCs) Using Patient Satisfaction and Access Measures in the Veterans Health Administration

Science.gov (United States)

2009-06-01

staffed CBOC, with dependent variables adjusting for SHEP scores and case mix factors. The equation for the null hypothesis is Hho = In (estimated...that the model can be further improved through combining several of the satisfaction scores. The equation for the null hypothesis is that Hho = In

Interest in health promotion among Korean American Seventh-day Adventists attending a religious retreat.

Science.gov (United States)

Jo, Angela M; Maxwell, Annette E; Choi, Sunhye; Bastani, Roshan

2012-01-01

Little is known about interest in faith-based health promotion programs among Asian American populations. Among the Christian denominations, the Seventh-day Adventist (SDA) church is known to place a strong doctrinal emphasis on health. To understand appropriate ways to develop and implement health promotion programs and to conduct research among Korean American SDAs. We collaborated with the North American Division of Korean SDA Churches which sponsors annual week-long religious retreats for their church members. We developed and administered a 10-page questionnaire at their 2009 retreat in order to assess socio-demographic and church characteristics, religiosity, perceived relationship between health and religion, and interest and preferences for church-based health promotion programs. Overall, 223 participants completed our survey (123 in Korean and 100 in English). The sample consisted of regular churchgoers who were involved in a variety of helping activities, and many holding leadership positions in their home churches. The vast majority was interested in receiving health information at church (80%) in the form of seminars, cooking classes and workshops (50-60%). Fewer respondents were interested in support groups (27%). Some interests and preferences differed between English and Korean language groups. Korean American SDA church retreat participants from a large geographic area are very interested in receiving health information and promoting health at their churches and can potentially serve as "agents of influence" in their respective communities.

Yoga, Meditation and Mind-Body Health: Increased BDNF, Cortisol Awakening Response, and Altered Inflammatory Marker Expression after a 3-Month Yoga and Meditation Retreat

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B. Rael Cahn

2017-06-01

Full Text Available Thirty-eight individuals (mean age: 34.8 years old participating in a 3-month yoga and meditation retreat were assessed before and after the intervention for psychometric measures, brain derived neurotrophic factor (BDNF, circadian salivary cortisol levels, and pro- and anti-inflammatory cytokines. Participation in the retreat was found to be associated with decreases in self-reported anxiety and depression as well as increases in mindfulness. As hypothesized, increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR were also observed. The normalized change in BDNF levels was inversely correlated with BSI-18 anxiety scores at both the pre-retreat (r = 0.40, p < 0.05 and post-retreat (r = 0.52, p < 0.005 such that those with greater anxiety scores tended to exhibit smaller pre- to post-retreat increases in plasma BDNF levels. In line with a hypothesized decrease in inflammatory processes resulting from the yoga and meditation practices, we found that the plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Contrary to our initial hypotheses, plasma levels of other pro-inflammatory cytokines, including Interferon Gamma (IFN-γ, Tumor Necrosis Factor (TNF-α, Interleukin-1β (IL-1β, Interleukin-6 (IL-6, and Interleukin-8 (IL-8 were increased after the retreat. Given evidence from previous studies of the positive effects of meditative practices on mental fitness, autonomic homeostasis and inflammatory status, we hypothesize that these findings are related to the meditative practices throughout the retreat; however, some of the observed changes may also be related to other aspects of the retreat such as physical exercise-related components of the yoga practice and diet. We hypothesize that the patterns of change observed here reflect mind-body integration and well-being. The increased BDNF levels

[The new methods to define the staffing requirements for doctors,nurses and nurses aides: an example of their implementation in an Italian hospital].

Science.gov (United States)

Laquintana, Dario; Pazzaglia, Silvia; Demarchi, Antonia

2017-01-01

. The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of € 1.828.562,00. The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.

Enhancing Nursing Staffing Forecasting With Safety Stock Over Lead Time Modeling.

Science.gov (United States)

McNair, Douglas S

2015-01-01

In balancing competing priorities, it is essential that nursing staffing provide enough nurses to safely and effectively care for the patients. Mathematical models to predict optimal "safety stocks" have been routine in supply chain management for many years but have up to now not been applied in nursing workforce management. There are various aspects that exhibit similarities between the 2 disciplines, such as an evolving demand forecast according to acuity and the fact that provisioning "stock" to meet demand in a future period has nonzero variable lead time. Under assumptions about the forecasts (eg, the demand process is well fit as an autoregressive process) and about the labor supply process (≥1 shifts' lead time), we show that safety stock over lead time for such systems is effectively equivalent to the corresponding well-studied problem for systems with stationary demand bounds and base stock policies. Hence, we can apply existing models from supply chain analytics to find the optimal safety levels of nurse staffing. We use a case study with real data to demonstrate that there are significant benefits from the inclusion of the forecast process when determining the optimal safety stocks.

A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

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Kamis-Gould, Edna; And Others

1991-01-01

A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

Creating a specialist protein resource network: a meeting report for the protein bioinformatics and community resources retreat

DEFF Research Database (Denmark)

Babbitt, Patricia C.; Bagos, Pantelis G.; Bairoch, Amos

2015-01-01

During 11–12 August 2014, a Protein Bioinformatics and Community Resources Retreat was held at the Wellcome Trust Genome Campus in Hinxton, UK. This meeting brought together the principal investigators of several specialized protein resources (such as CAZy, TCDB and MEROPS) as well as those from...... protein databases from the large Bioinformatics centres (including UniProt and RefSeq). The retreat was divided into five sessions: (1) key challenges, (2) the databases represented, (3) best practices for maintenance and curation, (4) information flow to and from large data centers and (5) communication...

Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface.

Science.gov (United States)

Simon, Michael; Hausner, Elke; Klaus, Susan F; Dunton, Nancy E

2010-08-23

The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized terminology (e.g. by consistent use of the

The Creation of Task-Based Differentiated Learning Materials for Students with Learning Difficulties and/or Disabilities.

Science.gov (United States)

Barker, Trevor; Jones, Sara; Britton, Carol; Messer, David

This paper describes Horizon, a European-funded project designed to increase employment opportunities for students with disabilities or learning difficulties. The project established a working cafe/restaurant (Cafe Horizon) in East London staffed by students. Part of the project involved the creation of multimedia units linked directly to Level 1…

Retreatment of patients with treatment failure of direct-acting antivirals: Focus on hepatitis C virus genotype 1b.

Science.gov (United States)

Kanda, Tatsuo; Nirei, Kazushige; Matsumoto, Naoki; Higuchi, Teruhisa; Nakamura, Hitomi; Yamagami, Hiroaki; Matsuoka, Shunichi; Moriyama, Mitsuhiko

2017-12-14

The recent development of direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) infection could lead to higher sustained virological response (SVR) rates, with shorter treatment durations and fewer adverse events compared with regimens that include interferon. However, a relatively small proportion of patients cannot achieve SVR in the first treatment, including DAAs with or without peginterferon and/or ribavirin. Although retreatment with a combination of DAAs should be conducted for these patients, it is more difficult to achieve SVR when retreating these patients because of resistance-associated substitutions (RASs) or treatment-emergent substitutions. In Japan, HCV genotype 1b (GT1b) is founded in 70% of HCV-infected individuals. In this minireview, we summarize the retreatment regimens and their SVR rates for HCV GT1b. It is important to avoid drugs that target the regions targeted by initial drugs, but next-generation combinations of DAAs, such as sofosbuvir/velpatasvir/voxilaprevir for 12 wk or glecaprevir/pibrentasvir for 12 wk, are proposed to be potential solution for the HCV GT1b-infected patients with treatment failure, mainly on a basis of targeting distinctive regions. Clinicians should follow the new information and resources for DAAs and select the proper combination of DAAs for the retreatment of HCV GT1b-infected patients with treatment failure.

Visual arts student Bryan Lawson creates award-winning crop circle design

OpenAIRE

Chadwick, Heather Riley

2009-01-01

Bryan Lawson of Rural Retreat, Va., a senior visual communication design/studio art student in Virginia Tech's School of Visual Arts, College of Architecture and Urban Studies, won third place in the international Red Bull Art of Can design competition.

Reversing Course: The Troubled State of Academic Staffing and a Path Forward

Science.gov (United States)

American Federation of Teachers (NJ), 2008

2008-01-01

Over the last generation, the instructional staffing system in American higher education has experienced a significant reduction in the proportion of jobs for full-time tenured and tenure-track faculty members and a dramatic growth in fixed-term full- and part-time instructional jobs without tenure. About 70 percent of the people teaching in…

The paradox of a long grounding during West Antarctic Ice Sheet retreat in Ross Sea.

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Bart, Philip J; Krogmeier, Benjamin J; Bart, Manon P; Tulaczyk, Slawek

2017-04-28

Marine geological data show that the West Antarctic Ice Sheet (WAIS) advanced to the eastern Ross Sea shelf edge during the Last Glacial Maximum (LGM) and eventually retreated ~1000 km to the current grounding-line position on the inner shelf. During the early deglacial, the WAIS deposited a voluminous stack of overlapping grounding zone wedges (GZWs) on the outer shelf of the Whales Deep Basin. The large sediment volume of the GZW cluster suggests that the grounding-line position of the paleo-Bindschadler Ice Stream was relatively stationary for a significant time interval. We used an upper bound estimate of paleo-sediment flux to investigate the lower bound duration over which the ice stream would have deposited sediment to account for the GZW volume. Our calculations show that the cluster represents more than three millennia of ice-stream sedimentation. This long duration grounding was probably facilitated by rapid GZW growth. The subsequent punctuated large-distance (~200 km) grounding-line retreat may have been a highly non-linear ice sheet response to relatively continuous external forcing such as gradual climate warming or sea-level rise. These findings indicate that reliable predictions of future WAIS retreat may require incorporation of realistic calculations of sediment erosion, transport and deposition.

Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease

Directory of Open Access Journals (Sweden)

Karlsson Mats

2010-07-01

Full Text Available Abstract Background Patients with IBD and chronic inflammation refractory to conventional therapy often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment as well as surgical intervention are often used in this patient group. Hence, there is need for additional treatment options. In this observational study, focused on re-treatment and long-term results, Granulocyte/Monocyte Adsorption (GMA, Adacolumn® treatment has been investigated to study efficacy, safety and quality of life in IBD-patients with chronic activity. Methods Fifteen patients with ulcerative colitis and 25 patients with Crohn's disease, both groups with chronically active inflammation refractory to conventional medication were included in this observational study. The patients received 5-10 GMA sessions, and the clinical activity was assessed at baseline, after each completed course, and at week 10 and 20 by disease activity index, endoscopy and quality of life evaluation. Relapsed patients were re-treated by GMA in this follow-up study up to 58 months. Results Clinical response was seen in 85% and complete remission in 65% of the patients. Ten patients in the UC-group (66% and 16 patients in the CD-group (64% maintained clinical and endoscopic remission for an average of 14 months. Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93% went into a second remission. Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time. Conclusions IBD-patients with chronic inflammation despite conventional therapy seem to benefit from GMA. Re-treatment of relapsing remission patients seems to be effective.

The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: a questionnaire study.

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Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Kuusio, Hannamaria; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo

2011-12-01

Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. Cross-sectional questionnaire study. 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important. 2011 Elsevier Ltd. All rights reserved.

Evidence for slow late-glacial ice retreat in the upper Rangitata Valley, South Island, New Zealand

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Shulmeister, J.; Fink, D.; Winkler, S.; Thackray, G. D.; Borsellino, R.; Hemmingsen, M.; Rittenour, T. M.

2018-04-01

A suite of cosmogenic radionuclide ages taken from boulders on lateral and latero-terminal moraines in the Rangitata Valley, eastern South Island, New Zealand demonstrates that relatively thick ice occupied valley reaches inland of the Rangitata Gorge until c. 21 ka. Thereafter ice began to thin, and by c. 17 ka it had retreated 33 km up-valley of the Rangitata Gorge to the Butler-Brabazon Downs, a structurally created basin in the upper Rangitata Valley. Despite its magnitude, this retreat represents a minor ice volume reduction from 21 ka to 17 ka, and numerous lateral moraines preserved suggest a relatively gradual retreat over that 4 ka period. In contrast to records from adjacent valleys, there is no evidence for an ice-collapse at c. 18 ka. We argue that the Rangitata record constitutes a more direct record of glacial response to deglacial climate than other records where glacial dynamics were influenced by proglacial lake development, such as the Rakaia Valley to the North and the major valleys in the Mackenzie Basin to the south-west. Our data supports the concept of a gradual warming during the early deglaciation in the South Island New Zealand.

Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

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Subhakar Kandi

2013-01-01

Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

Seabed Gradient Controlling Onshore Transport Rates of Surf Sand during Beach Retreat by Sea Level Rise

Science.gov (United States)

Lee, Hee Jun; Yi, Hi-Il

2018-03-01

A simple relationship is proposed for the onshore transport rates of surf-zone sand to evaluate the beach retreat caused by sea level rise. It suggests that the preservation potential of surf sand is proportional inversely to the seabed gradient during beach retreat. According to this relationship, the erosional remnants of surf sand would be more readily developed on a gentler shelf collectively as transgressive sand sheets. This finding may explain the previous studies regarding the Korean shelves that proposed that the Holocene transgressive sand sheets (HTSS) occur not in the steep eastern shelf but in the gentle western shelf. In line with such presence/absence of the HTSS are the results from some coastal seismic profiles obtained in the present study. The profiles indicate that sand deposits are restricted within the nearshore in the eastern coast, whereas they are persistently traceable to the offshore HTSS in the western coast. Tide is proven to have a negligible influence on the total duration of surf-zone processes. This study may be useful in predicting the consequences of the beach retreat that takes place worldwide as sea levels rise as a result of global warming.

Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.

Science.gov (United States)

Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H

2011-12-01

To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.

Pathology informatics fellowship retreats: The use of interactive scenarios and case studies as pathology informatics teaching tools.

Science.gov (United States)

Lee, Roy E; McClintock, David S; Balis, Ulysses J; Baron, Jason M; Becich, Michael J; Beckwith, Bruce A; Brodsky, Victor B; Carter, Alexis B; Dighe, Anand S; Haghighi, Mehrvash; Hipp, Jason D; Henricks, Walter H; Kim, Jiyeon Y; Klepseis, Veronica E; Kuo, Frank C; Lane, William J; Levy, Bruce P; Onozato, Maristela L; Park, Seung L; Sinard, John H; Tuthill, Mark J; Gilbertson, John R

2012-01-01

Last year, our pathology informatics fellowship added informatics-based interactive case studies to its existing educational platform of operational and research rotations, clinical conferences, a common core curriculum with an accompanying didactic course, and national meetings. The structure of the informatics case studies was based on the traditional business school case study format. Three different formats were used, varying in length from short, 15-minute scenarios to more formal multiple hour-long case studies. Case studies were presented over the course of three retreats (Fall 2011, Winter 2012, and Spring 2012) and involved both local and visiting faculty and fellows. Both faculty and fellows found the case studies and the retreats educational, valuable, and enjoyable. From this positive feedback, we plan to incorporate the retreats in future academic years as an educational component of our fellowship program. Interactive case studies appear to be valuable in teaching several aspects of pathology informatics that are difficult to teach in more traditional venues (rotations and didactic class sessions). Case studies have become an important component of our fellowship's educational platform.

The profile and treatment outcomes of sputum smear positive pulmonary tuberculosis re-treatment cases, in a district medical college of West Bengal, India

Directory of Open Access Journals (Sweden)

Abinash Agarwala

2014-01-01

Full Text Available Background: In a high tuberculosis (TB burden county like India with different regional demography, knowledge about patient profile has a pivotal role in determining and identifying the factors associated with poor treatment outcomes among TB re-treatment cases. Aim: The aim was to describe the demography and clinical characteristics of TB re-treatment cases and to evaluate the factors associated with poor treatment outcomes among those patients. Settings and Design: A prospective longitudinal cohort study was carried out at chest medicine outdoor from February, 2011 to 2014 in a district medical college of West Bengal, India. Materials and Methods: Sputum smear positive re-treatment pulmonary TB patients attending our chest medicine outdoor during the 3 years study period were evaluated for demographic and clinical characteristics on the basis of previous treatment history and records at the beginning of the study. Patients were followed-up during the 8 months treatment period (Category II treatment regimen under Revised National TB Control Program. At the end of the study period, treatment outcomes were analyzed and factors associated with poor treatment outcomes were identified. Statistical Analysis: All variables were described by proportions, and differences between independent groups were compared using the Chi-square test and Fisher′s exact test, as applicable. Results: Among 74 patients, re-treatment was successful in 75.7% of relapse case, 66.7% of loss to follow-up cases and 53.8% of failure cases. Re-treatment failure was higher (38.5% in treatment failure cases compare to relapse cases (10.8% and initial loss to follow-up cases (16.7%. Young age, male, unmarried, employed who work outside appears to be the risk factors for loss to follow-up. Low body mass index, treatment from the private sector, history of alcoholism, radiological cavitory lesion, larger duration of previous treatment, lesser gap from previous treatment has

Staffing requirements for future small and medium reactors (SMRs) based on operating experience and projections

International Nuclear Information System (INIS)

2001-01-01

At the time of this study there were about 160 small and medium sized nuclear power reactors (referred to as SMRs) in operation worldwide, and about 25 more under construction. Operation and maintenance costs for operating SMRs represent a substantial portion of the cost of electricity produced. Of these costs, the direct and indirect cost of staff represents the major cost component. In recent years, particularly since 1990, there has been increased interest in SMRs by many developing countries wishing to take advantage of nuclear power and several small and medium reactor designs are in various stages of development. To enhance the economic competitive position of SMRs relative to alternative methods of electricity generation, it is essential to ensure that new SMRs can be operated reliably and efficiently using the optimum number of staff. This publication reviews the lessons learned from the reactor operation, and the insights gained through the design of new SMRs, with a view to optimizing staffing in order to improve overall plant economics without compromising safety.This publication is intended to evaluate the estimated staffing size of various SMRs, the staff qualification and training required for the operation of future SMRs. and the key issues which impact the staffing requirements that should be considered in the development and deployment of future SMRs

The role of bank collapse on tidal creek ontogeny: A novel process-based model for bank retreat

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Gong, Zheng; Zhao, Kun; Zhang, Changkuan; Dai, Weiqi; Coco, Giovanni; Zhou, Zeng

2018-06-01

Bank retreat in coastal tidal flats plays a primary role on the planimetric shape of tidal creeks and is commonly driven by both flow-induced bank erosion and gravity-induced bank collapse. However, existing modelling studies largely focus on bank erosion and overlook bank collapse. We build a bank retreat model coupling hydrodynamics, bank erosion and bank collapse. To simulate the process of bank collapse, a stress-deformation model is utilized to calculate the stress variation of bank soil after bank erosion, and the Mohr-Coulomb failure criterion is then applied to evaluate the stability of the tidal creek bank. Results show that the bank failure process can be categorized into three stages, i.e., shear failure at the bank toe (stage I), tensile failure on the bank top (stage II), and sectional cracking from the bank top to the toe (stage III). With only bank erosion, the planimetric shapes of tidal creeks are funneled due to the gradually seaward increasing discharge. In contrast to bank erosion, bank collapse is discontinuous, and the contribution of bank collapse to bank retreat can reach 85%, highlighting that the expansion of tidal creeks can be dominated by bank collapse process. The planimetric shapes of tidal creeks are funneled with a much faster expansion rate when bank collapse is considered. Overall, this study makes a further step toward more physical and realistic simulation of bank retreat in estuarine and coastal settings and the developed bank collapse module can be readily included in other morphodynamic models.

The Comparative Efficacy of Different Files in The Removal of Different Sealers in Simulated Root Canal Retreatment- An In-vitro Study.

Science.gov (United States)

Kanaparthy, Aruna; Kanaparthy, Rosaiah

2016-05-01

Root canal treatment enjoys a high success rate all over the world and has saved billions of teeth from extraction. However, there are instances of failure, the main causes being insufficient cleaning and inadequate obturation. In such cases the most conservative treatment option would be non-surgical retreatment. It requires regaining access to the entire root canal system through removal of the original root canal filling thus permitting further cleaning and re- obturation. Removal of gutta-percha and sealer becomes a critical step to gain access to the root canal system, remove necrotic tissue debris, bacteria and infected dentin. To compare and evaluate the efficacy of manual hand Hedstrom files and two rotary retreatment file systems ProTaper Universal retreatment files and Mtwo(R) (retreatment) files in the removal of root canal filling material during root canal retreatment and the influence of the type of sealers zinc oxide eugenol and AH plus on the presence of remaining debris in the reinstrumented canals in the apical, middle and coronal third. Sixty single rooted human premolar teeth were divided into 3 Groups of 20 teeth each Group I (20 Teeth): prepared using hand K Files, Group II (20 Teeth): prepared using ProTaper rotary system and Group III (20 Teeth): prepared using Mtwo rotary system. In Groups- IA, IIA, IIIA: (10 teeth each) Obturation was done using Zinc Oxide Eugenol sealer and gutta percha. In Groups- IB, IIB, IIIB: (10 teeth each) obturation was done with AH Plus sealer and gutta percha. All the teeth were subjected to retreatment. Groups IA and IB with Hedstrom files, Groups IIA and IIB with ProTaper retreatment files and for Groups IIIA and IIIB with Mtwo retreatment Files. The roots were longitudinally split and were observed under a stereomicroscope for remaining amount of filling material on the canal walls. Statistical analysis was done using One-way ANOVA (Analysis of variance) test and Tukey HSD Test. Mtwo(R) files showed

Knickpoint formation and retreat: stairway to heaven or pathway to declivity

Science.gov (United States)

Rengers, Francis; Tucker, Gregory

2016-04-01

The importance of knickpoints in shaping fluvial systems has been observed in laboratory settings, small experimental plots, and at the landscape scale. By creating a step in a river's longitudinal profile, knickpoints can shield upstream tributaries from a much lower base level, and therefore represent a buffer in the energy transfer of a stream system. Knickpoints are located at a transition point between the potential energy of material stored upstream and the kinetic energy of erosion processes and sediment transport below the knickpoint. We hypothesize that the long-term persistence of a discrete, retreating knickpoint requires a balance between the fluvial erosion of the feature, and sedimentation rates downstream. Here we present the results of a short-term (four year) study of knickpoint morphology in a natural gully system to better constrain the conditions necessary to preserve distinct knickpoints over time. We monitored knickpoint erosion using time-lapse photography, repeat terrestrial lidar, soil moisture monitoring, and rainfall-runoff measurements. Our results indicate that shallow subsurface hydrology leads to knickpoint erosion via mass failure, and produces a stable and predictable morphological signature of knickpoint erosion (amphitheater shaped heads). We generalized these observations into a numerical model of erosion/sedimentation to understand the geomorphic legacy of knickpoints in deeply incised gullies. Modeling showed that knickpoints can maintain an incisional step for hundreds to thousands of years when knickpoints retreat via mass failure and sediment is removed from the knickpoint base by fluvial scour. To test simulations of long-term stability generated by the numerical model, we used Optically Stimulated Luminesence to date alluvial deposits at existing gully knickpoints. This geochronological dating confirmed that gully knickpoints have been active in our study area for hundreds to thousands of years, particularly during drought

The Staffing Policies of Swedish Companies at their Chinese Production Units

OpenAIRE

Dolinska, Nina; Hrlovic, Dzenita; Swane, Katarina

2006-01-01

Increasing production costs and high pressure from the consumers are leading Swedish companies towards an expansion to China. Since more and more companies are moving their production, we found it interesting to study the problems they might encounter while employing personnel. The purpose of this dissertation is to analyse what staffing policies companies choose and variables that influence the decision at Swedish production plants in China. Ethnocentric, polycentric and geocentric polic...

Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

Science.gov (United States)

Haas, Sheila A; Vlasses, Frances; Havey, Julia

2016-01-01

There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

Mentored residential writing retreats: a leadership strategy to develop skills and generate outcomes in writing for publication.

Science.gov (United States)

Jackson, Debra

2009-01-01

There is an increasing expectation that academic and clinical nurses will contribute to disciplinary and professional discourses through scholarly writing. However, the difficulties and challenges associated with writing for publication mean that many papers will never be written. This current paper describes an innovative approach developed to support skill development and outcomes in writing for publication. Intensive residential writing retreats informed by the principles of servant leadership and incorporating strategies such as mentoring and peer learning were conducted in 2005 and 2007. Positive outcomes and benefits included publications submitted to peer-reviewed journals, as well as positive effects on collegial relationships, and team building. Novice writers benefited from intensive and sustained support and coaching by experienced writers. Organisational benefits included increased participation by staff and research higher degree students in publication activities, enhanced collegial relationships and opportunities for senior established writers to work with inexperienced writers.

[Test your decision-making. When to do endodontic retreatment? Results of a study].

Science.gov (United States)

Aryanpour, S; D'Hoore, W; Van Nieuwenhuysen, J P

2000-01-01

The goals of this survey were to determine the most frequent therapeutic option and to evaluate the consensus among a sample of Belgian practitioners managing the same simulated cases of root treated teeth. On average, conservative options (nonsurgical retreatment 35.27% and no retreatment 29.61%) are the most selected alternatives. Surgical options and extraction respectively constitute 21.18% and 13% of the treatment propositions. As expected, the presence of radiographic and/or clinical signs resulted in a more aggressive attitude, but the presence of symptoms does not seem to be a valid reason for reintervention. The results of the study demonstrate considerable interindividual variations in clinical management of root treated teeth, regardless of personal factors, such as gender, years of experience and graduation institution. Even if a consensus appears within a group of professionals, it is not necessarily applied by a majority of practitioners; this contributes certainly to the explanation of the geographical or institutional variations noted in the medical practices.

The Benefit Implications of Recent Trends in Flexible Staffing Arrangements. Staff Working Paper.

Science.gov (United States)

Houseman, Susan N.

Workers in flexible staffing arrangementsincluding temporary agency, direct-hire temporary, on-call, and contract workersare much less likely than regular, direct-hire employees to be covered by laws mandating or regulating workplace benefits. They are also much less likely to receive pension, health insurance, and other benefits on the job.…

Survey of foreign reactor operator qualifications, training, and staffing requirements. Final report

International Nuclear Information System (INIS)

Au, M.L.; DiSalvo, R.; Merschoff, E.

1982-05-01

The report is a compilation of the data obtained from a survey of foreign nuclear power plant operator requirements. Included among the considerations are: (1) shift staffing; (2) operator eligibility; (3) operator training programs; (4) operator licensing or certification; and (5) operator retraining. The data obtained from this survey are presented in matrix form and contrasted with U.S. requirements

Comparative evaluation of cyclic fatigue resistance of D-RaCe and ProTaper retreatment instruments in curved artificial canals.

Science.gov (United States)

Topçuoğlu, H S; Topçuoğlu, G; Aktı, A

2016-06-01

To compare the cyclic fatigue resistance of D-RaCe and ProTaper rotary nickel-titanium (NiTi) retreatment files when used in curved artificial canals. A total of 120 new D-RaCe DR2 and ProTaper D3 retreatment files were tested in stainless steel artificial canals having 45° and 60° angles of curvature. Thirty instruments of each of the file systems were tested in both angles of curvature (n = 30). The retreatment instruments were rotated until fracture to calculate the number of cycles to failure. The length of each fractured fragment was recorded. Data were analysed by independent sample t-test. Fractured surfaces of the instruments were analysed by scanning electron microscopy. In the canal with 45° angle of curvature, no significant difference was observed between the retreatment systems (P > 0.05); on the other hand, in the canal with 60° angle of curvature, D-RaCe DR2 instruments had greater cyclic fatigue resistance than ProTaper D3 (P  0.05). The fracture surfaces of the instruments had morphologic characteristics of ductile fracture. D-RaCe DR2 instrument exhibited greater cyclic fatigue resistance than ProTaper D3 only in root canals with 60° angle of curvature. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Efficacy of Twisted File Adaptive, Reciproc and ProTaper Universal Retreatment instruments for root-canal-filling removal: A cone-beam computed tomography study.

Science.gov (United States)

Akbulut, Makbule Bilge; Akman, Melek; Terlemez, Arslan; Magat, Guldane; Sener, Sevgi; Shetty, Heeresh

2016-01-01

The aim of this study was to evaluate the efficacy of Twisted File (TF) Adaptive, Reciproc, and ProTaper Universal Retreatment (UR) System instruments for removing root-canal-filling. Sixty single rooted teeth were decoronated, instrumented and obturated. Preoperative CBCT scans were taken and the teeth were retreated with TF Adaptive, Reciproc, ProTaper UR, or hand files (n=15). Then, the teeth were rescanned, and the percentage volume of the residual root-canal-filling material was established. The total time for retreatment was recorded, and the data was statistically analyzed. The statistical ranking of the residual filling material volume was as follows: hand file=TF Adaptive>ProTaper UR=Reciproc. The ProTaper UR and Reciproc systems required shorter periods of time for retreatment. Root canal filling was more efficiently removed by using Reciproc and ProTaper UR instruments than TF Adaptive instruments and hand files. The TF Adaptive system was advantageous over hand files with regard to operating time.

District nursing renascent as Wales adopts safe staffing levels.

Science.gov (United States)

Labourne, Paul

2018-05-02

This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.

Endodontic retreatment of dens invaginatus presenting with gutta-percha overfilling at the attached gingiva and chronic apical periodontitis: unusual clinical report.

Science.gov (United States)

Robazza, Carlos Roberto Colombo; Alves e Motta, Julio Cesar; de Carli, Marina Lara; de Oliveira Pedreira, Fernanda Rafaelly; Hanemann, Joao Adolfo Costa

2013-05-01

This work describes the retreatment of an unusual case of dens invaginatus with gutta-percha overfilling at the gingival mucosa and chronic apical periodontitis in a 34-year-old woman. Initial periapical radiograph showed the presence of type II dens invaginatus with poor quality obturation, root perforation and chronic apical periodontitis of tooth 22. Dens invaginatus is a tooth malformation caused by infolding of the dental papilla during tooth development. This anomaly has been associated with increased prevalence of pulpal and periapical diseases. Conventional endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal dressing. After 7 days, root canal was filled with guttapercha points and Sealapex® sealer. Obturation was radiographically followed and, after 3 years, absence of fistula and periapical radiolucency was observed, thus conventional endodontic therapy proved to be successful. Conventional endodontic retreatment of type II dens invaginatus has been successful for a 3-year period, showing a better treatment alternative. Conservative endodontic retreatment of dens invaginatus should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years. Moreover, it preserves the entire tooth.

Retreatment of Recurrent Cystic Craniopharyngioma With Chromic Phosphorus P 32

Science.gov (United States)

Kumar, P.P.; Good, R.R.; Skultety, F.M.; Jones, E.O.; Chu, W.K.

1986-01-01

A cystic craniopharyngioma in a two-year-old boy recurred six months after surgery and postoperative external-beam radiotherapy. Successful retreatment was accomplished with radioisotope injection of 0.5 mCi of chromic phosphorus P 32 into the intracranial cyst, which delivered approximately 300.00 Gy to the cyst wall. The patient's symptoms were relieved, and he is without evidence of disease or cystic fluid accumulation four years after intracavitary 32P irradiation. ImagesFigure 1Figure 2Figure 3 PMID:3735454

Evaluation of Dentin Defect Formation during Retreatment with Hand and Rotary Instruments: A Micro-CT Study.

Science.gov (United States)

Yilmaz, Ayca; Helvacioglu-Yigit, Dilek; Gur, Cansu; Ersev, Handan; Kiziltas Sendur, Gullu; Avcu, Egemen; Baydemir, Canan; Abbott, Paul Vincent

2017-01-01

The purpose of this study was to compare the incidence and longitudinal propagation of dentin defects after gutta-percha removal with hand and rotary instruments using microcomputed tomography. Twenty mandibular incisors were prepared using the balanced-force technique and scanned in a 19.9  μ m resolution. Following filling with the lateral compaction technique, gutta-percha was removed with ProTaper Universal Retreatment (PTUR) or hand instruments. After rescanning, a total of 24,120 cross-sectional images were analyzed. The numbers, types, and longitudinal length changes of defects were recorded. Defects were observed in 36.90% of the cross sections. A total of 73 defects were comprised of 87.67% craze lines, 2.73% partial cracks, and 9.58% fractures. No significant difference in terms of new defect formation was detected between the retreatment groups. The apical and middle portions of the roots had more dentin defects than the coronal portions. Defects in three roots of the PTUR instrument group increased in length. Under the conditions of this in vitro study, gutta-percha removal seemed to not increase the incidence of dentin defect formation, but the longitudinal defect propagation finding suggests possible cumulative dentinal damage due to additional endodontic procedures. Hand and rotary instrumentation techniques caused similar dentin defect formation during root canal retreatment.

Where to “Rock”? Choice of retreat sites by a gecko in a semi-arid habitat

Directory of Open Access Journals (Sweden)

Andreia Penado

2015-06-01

Full Text Available The Selvagens gecko (Tarentola boettgeri bischoffi Joger, 1984 is a medium sized gecko endemic to the Selvagens archipelago, Madeira, Portugal. The biology of this gecko is poorly known and in this study we present the first evidence regarding its habitat use. In 2010 (spring and autumn and 2011 (spring, we collected data on the characteristics of the habitat surrounding 168 rocks used by these geckos as retreat sites, as well as on 75 randomly selected rocks. We also recorded body measurements of the individuals caught under each rock. In both seasons retreat site occupancy was found to be related to rock area, with geckos being found mainly under large rocks. Interestingly, we found that in spring heavier males, in better body condition, occupied the largest rocks and larger geckos occupied rocks closer to creek beds. Our results shed some light upon the behavioural ecology of this nocturnally active ectotherm, that spends the day under a retreat site: i intraspecific competition may be an ecological factor prevalent in this species, since larger individuals occupy larger rocks, located in a presumably high quality micro-habitat; ii the possibility of spring territoriality in males, that compete for good quality shelters.

Pathology informatics fellowship retreats: The use of interactive scenarios and case studies as pathology informatics teaching tools

Directory of Open Access Journals (Sweden)

Roy E Lee

2012-01-01

Full Text Available Background: Last year, our pathology informatics fellowship added informatics-based interactive case studies to its existing educational platform of operational and research rotations, clinical conferences, a common core curriculum with an accompanying didactic course, and national meetings. Methods: The structure of the informatics case studies was based on the traditional business school case study format. Three different formats were used, varying in length from short, 15-minute scenarios to more formal multiple hour-long case studies. Case studies were presented over the course of three retreats (Fall 2011, Winter 2012, and Spring 2012 and involved both local and visiting faculty and fellows. Results: Both faculty and fellows found the case studies and the retreats educational, valuable, and enjoyable. From this positive feedback, we plan to incorporate the retreats in future academic years as an educational component of our fellowship program. Conclusions: Interactive case studies appear to be valuable in teaching several aspects of pathology informatics that are difficult to teach in more traditional venues (rotations and didactic class sessions. Case studies have become an important component of our fellowship′s educational platform.

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations

International Nuclear Information System (INIS)

Isambert, Aurelie; Valero, Marc; Rousse, Carole; Blanchard, Vincent; Le Du, Dominique; Guilhem, Marie-Therese; Dieudonne, Arnaud; Pierrat, Noelle; Salvat, Cecile

2015-01-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. (authors)

Nonsurgical endodontic retreatment of fused teeth with transposition: a case report

Directory of Open Access Journals (Sweden)

Miguel Agostinho Beco Pinto Cardoso

2016-05-01

Full Text Available Tooth transposition is a disorder in which a permanent tooth develops and erupts in the normal position of another permanent tooth. Fusion and gemination are developmental disturbances presenting as the union of teeth. This article reports the nonsurgical retreatment of a very rare case of fused teeth with transposition. A patient was referred for endodontic treatment of her maxillary left first molar in the position of the first premolar, which was adjacent to it on the distobuccal side. Orthopantomography and periapical radiography showed two crowns sharing the same root, with a root canal treatment and an associated periapical lesion. Tooth fusion with transposition of a maxillary molar and a premolar was diagnosed. Nonsurgical endodontic retreatment was performed. At four yr follow-up, the tooth was asymptomatic and the radiolucency around the apical region had decreased, showing the success of our intervention. The diagnosis and treatment of fused teeth require special attention. The canal system should be carefully explored to obtain a full understanding of the anatomy, allowing it to be fully cleaned and obturated. Thermoplastic techniques were useful in obtaining hermetic obturation. A correct anatomical evaluation improves the set of treatment options under consideration, leading to a higher likelihood of esthetically and functionally successful treatment.

Lessons learned from Gen II NPP staffing approaches applicable to new reactors - 15003

International Nuclear Information System (INIS)

Goodnight, C.

2015-01-01

This paper discusses lessons learned from the operation of the Gen II fleet of existing nuclear power plants (NPPs), in terms of staffing, that can be applied to the final design, deployment, and operation of new reactor designs. The most significant of these lessons is the need to appropriately staff the facility, having the right number of people with the required skills and experience. This begs the question of how to identify those personnel requirements. For NPPs, there are five key factors that ultimately will determine the effectiveness and costs of operating nuclear power plants (NPPs): 1) The Nuclear Steam Supply System (NSSS) and the layout of the plant site; 2) The processes which the operating organization applies; 3) The organizational structure of the operating organization; 4) The organizational culture of the operating organization, and 5) The regulatory framework under which the licensee must operate. In summary, this paper identifies opportunities to minimize staffing and costs learned from Gen II NPPs that may be applicable for new nuclear plants. (author)

Predicting the retreat and migration of tidal forests along the northern Gulf of Mexico under sea-level rise

Science.gov (United States)

Doyle, T.W.; Krauss, K.W.; Conner, W.H.; From, A.S.

2010-01-01

Tidal freshwater forests in coastal regions of the southeastern United States are undergoing dieback and retreat from increasing tidal inundation and saltwater intrusion attributed to climate variability and sea-level rise. In many areas, tidal saltwater forests (mangroves) contrastingly are expanding landward in subtropical coastal reaches succeeding freshwater marsh and forest zones. Hydrological characteristics of these low-relief coastal forests in intertidal settings are dictated by the influence of tidal and freshwater forcing. In this paper, we describe the application of the Sea Level Over Proportional Elevation (SLOPE) model to predict coastal forest retreat and migration from projected sea-level rise based on a proxy relationship of saltmarsh/mangrove area and tidal range. The SLOPE model assumes that the sum area of saltmarsh/mangrove habitat along any given coastal reach is determined by the slope of the landform and vertical tide forcing. Model results indicated that saltmarsh and mangrove migration from sea-level rise will vary by county and watershed but greater in western Gulf States than in the eastern Gulf States where millions of hectares of coastal forest will be displaced over the next century with a near meter rise in relative sea level alone. Substantial losses of coastal forests will also occur in the eastern Gulf but mangrove forests in subtropical zones of Florida are expected to replace retreating freshwater forest and affect regional biodiversity. Accelerated global eustacy from climate change will compound the degree of predicted retreat and migration of coastal forests with expected implications for ecosystem management of State and Federal lands in the absence of adaptive coastal management.

Influences of Leadership Program Participation on Students' Capacities for Socially Responsible Leadership

Science.gov (United States)

Dugan, John P.; Bohle, Christopher W.; Gebhardt, Matt; Hofert, Meghan; Wilk, Emily; Cooney, Matthew A.

2011-01-01

This study examined differential effects of various types of individual leadership experiences (e.g., retreats, academic minors) on college students' capacities for socially responsible leadership using data from 8,961 seniors representing 99 colleges and universities. Participation in individual leadership experiences explained a significant,…

Yoga Retreat : Grafiikan työstäminen Facebook peliin

OpenAIRE

Kälviäinen, Jenna

2013-01-01

In the thesis the process of graphic design of Facebook games is discussed. The Author got an opportunity to work as a graphic designer for Gajatri Studios in their first video game project called Yoga Retreat. Experiences from the project, the decisions made and the problems faced were analyzed in detail. In the theory section the history of Facebook in general was explored and the question of how Facebook became one of the most well-known websites of the Internet was discussed as well as...

Retreatment with peg-interferon and ribavirin in patients with chronic hepatitis C virus genotype 2 or 3 infection with prior relapse

DEFF Research Database (Denmark)

Lagging, Martin; Rembeck, Karolina; Rauning Buhl, Mads

2013-01-01

Uncertainty remains regarding the efficacy of retreatment with current standard-of-care peg-interferon (peg-IFN) and ribavirin among patients infected with hepatitis C virus (HCV) genotypes 2 or 3 with relapse after prior therapy.......Uncertainty remains regarding the efficacy of retreatment with current standard-of-care peg-interferon (peg-IFN) and ribavirin among patients infected with hepatitis C virus (HCV) genotypes 2 or 3 with relapse after prior therapy....

Student Affairs in Complex Contexts

Directory of Open Access Journals (Sweden)

Birgit Schreiber

2017-02-01

Full Text Available While the Western world – with Brexit, Trump, Festung Europa, and so forth – seems to be increasingly retreating into narrow nationalism, the Journal of Student Affairs in Africa is connecting African academics, executives and administrators and is becoming an evermore accessed international, African platform for publishing research on higher education and Student Affairs in Africa. In this issue, we do not only publish several commentaries on the recent Global Summit of Student Affairs and Services held in October 2016 at Stellenbosch University, South Africa. We also publish contributions from Ethiopia alongside articles from Australia, the USA, and universities in South Africa (University of the Free State, University of Johannesburg.

Experiences and lessons learnt on staffing from the first Indian nuclear power plant (PHWR)

International Nuclear Information System (INIS)

Bhattacharya, A.S.

2001-01-01

Three decades of operating experience in India has led to sustained high performance of NPPs. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. Specific qualification levels apply to each position - six at management positions, five licensed positions with the rest qualified through an equivalent training scheme. Practically all O and M activities are carried out on-site by the utility manpower with minimum involvement of contractors. The entire process of human resource development is in-house - with each NPP organisation comprised of 30% experienced staff transferred from older NPPs and 70% totally developed out of fresh recruits. Four to eight years lead time goes to qualify fresh recruits depending on the position. This optimisation of manpower is a result of continuous learning - through operating experience and regulatory feed back and self assessment for (i) optimising quantum of work load and (ii) improving productivity. For the first category, design improvements over older NPP's increased reliability, operability, maintainability and human factors are described separately in the companion paper. In this paper the organisation factors are discussed, starting with the initial lessons that demanded improved management and enhanced quality programmes and caused temporarily, high demand of staffing for bringing out new systems, e.g., (i) attaining maturity of units; (ii) standardising training, retraining and cross training and qualifications; (in) job rotations, (iv) in service inspection of reactor components; (v) quality audits. The experiences on subsequent optimisation of staffing levels are outlined. (author)

Ontario: linking nursing outcomes, workload and staffing decisions in the workplace: the Dashboard Project.

Science.gov (United States)

Fram, Nancy; Morgan, Beverley

2012-03-01

Research shows that nurses want to provide more input into assessing patient acuity, changes in patient needs and staffing requirements. The Dashboard Project involved the further development and application of an electronic monitoring tool that offers a single source of nursing, patient and organizational information. It is designed to help inform nurse staffing decisions within a hospital setting. The Dashboard access link was installed in computers in eight nursing units within the Hamilton Health Sciences (HHS) network. The Dashboard indicators are populated from existing information/patient databases within the Decision Support Department at HHS. Committees composed of the unit manager, staff nurses, project coordinator, financial controller and an information controller met regularly to review the Dashboard indicators. Participants discussed the ability of the indicators to reflect their patients' needs and the feasibility of using the indicators to inform their clinical staffing plans. Project findings suggest that the Dashboard is a work in progress. Many of the indicators that had originally been incorporated were refined and will continue to be revised based on suggestions from project participants and further testing across HHS. Participants suggested the need for additional data, such as the time that nurses are off the unit (for code blue response, patient transfers and accompanying patients for tests); internal transfers/bed moves to accommodate patient-specific issues and particularly to address infection control issues; deaths and specific unit-centred data in addition to the generic indicators. The collaborative nature of the project enabled staff nurses and management to work together on a matter of high importance to both, providing valuable recommendations for shared nursing and interprofessional planning, further Dashboard development and project management.

Treatment and retreatment with omalizumab in chronic spontaneous urticaria: Real life experience with twenty-five patients

Directory of Open Access Journals (Sweden)

Murat Türk

2018-01-01

Conclusions: Omalizumab has high efficacy in both the treatment and retreatment of CSU; however, relapse rates after discontinuation are high. Autoimmune markers may be helpful in predicting treatment response and relapse.

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

Science.gov (United States)

Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic.

Science.gov (United States)

Imbery, Terence A; Greenfield, Kristy; Diaz, Nicholas; Janus, Charles; Best, Al M

2016-10-01

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

76 FR 72978 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing...

Science.gov (United States)

2011-11-28

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... workers are engaged in the production of refrigerators and trash compactors. The notice was published in...

IS Staffing during a Recession: Comparing Student and IS Recruiter Perceptions

Science.gov (United States)

Pratt, Jean A.; Hauser, Karina; Ross, Steven C.

2010-01-01

The current economic situation in the United States has associated ramifications for IS employment. This study identifies IS recruiters' perceptions vis-a-vis IT budget cuts and layoffs at their organizations. Additionally, it identifies IS student perceptions vis-a-vis employment opportunities and academic preparation. Similar surveys were…

Outcomes and Costs of Community Living: Semi-Independent Living and Fully Staffed Group Homes

Science.gov (United States)

Felce, David; Perry, Jonathan; Romeo, Renee; Robertson, Janet; Meek, Andrea; Emerson, Eric; Knapp, Martin

2008-01-01

In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes,…

Evaluation of image-guided helical tomotherapy for the retreatment of spinal metastasis

International Nuclear Information System (INIS)

Mahan, Stephen L.; Ramsey, Chester R.; Scaperoth, Daniel D.; Chase, Daniel J.; Byrne, Thomas E.

2005-01-01

Introduction: Patients with vertebral metastasis that receive radiation therapy are typically treated to the spinal cord tolerance dose. As such, it is difficult to successfully deliver a second course of radiation therapy for patients with overlapping treatment volumes. In this study, an image-guided helical tomotherapy system was evaluated for the retreatment of previously irradiated vertebral metastasis. Methods and Materials: Helical tomotherapy dose gradients and maximum cord doses were measured in a cylindrical phantom for geometric test cases with separations between the planning target volume (PTV) and the spinal cord organ at risk (OAR) of 2 mm, 4 mm, 6 mm, 8 mm, and 10 mm. Megavoltage computed tomography (CT) images were examined for their ability to localize spinal anatomy for positioning purposes by repeat imaging of the cervical spine in an anthropomorphic phantom. In addition to the phantom studies, 8 patients with cord compressions that had received previous radiation therapy were retreated to a mean dose of 28 Gy using conventional fractionation. Results and Discussion: Megavoltage CT images were capable of positioning an anthropomorphic phantom to within ±1.2 mm (2σ) superior-inferiorly and within ±0.6 mm (2σ) anterior-posteriorly and laterally. Dose gradients of 10% per mm were measured in phantom while PTV uniformity indices of less than 11% were maintained. The calculated maximum cord dose was 25% of the prescribed dose for a 10-mm PTV-to-OAR separation and 71% of the prescribed dose for a PTV-to-OAR separation of 2 mm. Eight patients total have been treated without radiation-induced myelopathy or any other adverse effects from treatment. Conclusions: A technique has been evaluated for the retreatment of vertebral metastasis using image-guided helical tomotherapy. Phantom and patient studies indicated that a tomotherapy system is capable of delivering dose gradients of 10% per mm and positioning the patient within 1.2 mm without the use of

Evaluation of Dentin Defect Formation during Retreatment with Hand and Rotary Instruments: A Micro-CT Study

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Ayca Yilmaz

2017-01-01

Full Text Available The purpose of this study was to compare the incidence and longitudinal propagation of dentin defects after gutta-percha removal with hand and rotary instruments using microcomputed tomography. Twenty mandibular incisors were prepared using the balanced-force technique and scanned in a 19.9 μm resolution. Following filling with the lateral compaction technique, gutta-percha was removed with ProTaper Universal Retreatment (PTUR or hand instruments. After rescanning, a total of 24,120 cross-sectional images were analyzed. The numbers, types, and longitudinal length changes of defects were recorded. Defects were observed in 36.90% of the cross sections. A total of 73 defects were comprised of 87.67% craze lines, 2.73% partial cracks, and 9.58% fractures. No significant difference in terms of new defect formation was detected between the retreatment groups. The apical and middle portions of the roots had more dentin defects than the coronal portions. Defects in three roots of the PTUR instrument group increased in length. Under the conditions of this in vitro study, gutta-percha removal seemed to not increase the incidence of dentin defect formation, but the longitudinal defect propagation finding suggests possible cumulative dentinal damage due to additional endodontic procedures. Hand and rotary instrumentation techniques caused similar dentin defect formation during root canal retreatment.

Application of safety checklist to the analysis of the IEA-R1 reactor water retreatment system

International Nuclear Information System (INIS)

Sauer, Maria Eugenia Lago Jacques; Sara Neto, Antonio Jorge; Lima, Toni Carlos Caboclo de; Ribeiro, Maria Alice Morato

2005-01-01

In 1999, the management of the IEA-R1 Research Reactor (pool type - 5 MWth), located at IPEN/CNEN-SP, started the evaluation of the Reactor Pool Water Retreatment System to identify operational aspects, which could compromise the operators safety. The purpose was to identify and propose enhancements to the system which would be installed to substitute for the existing one. This process was conducted through a qualitative study of the system in operation. This study was carried out by a team composed of specialists in reactor operation, systems maintenance and radiological protection, and one safety analyst. The study consisted, basically, in local inspections to verify the physical and operational conditions of each equipment / component as well as aspects related to maintenance activities of the system. The process control and the operator procedures associated with the retreatment of the reactor pool water were also reviewed. The methodology adopted to develop the study was based in process hazard analysis technique named Safety Checklist. This paper presents a summary of this study and the main results obtained. Some operational and safety problems identified, the prevention and/or correction means to avoid them, and the recommendations and suggestions that have been implemented to the new design of the IEA-R1 Reactor Water Retreatment System, whose installation was concluded in 2003, are also presented. (author)

Factors contributing to the surgical retreatment of mandibular fractures

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João Gualberto de Cerqueira Luz

2013-06-01

Full Text Available The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7% required a second surgery and thus composed the “reoperated” group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006, dental condition (p < 0.001, location of fracture (p = 0.010, degree of fragmentation (p = 0.003 and fracture exposure (p < 0.001 were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1 and a delay in fracture repair (19.1 days, SD = 18.7 were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Pop-up Library at the University of Birmingham: Extending the Reach of an Academic Library by Taking "The Library" to the Students

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Barnett, James; Bull, Stephen; Cooper, Helen

2016-01-01

Aligning with student engagement and promotional strategies, a Pop-Up Library project was initiated at the University of Birmingham. This involved setting up temporary, staffed stalls in different locations across campus in order to informally communicate with students and effectively take "the Library" to them. This article discusses…

Staffing, recruitment, training, qualification and certification of operating personnel of nuclear power plants

International Nuclear Information System (INIS)

1999-10-01

Safety of public, occupational workers and the protection of environment should be assured while activities for economic and social progress are pursued. These activities include the establishment and utilisation of nuclear facilities and the use of radioactive sources. This safety guide provides guidance on the aspects of staffing, recruitment, training, qualification and certification of operating personnel of nuclear power plants

Linking Tarim Basin sea retreat (west China) and Asian aridification in the late Eocene

NARCIS (Netherlands)

Bosboom, R.; Dupont-Nivet, G.; Grothe, A.; Brinkhuis, H.; Villa, G.; Mandic, O.; Stoica, M.; Huang, W.; Yang, W.; Guo, Z.; Krijgsman, W.

2014-01-01

The Tarim Basin in western China formed the easternmost margin of a shallow epicontinental sea that extended across Eurasia and was well connected to the western Tethys during the Paleogene. Climate modelling studies suggest that the westward retreat of this sea from Central Asia may have been as

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

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Christopher E. Pelt, MD

2017-03-01

Conclusions: A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

76 FR 73683 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing...

Science.gov (United States)

2011-11-29

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... refrigerators and trash compactors. The notice was published in the Federal Register on October 25, 2010 (75 FR...

75 FR 16512 - Willstaff Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working...

Science.gov (United States)

2010-04-01

... Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working On-Site at Tyler Pipe... MDS Industrial Resources, Inc., working on-site at Tyler Pipe Company, Waterworks Division, South... Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., working on-site at Tyler Pipe...

Diagnostic Grouping among Adults with Intellectual Disabilities and Autistic Spectrum Disorders in Staffed Housing

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Felce, D.; Perry, J.

2012-01-01

Background: There is little evidence to guide the commissioning of residential provision for adults with autistic spectrum disorder (ASD) in the UK. We aim to explore the degree and impact of diagnostic congregation among adults with intellectual disabilities (ID) and ASD living in staffed housing. Methods: One hundred and fifty-seven adults with…

Efficacy of Different Nickel-Titanium Instruments in Removing Gutta-percha during Root Canal Retreatment.

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Özyürek, Taha; Demiryürek, Ebru Özsezer

2016-04-01

The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Twisted File Adaptive (TFA; Axis/SybronEndo, Orange, CA), Reciproc (PRC; VDW, Munich, Germany), and ProTaper Universal retreatment (PTR, Dentsply Maillefer) nickel-titanium systems and the time required for gutta-percha and sealer removal. Eighty human maxillary central incisors with single and straight root canals were instrumented up to #40.02 with manual K-files (Dentsply Maillefer) and obturated using the continuous wave of condensation technique. Removal of the gutta-percha and sealer was performed using 1 of the following nickel-titanium systems: PTN, TFA, RPC, or PTR. The teeth were sectioned, and digital images were captured. The photographs were analyzed using AutoCAD software (Autodesk, San Rafael, CA). Also, the total time required for gutta-percha removal was calculated by a chronometer. The total retreatment time was significantly shorter in the PTR group compared with the other groups (P < .05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (P < .05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the TFA and RPC groups (P < .05). Within the limitations of this study, the PTN and the PTR groups showed less residual gutta-percha and sealer than the TFA and RPC groups. The time required for gutta-percha and sealer removal was similar for all the groups, except for the PTR group. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Call for papers: SAJHE special issue 'Re-imagining writing retreats for academic staff in higher education'

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Guest Editors

2016-06-01

Full Text Available Call for papers for an upcoming special issue of the South African Journal of Higher Education (SAJHE in 2016: ‘Re-imagining writing retreats for academic staff in higher education’.

LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable?

Science.gov (United States)

Frings, Andreas; Richard, Gisbert; Steinberg, Johannes; Druchkiv, Vasyl; Linke, Stephan Johannes; Katz, Toam

2016-01-01

To analyze the refractive and keratometric stability in hyperopic astigmatic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) during the first 6 months after surgery. This retrospective cross-sectional study included 97 hyperopic eyes; 55 were treated with LASIK and 42 with PRK. Excimer ablation for all eyes was performed using the ALLEGRETTO excimer laser platform using a mitomycin C for PRK and a mechanical microkeratome for LASIK. Keratometric and refractive data were analyzed during three consecutive follow-up intervals (6 weeks, 3 months, and 6 months). The corneal topography was obtained using Scheimpflug topography, and subjective refractions were acquired by expert optometrists according to a standardized protocol. After 3 months, mean keratometry and spherical equivalent were stable after LASIK, whereas PRK-treated eyes presented statistically significant (P1 D occurred. The optical zone diameter did not correlate with the development of regression. After corneal laser refractive surgery, keratometric changes are followed by refractive changes and they occur up to 6 months after LASIK and for at least 6 months after PRK, and therefore, caution should be applied when retreatment is planned during the 1st year after surgery because hyperopic refractive regression can lead to suboptimal visual outcome. Keratometric and refractive stability is earlier achieved after LASIK, and therefore, retreatment may be independent of late regression.

Decline in Reference Transactions with Few Questions Referred to Librarian when the Reference Desk is Staffed by a Paraprofessional. A Review of: Dinkins, D., & Ryan, S. M. (2010. Measuring referrals: The use of paraprofessionals at the reference desk. The Journal of Academic Librarianship, 36(4, 279-286.

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Diana K. Wakimoto

2011-03-01

Full Text Available Objective — To determine the type and percentage of questions referred to a librarian by a paraprofessional (i.e., an individual without an MLIS staffing the reference desk, whether the percentage of referrals would decrease over time, and any consequences from having a paraprofessional rather than a librarian staffing the desk.Design — Quantitative analysis of reference desk transaction statistics.Setting — Reference desk at the main library of Stetson University, a private university in the United States of America with approximately 2,500 FTE (full-time equivalent students.Subjects — A total of 486 reference desk transactions recorded by a paraprofessional staffing the reference desk during the Fall and Spring semesters of the 2008-2009 academic year.Methods — The first year that he worked in the Library at Stetson University, a paraprofessional recorded all reference desk transactions during his shift from 10:00am to 12:00pm, four days a week, for the Fall and Spring semesters of the 2008-2009 academic year. This paraprofessional, with computer expertise, received "relatively minimal" (p. 281 training on "reference desk policies and procedures… the use of the catalogue and the subscription databases" (p. 281. For each transaction, the paraprofessional categorized the question as "direction, " "reference, " or "machine. " He was instructed to contact a librarian if he could not answer a reference question. The paraprofessional also completed a questionnaire regarding his level of comfort answering questions and his thoughts on the training at the end of his first year of staffing the reference desk.Main Results — In the Fall semester, 9.5% of all reference desk transactions were referred to a librarian. This decreased to 4.2% of the total transactions during the Spring semester. The percentage of reference questions referred to a librarian in the Fall semester was 21.9% and only 5.0% in the Spring semester. There was a 49

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations.

Science.gov (United States)

Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile

2015-04-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The St. Ignatius Jesuit Retreat and Training Centre: Cultivating Ecological Awareness and Connection with the Earth

Science.gov (United States)

Groen, Janet

2017-01-01

This chapter focuses on the role of religiously based spirituality in cultivating environmental awareness and citizenship by examining an adult environmental education program offered at the Ignatius Jesuit Centre, a religious retreat center in Guelph, Canada.

Comparison of debris extruded apically and working time used by ProTaper Universal rotary and ProTaper retreatment system during gutta-percha removal

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Mary Kinue Nakamune Uezu

2010-12-01

Full Text Available OBJECTIVE: The aim of this study was to evaluate the in vitro action of ProTaper retreatment files and ProTaper Universal in the retreatment of mandibular premolars. MATERIAL AND METHODS: The amount of debris extruded apically was measured and the time to reach the working length and to complete the removal of gutta-percha was observed. Thirty teeth had their canals prepared using ProTaper Universal files and were obturated by the single cone technique. The teeth were then stored at 37ºC in a humid environment for 7 days. During the use of the rotary instruments for root canal filling removal, the apical portions of the teeth were attached to the open end of a resin tube to collect the apically extruded debris. RESULTS: ProTaper Universal files were significantly faster (p=0.0011 than the ProTaper retreatment files to perform gutta-percha removal, but no significant difference was found between the files regarding the time to reach the working length or the amount of apical extrusion. CONCLUSIONS: ProTaper Universal rotary had better results for endodontic retreatment, and both techniques promote similar apical extrusion of debris.

Interference of partial visual analysis of root filling quality and apical status on retreatment decisions

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Renata Dornelles Morgental

2012-04-01

Full Text Available OBJECTIVE: The presence of periapical radiolucency has been used as a criterion for endodontic treatment failure. However, in addition to the inherent limitations of radiographic examinations, radiographic interpretations are extremely subjective. Thus, this study investigated the effect of partial analysis of root filling quality and periapical status on retreatment decisions by general dentists. MATERIAL AND METHODS: Twelve digitalized periapical radiographs were analyzed by 10 observers. The study was conducted at three time points at 1-week intervals. Radiographs edited with the Adobe Photoshop CS4 software were analyzed at three time points: first, only root filling quality was analyzed; second, only the periapical areas of the teeth under study were visualized; finally, observers analyzed the unedited radiographic image. Spearman ’s coefficient was used to analyze the correlations between the scores assigned when the periapical area was not visible and when the unedited radiograph was analyzed, as well as between the scores assigned when root fillings where not visible and when the unedited radiograph was analyzed. Sensitivity, specificity, positive and negative predictive values between partial images and unedited radiographs were also used to analyze retreatment decisions. The level of significance was set at 5%. RESULTS: The visualization of the root filling on the unedited radiograph affected the interpretation of the periapical status and the technical quality of the fillings has a greater influence on the general dentist’s decision to prescribe endodontic retreatment than the periapical condition. CONCLUSION: In order to make endodontic diagnosis, radiographic interpretation process should not only emphasize technical aspects, but also consider biological factors.

Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

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Lumley Judith

2006-07-01

Full Text Available Abstract Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73, exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning. Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives providing postnatal care

Dry-season retreat and dietary shift of the dart-poison frog Dendrobates tinctorius (Anura: Dendrobatidae)

NARCIS (Netherlands)

Born, M.; Bongers, F.; Poelman, E.H.; Sterck, F.J.

2010-01-01

Dry-season retreat and dietary shift of the dart-poison frog Delldrobates tillCtOrillS (Anura: Dendrobatidae). Seasonal rainfall affects tropical forest dynamics and behavior of species that are part of these ecosystems. TIle positive correlation between amphibian ac tivity pattems and rainfall has

Got Dating: Outcomes of a Teen 4-H Relationship Retreat

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Naomi Brower

2012-03-01

Full Text Available To support youth in developing healthy relationships, state and county staff collaborated to offer a statewide overnight teen retreat to teach health relationship skills. Evaluation of 64 youth participants from rural and urban counties found significant increases in posttest knowledge of relationship skills for both male and female youth. Youth also reported that the content was very helpful and worth repeating. Program success may be attributed to addressing the interesting and needed subject of dating relationships as well as involvement of state ambassador and collegiate 4-H members as teachers. Implications and replication suggestions are outlined.

Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics.

Science.gov (United States)

Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I

2014-01-01

Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able

75 FR 43556 - Badger Meter, Inc., Including On-Site Leased Workers From Sourcepoint Staffing, Seek, and...

Science.gov (United States)

2010-07-26

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,666] Badger Meter, Inc... of Badger Meter, Inc., including on-site leased workers from Sourcepoint Staffing, Milwaukee... workers are engaged in the production of flow measurement devices and automatic meter reading equipment...

Late Eocene sea retreat from the Tarim Basin (west China) and concomitant Asian paleoenvironmental change

NARCIS (Netherlands)

Bosboom, R.E.; Dupont-Nivet, G.; Houben, A.J.P.; Brinkhuis, H.; Villa, G.; Mandic, O.; Stoica, M.; Zachariasse, W.J.; Guo, ZJ.; Li, CX.; Krijgsman, W.

2011-01-01

The Paleogene sediments of the southwest Tarim Basin along the West Kunlun Shan in western China include the remnants of the easternmost extent of a large epicontinental sea. This shallow sea once extended across the Eurasian continent before it retreated westward and eventually separated as the

Strategies for using international domain standards within a national context: The case of the Dutch temporary staffing industry

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Folmer, Erwin Johan Albert; van Bekkum, Michael; Verhoosel, Jack

2009-01-01

This paper will discuss strategies for using international domain standards within a national context. The various strategies are illustrated by means of a case study of the temporary staffing industry.

Qualidade visual após retratamento de LASIK personalizado versus convencional Visual quality after custom versus standard LASIK retreatment

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Andréia Peltier Urbano

2008-12-01

Full Text Available OBJETIVO: Avaliar a qualidade visual após retratamento personalizado e retratamento convencional em olhos submetidos a LASIK primário convencional. MÉTODOS: Foi realizado estudo prospectivo de 74 olhos submetidos ao retratamento de LASIK para correção de miopia e astigmatismo. Cada paciente foi submetido ao retratamento de LASIK com ablação personalizada (Zyoptix, Bausch & Lomb em um olho e ablação convencional (Planoscan, Bausch & Lomb no olho contralateral. Foram comparados os resultados do teste de ofuscamento e da sensibilidade ao contraste durante o acompanhamento de seis meses. RESULTADOS: Os olhos do grupo Zyoptix apresentaram melhores resultados no teste de ofuscamento e na sensibilidade ao contraste do que o olho contralateral, quando se compararam os resultados. CONCLUSÕES: O retratamento personalizado resultou em melhor qualidade visual pós-operatória do que o retratamento convencional de LASIK primário convencional.PURPOSE: To evaluate visual quality after wavefront-guided LASIK versus standard LASIK in retreatment of primary LASIK for myopia and myopic astigmatism. METHODS: A prospective study was performed with paired eye control of 74 eyes with LASIK retreatment. Each patient underwent retreatment using custom ablation (Zyoptix, Bausch & Lomb in 1 eye and standard ablation LASIK (PlanoScan, Bausch & Lomb in the contralateral eye. A complete ophthalmologic examination was performed, including evaluation of glare test and contrast sensitivity test, with a follow-up of 6 months. RESULTS: Zyoptix eyes showed better results of glare test and contrast sensitivity test than the contralateral eyes. CONCLUSIONS: Wavefront-guided LASIK produces better visual quality than standard LASIK in the retreatment of refractive errors after primary LASIK.

Impact of glaciers retreat on highland Andean wetlands and communities: lessons from the upper Cachi catchment (Ayacucho, Peru)

Science.gov (United States)

Angulo, Oscar; Biévre Bert, De

2017-04-01

The vulnerability of water resources under climate change scenarios in Peru is generally regarded to be connected to a diminished availability of water due to retreating glaciers. However, the impact of glacier retreat goes much beyond a decline of glacial water reserves. This article argues that another important impact is the extreme erosion in areas where glaciers have recently melted, as well as the accumulation of erosion material in highland wetlands located downslope. As a direct consequence of these changes highland Andean communities which depend on these ecosystems are affected in socio-economic terms as they find themselves forced to alter ancestral dynamics and traditional practices of land and water use. This quickly leads to a vicious cycle of risks and threats. In such a context a possibility to adapt to glacial retreat should be to protect areas affected by glacial melt in order to enable a rapid development of protective vegetation cover. In the upper catchment of the Cachi River interesting experiences of protection and water harvesting exist that could be extended to other high vulnerability areas for the benefit of highland populations as well as downstream water users, such as the irrigation system of Cachi and the city of Ayacucho.

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

Science.gov (United States)

Lisboa, Cinthia de Oliveira; Borges, Marlon Sampaio; Medeiros, Paulo José D'Albuquerque; Motta, Alexandre Trindade; Mucha, José Nelson

2017-08-01

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey.

Science.gov (United States)

Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M

2016-09-01

We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Staffing and training experience at the Bilibino nuclear power plant

International Nuclear Information System (INIS)

Tukhvetov, F.

2001-01-01

Bilibino NPP has four 12 MW(e) water cooled graphite moderated channel reactors. The plant has been in operation since 1973 in conditions of isolated local energy system in a remote area with extreme climatic conditions. The plant accounts for almost 70 per cent of energy produced in the region, it also provides heating to the regional centre. The plant's organisational structure is on the whole consistent with the standard structure of other NPPs of ex-USSR. At the same time there are some specific features due to high cost of personnel in the prime cost of the generated energy. As a result a need arises to broaden the task of catering for each worker and, therefore, to extend and increase the level of training. The number of high-quality personnel is on the increase. A method of step-by-step training is widely used at all work areas for training operations personnel. At the end of each step a worker is engaged in independent activities at this work area. When a plant is located in a remote area efficient and effective maintenance becomes highly instrumental. The engineering and design support on the part of the utility and equipment manufacturer begins to play a greater role. Activities to optimise the plant organisational structure were mostly characterised by merging of subdivisions and by some change in the proportion of different categories of personnel. It would be an optimum decision to put all supporting services, namely, logistics, book-keeping and staffing departments, within the utility's authority. Operations experience of the Bilibino plant will certainly be valuable for projection, location choice and staffing of plants with small and medium reactors. (author)

Retreatment with bevacizumab in patients with gynecologic malignancy is associated with clinical response and does not increase morbidity

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Laskey RA

2014-03-01

Full Text Available Robin A Laskey,1 Scott D Richard,2 Ashlee L Smith,1 Jeff F Lin,1 Tiffany L Beck,3 Jamie L Lesnock,1 Joseph L Kelley 3rd,1 Alexander B Olawaiye,1 Paniti Sukumvanich,1 Thomas C Krivak4 1Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, 2Division of Gynecologic Oncology, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, 3Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, 4Division of Gynecologic Oncology, Western Pennsylvania Hospital, Pittsburgh, PA, USA Purpose: Bevacizumab (Bev is associated with improved progression-free survival in advanced epithelial ovarian cancer. The use of Bev in patients with gynecologic malignancy is increasing; however, little is known about cumulative toxicity and response in patients retreated with Bev. Our goal was to determine cumulative side effects and response in patients retreated with Bev. Patients and methods: Women with recurrent gynecologic malignancy treated with Bev between January 2007 and March 2012 at a single institution were identified, including a subset who received Bev in a subsequent regimen. The primary outcome was Bev-associated toxicity, and the secondary outcome was response. Results: Of 83 patients that received Bev for recurrent disease, 23 were retreated with Bev and four received Bev maintenance. Three patients (13% developed grade 3 or 4 hypertension; all had a history of chronic hypertension. One (4.3% patient developed grade 3 proteinuria, and one (4.3% developed an enterovaginal fistula. Four patients discontinued Bev secondary to toxicity. Toxicity was not related to the cumulative number of cycles. Twenty-six percent of patients responded to Bev retreatment. On univariate analysis, there was a significant (P=0.003 overall survival advantage when the Bev-free interval was >9 months (95% confidence interval [CI] 4.9–43.7 compared to ≤9 months (95% CI 2.1–11.5, 24

75 FR 77665 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and...

Science.gov (United States)

2010-12-13

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and Andrews International, Fort Smith... subject firm. The workers are engaged in the production of refrigerators and trash compactors. The company...

The Impact of New York's School Libraries on Student Achievement and Motivation: Phase I

Science.gov (United States)

Small, Ruth V.; Snyder, Jaime; Parker, Katie

2009-01-01

In recent years, a number of statewide research studies have been conducted to determine the impact of school library media centers and their school library media specialists (SLMSs) on student achievement. Research studies in eighteen states have clearly established the relationship between well-staffed, well-funded school libraries on student…

The potential for retreating alpine glaciers to alter alpine ecosystems in the Colorado Front Range

Science.gov (United States)

Hall, E.; Baron, J.

2013-12-01

Glaciers are retreating at an unprecedented rate. In mid-latitude alpine ecosystems the presence of glaciers and rock glaciers govern rates and ecology of alpine and sub-alpine ecosystems. Changes in the thermal environment due to the loss of isothermal habitat and inputs from glacier melt chemistry are altering alpine ecosystems in unpredictable ways. In particular, glacier may be a source of nitrogen that is altering alpine ecosystem dynamics. Loch Vale Watershed (LVWS) located within Rocky Mountain National Park. LVWS contains a surface glacier (Andrew's glacier) and a rock glacier (Taylor's glacier) at the headwater of each of the two drainages within the watershed. We collected precipitation from a National Atmospheric Deposition Site and surface water from multiple alpine lakes and streams during a particularly high and low snow year in the Colorado Front Range. We also sampled stream and lake sediments at each site to analyze the associated microbial community. Concentrations of nitrate and ammonium, relative abundance of amoA (the gene responsible for a key step in the microbial nitrification pathway), and the dual isotope signal to nitrate all point to snow melt as a key deliverer of nitrogen to ecosystems along the Colorado Front Range. However, late summer surface water chemistry is isotopically similar to the chemistry of glacial ice. This suggests that retreating glacier may be an additional source of N to alpine ecosystems and have the potential to alter microbial community composition, biogeochemical rate processes, and ecosystem function. These dynamics are most likely not unique to the Colorado Front Range and should be globally distributed as glaciers continue to retreat in high altitude ecosystems around the world.

Contributions of culture and antimicrobial susceptibility tests to the retreatment of patients with pulmonary tuberculosis

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Bruno Horta Andrade

2013-08-01

Full Text Available Introduction This study evaluated the efficacy of retreatment of pulmonary tuberculosis (TB with regard to treatment outcomes and antimicrobial susceptibility testing (ST profiles. Methods This retrospective cohort study analyzed 144 patients treated at a referral hospital in Brazil. All of them had undergone prior treatment, were smear-positive for TB and received a standardized retreatment regimen. Fisher's 2-tailed exact test and the χ2 test were used; RRs and 95% CIs were calculated using univariate and multivariate binary logistic regression. Results The patients were cured in 84 (58.3% cases. Failure was associated with relapsed treatment and abandonment (n=34. Culture tests were obtained for 103 (71.5% cases; 70 (48.6% had positive results. ST results were available for 67 (46.5% cases; the prevalence of acquired resistance was 53.7%. There were no significant differences between those who achieved or not therapeutic success (p=0.988, despite being sensitive or resistant to 1 or more drugs. Rifampicin resistance was independently associated with therapeutic failure (OR: 4.4, 95% CI:1.12-17.37, p=0.034. For those cases in which cultures were unavailable, a 2nd model without this information was built. In this, return after abandonment was significantly associated with retreatment failure (OR: 3.59, 95% CI:1.17-11.06, p=0.026. Conclusions In this cohort, the general resistance profile appeared to have no influence on treatment outcome, except in cases of rifampicin resistance. The form of reentry was another independent predictor of failure. The use of bacterial culture identification and ST in TB management must be re-evaluated. The recommendations for different susceptibility profiles must also be improved.

Student Assessment in the Ubiquitously Connected World

OpenAIRE

Adams, A. A.

2017-01-01

Student cheating on university assessments from entrance exams to finals and from contract cheating on coursework to requesting exam answers using a mobile phone during the exam, has received more and more attention of late. As connection to the Internet becomes ubiquitous and computing and communications technology more embedded in our environment, it is argued that a re-focussing on providing educational opportunities is needed in higher education, rather than chasing the ever-retreating p...

Differences in the clinical-epidemiological profile between new cases of tuberculosis and retreatment cases after default.

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Belchior, Aylana de Souza; Arcêncio, Ricardo Alexandre; Mainbourg, Evelyne Marie Therese

2016-01-01

To identify the socioeconomic and clinical-epidemiological factors related to tuberculosis in new cases and retreatment cases. Comparative study with 126 patients, of which 42 were retreatment cases after default attended in a reference center, and 84 were new cases completing the first treatment and treated in Basic Health Units. The collection of primary data was through interview, and of secondary data by records of the Notifiable Diseases Information System. Comparative analysis between the two groups. The new cases differ from retreatment cases regarding educational level. The clinical-epidemiological profile shows a significant difference in relation to performance of the tuberculin skin test, and the HIV test result (positive) in favor of new cases. In relation to performance of sputum culture and the result (positive) of the first sputum smear of the first and second samples, in favor of retreatment cases. The two groups are significantly different in clinical and epidemiological characteristics that show the access to exams. Identificar fatores socioeconômicos e clínico-epidemiológicos associados à tuberculose em casos novos e em casos em retratamento. Estudo comparativo de 126 pacientes, sendo 42 casos em retratamento por abandono atendidos num Centro de Referência e 84 casos novos concluindo o primeiro tratamento, atendidos em Unidades Básicas de Saúde. Levantamento de dados primários por entrevista e dados secundários pela Ficha de Informação de Agravos de Notificação. Análise comparativa entre os dois grupos. Os casos novos diferem dos em retratamento quanto à escolaridade. O perfil clínico-epidemiológico mostra que há diferença significativa quanto à realização do teste tuberculínico e o resultado do teste HIV (positivo) a favor dos casos novos. Quanto à realização da cultura de escarro e o resultado (positivo) da baciloscopia de escarro da primeira e da segunda amostras, a favor dos casos em retratamento. Os dois grupos

Management of curved root canals in endodontics: clinical case of retreatment

International Nuclear Information System (INIS)

Meneses Guzman, Jose Pablo

2005-01-01

The management of curved root canals in endodontics therapy has required time, patience and skill of the operator, and lots collaboration by the patient. Proper cleaning, disinfection, conformation and root canal filling, in most cases, has prevented the appearance of lesions of bacterial origin to apical or maintenance of these lesions in teeth that are portrayed level. A clinical case is described of retreatment of a first mandibular molar by conventional endodontic treatment with their respective steps, to achieve signs of tissue repair at the apical level. (author) [es

A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections.

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Morrison, Aileen P; Tanasijevic, Milenko J; Torrence-Hill, Joi N; Goonan, Ellen M; Gustafson, Michael L; Melanson, Stacy E F

2011-12-01

The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.

Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives.

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Parker, Stephen; Dark, Frances; Newman, Ellie; Korman, Nicole; Meurk, Carla; Siskind, Dan; Harris, Meredith

2016-06-02

A novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives. The longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with

The daily relationships between staffing, safety perceptions and personality in hospital nursing: A longitudinal on-line diary study.

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Louch, Gemma; O'Hara, Jane; Gardner, Peter; O'Connor, Daryl B

2016-07-01

The association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. To further our understanding of these associations, this paper takes a within-person approach to examine nurses' daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. We recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three-five shifts which collected information on perceptions of staffing, patient-nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. On days when lower patient-nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p=.011) and more favourable perceptions of patient safety (p=workplace cognitive failure (p=personality factors. The findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these

River piracy and drainage basin reorganization led by climate-driven glacier retreat

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Shugar, Daniel H.; Clague, John J.; Best, James L.; Schoof, Christian; Willis, Michael J.; Copland, Luke; Roe, Gerard H.

2017-04-01

River piracy--the diversion of the headwaters of one stream into another one--can dramatically change the routing of water and sediment, with a profound effect on landscape evolution. Stream piracy has been investigated in glacial environments, but so far it has mainly been studied over Quaternary or longer timescales. Here we document how retreat of Kaskawulsh Glacier--one of Canada's largest glaciers--abruptly and radically altered the regional drainage pattern in spring 2016. We use a combination of hydrological measurements and drone-generated digital elevation models to show that in late May 2016, meltwater from the glacier was re-routed from discharge in a northward direction into the Bering Sea, to southward into the Pacific Ocean. Based on satellite image analysis and a signal-to-noise ratio as a metric of glacier retreat, we conclude that this instance of river piracy was due to post-industrial climate change. Rapid regional drainage reorganizations of this type can have profound downstream impacts on ecosystems, sediment and carbon budgets, and downstream communities that rely on a stable and sustained discharge. We suggest that the planforms of Slims and Kaskawulsh rivers will adjust in response to altered flows, and the future Kaskawulsh watershed will extend into the now-abandoned headwaters of Slims River and eventually capture the Kluane Lake drainage.

Pre-Service Teachers’ Responses to Student Behavior in a Mixed-Reality Environment

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Jillian Black

2016-02-01

Full Text Available This study examined whether student gender and the type of student misbehavior affected the classroom management techniques of pre-service teachers. Participants were pre-service teachers who interacted with avatar students controlled by an actor in a mixed-reality environment. Avatar students’ behaviors were systematically coded along with their gender. Pre-service teachers’ responses were organized into four categories: coercion, retreatism, normative, and remunerative. Pre-service teachers’ use of proximity and tone of voice were also recorded. Data were analyzed using chi-square and ANOVA tests. Significant differences in pre-service teacher responses were found for type of avatar student misbehavior but not avatar student gender. Results and implications for future research are discussed.

Workload and time management in central cancer registries: baseline data and implication for registry staffing.

Science.gov (United States)

Chapman, Susan A; Mulvihill, Linda; Herrera, Carolina

2012-01-01

The Workload and Time Management Survey of Central Cancer Registries was conducted in 2011 to assess the amount of time spent on work activities usually performed by cancer registrars. A survey including 39 multi-item questions,together with a work activities data collection log, was sent by email to the central cancer registry (CCR) manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded to the survey.Results indicate that registries faced reductions in budgeted staffing from 2008-2009. The number of source records and total cases were important indicators of workload. Four core activities, including abstracting at the registry, visual editing,case consolidation, and resolving edit reports, accounted for about half of registry workload. We estimate an average of 12.4 full-time equivalents (FTEs) are required to perform all cancer registration activities tracked by the survey; however,estimates vary widely by registry size. These findings may be useful for registries as a benchmark for their own registry workload and time-management data and to develop staffing guidelines.

Cost-effectiveness of retreatment with varenicline after failure with or relapse after initial treatment for smoking cessation

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Lieven Annemans

2015-01-01

Conclusion: This analysis suggests that in the long term, varenicline retreatment is a dominant intervention, meaning both greater health gains and greater costs saved, over other possible interventions and therefore should be considered as a standard option.

The solutions to your problems in endodontic retreatment and microsurgery

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Leslie Ang

2016-06-01

How to find the 4th canal in the upper Second molars in 60% of your patients, How to find the 4th canal in the upper First molars in 90% of your patients, How to retreat canals root filled with metal posts, fiber posts, gutta percha, hard canal cement & thermafils, How to remove fractured posts and posts cemented with resin cements. Understand why and how to perform Endodontic Surgery: How to treat large periapical lesions microsurgically, How to use the latest Ultrasonic technology under the Surgical Operating Microscope in all forms of microsurgery, Learn about the modern concepts in transplants, apicoectomies and intentional replantations.

Correção das aberrações oculares nos retratamentos de LASIK personalizado e convencional Correction of ocular aberrations in custom and standard LASIK retreatments

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Andréia Peltier Urbano

2009-10-01

Full Text Available OBJETIVO: Comparar a correção das aberrações oculares nos retratamentos de LASIK personalizado e convencional. MÉTODOS: Foi realizado um estudo prospectivo, randomizado, de 74 olhos de 37 pacientes submetidos ao retratamento de LASIK para correção de miopia e astigmatismo. Cada paciente foi submetido ao retratamento de LASIK personalizado Zyoptix (Bausch & Lomb em um olho e convencional Planoscan (Bausch & Lomb no olho contralateral. Foi comparada a correção das aberrações oculares nos retratamentos personalizado e convencional. RESULTADOS: No sexto mês pós-operatório, os olhos submetidos ao retratamento Zyoptix apresentaram diminuição estatisticamente significativa do defocus, astigmatismo, coma, aberração esférica, segunda ordem, terceira ordem, alta ordem e aberrações totais. Os olhos submetidos ao retratamento Planoscan apresentaram diminuição estatisticamente significativa do defocus, segunda ordem e aberrações totais. CONCLUSÕES: O retratamento personalizado foi superior ao retratamento convencional para a correção das aberrações oculares de baixa e alta ordens.PURPOSE: To compare the correction of ocular aberrations between custom and standard LASIK retreatment. METHODS: Prospective, randomized trial with paired eye control of 74 eyes from 37 patients who underwent LASIK retreatment. Each patient underwent retreatment using Zyoptix LASIK (Bausch & Lomb in 1 eye and Planoscan LASIK (Bausch & Lomb in the fellow eye. Correction of ocular aberrations was compared between custom and standard LASIK retreatments. RESULTS: At 6 months, there was a statistically significant reduction in defocus, astigmatism, coma, spherical aberration, second, third, higher-order and total aberration in Zyoptix eyes. There was a statistically significant reduction in defocus, second-order and total aberration in Planoscan eyes. CONCLUSIONS: Custom retreatment was statistically superior than standard retreatment for correction of lower

Characteristics and Working Conditions of Moonlighting Teachers: Evidence from the 2011-2012 Schools and Staffing Survey

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Fitchett, Paul G.; Heafner, Tina L.; Harden, Susan B.

2016-01-01

Moonlighting, an employment practice where individuals work outside of their primary job, is popular within the public education sector. Using data from the National Center for Education Statistics Schools and Staffing Survey, this study examined both the characteristics and motivations of public school teachers across moonlighting categories.…

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

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Schroder Kate

2010-06-01

Full Text Available Abstract Background The Ministry of Health (MOH in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007, the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health

Vital School Professionals Eliminated: Student Health, Career Preparation, Art Exposure Suffer. Executive Summary

Science.gov (United States)

Jackson, Victoria

2016-01-01

Until last year, Ohio had in place a rule requiring a minimum level of staffing for music, visual arts, physical education, counselors, librarians, nurses, social workers and visiting teachers. School districts had to have at least five of these eight positions for every 1,000 students. In March 2015, the State Board of Education eliminated this…

Influence of the Gulf Stream on the Barents Sea ice retreat and Eurasian coldness during early winter

International Nuclear Information System (INIS)

Sato, Kazutoshi; Inoue, Jun; Watanabe, Masahiro

2014-01-01

Abnormal sea-ice retreat over the Barents Sea during early winter has been considered a leading driver of recent midlatitude severe winters over Eurasia. However, causal relationships between such retreat and the atmospheric circulation anomalies remains uncertain. Using a reanalysis dataset, we found that poleward shift of a sea surface temperature front over the Gulf Stream likely induces warm southerly advection and consequent sea-ice decline over the Barents Sea sector, and a cold anomaly over Eurasia via planetary waves triggered over the Gulf Stream region. The above mechanism is supported by the steady atmospheric response to the diabatic heating anomalies over the Gulf Stream region obtained with a linear baroclinic model. The remote atmospheric response from the Gulf Stream would be amplified over the Barents Sea region via interacting with sea-ice anomaly, promoting the warm Arctic and cold Eurasian pattern. (letter)

Creating a specialist protein resource network: a meeting report for the protein bioinformatics and community resources retreat.

Science.gov (United States)

Babbitt, Patricia C; Bagos, Pantelis G; Bairoch, Amos; Bateman, Alex; Chatonnet, Arnaud; Chen, Mark Jinan; Craik, David J; Finn, Robert D; Gloriam, David; Haft, Daniel H; Henrissat, Bernard; Holliday, Gemma L; Isberg, Vignir; Kaas, Quentin; Landsman, David; Lenfant, Nicolas; Manning, Gerard; Nagano, Nozomi; Srinivasan, Narayanaswamy; O'Donovan, Claire; Pruitt, Kim D; Sowdhamini, Ramanathan; Rawlings, Neil D; Saier, Milton H; Sharman, Joanna L; Spedding, Michael; Tsirigos, Konstantinos D; Vastermark, Ake; Vriend, Gerrit

2015-01-01

During 11-12 August 2014, a Protein Bioinformatics and Community Resources Retreat was held at the Wellcome Trust Genome Campus in Hinxton, UK. This meeting brought together the principal investigators of several specialized protein resources (such as CAZy, TCDB and MEROPS) as well as those from protein databases from the large Bioinformatics centres (including UniProt and RefSeq). The retreat was divided into five sessions: (1) key challenges, (2) the databases represented, (3) best practices for maintenance and curation, (4) information flow to and from large data centers and (5) communication and funding. An important outcome of this meeting was the creation of a Specialist Protein Resource Network that we believe will improve coordination of the activities of its member resources. We invite further protein database resources to join the network and continue the dialogue.

Managerial Ownership in Nursing Homes: Staffing, Quality, and Financial Performance.

Science.gov (United States)

Huang, Sean Shenghsiu; Bowblis, John R

2017-06-20

Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Preemption versus Entrenchment: Towards a Construction-General Solution to the Problem of the Retreat from Verb Argument Structure Overgeneralization.

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Ben Ambridge

Full Text Available Participants aged 5;2-6;8, 9;2-10;6 and 18;1-22;2 (72 at each age rated verb argument structure overgeneralization errors (e.g., *Daddy giggled the baby using a five-point scale. The study was designed to investigate the feasibility of two proposed construction-general solutions to the question of how children retreat from, or avoid, such errors. No support was found for the prediction of the preemption hypothesis that the greater the frequency of the verb in the single most nearly synonymous construction (for this example, the periphrastic causative; e.g., Daddy made the baby giggle, the lower the acceptability of the error. Support was found, however, for the prediction of the entrenchment hypothesis that the greater the overall frequency of the verb, regardless of construction, the lower the acceptability of the error, at least for the two older groups. Thus while entrenchment appears to be a robust solution to the problem of the retreat from error, and one that generalizes across different error types, we did not find evidence that this is the case for preemption. The implication is that the solution to the retreat from error lies not with specialized mechanisms, but rather in a probabilistic process of construction competition.

Impact of Basal Conditions on Grounding-Line Retreat

Science.gov (United States)

Koellner, S. J.; Parizek, B. R.; Alley, R. B.; Muto, A.; Holschuh, N.; Nowicki, S.

2017-12-01

current grounding-line position. Mixed rheology beds tend to mimic the retreat of the higher-exponent bed, a behavior enhanced over bumps as the stabilizing ridges tap into ice from local valleys. Thus, accounting for variable basal conditions in ice-sheet model projections is critical for improving both the timing and magnitude of retreat.

Modeling subglacial sediment discharge in 1-dimension: comparison with measurments and implications for glacial retreat

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Delaney, I. A.; Werder, M.; Farinotti, D.

2017-12-01

In recent decades increased sedimentation rates have been observed in reservoirs downstream of some retreating glaciers. This material either originates from slopes recently exposed by glacier retreat and no longer stabilized by ice, or subglacially, where pressurized melt water transports sediments from the glacier bed. Some evidence suggests that recently exposed periglacial areas can stablize relatively quickly and in some catchments provides a smaller precentage of the total sediment compared to the subglacial environment. As a result, in order predict and forecast sediment yield from glaciated catchments as glaciers thin and thier hydrology evolves, a subglacial sediment transport model must be implemented. Here a simple 1-dimensional glacio-hydraulic model uses the Darcy-Weissbach relationship to determine shear-stress of presurized water on the glacier bed. This is coupled with a sediment transport relationship to determine quantity of discharged material from the glacier snout. Several tuning factors allow calibration and the model to reproduces processes known to occur subglacially, including seasonal evolution of sediment expulsion and deposition of sediment on adverse slopes of overdeepenings. To asses the model's application to real glaciers, sediment flux data has been collected from Gornergletscher, Aletschgletscher and Griesgletscher in the Swiss Alps over time-scales of up to decades. By calibrating to these data, the skill of the model in recreating sediment trends and volumes is assesed. The outputs capture annual erosion quanities relatively well, however, challenges exist in capturing inter-annual variations in sediment discharge. Many of the model's short comings relate to caputuring the spatial distribution of sediment throughout the glacier bed, which is particularing difficult in 1-dimension. However, this work suggests that a simple models can be used to predict subglacial sediment transport with reasonable ability. Additionally, further

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes--A cross-sectional study.

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Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

2015-09-01

Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically

Costs and effectiveness of fingolimod versus alemtuzumab in the treatment of highly active relapsing-remitting multiple sclerosis in the UK: re-treatment, discount, and disutility.

Science.gov (United States)

Montgomery, Stephen M; Kusel, Jeanette; Nicholas, Richard; Adlard, Nicholas

2017-09-01

Patients with relapsing-remitting multiple sclerosis (RRMS) treated with disease modifying therapies (DMTs) who continue to experience disease activity may be considered for escalation therapies such as fingolimod, or may be considered for alemtuzumab. Previous economic modeling used Markov models; applying one alternative technique, discrete event simulation (DES) modeling, allows re-treatment and long-term adverse events (AEs) to be included in the analysis. A DES was adapted to model relapse-triggered re-treatment with alemtuzumab and the effect of including ongoing quality-adjusted life year (QALY) decrements for AEs that extend beyond previous 1-year Markov cycles. As the price to the NHS of fingolimod in the UK is unknown, due to a confidential patient access scheme (PAS), a variety of possible discounts were tested. The interaction of re-treatment assumptions for alemtuzumab with the possible discounts for fingolimod was tested to determine which DMT resulted in lower lifetime costs. The lifetime QALY results were derived from modeled treatment effect and short- and long-term AEs. Most permutations of fingolimod PAS discount and alemtuzumab re-treatment rate resulted in fingolimod being less costly than alemtuzumab. As the percentage of patients who are re-treated with alemtuzumab due to experiencing a relapse approaches 100% of those who relapse whilst on treatment, the discount required for fingolimod to be less costly drops below 5%. Consideration of treatment effect alone found alemtuzumab generated 0.2 more QALYs/patient; the inclusion of AEs up to a duration of 1 year reduced this advantage to only 0.14 QALYs/patient. Modeling AEs with a lifetime QALY decrement found that both DMTs generated very similar QALYs with the difference only 0.04 QALYs/patient. When the model captured alemtuzumab re-treatment and long-term AE decrements, it was found that fingolimod is cost-effective compared to alemtuzumab, assuming application of only a modest level of

ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI TURNOVER INTENTIONS PADA STAF KANTOR AKUNTAN PUBLIK

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Agus Arianto Toly

2001-01-01

Full Text Available The high level of turnover intentions by accountant staffs had raised the potential cost for public accountant firms. The prior research done by Suwandi and Indriantoro (1999 had succesfully identified the process of turnover intentions, which related to the antecedents and consequences of job insecurity. The responses of 30 accountant staffs from some public accountant firms to a questionnaire designed to measure variables were analyzed using a Pearson's correlation coefficient. The result of this study was not generally consistent with Suwandi and Indriantoro (1999 because some hypotheses were rejected. This study identified that public accountant firm must be noticed organizational factors, such as organizational commitment, role conflict, role ambiguity, and organizational change. Abstract in Bahasa Indonesia : Tingkat keinginan berpindah yang tinggi para staf akuntan telah menimbulkan biaya potensial untuk Kantor Akuntan Publik (KAP. Penelitian sebelumnya yang dilakukan oleh Suwandi dan Indriantoro (1999 telah berhasil mengidentifikasi proses keinginan berpindah, yang berhubungan dengan anteseden dan konsekuensi dari ketidakamanan kerja. Respon 30 staf akuntan dari beberapa KAP terhadap kuesioner yang dibuat untuk mengukur berbagai variabel, dianalisis menggunakan kofisien korelasi Pearson. Hasil dari studi ini secara umum tidak konsisten dengan Suwandi dan Indriantoro (1999 karena ditolaknya beberapa hipotesis. Studi ini mengidentifikasi bahwa KAP harus memberi perhatian terhadap beberapa faktor organisasional, seperti komitmen organisasional, konflik peran, ketidakjelasan peran, dan perubahan organisasional. Kata kunci: konflik peran; ketidakjelasan peran; perubahan organisasional; ketidakamanan kerja; komitmen organisasional; keinginan berpindah.

Influence of design improvements in optimising staffing of NPPs - an Indian experience

International Nuclear Information System (INIS)

Bhattacharya, A.S.

2001-01-01

Three decades of operating experience in India has led to sustained high performance of NPP's. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. The organisational factors that led to optimising of staff are described in the companion paper. This optimisation of manpower is a result of continuous learning - for (i) optimising quantum of workload and (ii) improving productivity. For the first category, design improvements over older Indian NPP's have increased reliability, operability, maintainability and human factors. Few examples: (i) improved man-machine interface in plant controls and on-power refuelling system with operator guidance, logging as well as diagnostic/health monitoring features; (ii) spread out layout for better access and ease of maintenance, separation of plant services for unit-1 from unit-2 and, removal of reactor auxiliaries out to separate buildings; (iii) reduction of maintenance tasks through redesigned equipment and improved condition monitoring means. However, design and procedural improvements also include additional equipment for upgradation of safety measures, e.g. larger number of safety related pumps separate switchyard control room and increased service system equipment. This paper outlines experience of design improvements in optimising staffing and uses a specific case illustration to establish the findings for better use of staff. (author)

Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

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Yasunaga Hideo

2012-05-01

Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey

International Nuclear Information System (INIS)

Dunscombe, Peter; Grau, Cai; Defourny, Noémie; Malicki, Julian; Borras, Josep M.; Coffey, Mary; Bogusz, Marta; Gasparotto, Chiara; Slotman, Ben; Lievens, Yolande; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; De Hertogh, Olivier; Hadjieva, Tatiana; Petera, Jiri; Eriksen, Jesper Grau; Jaal, Jana; Bly, Ritva; Azria, David

2014-01-01

Background and purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe. Materials and methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need

Nutrient biogeochemistry of the eastern Arabian Sea during the southwest monsoon retreat

Digital Repository Service at National Institute of Oceanography (India)

George, R; Muraleedharan, K.R; Martin, G.D.; Sabu, P.; Gerson, V.J.; Dineshkumar, P.K.; Nair, S.M.; Chandramohanakumar, N.; Nair, K.K.C.

and adjoining southeastern Arabian Sea. Curr Sci 96:364–375 Jyothibabu R, Madhu NV, Jayalakshmi KV, Balachandran KK, Shiyas CA, Martin GD, Nair KKC (2006) Impact of freshwater influx on microzooplankton mediated food web in a tropical estuary (Cochin backwaters... ARTICLE Nutrient biogeochemistry of the eastern Arabian Sea during the southwest monsoon retreat Rejomon George • K. R. Muraleedharan • G. D. Martin • P. Sabu • Vijay John Gerson • P. K. Dineshkumar • S. M. Nair • N. Chandramohanakumar • K. K. C. Nair...

Glacier Retreat in the Southern Peruvian Andes: Climate Change, Environmental Impacts, Human Perception and Social Response

Science.gov (United States)

Orlove, B.

2007-12-01

This paper presents results from recent environmental and anthropological research near glacierized areas in the department of Cusco, Peru, home to the well-known Quelccaya Ice Cap and to the peak of Ausangate (6384 m). Glaciers in the region are in negative mass balance, losing volume and area, with upslope movement of the glacier fronts. Somewhat paradoxically, flows in many streams close to the glaciers are reduced, particularly in the dry season, due to a shift in the seasonal distribution of melting, to increased evaporation and to increased percolation into newly-exposed sands and gravels. Associated with this reduction in flow is a desiccation of some anthropogenic and natural wetlands, reducing the availability of dry season forage to wild (vicuna) and domesticated (alpaca, llama) ruminants. Interviews and ethnographic observations with local populations of Quechua-speaking herders at elevations of 4500-5200 meters provide detailed comments on these changes. They have an extensive vocabulary of terms for glacial features associated with retreat. They link this treat with environmental factors (higher temperatures, greater winds that deposit dust on lower portions of glaciers) and with religious factors (divine punishment for human wrong-doing, failure of humans to respect mountain spirits). They describe a variety of economic and extra-economic impacts of this retreat on different spatial, social and temporal scales. Though they face other issues as well (threats of pollution from new mining projects, inadequacy of government services), glacier retreat is their principal concern. Many herders express extreme distress over this unprecedented threat to their livelihoods and communities, though a few propose responses - out-migration, the formation of an association of neighboring communities, development of irrigation works - that could serve as adaptations.

The retreatment of carboplatin via high-dose intraperitoneal chemotherapy in patients with a history of a hypersensitivity reaction

NARCIS (Netherlands)

Kerkhof, M.H.; Ruiz Zapata, A.M.; Bril, H.; Bleeker, M.C.G.; Belien, J.A.M.; Stoop, R.; Helder, M.N.

2014-01-01

A hypersensitivity reaction attributed to platinum-based chemotherapy is a relatively common occurrence. Hyperthermic intraperitoneal chemotherapy potentially facilitates the safe retreatment of platinum therapy following this complication. We describe 3 ovarian cancer patients who were successfully

77 FR 29362 - Kohler Company, Malvern Division, Including On-Site Leased Workers From Manpower Staffing and Dow...

Science.gov (United States)

2012-05-17

... Division, Including On-Site Leased Workers From Manpower Staffing and Dow Cleaning Services, Malvern, AR..., and components. The company reports that workers from Dow Cleaning Services were employed on-site at... leased from Dow Cleaning Services working on-site at the Malvern, Arkansas location of Kohler Company...

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype-4 who failed a previous interferon-free regimen: a case series.

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Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analysed in this case series the role of RAS on the TF in cirrhotic patients with genotype (GT)4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pugh A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained SVR. MELD score improved in all subjects with a median change of 3 points. No significant side effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype 4 who failed a previous interferon-free regimen: a case series.

Science.gov (United States)

Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side-effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analyzed in this case-series the role of RAS on the TF in cirrhotic patients with GT4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pug A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained the SVR. MELD score improved in all subjects with a median change of 3 points. No significant side-effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

Feasibility and utility of re-treatment with 177Lu-DOTATATE in GEP-NENs relapsed after treatment with 90Y-DOTATOC

International Nuclear Information System (INIS)

Severi, Stefano; Sansovini, Maddalena; Ianniello, Annarita; Nicolini, Silvia; Caroli, Paola; Paganelli, Giovanni; Bodei, Lisa; Ibrahim, Toni; Di Iorio, Valentina; D'Errico, Vincenzo; Monti, Manuela

2015-01-01

Peptide receptor radionuclide therapy (PRRT) is a valid therapy for grade 1/2 gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs). Although a median progression-free survival (PFS) of more than 20 months is frequently observed, the majority of patients relapse after 2 - 3 years. In the present study, we investigated the use of low dosage re-treatment with 177 Lu-DOTATATE (Lu-PRRT) in patients with GEP-NENs who relapsed after treatment with 90 Y-DOTATOC (Y-PRRT). Upon tumour progression, 26 patients with a PFS of at least 12 months after Y-PRRT were consecutively enrolled in a phase II study of re-treatment with Lu-PRRT. All patients had preserved kidney and haematological parameters and received 14.8 - 18.5 GBq of Lu-PRRT in four or five cycles. The disease control rate (DCR), toxicity, PFS and prognostic factors were evaluated. Median total activity of Lu-PRRT was 16.5 GBq in five cycles. The DCR was 84.6 %, median PFS was 22 months (95 % CI 16 months - not reached) compared to 28 months (95 % CI 20 - 36 months) after Y-PRRT. Tumour burden and number of liver metastases were important prognostic factors. Toxicity was mild after Lu-PRRT re-treatment in the majority of patients, with only two patients with grade 2 and one with grade 3 bone marrow toxicity; one patient had grade 2 and one grade 3 renal toxicity. Patients with GEP-NEN who have previously responded to Y-PRRT are suitable candidates for Lu-PRRT re-treatment on progression. Although our sample size was limited, low-dosage Lu-PRRT was safe, and led to DCR and PFS rates comparable with those observed when Y-PRRT was used as primary treatment. (orig.)

Potential of the solid-Earth response for limiting long-term West Antarctic Ice Sheet retreat

Science.gov (United States)

Konrad, Hannes; Sasgen, Ingo; Pollard, David; Klemann, Volker

2016-04-01

The West Antarctic Ice Sheet (WAIS) is assumed to be inherently unstable because it is grounded below sea level in a large part, where the bedrock deepens from today's grounding line towards the interior of the ice sheet. Idealized simulations have shown that bedrock uplift due to isostatic adjustment of the solid Earth and the associated sea-level fall may stop the retreat of such a marine-based ice sheet (Gomez et al., 2012). Here, we employ a coupled model for ice-sheet dynamics and solid-Earth dynamics, including a gravitationally consistent description of sea level, to investigate the influence of the viscoelastic Earth structure on the WAIS' future stability (Konrad et al. 2015). For this, we start from a steady-state condition for the Antarctic Ice Sheet close to present-day observations and apply atmospheric and oceanic forcing of different strength to initiate the retreat of the WAIS and investigate the effect of the viscoelastic deformation on the ice evolution for a range of solid-Earth rheologies. We find that the climate forcing is the primary control on the occurrence of the WAIS collapse. However, for moderate climate forcing and a weak solid-Earth rheology associated with the West Antarctic rift system (asthenosphere viscosities of 3x10^19 Pa s or less), we find that the combined effect of bedrock uplift and gravitational sea-level fall limits the retreat to the Amundsen Sea embayment on millennial time scales. In contrast, a stiffer Earth rheology yields a collapse under these conditions. Under a stronger climate forcing, weak Earth structures do not prevent the WAIS collapse; however, they produce a delay of up to 5000 years in comparison to a stiffer solid-Earth rheology. In an additional experiment, we test the impact of sea-level rise from an assumed fast deglaciation of the Greenland Ice Sheet. In cases when the climatic forcing is too weak to force WAIS collapse by itself, the additional rise in sea-level leads to disintegration of the WAIS

Teacher Quality and Student Achievement

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Linda Darling-Hammond

2000-01-01

Full Text Available Using data from a 50-state survey of policies, state case study analyses, the 1993-94 Schools and Staffing Surveys (SASS, and the National Assessment of Educational Progress (NAEP, this study examines the ways in which teacher qualifications and other school inputs are related to student achievement across states. The findings of both the qualitative and quantitative analyses suggest that policy investments in the quality of teachers may be related to improvements in student performance. Quantitative analyses indicate that measures of teacher preparation and certification are by far the strongest correlates of student achievement in reading and mathematics, both before and after controlling for student poverty and language status. State policy surveys and case study data are used to evaluate policies that influence the overall level of teacher qualifications within and across states. This analysis suggests that policies adopted by states regarding teacher education, licensing, hiring, and professional development may make an important difference in the qualifications and capacities that teachers bring to their work. The implications for state efforts to enhance quality and equity in public education are discussed.

Nursing Personnel Planning for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs

Science.gov (United States)

Roy, Rabindra Nath; Dasgupta, Samir; Bhattacharyya, Krishna Das; Misra, Raghu Nath; Roy, Sima; Saha, Indranil

2014-01-01

ABSTRACT Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO—Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel. PMID:25895199

Apical surgery vs apical surgery with simultaneous orthograde retreatment: A prospective cohort clinical study of teeth affected by persistent periapical lesion

Directory of Open Access Journals (Sweden)

Carlo Prati

2018-06-01

Full Text Available Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years. Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2, healing (without any symptoms and PAI = 3 or diseased (with symptoms or PAI ≥ 4 and not functional on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p < 0.05. Results: Total drop-out was 7% (n = 6. After 6–9 months, 6 teeth (3 from apical surgery, 2 from simultaneous treatment and 1 from orthograde retreatment were extracted for root fracture. Twenty-four-month success rate of apical surgery group was 78% (n = 17, apical surgery with simultaneous orthograde retreatment presented 81% (n = 10 and orthograde retreatment success was 80% (n = 24. There was no statistically difference between the groups at 24 months (p = 0.890. Conclusions: Both surgical techniques revealed a high percentage of healing, similar to that reported by previous studies. Apical surgery with simultaneous orthograde retreatment showed a faster healing after 12 months comparing to the control group. Riassunto: Scopo: In

Creating a specialist protein resource network: a meeting report for the protein bioinformatics and community resources retreat

NARCIS (Netherlands)

Babbitt, P.C.; Bagos, P.G.; Bairoch, A.; Bateman, A.; Chatonnet, A.; Chen, M.J.; Craik, D.J.; Finn, R.D.; Gloriam, D.; Haft, D.H.; Henrissat, B.; Holliday, G.L.; Isberg, V.; Kaas, Q.; Landsman, D.; Lenfant, N.; Manning, G.; Nagano, N.; Srinivasan, N.; O'Donovan, C.; Pruitt, K.D.; Sowdhamini, R.; Rawlings, N.D.; Saier, M.H., Jr.; Sharman, J.L.; Spedding, M.; Tsirigos, K.D.; Vastermark, A.; Vriend, G.

2015-01-01

During 11-12 August 2014, a Protein Bioinformatics and Community Resources Retreat was held at the Wellcome Trust Genome Campus in Hinxton, UK. This meeting brought together the principal investigators of several specialized protein resources (such as CAZy, TCDB and MEROPS) as well as those from

Yoga, Meditation and Mind-Body Health: Increased BDNF, Cortisol Awakening Response, and Altered Inflammatory Marker Expression after a 3-Month Yoga and Meditation Retreat.

Science.gov (United States)

Cahn, B Rael; Goodman, Matthew S; Peterson, Christine T; Maturi, Raj; Mills, Paul J

2017-01-01

Thirty-eight individuals (mean age: 34.8 years old) participating in a 3-month yoga and meditation retreat were assessed before and after the intervention for psychometric measures, brain derived neurotrophic factor (BDNF), circadian salivary cortisol levels, and pro- and anti-inflammatory cytokines. Participation in the retreat was found to be associated with decreases in self-reported anxiety and depression as well as increases in mindfulness. As hypothesized, increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR) were also observed. The normalized change in BDNF levels was inversely correlated with BSI-18 anxiety scores at both the pre-retreat ( r = 0.40, p mind-body integration and well-being. The increased BDNF levels observed is a potential mediator between meditative practices and brain health, the increased CAR is likely a reflection of increased dynamic physiological arousal, and the relationship of the dual enhancement of pro- and anti-inflammatory cytokine changes to healthy immunologic functioning is discussed.

Comparison of different retreatment techniques and root canal sealers: a scanning electron microscopic study

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Neslihan Simsek

2014-05-01

Full Text Available The aim of this study was to evaluate the effectiveness of two retreatment techniques, in terms of the operating time and scanning electron microscopy (SEM results, in removing three different root canal sealers from root canals that were previously filled with gutta-percha. Sixty extracted single-rooted human premolars were divided into three groups and filled with iRoot SP, MM Seal, and AH Plus sealers, along with gutta-percha, through a lateral compaction technique. Root canal fillings of the samples were removed by ESI ultrasonic tips or R-Endo files. The time to reach the working length was recorded. Longitudinally sectioned samples were examined under SEM magnification. Each picture was evaluated in terms of the residual debris. Data were statistically analyzed with the Kruskall-Wallis test. No statistically significant differences were found in terms of operating time (p>0.05. Significant differences in the number of debris-free dentinal tubules were found among the root canal thirds, but this finding was not influenced by the experimental group (p < 0.05. Resin sealer tags were observed inside the dentinal tubules in the MM Seal group. Under the conditions of this study, it may be established that there was no difference among the sealers and retreatment techniques.

The future of ice sheets and sea ice: between reversible retreat and unstoppable loss.

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Notz, Dirk

2009-12-08

We discuss the existence of cryospheric "tipping points" in the Earth's climate system. Such critical thresholds have been suggested to exist for the disappearance of Arctic sea ice and the retreat of ice sheets: Once these ice masses have shrunk below an anticipated critical extent, the ice-albedo feedback might lead to the irreversible and unstoppable loss of the remaining ice. We here give an overview of our current understanding of such threshold behavior. By using conceptual arguments, we review the recent findings that such a tipping point probably does not exist for the loss of Arctic summer sea ice. Hence, in a cooler climate, sea ice could recover rapidly from the loss it has experienced in recent years. In addition, we discuss why this recent rapid retreat of Arctic summer sea ice might largely be a consequence of a slow shift in ice-thickness distribution, which will lead to strongly increased year-to-year variability of the Arctic summer sea-ice extent. This variability will render seasonal forecasts of the Arctic summer sea-ice extent increasingly difficult. We also discuss why, in contrast to Arctic summer sea ice, a tipping point is more likely to exist for the loss of the Greenland ice sheet and the West Antarctic ice sheet.

Orthograde retreatment failure with extruded MTA apical plug in a large periradicular lesion followed by surgical intervention: case report.

Science.gov (United States)

Brito-Junior, Manoel; Faria-e-Silva, Andre Luis; Quintino, Alex Carvalho; Moreira-Junior, Gil; Geber, Mauro; Camilo, Carla Cristina; Soares, Janir Alves

2012-01-01

Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.

77 FR 63873 - Johnson Controls, Inc. Including On-Site Leased Workers of Valley Staffing and AZ Quality Hudson...

Science.gov (United States)

2012-10-17

... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson..., Wisconsin location of Johnson Controls, Inc. The Department has determined that these workers were sufficiently under the control of the subject firm to be considered leased workers. Based on these findings...

Efficacy of D-RaCe and ProTaper Universal Retreatment NiTi instruments and hand files in removing gutta-percha from curved root canals - a micro-computed tomography study.

Science.gov (United States)

Rödig, T; Hausdörfer, T; Konietschke, F; Dullin, C; Hahn, W; Hülsmann, M

2012-06-01

To compare the efficacy of two rotary NiTi retreatment systems and Hedström files in removing filling material from curved root canals. Curved root canals of 57 extracted teeth were prepared using FlexMaster instruments and filled with gutta-percha and AH Plus. After determination of root canal curvatures and radii in two directions, the teeth were assigned to three identical groups (n = 19). The root fillings were removed with D-RaCe instruments, ProTaper Universal Retreatment instruments or Hedström files. Pre- and postoperative micro-CT imaging was used to assess the percentage of residual filling material as well as the amount of dentine removal. Working time and procedural errors were recorded. Data were analysed using analysis of covariance and analysis of variance procedures. D-RaCe instruments were significantly more effective than ProTaper Universal Retreatment instruments and Hedström files (P ProTaper group, four instrument fractures and one lateral perforation were observed. Five instrument fractures were recorded for D-RaCe. D-RaCe instruments were associated with significantly less residual filling material than ProTaper Universal Retreatment instruments and hand files. Hedström files removed significantly less dentine than both rotary NiTi systems. Retreatment with rotary NiTi systems resulted in a high incidence of procedural errors. © 2012 International Endodontic Journal.

Antimicrobial usage and risk of retreatment for mild to moderate clinical mastitis cases on dairy farms following on-farm bacterial culture and selective therapy.

Science.gov (United States)

McDougall, S; Niethammer, J; Graham, E M

2018-03-01

To assess antimicrobial usage for treatment of mild to moderate clinical mastitis, and risk of retreatment, following implementation of an on-farm bacterial culture system and selective therapy based on culture results, and to assess compliance with treatment decision tree protocols and the level of agreement between results from on-farm culture and laboratory-based microbiology methods. Herdowners from seven dairy herds were asked to collect milk samples from cases of mild to moderate clinical mastitis between July 2015 and May 2016. All samples were cultured on-farm using a commercially available selective media and were also submitted for laboratory-based culture. Within sequential pairs of cows with mastitis, half were assigned to be treated without regard to culture results (Blanket group), and half were treated based on the on-farm culture results (Selective group) according to decision tree diagrams provided to the farmers. Culture results, treatments, and retreatments for clinical mastitis were recorded. The sum of the daily doses of antimicrobials used per cow, the number of retreatments and interval to first retreatment were compared between treatment groups. The geometric mean sum of daily doses for quarters assigned to the Selective (1.72 (95% CI=1.55-1.90)) group was lower than for the Blanket (2.38 (95% CI=2.17-2.60)) group (p=0.005). The percentage of cows retreated for clinical mastitis did not differ between the Selective (21.7 (95% CI=10.5-25.9)%) and Blanket (26.1 (95% CI=20.9-31.3)%) groups (p=0.13), and there was no difference between groups in the hazard that cows would be retreated within 60 days of enrolment (hazard ratio=0.82 (95% CI=0.39-1.69); p=0.59). Compliance with the treatment protocols was higher amongst quarters assigned to the Selective (199/233; 85.4%) compared with the Blanket (171/249; 68.7%) group (p<0.001), and varied between farms from 64-94%. The overall agreement between results from on-farm and laboratory culture was 188

Rate of bedrock channel incision by waterfall retreat and landscape response constrained by cosmogenic 3He, Kauai, Hawaii

Science.gov (United States)

Mackey, B. H.; Lamb, M. P.; Scheingross, J. S.; Farley, K. A.

2011-12-01

Channel incision and knickpoint retreat are the drivers of landscape evolution, yet we are still challenged to quantify the rate and processes by which rivers cut into rock. The Napali Coast on the northwestern side of Kauai, Hawaii, has multiple linear channels incising >200 m into the shield volcano surface. The channels have well-constrained initial conditions, including original topography, and relatively uniform layered basalt of known age (~4.5 Ma), which have attracted previous studies of channel evolution (e.g., Seidl et al., 1994, 1997). Many channels feature prominent waterfalls, although the mechanism of knickpoint initiation (submarine landslide vs cliff erosion) and subsequent retreat remain ambiguous. Motivated by these knowledge gaps and recent advances in cosmogenic helium geochronology, we revisited the Kaulaula Valley, a 9 km long narrow valley, beheaded on its upslope extent by the Waimea Canyon, and ending near the coast at the northern Mana Plain. Four kilometers up the canyon is a prominent 40 m high vertical knickpoint, dividing the valley into strongly contrasting geomorphic domains. The boulder-lined channel below the knickpoint is linear, steep (15%), and confined to a narrow valley with steep rocky cliffs (average slope 31°). Large, >2 m diameter angular boulders in the lower section of channel show evidence of mobility from debris flows. Above the knickpoint, average channel gradient is reduced (9%), bed load is much finer, and convex, soil-mantled hillslopes have a consistently lower mean slope of 18°. We constrained the exposure age of 18 features (in-channel boulders, stable boulders on terraces, and in-channel bedrock) along the length of the channel, by analysis of cosmogenic 3He in olivine phenocrysts. Cosmogenic exposure ages are oldest near the coast (80 ka) and systematically decrease with upstream distance towards the waterfall (model of knickpoint retreat and downstream terrace abandonment advocated by Seidl (1997), and we

Reassessment of Colombia's tropical glaciers retreat rates: are they bound to disappear during the 2010–2020 decade?

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G. Poveda

2009-12-01

Full Text Available Clear-cut evidences of global environmental change in Colombia are discussed for diverse hydro-climatic records, and illustrated herein for increasing minimum temperature and decreasing annual maximum river flows records. As a consequence, eight tropical glaciers disappeared from the Colombian Andes during the 20th century, and the remaining six have experienced alarming retreat rates during the last decade. Here we report an updated estimation of retreat rates in the six remaining glacierized mountain ranges of Colombia for the period 1987–2007, using Landsat TM and TM+ imagery. Analyses are performed using detailed pre-processing, processing and post-processing satellite imagery techniques. Alarming retreat rates are confirmed in the studied glaciers, with an overall area shrinkage from 60 km² in 2002, to 55.4 km² in 2003, to less than 45 km² in 2007. Assuming such linear loss rate (~3 km² per year, for the near and medium term, the total collapse of the Colombian glaciers can be foreseen by 2022, but diverse physical mechanisms discussed herein would exacerbate the shrinkage processes, thus prompting us to forecast a much earlier deadline by the late 2010–2020 decade, long before the 100 years foreseen by the 2007 IPCC Fourth Assessment Report. This forecast demands detailed monitoring studies of mass and energy balances. Our updated estimations of Colombia's glacier retreat rates posse serious challenges for highly valuable ecosystem services, including water supply of several large cities and hundreds of rural settlements along the Colombian Andes, but also for cheap and renewable hydropower generation which provides 80% of Colombia's demand. Also, the identified changes threaten the survivability of unique and fragile ecosystems like paramos and cloud forests, in turn contributing to exacerbate social unrest and ongoing environmental problems in the tropical Andes which have been

Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review

OpenAIRE

Griffiths, P; Goryakin, Y.; Maben, J.

2010-01-01

OBJECTIVE: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provide...

Restoration and recovery of hurricane-damaged mangroves using the knickpoint retreat effect and tides as dredging tools.

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Bashan, Yoav; Moreno, Manuel; Salazar, Bernardo G; Alvarez, Leonardo

2013-02-15

In 2001, a hurricane moved a large sand dune, blocking the sole outlet channel of a mangrove. In the absence of daily tidal flow, the two ponds containing the mangrove vegetation evaporated, the secondary drainage channels were lost, and a salt crust formed on the bed of the ponds. The mangrove lost most of its trees and the remaining suffered from osmotic shock that led to defoliation. Restoration involved creating a knickpoint retreat (waterfall retreat effect) and tidal flow as a dredging mechanism to restore the outlet and form secondary channels in the ponds. During a very low tide, we deepened the mouth of the outlet channel by 1 m below high tide level to form a small waterfall when high tides receded. During successive tides, this one-step knickpoint deteriorated and formed a series of low rapids. With a steep gradient, the rapids retreated upstream into the ponds, first reopening the outlet channel and then carving new secondary channels in the pond mud flat. The excavation process of the outlet channel was repeated three times and was sufficient to effectively improve the hydrology of the entire pond system; allowing adequate flooding and draining of the mangrove ponds. Hydrology analysis tested by the Engelund-Hansen sediment transport formula established that the output of sediment from the ecosystem is greater than the input of sand into the mangroves. This is keeping the main channel continuously open. After eight years, tidal flow continues to keep the channels open; the salt crust has disappeared; the trees have recovered, and a large area of new vegetation has emerged. Copyright © 2012 Elsevier Ltd. All rights reserved.

Seniority Rules: Do Staffing Reforms Help Redistribute Teacher Quality and Reduce Teacher Turnover? CRPE Working Paper 2010-1

Science.gov (United States)

Gross, Betheny; DeArmond, Michael; Goldhaber, Dan

2010-01-01

Education reformers routinely call on school districts to stop hiring teachers based on seniority, which they argue interferes with effective staffing, especially in disadvantaged schools. The few researchers who have empirically studied the issue, however, disagree about whether seniority-based hiring is systematically associated with staffing…

Evaluation of debris extruded apically during the removal of root canal filling material using ProTaper, D-RaCe, and R-Endo rotary nickel-titanium retreatment instruments and hand files.

Science.gov (United States)

Topçuoğlu, Hüseyin Sinan; Aktı, Ahmet; Tuncay, Öznur; Dinçer, Asiye Nur; Düzgün, Salih; Topçuoğlu, Gamze

2014-12-01

The aim of this study was to evaluate the amount of debris extruded apically during the removal of root canal filling material using ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), D-RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland), and R-Endo (Micro-Mega, Besançon, France) nickel-titanium (NiTi) rotary retreatment instruments and hand files. Sixty extracted single-rooted mandibular premolar teeth were prepared with K-files and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). The teeth were then randomly assigned to 4 groups (n = 15 for each group) for retreatment. The removal of canal filling material was performed as follows: hand files, ProTaper, D-RaCe, and R-Endo retreatment instruments. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using 1-way analysis of variance and Tukey post hoc tests. All retreatment techniques caused the apical extrusion of debris. Hand files produced significantly more debris when compared with ProTaper, D-RaCe, and R-Endo rotary systems (P ProTaper, D-RaCe, and R-Endo retreatment systems (P > .05). The findings showed that during the removal of root canal filling material, rotary NiTi retreatment instruments used in this study caused less apical extrusion of debris compared with hand files. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Relationship between student selection criteria and learner success for medical dosimetry students

International Nuclear Information System (INIS)

Baker, Jamie; Tucker, Debra; Raynes, Edilberto; Aitken, Florence; Allen, Pamela

2016-01-01

Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student's previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant's undergraduate cumulative GPA and increase the weight assigned to previous degrees.

Relationship between student selection criteria and learner success for medical dosimetry students

Energy Technology Data Exchange (ETDEWEB)

Baker, Jamie, E-mail: jabaker@mdanderson.org [Medical Dosimetry Program, School of Health Professions, The University of Texas MD Anderson Cancer Center School of Health Professions, Houston, TX (United States); Tucker, Debra [Arizona State University, Phoenix, AZ (United States); Raynes, Edilberto [University of Phoenix, Phoenix, AZ (United States); Aitken, Florence [University of Nevada, Las Vegas, NV (United States); Allen, Pamela [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States)

2016-04-01

Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student's previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant's undergraduate cumulative GPA and increase the weight assigned to previous degrees.

Nursing Management Minimum Data Set: Cost-Effective Tool To Demonstrate the Value of Nurse Staffing in the Big Data Science Era.

Science.gov (United States)

Pruinelli, Lisiane; Delaney, Connie W; Garciannie, Amy; Caspers, Barbara; Westra, Bonnie L

2016-01-01

There is a growing body of evidence of the relationship of nurse staffing to patient, nurse, and financial outcomes. With the advent of big data science and developing big data analytics in nursing, data science with the reuse of big data is emerging as a timely and cost-effective approach to demonstrate nursing value. The Nursing Management Minimum Date Set (NMMDS) provides standard administrative data elements, definitions, and codes to measure the context where care is delivered and, consequently, the value of nursing. The integration of the NMMDS elements in the current health system provides evidence for nursing leaders to measure and manage decisions, leading to better patient, staffing, and financial outcomes. It also enables the reuse of data for clinical scholarship and research.

The efficacy of ProTaper Universal rotary retreatment instrumentation to remove single gutta-percha cones cemented with several endodontic sealers.

Science.gov (United States)

Ersev, H; Yilmaz, B; Dinçol, M E; Dağlaroğlu, R

2012-08-01

To evaluate residual root filling material following removal of three newly developed root canal sealers used with a matched-taper single-cone root filling technique and to compare the efficacy of ProTaper Universal rotary retreatment instruments with that of a conventional manual technique. The canals of 120 palatal roots in maxillary molar teeth were instrumented with EndoWave nickel-titanium rotary instruments and filled using Hybrid Root SEAL, EndoSequence BC Sealer, Activ GP system or AH Plus with matched-taper single gutta-percha cones. The root fillings were then removed with ProTaper Universal retreatment rotary instruments or a manual technique. Buccolingual and proximal digital radiographs of the roots were exposed to determine the area of remaining filling material in the coronal, middle and apical thirds. The area percentages of remaining filling material in each third and total canal area were calculated. Data were analysed statistically with Kruskal-Wallis and Mann-Whitney U-tests. The level of significance was set at PProTaper groups. When using gross radiographic criteria, the Activ GP was more effectively removed from root canals than AH Plus with hand instrumentation. Hybrid Root SEAL, EndoSequence BC Sealer and AH Plus were removed to a similar extent. ProTaper Universal retreatment instruments were as safe and effective as hand instruments in reaching the working length. © 2012 International Endodontic Journal.

Glacier retreat of the Tian Shan and its impact on the urban growth and environment evaluated from satellite remote sensing data

Science.gov (United States)

Fu, B. H.; Guo, Q.; Yan, F.; Zhang, J.; Shi, P. L.; Ayinuer, M.; Xue, G. L.

2017-07-01

The retreat of mountain glaciers, notably in high Asia, provides evidence for the rise of global temperature. The mass balance is vital for the health of a glacier. If the amount of frozen precipitation in the accumulation zone exceeds the quantity of glacial ice loss due to melting or lies in the ablation zone, the glacier will advance. Conversely, if the accumulation is less than the ablation, the glacier will retreat. Glaciers in retreat will have negative mass balances, and if they do not reach an equilibrium between accumulation and ablation, will eventually disappear. Long-term changes of the mountain glaciers in the Tian Shan, Central Asia, are not well constrained. Analyses of satellite remote sensing data combined with the ground observations reveal a 37.5% decline of glaciered area from 1989 to 2014 in No.1 Glacier, the headwaters of the Urumqi River basin, Chinese Tian Shan, which could be linked to increased summer melting. The results show that the area of glaciers was reduced from 31.55 km2 in 18 August 1989 to 28.66 km2 in 24 August 1994 and 19.74 km2 in 31 August 2014. The glacier area was reduced by 0.47 km2/per year in recent 25 years since 1989, and the annual reduction was 1.5%. Meanwhile, the urban area of Urumqi, the biggest city of Xinjiang Uygur Autonomous Region, increased from 156 km2 in 1989 to 555 km2 in 2014. Correspondingly, the population of permanent residents increased from 1.06 million in 1989 to 3.53 million in 2014. We suggest that the decline of glacier area is driven primarily by summer melting and, possibly, linked to the combined effects of the global rise in temperatures and black carbon/CO2 emission from coal-fired power plants, cement plants and petroleum chemical plants from the nearby Urumqi and surrounding regions. The continuing retreat of glaciers will have a number of different quantitative impacts. Populations in the arid Central Asia regions are heavily dependent on snow and glacier melt for their irrigation and

The First Class of Students at the Full Medical Faculty in Ljubljana in 1945: The 65th Anniversary of Their Enrollment

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Zvonka Zupanič Slavec

2011-08-01

Full Text Available In 1945, a class of 302 students enrolled at the newly established full Faculty of Medicine in Ljubljana with ten semesters of courses. Approximately 200 of them graduated five years later notwithstanding the faculty’s deficiencies in staffing and funding. By the end of 2009, the Ljubljana Faculty of Medicine had trained over 8,500 doctors and dentists. The first class of teachers and students faced many problems, but solved them over time. The spatial situation was solved by government decrees that temporarily assigned the Šempeter barracks, the clinics and health centers of the Ljubljana Hospital to the Faculty of Medicine. Staffing difficulties were solved by awarding professorships to experts in various areas. The problem of textbooks was overcome by students taking notes during lectures and copying them. Initial over-enrollment was solved by academic selection with strict criteria. The student youth organization directed cultivation of the body and mind with political overtones, and led compulsory “volunteer” labor campaigns throughout Yugoslavia. With great effort, despite all the postwar deficiencies, and at the same time enthusiasm for success and the zeal of all involved, the school was formed. It was further developed, year after year, producing ever better doctors with increasingly greater knowledge, comparable to global standards.

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

Science.gov (United States)

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

2017-03-01

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

Incorporating nurse absenteeism into staffing with demand uncertainty.

Science.gov (United States)

Maass, Kayse Lee; Liu, Boying; Daskin, Mark S; Duck, Mary; Wang, Zhehui; Mwenesi, Rama; Schapiro, Hannah

2017-03-01

Increased nurse-to-patient ratios are associated negatively with increased costs and positively with improved patient care and reduced nurse burnout rates. Thus, it is critical from a cost, patient safety, and nurse satisfaction perspective that nurses be utilized efficiently and effectively. To address this, we propose a stochastic programming formulation for nurse staffing that accounts for variability in the patient census and nurse absenteeism, day-to-day correlations among the patient census levels, and costs associated with three different classes of nursing personnel: unit, pool, and temporary nurses. The decisions to be made include: how many unit nurses to employ, how large a pool of cross-trained nurses to maintain, how to allocate the pool nurses on a daily basis, and how many temporary nurses to utilize daily. A genetic algorithm is developed to solve the resulting model. Preliminary results using data from a large university hospital suggest that the proposed model can save a four-unit pool hundreds of thousands of dollars annually as opposed to the crude heuristics the hospital currently employs.

Effect of tofacitinib withdrawal and re-treatment on patient-reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis.

Science.gov (United States)

Griffiths, C E M; Vender, R; Sofen, H; Kircik, L; Tan, H; Rottinghaus, S T; Bachinsky, M; Mallbris, L; Mamolo, C

2017-02-01

Tofacitinib is an oral Janus kinase inhibitor being investigated for psoriasis. A Phase 3 withdrawal/re-treatment study (NCT01186744; OPT Retreatment) showed tofacitinib re-treatment was effective in patients with chronic plaque psoriasis. To describe the effects of tofacitinib withdrawal/re-treatment on health-related quality of life (HRQoL) and disease symptoms measured by patient-reported outcomes (PROs). The study was divided into initial treatment, treatment withdrawal, and re-treatment periods. Initial treatment: patients were randomized to receive tofacitinib 5 (n = 331) or 10 mg (n = 335) BID for 24 weeks. Treatment withdrawal: patients who achieved both ≥ 75% reduction in Psoriasis Area and Severity Index (PASI) score from baseline and Physician's Global Assessment of 'clear'/'almost clear' at Week (W)24 received placebo (withdrawal) or the previous dose (continuous treatment). Re-treatment: at relapse (> 50% loss of W24 PASI response) or at W40, patients received their initial tofacitinib dose. PROs included: Dermatology Life Quality Index (DLQI), Itch Severity Item (ISI), Short Form-36 (SF-36) and Patient's Global Assessment (PtGA). After initial treatment with tofacitinib 5 and 10 mg BID, substantial and significant improvements were reported for mean DLQI (baseline: 12.6 and 12.6; W24: 5.1 and 2.6) and ISI (baseline: 6.7 and 6.9; W24: 2.9 and 1.6). Patients continuously treated with tofacitinib 5 and 10 mg BID maintained those improvements through Week 56 (DLQI: 3.0 and 2.1; ISI: 2.3 and 1.4). By W40, patients withdrawn from tofacitinib 5 and 10 mg BID showed worsening in DLQI (5.0 and 6.2) and ISI (3.7 and 4.0) scores; improvements were regained upon re-treatment (W56, DLQI: 3.4 and 2.4; ISI: 2.2 and 1.6). Similar results were reported for PtGA and SF-36. Continuous tofacitinib treatment provided sustained improvement in HRQoL and disease symptoms. Patients randomized to treatment withdrawal lost initial improvements. Upon re-treatment, improvements

Is raised helicobacter pylori antibody titre enough to decide retreatment

International Nuclear Information System (INIS)

Bibi, S.; Ahmed, W.; Arif, A.; Alam, S.E.

2011-01-01

Background: Helicobacter pylori infection causes a rise in its antibodies which take almost a year to come to baseline following successful eradication treatment. Checking these values in between a year may give falsely high values and many patients may thus be over treated. Aims: To serially determine Helicobacter pylori antibody titres in patients after giving them triple therapy for H. pylori eradication and see how these values drop over time. Study type, Settings and duration: Longitudinal study conducted in Department of Gastroenterology and Hepatology, Pakistan Medical Research Council, Research Centre, Jinnah Post Graduate Medical Centre, Karachi, from May 2006 to April 2010. Subjects and Methods: Over the period of four years, 186 patients who were found positive for campylobacter like organism test during endoscopy were further tested for anti H. pylori IgG titre before being treated for H. pylori. Patients were given triple therapy comprising of Omeprazole (20 mg twice daily), Amoxicillin (1 gm twice daily) and Clarythromycin (500 mg twice daily) for a week and were followed at 1, 3, 6 and 12 months to check symptomatic relief and they were tested again for H.Pylori antibody titres. Data was collected on pre-designed proforma which included patient's demography, symptoms and diagnosis. Results: Out of 186 patients who had a positive campylobacter like organism test, 173 patients consented to participate in the study. Serology for H.Pylori was positive in 119(68%) cases. A decline in mean antibody titres was observed as 11%, 21.5%, 54.7% and 59.2% at 1, 3, 6 and 12 months respectively. Conclusions: Sensitivity of serology for diagnosing H. pylori infection is good but using these as a tool for monitoring response to treatment is doubtful. A slow drop in H.pylori antibodies was seen over 12 months and therefore, physicians are cautioned not to retreat the already treated cases till about one year post treatment. Policy message: H. pylori antibodies should

Calibrated prediction of Pine Island Glacier retreat during the 21st and 22nd centuries with a coupled flowline model

Science.gov (United States)

Gladstone, Rupert M.; Lee, Victoria; Rougier, Jonathan; Payne, Antony J.; Hellmer, Hartmut; Le Brocq, Anne; Shepherd, Andrew; Edwards, Tamsin L.; Gregory, Jonathan; Cornford, Stephen L.

2012-06-01

A flowline ice sheet model is coupled to a box model for cavity circulation and configured for the Pine Island Glacier. An ensemble of 5000 simulations are carried out from 1900 to 2200 with varying inputs and parameters, forced by ocean temperatures predicted by a regional ocean model under the A1B ‘business as usual’ emissions scenario. Comparison is made against recent observations to provide a calibrated prediction in the form of a 95% confidence set. Predictions are for monotonic (apart from some small scale fluctuations in a minority of cases) retreat of the grounding line over the next 200 yr with huge uncertainty in the rate of retreat. Full collapse of the main trunk of the PIG during the 22nd century remains a possibility.

Potential to induce dentinal cracks during retreatment procedures of teeth treated with “Russian red”: An ex vivo study

Directory of Open Access Journals (Sweden)

Eglė Nedzinskienė

2017-01-01

Conclusions: Retreatment methods had a damaging effect on the root dentin of teeth previously treated with resorcinol–formaldehyde resin. At magnification ×16, the efficacy of using the dye for the detection of cracks was higher than detection without the dye.

Relationship between student selection criteria and learner success for medical dosimetry students.

Science.gov (United States)

Baker, Jamie; Tucker, Debra; Raynes, Edilberto; Aitken, Florence; Allen, Pamela

2016-01-01

Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student׳s previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant׳s undergraduate cumulative GPA and increase the weight assigned to previous degrees. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Risk factors associated with default among retreatment tuberculosis patients on DOTS in Paschim Medinipur district (West Bengal).

Science.gov (United States)

Sarangi, S S; Dutt, D

2014-07-01

In India in 2010, 14.1% of retreatment of TB patients' treatment outcome was 'default'. Since 2002, in Paschim Midnapur District (West Bengal), it has been around 15-20%. To determine the timing, characteristics and risk factors associated with default among retreatment TB patients on DOTS. It was a case control study, conducted in six TB units (TU) of Paschim Midnapur District, which were selected by simple random sampling. Data was collected from treatment records of TUs/DTC. Data was also collected through interviews of the patients using the same pre-tested semi-structured questionnaire from 87 defaulters and 86 consecutively registered non-defaulters registered in first quarter, 2009 to second quarter, 2010. Median duration of treatment taken before default was 121 days (inter-quartile range of 64-176 days). Median number of doses of treatment taken before default was 36 (inter -quartile range of 26-63 doses). No retrieval action was documented in 57.5% cases. Retrieval was done between 0-7 days of missed doses in 29.9% cases. Multiple logistic regression analysis indicated the following important risk factors for default at 95% confidence interval: male-sex limit: [aOR 3.957 (1.162-13.469)], alcoholic inebriation[ aOR6.076 (2.088-17.675)], distance from DOT centre [aOR 4.066 (1.675-9.872)], number of missed doses during treatment [aOR 1.849 (1.282-2.669)] and no initial home visit [aOR 10.607 (2.286 -49.221)]. In Paschim Midnapur district, default of retreatment TB occurs mostly after a few doses in continuation phase. Initial home visit, patient provider meeting, retrieval action, community-based treatment as per RNTCP guidelines are required to uplift the programme.

Feasibility and utility of re-treatment with {sup 177}Lu-DOTATATE in GEP-NENs relapsed after treatment with {sup 90}Y-DOTATOC

Energy Technology Data Exchange (ETDEWEB)

Severi, Stefano; Sansovini, Maddalena; Ianniello, Annarita; Nicolini, Silvia; Caroli, Paola; Paganelli, Giovanni [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Nuclear Medicine Unit, Meldola, FC (Italy); Bodei, Lisa [European Institute of Oncology, Division of Nuclear Medicine, Milan (Italy); Ibrahim, Toni [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Osteoncology and Rare Tumors Center, Meldola (Italy); Di Iorio, Valentina [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Oncology Pharmacy Laboratory, Meldola (Italy); D' Errico, Vincenzo [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Medical Physics Unit, Meldola (Italy); Monti, Manuela [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Unit of Biostatistics and Clinical Trials, Meldola (Italy)

2015-12-15

Peptide receptor radionuclide therapy (PRRT) is a valid therapy for grade 1/2 gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs). Although a median progression-free survival (PFS) of more than 20 months is frequently observed, the majority of patients relapse after 2 - 3 years. In the present study, we investigated the use of low dosage re-treatment with {sup 177}Lu-DOTATATE (Lu-PRRT) in patients with GEP-NENs who relapsed after treatment with {sup 90}Y-DOTATOC (Y-PRRT). Upon tumour progression, 26 patients with a PFS of at least 12 months after Y-PRRT were consecutively enrolled in a phase II study of re-treatment with Lu-PRRT. All patients had preserved kidney and haematological parameters and received 14.8 - 18.5 GBq of Lu-PRRT in four or five cycles. The disease control rate (DCR), toxicity, PFS and prognostic factors were evaluated. Median total activity of Lu-PRRT was 16.5 GBq in five cycles. The DCR was 84.6 %, median PFS was 22 months (95 % CI 16 months - not reached) compared to 28 months (95 % CI 20 - 36 months) after Y-PRRT. Tumour burden and number of liver metastases were important prognostic factors. Toxicity was mild after Lu-PRRT re-treatment in the majority of patients, with only two patients with grade 2 and one with grade 3 bone marrow toxicity; one patient had grade 2 and one grade 3 renal toxicity. Patients with GEP-NEN who have previously responded to Y-PRRT are suitable candidates for Lu-PRRT re-treatment on progression. Although our sample size was limited, low-dosage Lu-PRRT was safe, and led to DCR and PFS rates comparable with those observed when Y-PRRT was used as primary treatment. (orig.)

Research-retreat-recovery: A potential model for organization and completion of research projects. Experience from a neurosurgery department in a developing country.

Science.gov (United States)

Godil, Saniya Siraj; Kazim, Syed Faraz; Shamim, Muhammad Shahzad

2010-10-30

In the current era of biomedical research, it is imperative that every research study at an institution is properly organized, and frequently audited to streamline efforts and maintain standards. Recently, a research retreat was organized by the Section of Neurosurgery at Aga Khan University Hospital, Karachi, Pakistan, and following that a recovery team was made with the aim of recovering "lost in translation" research projects. In the realm of our experience, the current model is being proposed as a means for organization of departmental research. The "research" component of the model comprised compilation of an abstract book of all research work done within the section during the last five years. The "retreat" component of the model was intended with objectives of analysis of past research and generation of fresh ideas. The "recovery" component of the model was accomplished by formation of a research recovery team with the aim of recovering unfinished, and/or unpublished research projects. The abstract book comprised 103 abstracts: 52.4% original research studies, 12.6% review articles, and 34.9% case report/series. Only 8.7% abstracts were of basic science research whereas the remaining 91.3% were clinical research papers. Only 34% had been published in an article form in a biomedical research journal (51.4% in international journals and 48.6% in national journals); remaining papers were either in submission/preparation process or had been abandoned. As part of research recovery, 29.4% projects were recovered within 12 weeks of the retreat component. We conclude that the model of "research-retreat-recovery" is highly successful in the context of neurosurgery departments in developing countries without a proper research unit, and can result in better organization of departmental research, recovery of unfinished projects, and initiation of new research studies.

Efficacy of ProTaper retreatment system in root canals filled with gutta-percha and two endodontic sealers.

Science.gov (United States)

Só, Marcus Vinícius Reis; Saran, Caroline; Magro, Miriam Lago; Vier-Pelisser, Fabiana Vieira; Munhoz, Marcelo

2008-10-01

This study evaluated the efficacy of ProTaper Universal rotary retreatment system and hand files for filling material removal during retreatment and the influence of sealer type on the presence of filling debris in the reinstrumented canals. The canals of 60 palatal roots of first molars were obturated with gutta-percha and either a zinc oxide-eugenol-based or a resin-based sealer and reinstrumented: G1, EndoFill/hand files; G2, AH Plus/hand files; G3, EndoFill/ProTaper; G4, AH Plus/ProTaper. Roots were cleaved and examined with an optical microscope, and the amount of filling debris on canal walls was analyzed on digitized images. There was no significant difference (P > .05) among the root canal thirds within each group. G3 presented significantly more filling debris than G1 in the cervical third (P = .04). In the middle third, G2/G3/G4 showed more debris than G1 (P = .03). The techniques were similar (P = .64) in the apical third. All groups presented filling debris in the 3 canal thirds after reinstrumentation.

Staffing for Success

Science.gov (United States)

Perozzi, Brett; Seifert, Tricia; Al-Sharif, Mary Ann Bodine

2016-01-01

This chapter explores institutional capacity building in cross-border student affairs and services. The focus is on human capital and its importance to international higher education within local contexts.

Selective embolization of unruptured intracranial aneurysms is associated with low retreatment rate

Energy Technology Data Exchange (ETDEWEB)

Bandeira, Alexandra; Raphaeli, Guy [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Erasme University Hospital, Interventional Neuroradiology Fellows, Brussels (Belgium); Baleriaux, Danielle [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Bruneau, Michael; Witte, Olivier De [Erasme University Hospital, Neurosurgery, Brussels (Belgium); Lubicz, Boris [Erasme University Hospital, Department of Radiology, Neuroradiology Section, Brussels (Belgium); Hopital Erasme, Service de Radiologie, Brussels (Belgium)

2010-02-15

To report long-term imaging findings of 101 patients with 129 unruptured intracranial aneurysms (UIA) treated by embolization. A retrospective review of our prospectively maintained database identified all patients with an UIA treated by embolization with coils only and with a minimal 12-month imaging follow-up. The clinical charts, procedural data, and angiographic results were reviewed. Between March 2004 and June 2009, 101 patients with 129 UIA were identified (71 women/30 men, mean age = 51.4 years). Ninety-four aneurysms (73%) were large (10-25 mm), and 35 (27%) were small (<10 mm). Aneurysms mean size was 10.7 mm (median, 9 mm; range 3-22 mm); 87 UIA (67.5%) had a small neck (<4 mm or neck/sac ratio < 0.7), and 42 (32.5%) had a wide neck ({>=}4 mm or neck/sac ratio {>=} 0.7). Selective coiling with bare/coated coils was performed in 125 cases and four cases, respectively. The balloon-assisted technique was used in 47 cases (36.4%). Only one patient experienced a symptomatic complication (thromboembolism) and kept a slight hemiparesis. Immediate results included 77 complete occlusions (59.7%), 45 neck remnants (34.9%), and 7 incomplete occlusions (5.4%). Mean imaging follow-up of 32 months showed 104 stable occlusions (80.6%), 12 further thrombosis (9.3%), 7 major recanalizations (5.4%), and 6 minor recanalizations (4.7%). Retreatment was required in seven wide-necked and/or large aneurysms including four treated with coated coils. No bleeding occurred during follow-up. Selective embolization of UIA is associated with stable long-term anatomical results and low retreatment rate. (orig.)

The Implications of Flexible Staffing Arrangements for Job Stability. Upjohn Institute Staff Working Paper No. 99-056. Revised.

Science.gov (United States)

Houseman, Susan N.; Polivka, Anne E.

A study examined the job stability of workers in the following flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. Two data sources were used in the analysis. The first was a nationwide survey of employers on their use of flexible staffing…

Educational Reforms and Implementation of Student-Centered Active Learning in Science at Secondary and University Levels in Qatar

Science.gov (United States)

Qureshi, Sheila; Bradley, Katherine; Vishnumolakala, Venkat Rao; Treagust, David F.; Southam, Daniel C.; Mocerino, Mauro; Ojeil, Joseph

2016-01-01

The Qatari government has made significant changes in the organization and staffing of schools over the past decade in an effort to improve the academic performance of school-aged citizens. Of interest is the need to encourage teachers to move from a didactic teacher-led mode of instruction to one that is more student-centred, but also…

Metadata Quality in Institutional Repositories May be Improved by Addressing Staffing Issues

Directory of Open Access Journals (Sweden)

Elizabeth Stovold

2016-09-01

Full Text Available A Review of: Moulaison, S. H., & Dykas, F. (2016. High-quality metadata and repository staffing: Perceptions of United States–based OpenDOAR participants. Cataloging & Classification Quarterly, 54(2, 101-116. http://dx.doi.org/10.1080/01639374.2015.1116480 Objective – To investigate the quality of institutional repository metadata, metadata practices, and identify barriers to quality. Design – Survey questionnaire. Setting – The OpenDOAR online registry of worldwide repositories. Subjects – A random sample of 50 from 358 administrators of institutional repositories in the United States of America listed in the OpenDOAR registry. Methods – The authors surveyed a random sample of administrators of American institutional repositories included in the OpenDOAR registry. The survey was distributed electronically. Recipients were asked to forward the email if they felt someone else was better suited to respond. There were questions about the demographics of the repository, the metadata creation environment, metadata quality, standards and practices, and obstacles to quality. Results were analyzed in Excel, and qualitative responses were coded by two researchers together. Main results – There was a 42% (n=21 response rate to the section on metadata quality, a 40% (n=20 response rate to the metadata creation section, and 40% (n=20 to the section on obstacles to quality. The majority of respondents rated their metadata quality as average (65%, n=13 or above average (30%, n=5. No one rated the quality as high or poor, while 10% (n=2 rated the quality as below average. The survey found that the majority of descriptive metadata was created by professional (84%, n=16 or paraprofessional (53%, n=10 library staff. Professional staff were commonly involved in creating administrative metadata, reviewing the metadata, and selecting standards and documentation. Department heads and advisory committees were also involved in standards and documentation

The antimicrobial effectiveness of photodynamic therapy used as an addition to the conventional endodontic re-treatment: a clinical study.

Science.gov (United States)

Jurič, Ivona Bago; Plečko, Vanda; Pandurić, Dragana Gabrić; Anić, Ivica

2014-12-01

The purpose of the study was to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) used as an adjunct to the endodontic re-treatment in the eradication of microorganisms from previously filled root canals. The study sample consisted of 21 randomly selected patients with root filled and infected root canal system with chronic apical periodontitis on incisors or canines, who have had previously endodontic treatment. Microbiological samples from the root canals were collected after accessing the canal, following the endodontic re-treatment and after the aPDT procedure. During instrumentation, the root canals were irrigated with 2.5% sodium hypochlorite (NaOCl), and the final irrigation protocol included 17% ethylenediaminetetraacetic acid followed by NaOCl. Root canals were filled with a phenothiazinium chloride and irradiated with a diode laser (λ=660 nm, 100 mW) for 1 min. Microbiological samples from the root canals were cultivated on selective plates, and the identification was done by micromorphology, macromorphology and different API strips as well as bacterial counts (colony forming units). Fourteen bacteria species were isolated from the root canals initially, with a mean value of 4.57 species per canal. Although endodontic re-treatment alone produced a significant reduction in the number of bacteria species (pendodontic treatment and aPDT was statistically more effective (proot canals of 11 teeth. The results indicated that the aPDT used as an adjunct to the conventional endodontic therapy achieved a significant further reduction of intracanal microbial load. Copyright © 2014 Elsevier B.V. All rights reserved.

Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues.

Science.gov (United States)

Pandit, Jaideep J; Dexter, Franklin

2009-06-01

At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously. We used Monte-Carlo simulation using normal and Weibull distributions to estimate the times to complete lists of cases scheduled into such 8 h sessions. For each combination of mean and standard deviation, inefficiencies of use of OR time were determined for 10 h versus 8 h of staffing. When the mean actual hours of OR time used averages standard deviation and relative cost of over-run to under-run. When mean > or = 8 h 50 min, 10 h staffing has higher OR efficiency. For 8 h 25 min standard deviation of 60 min and relative cost of over-run to under-run of 2.0 versus (b) 8 h 48 min for normal, standard deviation of 0 min and relative cost ratio of 1.50. Although the simplest decision rule would be to staff for 8 h if the mean workload is standard deviation 60 min, and relative cost ratio of 2.00, the inefficiency of use of OR time would be 34% larger if staffing were planned for 8 h instead of 10 h. For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages or = 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499-516).

Retarded deglaciation of north-Spitsbergen fjords during the last glacial - an example of bathymetric controls on the dynamics of retreating glaciers

Science.gov (United States)

Forwick, M.; Vorren, T. O.; Hass, H.; Vogt, C. M.

2012-12-01

North and west Spitsbergen fjords acted as pathways for fast-flowing ice streams during the last glacial (e.g. Ottesen et al., 2005). The deglaciation of west Spitsbergen fjords occurred stepwise and the ice retreat terminated around 11,200 cal. years BP (calendar years before the present; e.g. Forwick & Vorren, 2009, 2011, and references therein; Baeten et al., 2010). However, the deglaciation dynamics and chronology of north Spitsbergen fjords still remain poorly understood. We present swath-bathymetry, high-resolution seismic data and two sediment cores from the approx. 110 km long, N-S oriented Wijdefjorden-Austfjorden fjord system, the largest fjord system on northern Spitsbergen. The data indicate that - as in the fjords on west Spitsbergen - multiple halts and/or readvances interrupted the retreat of the ice front during the final phase of the last glacial. However, even though the study area and several west Spitsbergen fjords are fed by the same glacier source (the ice field Lomonosovfonna), the final deglaciation of Wijdefjorden-Austfjorden took place after 9300 cal. years BP, i.e. at least approx. 2000 years later than in the west. We assume that the retarded deglaciation in the north is mainly related to the fjord bathymetry, i.e. a more than 35 km wide and up to 60 m high area in the central parts of the study area (approx. 45 km beyond the present fjord head) that acted as pinning point for the grounded glacier. Multiple, relatively large and partly stacked moraine ridges and sediment wedges are suggested to reflected that the ice front retreated slowly across this shallow area and that repeated readvances interrupted this retreat. The absence of larger sediment wedges in the deeper parts between the shallow area and the fjord head may indicate that the final retreat occurred relatively rapid. References: Baeten, N.J., Forwick, M., Vogt, C. & Vorren, T.O., 2010. Late Weichselian and Holocene sedimentary environments and glacial activity in

Effect of retreating sea ice on Arctic cloud cover in simulated recent global warming

Directory of Open Access Journals (Sweden)

M. Abe

2016-11-01

Full Text Available This study investigates the effect of sea ice reduction on Arctic cloud cover in historical simulations with the coupled atmosphere–ocean general circulation model MIROC5. Arctic sea ice has been substantially retreating since the 1980s, particularly in September, under simulated global warming conditions. The simulated sea ice reduction is consistent with satellite observations. On the other hand, Arctic cloud cover has been increasing in October, with about a 1-month lag behind the sea ice reduction. The delayed response leads to extensive sea ice reductions because the heat and moisture fluxes from the underlying open ocean into the atmosphere are enhanced. Sensitivity experiments with the atmospheric part of MIROC5 clearly show that sea ice reduction causes increases in cloud cover. Arctic cloud cover increases primarily in the lower troposphere, but it decreases in the near-surface layers just above the ocean; predominant temperature rises in these near-surface layers cause drying (i.e., decreases in relative humidity, despite increasing moisture flux. Cloud radiative forcing due to increases in cloud cover in autumn brings an increase in the surface downward longwave radiation (DLR by approximately 40–60 % compared to changes in clear-sky surface DLR in fall. These results suggest that an increase in Arctic cloud cover as a result of reduced sea ice coverage may bring further sea ice retreat and enhance the feedback processes of Arctic warming.

Does mental health staffing level affect antipsychotic prescribing? Analysis of Italian national statistics.

Science.gov (United States)

Starace, Fabrizio; Mungai, Francesco; Barbui, Corrado

2018-01-01

In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.

25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false How many hours can a student be taken out of the academic setting to receive behavioral health services? 36.83 Section 36.83 Indians BUREAU OF INDIAN AFFAIRS... AND NATIONAL CRITERIA FOR DORMITORY SITUATIONS Homeliving Programs Staffing § 36.83 How many hours can...

Sub-ice-shelf sediments record history of twentieth-century retreat of Pine Island Glacier

OpenAIRE

Smith, J.A.; Andersen, T.J.; Shortt, M.; Gaffney, A.M.; Truffer, M.; Stanton, T.P.; Bindschadler, R.; Dutrieux, P.; Jenkins, A.; Hillenbrand, C.-D.; Ehrmann, W.; Corr, H.F.J.; Farley, N.; Crowhurst, S.; Vaughan, D.G.

2016-01-01

The article of record as published may be found at http://dx.doi.org/10.1038/nature20136 The West Antarctic Ice Sheet is one of the largest potential sources of rising sea levels. Over the past 40 years, glaciers flowing into the Amundsen Sea sector of the ice sheet have thinned at an accelerating rate, and several numerical models suggest that unstable and irreversible retreat of the grounding line—which marks the boundary between grounded ice and floating ice shelf—is underway. Under...

Late effects of radiation on the lumbar spinal cord of guinea pigs: Re-treatment tolerance

International Nuclear Information System (INIS)

Mason, K.A.; Withers, H.R.; Chiang, Chi-Shiun

1993-01-01

Using a guinea pig model of lumbar myelopathy, various factors affecting the tolerance of spinal cord to irradiation were assessed: (a) extent of initial injury; (b) time interval between priming and test doses; and (c) animal age at the time of initial radiation treatment. A 3 cm section of lumbar spinal cord of guinea pigs was irradiated with fractionated doses of 4.5 Gy gamma rays given as 9 fractions per week. Guinea pigs were primed with 9 x 4.5 Gy in 7 days which is 60% of the ED 50 for a continuous course of treatment. After 28 or 40 weeks, animal were retreated with 6-14 fractions of 4.5 Gy. Animals were observed for 2 years following the priming dose and both the incidence and latency of myelopathy recorded. Young adult guinea pigs (8 wk old) showed both a decreased radiation tolerance and latency compared to old individuals (40 wk old). At 28 or 40 wk after 9 x 4.5 Gy, only about 8% of the initial injury was remembered in young adult guinea pigs. The amount of residual injury was dependent on the initial damage as a proportion of the tolerance dose. The spinal cord shows a greater capacity for long-term recovery than generally appreciated and re-treatment doses clinically prescribed may be lower than necessary. 8 refs., 3 figs., 2 tabs

"Managed Retreat" in Response to Superstorm Sandy: The Oakwood Beach Story

Science.gov (United States)

Tirone, J.

2017-12-01

This presentation shares lessons learned from firsthand experience of the home buyout process in New York City after Superstorm Sandy. Many have described Sandy as "the perfect storm" from a meteorological perspective, but it was also the perfect storm from a government-buyout perspective. For a buyout to work in New York City, with its high property values and dense housing and population, many conditions had to be in place before the storm. Before Sandy hit, Oakwood Beach on Staten Island had already had enough. Hurricane Isaac flooded streets and basements in 2010, followed by Hurricane Irene in 2011. Many residents of this multi-generational neighborhood had just finished fixing their homes. A few years before, a brush fire spread through the invasive and highly flammable Phragmites reeds, destroying a protective berm installed by the Army Corps of Engineers in 2000 and threatening to damage many homes. An aerial view would show how these homes incredulously sat in the middle of a marsh, a marsh designated as part of the Bluebelt wetlands storm water management system by New York City's Department of Environmental Protection. Even more incredulously, while New York City was buying up unimproved lots to expand the Bluebelt to improve drainage for inland homes, the City was also issuing building permits to developers - sometimes for lots directly in the Bluebelt's path. Welcome to Staten Island, where the political influence of developers made any effort to retreat from the waterfront especially difficult and contentious. Before the storm, no one knew what a buyout was, never mind how to go about seeking one. For the most part, this included local officials. Managed retreat is typically understood as a top-down directive, but in this case the buyout plan was initiated from the bottom up by eight ordinary citizens who used research, trust, and networking to get their voices heard and, against all odds, to drive a highly successful State-supported buyout program.

Comparative analysis of efficacy and cleaning ability of hand and rotary devices for gutta-percha removal in root canal retreatment: an in vitro study.

Science.gov (United States)

Reddy, Narender; Admala, Shilpa Reddy; Dinapadu, Sainath; Pasari, Srikanth; Reddy, Manoranjan P; Rao, M S Rama

2013-07-01

To evaluate the efficacy and cleaning ability of Hedstrom files, and ProTaper retreatment instruments in removing gutta-percha from root canals with and without xylene as solvent. Sixty extracted single rooted human teeth were selected and decoronated, straight access established working length determined 1 mm short of canal, chemomechanical preparation done and obturated with guttapercha and AH plus sealer. Samples were stored for 1 week in humidifier divided into four groups of 15 teeth each. • Group I: Hedstrom files without xylene. • Group II: Hedstrom files with xylene. • Group III: ProTaper retreatment instruments without xylene. • Group IV: ProTaper retreatment instruments with xylene. and the following criteria were assessed - Time taken for initial plunge of instrument into guttapercha. - Time taken for complete removal of gutta-percha to reach working length - Ability of H files and ProTaper retreatment files with/ without xylene to remove gutta-percha in coronal, middle and apical 1/3 of canal. The teeth were grooved in labiolingual cross section, observed under a steromicroscope and scored according to gutta-percha debris left in the canal. Results were evaluated using ANOVA test and multiple comparisons done using Scheffe test. The least time to reach working length was found with group IV followed by groups III, II and group I respectively. Also the fastest way to remove maximum gutta-percha was group IV followed by groups III, II, and I respectively with a statistically significant difference among all groups. Apical 1/3 has more amount of remaining gutta-percha debris than middle and coronal 1/3 in all groups. The amount of gutta-percha debris in apical 1/3 was least in group IV followed by groups III, II and I respectively. The better performance of ProTaper rotary instruments has been attributed to their special flute design which tends to pull gutta-percha coronally directing it toward orifice. Also the movements of engine driven

Effect of Intracanal Medication with Calcium Hydroxide and 1% Chlorhexidine in Endodontic Retreatment Cases with Periapical Lesions: An In Vivo Study

Directory of Open Access Journals (Sweden)

Ertugrul Ercan

2007-01-01

Conclusion: Our results suggest that a combination of Ca(OH2 and 1% CHX can be successfully used as intracanal medicament for disinfection in endodontic retreatment cases with periapical lesions. [J Formos Med Assoc 2007;106(3:217-224

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Science.gov (United States)

Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A

2001-01-01

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Extinction and ecological retreat in a community of primates

Energy Technology Data Exchange (ETDEWEB)

Crowley, B. E.; Godfrey, L. R.; Guilderson, T. P.; Zermeno, P.; Koch, P. L.; Dominy, N. J.

2012-05-23

The lemurs of Madagascar represent a prodigious adaptive radiation. At least 17 species ranging from 11 to 160 kg have become extinct during the past 2000 years. The effect of this loss on contemporary lemurs is unknown. The concept of competitive release favours the expansion of living species into vacant niches. Alternatively, factors that triggered the extinction of some species could have also reduced community-wide niche breadth. Here, we use radiocarbon and stable isotope data to examine temporal shifts in the niches of extant lemur species following the extinction of eight large-bodied species. We focus on southwestern Madagascar and report profound isotopic shifts, both from the time when now-extinct lemurs abounded and from the time immediately following their decline to the present. Unexpectedly, the past environments exploited by lemurs were drier than the protected (albeit often degraded) riparian habitats assumed to be ideal for lemurs today. Neither competitive release nor niche contraction can explain these observed trends. We develop an alternative hypothesis: ecological retreat, which suggests that factors surrounding extinction may force surviving species into marginal or previously unfilled niches.

Staffing Foreign Subsidiaries with Parent Country Nationals or Host Country Nationals?

DEFF Research Database (Denmark)

Dörrenbächer, Christoph; Gammelgaard, Jens; McDonald, Frank

captures the effects of PCN verses HCN managers on key characteristics of subsidiaries. The results of the study indicate that the PCN/HCN dichotomy widely used in the international staffing literature needs to take account of the following issues: First: The study confirms theoretical assumptions based...... on social capital theory that subsidiaries led by HCNs are more embedded in the host country's external environment (by having more frequent relationships with host country customers, suppliers and competitors). However, the study reveals that the assumed advantages PCN led subsidiaries have...... to the local institutional environment (HRM). Our study finds that this is also the case with regard to strategic decisions on financial control as well as on R&D and new product development. Third: On average, HCN led subsidiaries perform significantly better than PCN led subsidiaries with regard to sales...

Successful retreatment with sofosbuvir plus ledipasvir for cirrhotic patients with hepatitis C virus genotype 1b, who discontinued the prior treatment with asunaprevir plus daclatasvir: A case series and review of the literature

Science.gov (United States)

Haga, Yuki; Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Ooka, Yoshihiko; Takahashi, Koji; Wu, Shuang; Nakamoto, Shingo; Arai, Makoto; Chiba, Tetsuhiro; Maruyama, Hitoshi; Yokosuka, Osamu; Takada, Nobuo; Moriyama, Mitsuhiko; Imazeki, Fumio; Kato, Naoya

2018-01-01

Background Interferon-free treatment results in higher sustained virologic response (SVR) rates, with no serious adverse events in hepatitis C virus (HCV)-infected patients. However, in some patients with treatment-failure in HCV NS5A inhibitor-including interferon-free regimens, the treatment-emergent HCV NS5A resistance-associated variants (RAVs), which are resistant to interferon-free retreatment including HCV NS5A inhibitors, are observed. In HCV-infected Japanese patients with daclatasvir and asunaprevir treatment failure, retreatment with sofosbuvir and ledipasvir could lead to only ∼70% SVR rates. Case summary Three HCV genotype (GT)-1b-infected cirrhotic patients who discontinued the combination of daclatasvir and asunaprevir due to adverse drug reactions within 4 weeks; retreatment with sofosbuvir and ledipasvir combination could result in SVR in these patients without RAVs. One HCV GT-1b-infected cirrhotic patient who discontinued the combination of daclatasvir and asunaprevir due to viral breakthrough at week 10; retreatment with sofosbuvir and ledipasvir combination for this patient with the treatment-emergent HCV NS5A RAV-Y93H resulted in viral relapse at week 4 after the end of the treatment. Conclusion Retreatment with sofosbuvir and ledipasvir is effective for HCV GT-1b patients who discontinue the combination of daclatasvir and asunaprevir within 4 weeks. The treatment response should be related to the existence of treatment-emergent HCV NS5A RAVs, but may not be related to the short duration of treatment. PMID:29435197

In Review (Geology): Alpine Landscape Evolution Dominated by Cirque Retreat

Science.gov (United States)

Oskin, Michael; Burbank, Doug

2005-01-01

Despite the abundance in alpine terrain of glacially dissected landscapes, the magnitude and geometry of glacial erosion can rarely be defined. In the eastern Kyrgyz Range, a widespread unconformity exhumed as a geomorphic surface provides a regional datum with which to calibrate erosion. As tectonically driven surface uplift has progressively pushed this surface into the zone of ice accumulation, glacial erosion has overprinted the landscape. With as little as 500 m of incision into rocks underlying the unconformity, distinctive glacial valleys display their deepest incision adjacent to cirque headwalls. The expansion of north-facing glacial cirques at the expense of south-facing valleys has driven the drainage divide southwards at rates up to 2 to 3 times the rate of valley incision. Existing ice-flux-based glacial erosion rules incompletely model expansion of glacial valleys via cirque retreat into the low-gradient unconformity remnants. Local processes that either directly sap cirque headwalls or inhibit erosion down-glacier appear to control, at least initially, alpine landscape evolution.

Drainage of ice-dammed lakes and glacier retreat - a link

DEFF Research Database (Denmark)

Kjeldsen, Kristian Kjellerup; Kjaer, K. H.; Rysgaard, Søren

2011-01-01

surface freshwater run-off is found in the top of the water column in the fjord while sub-glacial meltwater is entrained deeper in the water column. The latter is highly important as this colder buoyant freshwater is pushed to the water surface followed by a compensating deeper landward current bringing...... in the fjord. The large quantity of buoyant freshwater changed the osmotic pressure and pushed redfish to the water surface causing them to die from divers disease. Further investigation suggested that three ice-dammed lakes adjacent to the Narssap Sermia glacier had drained within the previous year. Analysis......-30 times the volume of an ice-dammed lake prior to drainage. The warm water influx in turn causes the glacier to retreat and to gradually become thinner which feeds back to an increase in drainage events of ice-dammed lakes over time. On a larger scale the feedback mechanism between the drainage of lakes...

Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard.

Science.gov (United States)

McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl

2008-01-01

This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.

Internationalization manager’s identity and authority identification:staffing of the export department in Greek internationalized manufacturing companies

OpenAIRE

Garri, Myropi; Konstantopoulos, Nikolaos

2011-01-01

The research objective of this paper is to examine the staffing procedure of the internationalization department of the company in reference to the origin of the individuals selected to compose it. Subsequently, we endeavour to outline the identity of the individual at the head of internationalization, where a special department doesn’t exist. Additionally, we attempt to recognize the overall responsibilities and authority spaces of the internationalization manager. Results implied the prefer...

Rituximab Extended Schedule or Re-Treatment Trial for Low–Tumor Burden Follicular Lymphoma: Eastern Cooperative Oncology Group Protocol E4402

Science.gov (United States)

Kahl, Brad S.; Hong, Fangxin; Williams, Michael E.; Gascoyne, Randy D.; Wagner, Lynne I.; Krauss, John C.; Habermann, Thomas M.; Swinnen, Lode J.; Schuster, Stephen J.; Peterson, Christopher G.; Sborov, Mark D.; Martin, S. Eric; Weiss, Matthias; Ehmann, W. Christopher; Horning, Sandra J.

2014-01-01

Purpose In low–tumor burden follicular lymphoma (FL), maintenance rituximab (MR) has been shown to improve progression-free survival when compared with observation. It is not known whether MR provides superior long-term disease control compared with re-treatment rituximab (RR) administered on an as-needed basis. E4402 (RESORT) was a randomized clinical trial designed to compare MR against RR. Patients and Methods Eligible patients with previously untreated low–tumor burden FL received four doses of rituximab, and responding patients were randomly assigned to either RR or MR. Patients receiving RR were eligible for re-treatment at each disease progression until treatment failure. Patients assigned to MR received a single dose of rituximab every 3 months until treatment failure. The primary end point was time to treatment failure. Secondary end points included time to first cytotoxic therapy, toxicity, and health-related quality of life (HRQOL). Results A total of 289 patients were randomly assigned to RR or MR. With a median follow-up of 4.5 years, the estimated median time to treatment failure was 3.9 years for patients receiving RR and 4.3 years for those receiving MR (P = .54). Three-year freedom from cytotoxic therapy was 84% for those receiving RR and 95% for those receiving MR (P = .03). The median number of rituximab doses was four patients receiving RR and 18 for those receiving MR. There was no difference in HRQOL. Grade 3 to 4 toxicities were infrequent in both arms. Conclusion In low–tumor burden FL, a re-treatment strategy uses less rituximab while providing disease control comparable to that achieved with a maintenance strategy. PMID:25154829

New details about the LGM extent and subsequent retreat of the West Antarctic Ice Sheet from the easternmost Amundsen Sea Embayment shelf

Science.gov (United States)

Klages, J. P.; Hillenbrand, C. D.; Kuhn, G.; Smith, J. A.; Graham, A. G. C.; Nitsche, F. O.; Frederichs, T.; Arndt, J. E.; Gebhardt, C.; Robin, Z.; Uenzelmann-Neben, G.; Gohl, K.; Jernas, P.; Wacker, L.

2017-12-01

In recent years several previously undiscovered grounding-zone wedges (GZWs) have been described within the Abbot-Cosgrove palaeo-ice stream trough on the easternmost Amundsen Sea Embayment shelf. These GZWs document both the Last Glacial Maximum (LGM; 26.5-19 cal. ka BP) grounding-line extent and the subsequent episodic retreat within this trough that neighbors the larger Pine Island-Thwaites trough to the west. Here we combine bathymetric, seismic, and geologic data showing that 1) the grounding line in Abbot Trough did not reach the continental shelf break at any time during the last glacial period, and 2) a prominent stacked GZW constructed from six individual wedges lying upon another was deposited 100 km upstream from the LGM grounding-line position. The available data allow for calculating volumes for most of these individual GZWs and for the entire stack. Sediment cores were recovered seawards from the outermost GZW in the trough, and from the individual wedges of the stacked GZW in order to define the LGM grounding-line extent, and provide minimum grounding-line retreat ages for the respective positions on the stacked GZW. We present implications of a grounded-ice free outer shelf throughout the last glacial period. Furthermore, we assess the significance of the grounding-line stillstand period recorded by the stacked GZW in Abbot Trough for the timing of post-LGM retreat of the West Antarctic Ice Sheet from the Amundsen Sea Embayment shelf.

Achieving effective staffing through a shared decision-making approach to open-shift management.

Science.gov (United States)

Valentine, Nancy M; Nash, Jan; Hughes, Douglas; Douglas, Kathy

2008-01-01

Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders and executive management. Leading healthcare organizations are using open-shift management technology as a strategy to improve staffing effectiveness and the work environment. In many hospitals, open-shift management technology has become an essential workforce management tool, nursing benefit, and recruitment and retention incentive. In this article, the authors discuss how a successful nursing initiative to apply automation to open-shift scheduling and fulfillment across a 3-hospital system had a broad enterprise-wide impact resulting in dramatic improvements in nurse satisfaction, retention, recruitment, and the bottom line.

Greenland's 20th Century retreat illuminated - great spatial variability with strong connections to subglacial topography and fjord bathymetry

Science.gov (United States)

Bjork, A. A.; Kjeldsen, K. K.; Boeckel, M. V.; Korsgaard, N. J.; Fenty, I. G.; Khan, S. A.; Mouginot, J.; Morlighem, M.; Rignot, E. J.; Dowdeswell, J. A.; Kjaer, K. H.

2017-12-01

Mass loss acceleration from the Greenland Ice Sheet is a dominant contributor in recent global sea-level rise, and has been for several decades. While ice sheet wide mass loss has recently been documented from the end of the Little Ice Age (c. 1900 CE) to the 1980s, the detailed changes during this period remain poorly known. In this study, we map glacier margins of Greenland's 310 largest outlet glaciers in order to get the full picture of the 20th Century mass loss. We take advantage of the rich history of aerial photography over Greenland and combine photos from archives in Denmark, Norway, United Kingdom, and United States. We supplement the historical aerial photographs with declassified US spy satellite imagery and recent satellite imagery to document glacial retreat and advance on a decadal scale. With recent advances in bathymetry mapping and subglacial topography mapping, we are able to show that spatial differences in retreat throughout the last 100 years are largely controlled by the underlying topography. Our study further highlights hotspots of past rapid mass loss in Greenland, and discusses implications for periods of regional stability and advance.

Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

Directory of Open Access Journals (Sweden)

Faul, Mark

2014-11-01

Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

Cohort Trends in Premarital First Births: What Role for the Retreat From Marriage?

Science.gov (United States)

Wu, Lawrence L.; Shafer, Emily Fitzgibbons

2015-01-01

We examine cohort trends in premarital first births for U.S. women born between 1920 and 1964. The rise in premarital first births is often argued to be a consequence of the retreat from marriage, with later ages at first marriage resulting in more years of exposure to the risk of a premarital first birth. However, cohort trends in premarital first births may also reflect trends in premarital sexual activity, premarital conceptions, and how premarital conceptions are resolved. We decompose observed cohort trends in premarital first births into components reflecting cohort trends in (1) the age-specific risk of a premarital conception taken to term; (2) the age-specific risk of first marriages not preceded by such a conception, which will influence women’s years of exposure to the risk of a premarital conception; and (3) whether a premarital conception is resolved by entering a first marriage before the resulting first birth (a “shotgun marriage”). For women born between 1920–1924 and 1945–1949, increases in premarital first births were primarily attributable to increases in premarital conceptions. For women born between 1945–1949 and 1960–1964, increases in premarital first births were primarily attributable to declines in responding to premarital conceptions by marrying before the birth. Trends in premarital first births were affected only modestly by the retreat from marriages not preceded by conceptions—a finding that holds for both whites and blacks. These results cast doubt on hypotheses concerning “marriageable” men and instead suggest that increases in premarital first births resulted initially from increases in premarital sex and then later from decreases in responding to a conception by marrying before a first birth. PMID:24072609

Strategic foresight, leadership, and the future of rural healthcare staffing in the United States.

Science.gov (United States)

Reimers-Hild, Connie

2018-05-01

This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends-exponential advances in science and technology and the continued evolution of the decentralized global marketplace-will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities.

"Get a Blue and You Will See Your Money Back Again": Staffing and Marketing the English Prep School, 1890-1912

Science.gov (United States)

Benson, John

2014-01-01

This article explores the ways in which English prep schools were staffed and marketed in the years before the First World War. Its aim more specifically is to employ a biographical approach to consider the emphasis that the schools placed upon sport, and in particular the extent to which they recruited Oxford and Cambridge Blues as teachers…

The 20th century retreat of ice caps in Iceland derived from airborne SAR

DEFF Research Database (Denmark)

Magnússon, Eyjólfur; Björnsson, Helgi; Dall, Jørgen

2005-01-01

with the Danish airborne EMISAR radar system. Polarimetric and interferometric SAR data reveal the margins of the present ice caps as well as a series of terminal moraines in the fore field. These moraines date back to the maximum Neoglacial extent at the end of the 19th century and the outermost allow...... of the surges in W-Vatnajokull in the 20th century are observed in the SAR data including the most recent surges in the 1990s. Interestingly no push moraines were observed in front of the surge advance, but the moraines appear when the glaciers start retreating. We estimate that the collective decrease...

Did the Recession Impact Student Success? Relationships of Finances, Staffing and Institutional Type on Retention

Science.gov (United States)

Gansemer-Topf, Ann M.; Downey, Jillian; Thompson, Katherine; Genschel, Ulrike

2018-01-01

Economic recessions impact higher education institutions in complex ways. Several analyses have examined the influence of the 2007-2009 recession on tuition, enrollments, revenues, and expenditures, but the connection of these resource allocation patterns to a student success outcome--namely, retention--is limited. This study examined…

Staffing Up and Dropping Out

Directory of Open Access Journals (Sweden)

Mark Fetler

1997-07-01

Full Text Available Growing public school enrollment and the need to maintain or improve service to students has increased the demand for teachers, perhaps more rapidly than existing sources can accommodate. While some schools recruit well qualified teachers by offering higher salaries or better working conditions, others may satisfy their need for staff by relaxing hiring standards or assigning novice teachers to difficult classrooms. Schools' hiring policies have consequences for student success. Dropout rates tend to be higher where faculties include a greater percentage of minimally educated teachers or teachers with little experience. The relationship between dropout rate and teacher qualifications is independent of student poverty, school size, and location. A proposed strategy to reduce dropout rates is to encourage higher preparation and employment standards, and to provide appropriate classroom assignments, mentoring, and support for new teachers.

Nitrogen-controlled intra- and interspecific competition between Populus purdomii and Salix rehderiana drive primary succession in the Gongga Mountain glacier retreat area.

Science.gov (United States)

Song, Mengya; Yu, Lei; Jiang, Yonglei; Lei, Yanbao; Korpelainen, Helena; Niinemets, Ülo; Li, Chunyang

2017-06-01

In this study, intra- and interspecific competition were investigated in early successional Salix rehderiana Schneider and later-appearing Populus purdomii Rehder under non-fertilized (control) and nitrogen (N)-fertilized conditions in the Hailuogou glacier retreat area. Our aim was to discover whether N is a key factor in plant-plant competition and whether N drives the primary succession process in a glacier retreat area. We analyzed differences in responses to intra- and interspecific competition and N fertilization between P. purdomii and S. rehderiana, including parameters such as biomass accumulation, nutrient absorption, non-structural carbohydrates, photosynthetic capacity, hydrolysable amino acids and leaf ultrastructure. In the control treatments, S. rehderiana individuals subjected to interspecific competition benefited from the presence of P. purdomii plants, as indicated by higher levels of biomass accumulation, photosynthetic capacity, N absorption, amino acid contents and photosynthetic N-use efficiency. However, in the N-fertilized treatments, P. purdomii individuals exposed to interspecific competition benefited from the presence of S. rehderiana plants, as shown by a higher growth rate, enhanced carbon gain capacity, greater amino acid contents, and elevated water-use efficiency, whereas the growth of S. rehderiana was significantly reduced. Our results demonstrate that N plays a pivotal role in determining the asymmetric competition pattern among Salicaceae species during primary succession. We argue that the interactive effects of plant-plant competition and N availability are key mechanisms that drive primary succession in the Gongga Mountain glacier retreat area. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

CO{sub 2} and N{sub 2}O emissions in a soil chronosequence at a glacier retreat zone in Maritime Antarctica

Energy Technology Data Exchange (ETDEWEB)

Thomazini, A., E-mail: andre.thz@gmail.com [Department of Plant Production, Federal University of Espírito Santo, 29500-000 Alegre, Espírito Santo (Brazil); Mendonça, E.S., E-mail: eduardo.mendonca@ufes.br [Department of Plant Production, Federal University of Espírito Santo, 29500-000 Alegre, Espírito Santo (Brazil); Teixeira, D.B., E-mail: daniel.dbt@hotmail.com [FCAV/UNESP, Via de Acesso, Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, SP (Brazil); Almeida, I.C.C., E-mail: ivancarreiro@yahoo.com.br [Instituto Federal do Norte de Minas Gerais, Fazenda São Geraldo, s/n km. 06, 39480-000 Januária, Minas Gerais (Brazil); La Scala, N., E-mail: lascala@fcav.unesp.br [FCAV/UNESP, Via de Acesso, Prof. Paulo Donato Castellane s/n, 14884-900 Jaboticabal, SP (Brazil); Canellas, L.P., E-mail: lucianocanellas@gmail.com [UENF — Universidade Estadual do Norte Fluminense Darcy Ribeiro, Núcleo de Desenvolvimento de Insumos Biológicos para a Agricultura (NUDIBA), Av. Alberto Lamego, 2000, Campos dos Goytacazes 28013-602, Rio de Janeiro (Brazil); Spokas, K.A., E-mail: kurt.Spokas@ars.usda.gov [USDA-ARS, Soil and Water Management Unit, University of Minnesota — St. Paul, MN 55108 (United States); Milori, D.M.B.P., E-mail: debora.milori@embrapa.br [Embrapa Instrumentation Brazilian Agricultural Research Corporation, São Carlos, SP (Brazil); Turbay, C.V.G., E-mail: cturbay@gmail.com [Department of Geology, Federal University of Espírito Santo, 29500-000 Alegre, Espírito Santo (Brazil); and others

2015-07-15

Studies of C cycle alterations are extremely important to identify changes due to climate change, especially in the polar ecosystem. The objectives of this study were to (i) examine patterns of soil CO{sub 2}-C and N{sub 2}O-N emissions, and (ii) evaluate the quantity and quality of soil organic matter across a glacier retreat chronosequence in the Maritime Antarctica. Field measurements were carried out during January and February 2010 (summer season) along a retreating zone of the White Eagle Glacier, at King George Island, Maritime Antarctica. Soil samples (0–10 cm) were collected along a 500-m transect at regular intervals to determine changes in soil organic matter. Field CO{sub 2}-C emission measurements and soil temperature were carried out at regular intervals. In addition, greenhouse gas production potentials were assessed through 100 days laboratory incubations. Soils exposed for a longer time tended to have greater concentrations of soluble salts and possess sandier textures. Total organic C (3.59 g kg{sup −1}), total N (2.31 g kg{sup −1}) and labile C (1.83 g kg{sup −1}) tended to be lower near the glacier front compared with sites away from it, which is correlated with decreasing degree of humification of the soil organic matter with exposure time. Soil CO{sub 2}-C emissions tended to increase with distance from the glacier front. On average, the presence of vegetation increased CO{sub 2}-C emissions by 440%, or the equivalent of 0.633 g of CO{sub 2}-C m{sup −2} h{sup −1}. Results suggest that newly exposed landsurfaces undergo soil formation with increasing labile C input from vegetation, accompanied by increasing soil CO{sub 2}-C emissions. Despite the importance of exposure time on CO{sub 2}-C production and emissions, there was no similar trend in soil N{sub 2}O-N production potentials as a function of glacial retreat. For N{sub 2}O, instead, the maximum production occurred in sites with the first stages of vegetation growth

Three-dimensional evaluation of effectiveness of hand and rotary instrumentation for retreatment of canals filled with different materials.

Science.gov (United States)

Hammad, Mohammad; Qualtrough, Alison; Silikas, Nick

2008-11-01

The aim of this study was to measure the remaining filling volume of different obturation materials from root-filled extracted teeth by using 2 removal techniques. Eighty single-rooted teeth were collected and decoronated, and the root canal was prepared by using the ProTaper nickel-titanium rotary files. The teeth were randomly allocated into 4 groups, and each group was obturated by using a different material. Group 1 was filled with gutta-percha and TubliSeal sealer, group 2 was filled with EndoRez points and EndoRez sealer, group 3 was filled with RealSeal points and RealSeal sealer, and Group 4 was filled with a gutta-percha point and GuttaFlow sealer. Teeth were scanned with a micro-computed tomography scan, and then root fillings were removed by using ProTaper retreatment files or hand K-files. Teeth were scanned again, and volume measurements were carried out with micro-computed tomography software. Statistical analysis showed significant differences between the 2 removal techniques for gutta-percha and for both techniques between gutta-percha and the other groups. The present study showed that all tested filling materials were not completely removed during retreatment by using hand or rotary files. Gutta-percha was more efficiently removed by using hand K-files.

Sediment contribution from coastal-cliff erosion into the Nile's littoral cell and its significance to cliff-retreat mitigation efforts

Science.gov (United States)

Katz, Oded; Mushkin, Amit; Crouvi, Onn; Alter, Samuel; Shemesh, Ran

2017-04-01

In 2013 the government of Israel initiated a national mitigation program aimed to prevent further collapse and retreat of the country's coastal cliffs, which occur along the northern termination of the Niles's littoral cell (NLC) in the eastern Mediterranean. The goals of this large-scale program are to protect infrastructure and property proximal to the cliff and to conduct long-term maintenance and monitoring of this highly dynamic and sensitive land-sea interface that spans 40 km of Israel's coast line. Here, we examine the possible impact of proposed cliff retreat mitigation efforts on long-shore sediment transport (LST) and coastal dynamics in the region. We used airborne LiDAR spanning a 9-year period between 2006 and 2015 to quantify the annual contribution of sediment eroded from a 20-km-long segment of Israel's coastal cliffs into the NLC. Our measurements reveal 282±85*103 m3 of sediment eroded from the cliff and delivered into the NLC during the studied period. Considering our study area comprises 50% of Israel's sea cliffs we infer an average contribution rate of 30,000-60,000 m^3/yr of cliff-derived sediment into the NLC prior to the planned broad-scale implementation of cliff-retreat mitigation measures. Previous studies report an average net LST flux of 80,000 - 90,000 m3 that reaches the northern termination of the NLC at Haifa Bay annually. Thus, our results suggest that Israel's actively eroding coastal cliffs are primary contributors (40-80%) to the LST budget along the northern termination of the NLC. It therefore appears that successful implementation of the coastal-cliff protection program along Israel's coastline will result in a significant sand deficit, which may drive LST in this part of the NLC out of its 'background' state. In the likely case that the energy/currents driving LST do not change, a possible outcome of this sediment deficit could be increased beach erosion along Israel's coast line to make up for the lost volumes of cliff

Knickpoint retreat and transient bedrock channel morphology triggered by base-level fall in small bedrock river catchments: The case of the Isle of Jura, Scotland

Science.gov (United States)

Castillo, Miguel; Bishop, Paul; Jansen, John D.

2013-01-01

A sudden drop in river base-level can trigger a knickpoint that propagates throughout the fluvial network causing a transient state in the landscape. Knickpoint retreat has been confirmed in large fluvial settings (drainage areas > 100 km2) and field data suggest that the same applies to the case of small bedrock river catchments (drainage areas UK), where rivers incise into dipping quartzite. The mapping of raised beach deposits and strath terraces, and the analysis of stream long profiles, were used to identify knickpoints that had been triggered by base-level fall. Our results indicate that the distance of knickpoint retreat scales to the drainage area in a power law function irrespective of structural setting. On the other hand, local channel slope and basin size influence the vertical distribution of knickpoints. As well, at low drainage areas (~ 4 km2) rivers are unable to absorb the full amount of base-level fall and channel reach morphology downstream of the knickpoint tends towards convexity. The results obtained here confirm that knickpoint retreat is mostly controlled by stream discharge, as has been observed for other transient landscapes. Local controls, reflecting basin size and channel slope, have an effect on the vertical distribution of knickpoints; such controls are also related to the ability of rivers to absorb the base-level fall.

Improving School Nurse Pain Assessment Practices for Students With Intellectual Disability.

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Quinn, Brenna L; Smolinski, Megan

2017-01-01

School nurses are afforded minimal resources related to assessing pain in students with intellectual disability (ID) and have called for continuing education. The purpose of this study was to measure the effectiveness of an education program regarding best practices for assessing pain in students with ID. Educational sessions were presented to 248 school nurses. Pre-, post-, and follow-up surveys measured (1) difficulty school nurses face when assessing pain, (2) knowledge and use of pain assessment methods, and (3) intent to change and actual changes to professional practices. Participants experienced less difficulty assessing pain following the educational program. Almost all participants intended to change pain assessment practices, but large caseloads limited new practice adoption. Policy makers must consider population size and acuity when determining school nurse staffing. Trainings and other resources should be made available to school nurses in order to make pain assessments for students with ID more thorough and efficient.

There's a New Alphabet in Town: ESSA and Its Implications for Students, Schools, and School Nurses.

Science.gov (United States)

Blackborow, Mary; Clark, Elizabeth; Combe, Laurie; Morgitan, Judith; Tupe, Anna

2018-03-01

The 2015 passage of the Every Student Succeeds Act (ESSA) provides state education agencies with more local control over educational planning, requires development of state accountability plans, and provides opportunities for advocacy surrounding school nursing-sensitive indicators of student success. Federal Title I, II, and IV funds are available for state and local education agency utilization in meeting educational needs of impoverished students and for development of high-quality instructional and support personnel. As Specialized Instructional Support Personnel, school nurses can utilize ESSA Title funding to positively impact chronic absenteeism, school climate, and school nurse staffing. ESSA can be a resource for funding school health services and professional education. This article will assist school nurses in better understanding ESSA and how funding is allocated to states and local education agencies.

The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction.

Science.gov (United States)

Sheward, Louisa; Hunt, Jennifer; Hagen, Suzanne; Macleod, Margaret; Ball, Jane

2005-01-01

To explore the relationship between nurse outcomes (dissatisfaction and emotional exhaustion) and nurse workload, nurse characteristics and hospital variables. Concern about the impact of restructuring of nurse staffing, and reports of nurse shortages, on nurse and patient outcomes led to the research being reported on in this article. A questionnaire survey of registered nurses in Scotland and England. A questionnaire survey of the hospitals in which these nurses worked. Respondents in the two countries were similar in terms of demographic, work and employment characteristics. Significant relationships were found using the combined English and Scottish data between nurse patient ratios and (1) emotional exhaustion and (2) dissatisfaction with current job reported by nurses. Increasing numbers of patients to nurses was associated with increasing risk of emotional exhaustion and dissatisfaction with current job.

Peptide receptor radionuclide therapy (PRRT): clinical significance of re-treatment?

Energy Technology Data Exchange (ETDEWEB)

Virgolini, Irene [Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck (Austria); Collaboration: The Innsbruck Team

2015-12-15

PRRT appears to be the most effective therapeutic option in the management of inoperable or metastasized NET patients with limited side effects if dose limits are respected. In patients with relapse after a first treatment period with {sup 90}Y-DOTATOC, multiple re-treatment cycles with {sup 177}Lu-DOTATATE are feasible, safe and efficacious. Quantitative imaging by dosimetry adds to formulate personalized and evidence-based treatment protocols. However, despite the large body of evidence regarding efficacy and safety of PRRT, the absence of prospective randomized controlled trials questions the utility of PRRT in the community. Furthermore, the growing number of pharmacological or liver-directed therapeutic options competes with the confusion based on the variety of somatostatin analogues to determine the optimal choice and sequencing of PRRT in the individual patient. However, the efficacy of PRRT should not be questioned rather than it should be explored as to when PRRT might be optimally applied in the sequence of available therapy modalities. The results of the present study by the Italian group [5] emphasizes that radiopharmaceuticals are still underused. Despite the huge potential of PRRT the non-availability of PRRT in many countries still limits its widespread use. After acquiring the exclusive rights for {sup 177}Lu-DOTATATE with granted orphan designation, the company Advanced Accelerator Applications (AAA) is currently running a phase III study comparing treatment with {sup 177}Lu-DOTATATE to Octreotide LAR in patients with inoperable, progressive, somatostatin receptor-positive, midgut carcinoid tumours with the aim of registering the radiopharmaceutical under the commercial name of Lutathera. Together with orphan designation also to other somatostatin-based radiopharmaceuticals, such as {sup 90}Y-DOTATOC, {sup 177}Lu-DOTATOC and the {sup 68}Ga-labelled somatostatin antagonist OPS202, these developments promote the advancement of PRRT and PET imaging

Successful retreatment with grazoprevir and elbasvir for patients infected with hepatitis C virus genotype 1b, who discontinued prior treatment with NS5A inhibitor-including regimens due to adverse events.

Science.gov (United States)

Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Nakamoto, Shingo; Takahashi, Koji; Wu, Shuang; Sasaki, Reina; Haga, Yuki; Ogasawara, Sadahisa; Saito, Tomoko; Kobayashi, Kazufumi; Kiyono, Soichiro; Ooka, Yoshihiko; Suzuki, Eiichiro; Chiba, Tetsuhiro; Maruyama, Hitoshi; Moriyama, Mitsuhiko; Kato, Naoya

2018-03-23

Sustained virologic response (SVR) by interferon and interferon-free treatment can results in the reduction of advanced liver fibrosis and the occurrence of hepatocellular carcinoma in patients infected with hepatitis C virus (HCV). Recent interferon-free treatment for HCV shortens the duration of treatment and leads to higher SVR rates, without any serious adverse events. However, it is important to retreat patients who have had treatment-failure with HCV non-structural protein 5A (NS5A) inhibitor-including regimens. Combination of sofosbuvir and ledipasvir only leads to approximately 100% SVR rates in HCV genotype (GT1b), NS5A inhibitor-naïve patients in Japan. This combination is not an indication for severe renal disease or heart disease, and these patients should be treated or retreated with a different regimen. Retreatment with HCV non-structural protein 3/4A inhibitor, grazoprevir, and HCV NS5A inhibitor, elbasvir, successfully eradicated HCV RNA in three patients with HCV genotype 1b infection who discontinued prior interferon-free treatments including HCV NS5A inhibitors due to adverse events within 2 weeks. Retreatment with the 12-week combination regimen of grazoprevir and elbasvir is effective for HCV GT1b patients who discontinue the HCV NS5A inhibitor-including regimens within 2 weeks. The treatment response may be related to the short duration of initial treatment, which did not produce treatment-emergent RASs.

The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital.

Science.gov (United States)

McIntosh, Catherine; Dexter, Franklin; Epstein, Richard H

2006-12-01

In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

Clinical education and student satisfaction: An integrative literature review

Directory of Open Access Journals (Sweden)

Karen F. Phillips, EdD, MSN, IBCLC, ICCE

2017-04-01

Full Text Available The clinical component of undergraduate clinical education is a critical area in nursing programs. Faculty shortages have made recruitment of clinical faculty and clinical teaching more challenging. As such, alternate models of clinical faculty assignments are being explored to address faculty shortages. This article contains an extensive literature review conducted to survey models of clinical education and student satisfaction with the clinical environment. The purpose of this paper is to examine student satisfaction in the clinical learning environment using articles employing the Clinical Learning Environment Inventory (CLEI along with examining the use of alternate clinical staffing models in differing levels of undergraduate nursing students. A literature search focusing on studies published between 2002 and 2015 was conducted from 5 electronic databases. Thirty-five articles were reviewed and 22 were selected for this literature review. The studies reviewed concluded that students favored a more positive and favorable clinical environment than they perceived as being actually present. A supportive clinical learning environment is of paramount importance in securing positive teaching learning outcomes. Nurse educators can apply the results of this review in order to develop and maintain quality clinical teaching and to promote a positive, student-centric, clinical learning environment.

Influence of Cone-beam Computed Tomography on Endodontic Retreatment Strategies among General Dental Practitioners and Endodontists.

Science.gov (United States)

Rodríguez, Gustavo; Patel, Shanon; Durán-Sindreu, Fernando; Roig, Miguel; Abella, Francesc

2017-09-01

Treatment options for endodontic failure include nonsurgical or surgical endodontic retreatment, intentional replantation, and extraction with or without replacement of the tooth. The aim of the present study was to determine the impact of cone-beam computed tomographic (CBCT) imaging on clinical decision making among general dental practitioners and endodontists after failed root canal treatment. A second objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan. Eight patients with endodontically treated teeth diagnosed as symptomatic apical periodontitis, acute apical abscess, or chronic apical abscess were selected. In the first session, the examiners were given the details of each case, including any relevant radiographs, and were asked to choose 1 of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 8 cases with the additional information from the CBCT data. The examiners altered their treatment plan after viewing the CBCT scan in 49.8% of the cases. A significant difference in the treatment plan between the 2 imaging modalities was recorded for endodontists and general practitioners (P < .05). After CBCT evaluation, neither group altered their self-reported level of difficulty when choosing a treatment plan (P = .0524). The extraction option rose significantly to 20% after viewing the CBCT scan (P < .05). CBCT imaging directly influences endodontic retreatment strategies among general dental practitioners and endodontists. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

GIS- and field based mapping of geomorphological changes in a glacier retreat area: A case study from the Kromer valley, Silvretta Alps (Austria)

Science.gov (United States)

Guttmann, Markus; Pöppl, Ronald

2017-04-01

Global warming results in an ongoing retreat of Alpine glaciers, leaving behind large amounts of easily erodible sediments. As a consequence processes like rockfalls, landslides and debris flows as well as fluvial processes occur more frequently in pro- and paraglacial areas, often involving catastrophic consequences for humans and infrastructure in the affected valleys. The main objective of the presented work was to map and spatially quantify glacier retreat and geomorphological changes in the Kromer valley, Silvretta Alps (Austria) by applying GIS- and field-based geomorphological mapping. In total six geomorphological maps (1950s, 1970s, 2001, 2006, 2012, and 2016) were produced and analyzed in the light of the study aim. First results have shown a significant decrease of total glaciated area from 96 ha to 53 ha which was accompanied by increased proglacial geomorphic activity (i.e. fluvial processes, rockfalls, debris flows, shallow landslides) in the last 15 years. More detailed results will be presented at the EGU General Assembly 2017.

Asian monsoons and aridification response to Paleogene sea retreat and Neogene westerly shielding indicated by seasonality in Paratethys oysters

Science.gov (United States)

Bougeois, Laurie; Dupont-Nivet, Guillaume; de Rafélis, Marc; Tindall, Julia C.; Proust, Jean-Noël; Reichart, Gert-Jan; de Nooijer, Lennart J.; Guo, Zhaojie; Ormukov, Cholponbelk

2018-03-01

Asian climate patterns, characterised by highly seasonal monsoons and continentality, are thought to originate in the Eocene epoch (56 to 34 million years ago - Ma) in response to global climate, Tibetan Plateau uplift and the disappearance of the giant Proto-Paratethys sea formerly extending over Eurasia. The influence of this sea on Asian climate has hitherto not been constrained by proxy records despite being recognised as a major driver by climate models. We report here strongly seasonal records preserved in annual lamina of Eocene oysters from the Proto-Paratethys with sedimentological and numerical data showing that monsoons were not dampened by the sea and that aridification was modulated by westerly moisture sourced from the sea. Hot and arid summers despite the presence of the sea suggest a strong anticyclonic zone at Central Asian latitudes and an orographic effect from the emerging Tibetan Plateau. Westerly moisture precipitating during cold and wetter winters appear to have decreased in two steps. First in response to the late Eocene (34-37 Ma) sea retreat; second by the orogeny of the Tian Shan and Pamir ranges shielding the westerlies after 25 Ma. Paleogene sea retreat and Neogene westerly shielding thus provide two successive mechanisms forcing coeval Asian desertification and biotic crises.

Paludification and forest retreat in northern oceanic environments.

Science.gov (United States)

Crawford, R M M; Jeffree, C E; Rees, W G

2003-01-01

Examination of temperature variations over the past century for Europe and the Arctic from northern Norway to Siberia suggests that variations in the North Atlantic Oscillation are associated with an increase in oceanicity in certain maritime regions. A southward depression of the tree line in favour of wet heaths, bogs and wetland tundra communities is also observed in northern oceanic environments. The physiological basis for this change in ecological succession from forest to bog is discussed in relation to the long-term effects of flooding on tree survival. The heightened values currently detected in the North Atlantic Oscillation Index, together with rising winter temperatures, and increased rainfall in many areas in northern Europe, presents an increasing risk of paludification with adverse consequences for forest regeneration, particularly in areas with oceanic climates. Climatic warming in oceanic areas may increase the area covered by bogs and, contrary to general expectations, lead to a retreat rather than an advance in the northern limit of the boreal forest. High water-table levels are not automatically detrimental to forest survival as can be seen in swamp, bottom land and mangrove forests. Consequently, the inhibitory effects of flooding on tree survival and regeneration in northern regions should not be uncritically accepted as merely due to high water levels. Evidence is discussed which suggests that physiological and ecological factors may interact to inhibit forest regeneration in habitats where there is a risk of prolonged winter-flooding combined with warmer winters and cool moist summers.

Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases.

Science.gov (United States)

Zerella, Joseph A; Fouad, Ashraf F; Spångberg, Larz S W

2005-12-01

The purpose of this in vivo investigation is to compare the effect of a slurry of Ca(OH)2 mixed in aqueous 2% chlorhexidine (CHX) versus aqueous Ca(OH)2 slurry alone on the disinfection of the pulp space of failed root-filled teeth during endodontic retreatment. Forty single-rooted previously root-filled teeth with associated periradicular lesions were included. The teeth were nonsurgically retreated and medicated over 3 treatment visits with 7-10-day intervals with either Ca(OH)2 in water or Ca(OH)2 in 2% aqueous CHX. Root canal cultures were collected in fluid thioglycollate, and bacterial growth was assessed by turbidity daily for 1 week, then weekly for an additional 3 weeks. The presence of enterococci in the root canals at the initial treatment session was determined. Of the total sample population, 12 of 40 (30%) were positive for bacteria before root filling. The control medication disinfected 12 of 20 (60%) teeth including 2 of 4 teeth originally diagnosed with enterococci. The experimental medication resulted in disinfected 16 of 20 (80%) teeth at the beginning of the third appointment. None of the teeth originally containing enterococci showed remaining growth. This difference between the overall positive cultures was not statistically significant (P > .05). Canal dressing with a mixture of 2% CHX and Ca(OH)2 slurry is as efficacious as aqueous Ca(OH)2 on the disinfection of failed root-filled teeth.