WorldWideScience

Sample records for staffing student retreats

  1. Successful Implementation of Six Sigma to Schedule Student Staffing for Circulation Service Desks

    Science.gov (United States)

    Jankowski, Janiece

    2013-01-01

    In fall of 2011 the University at Buffalo Libraries circulation department undertook Six Sigma training for the purpose of overhauling its student scheduling process. The department was able to mitigate significant staffing budgetary reductions and resource reallocations and to overcome the unique challenges of scheduling student labor for a…

  2. The Social Justice Leadership Retreat: A Phenomenological Case Study of Students' Construction of Race and Its Influence on Beliefs, Behavior, and Actions

    Science.gov (United States)

    Bettendorf, Anthony J.

    2016-01-01

    This study examines students' participation in an intensive intercultural experience, the Social Justice Leadership Retreat. The study utilizes the Intercultural Maturity Model, leadership and democracy outcomes as a framework for the research. Specifically, the study investigates how this experience impacts the ways students make meaning of…

  3. Directive Management Procedures, Staffing Patterns in Education for Emotionally Disturbed Students.

    Science.gov (United States)

    DeYoung, Michael

    A systematic procedure is outlined which gives guidance to therapists and teachers in managing seriously emotionally disturbed (SED) students (9 to 18 years old) who reside at a licensed children's institution or are attending a centralized public school facility for SED students. Among findings from a review of the literature was that intensive…

  4. 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…

  5. Staffing Up for Technology Support.

    Science.gov (United States)

    Carter, Kim

    2000-01-01

    Examines current technology staffing in school districts and compares technology-related roles with a similar study conducted in 1997. Discusses job titles; responsibilities; career paths; lack of technology support in schools; district-level support; teacher training; peer assistance; student roles; collaboration with library media specialists;…

  6. Brown & Smith Communication Solutions: A Staffing System Simulation

    Science.gov (United States)

    Small, Erika E.; Doll, Jessica L.; Bergman, Shawn M.; Heggestad, Eric D.

    2018-01-01

    Developing students' practical skills in strategic staffing and selection within the classroom can be challenging. This article describes a staffing system simulation designed to engage students and develop applied skills in strategic recruiting, assessment, and evaluation of job applicants. Instructors looking for a multifaceted team project…

  7. Endodontic retreatment decisions: no consensus.

    Science.gov (United States)

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

    2000-05-01

    The objectives of the present study were to: (i) evaluate the consensus, if any, amongst dental schools, students and their instructors managing the same clinical cases, all of which involved endodontically treated teeth; and (ii) determine the predominant proposed treatment option. Final year students, endodontic staff members and instructors of 10 European dental schools were surveyed as decision makers. Fourteen different radiographic cases of root canal treated teeth accompanied by a short clinical history were presented to them in a uniform format. For each case the decision makers were requested to: (i) choose only one out of nine treatment alternatives proposed, from 'no treatment' to 'extraction' via 'retreatment' and 'surgery' (ii) assess on two 5-point scales: the difficulty of making a decision, and the technical complexity of the retreatment procedure. The results indicate wide inter- and also intra-school disagreements in the clinical management of root canal treated teeth. Analysis of variance showed that the main source of variation was the 'school effect', explaining 1.8% (NS) to 18.6% (P < 0.0001) of the treatment variations. No other factor explained as much variance. Decision difficulty was moderately correlated to technical complexity (Pearsons' r ranging from 0.19 to 0.35, P < 0.0001). No clear consensus occurred amongst and within dental schools concerning the clinical management of the 14 cases. The lack of consensus amongst schools seems to be due mainly to chance or uncertainty, but can be partly explained by the 'school effect'.

  8. 77 FR 14832 - Plumchoice, Inc., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing...

    Science.gov (United States)

    2012-03-13

    ... Staffing, Insight Global Staffing, and Technisource, Scarborough, ME; Amended Certification Regarding..., Inc., including on-site leased workers from Balance Staffing, Insight Global Staffing, and... from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who became...

  9. Effective Staffing Takes a Village: Creating the Staffing Ecosystem.

    Science.gov (United States)

    Gavigan, Margaret; Fitzpatrick, Therese A; Miserendino, Carole

    2016-01-01

    The traditional approaches to staffing and scheduling are often ineffective in assuring sufficient budgeting and deployment of staff to assure the right nurse at the right time for the right cost. As hospital merger activity increases, this exercise is further complicated by the need to rationalize staffing across multiple enterprises and standardize systems and processes. This Midwest hospital system successfully optimized staffing at the unit and enterprise levels by utilizing operations research methodologies. Savings were reinvested to improve staffing models which provided sufficient nonproductive coverage and patient-driven ratios. Over/under-staffing was eliminated in support of the system's recognition that adequate resource planning and deployment are critical to the culture of safety.

  10. Torsional resistance of retreatment instruments.

    Science.gov (United States)

    Lopes, Hélio P; Elias, Carlos N; Vedovello, Gislaine A F; Bueno, Carlos E S; Mangelli, Marcelo; Siqueira, José F

    2011-10-01

    This study compared the torsional resistance of two brands of rotary nickel-titanium (NiTi) instruments indicated for endodontic retreatment. Mtwo retreatment instruments #15 and #25 (VDW, Munich, Germany) and ProTaper Universal retreatment instruments D2 and D3 (Maillefer/Dentsply, Ballaigues, Switzerland) were subjected to a torsional assay in clockwise rotation. The two parameters evaluated were maximum torque and angular deflection at failure. Fractured instruments had their fractured surfaces and helical shafts examined by scanning electron microscopy. The results indicated that the angular deflection at fracture decreased in the following order: Mtwo retreatment file #15 > Mtwo retreatment file #25 > ProTaper Universal retreatment file D2 > ProTaper Universal retreatment file D3. As for the maximum torque values, the results revealed the following descending order: ProTaper Universal file D2 > Mtwo retreatment file #25 > ProTaper Universal file D3 > Mtwo retreatment file #15. Scanning electron microscopic analysis revealed that plastic deformation occurred along the helical shaft of the fractured instruments. Fractured surfaces were of the ductile type. The instruments tested showed different torsional behavior depending on the parameter evaluated. If one considers that high angular deflection values may serve as a safety factor, then the Mtwo retreatment instruments showed significantly better results. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. 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.

  12. Endodontic retreatment: Analysis of three specialists’ retreatment rates

    OpenAIRE

    Gustavo Golgo Kunert; Itaborai Revoredo Kunert; Caroline Solda; Marina Canali Lângaro; Alessandra Nunes Machado; Fernando Branco Barletta

    2015-01-01

    Endodontic retreatment is a clinical intervention intended to correct errors that have occurred in a treatment performed previously. There are several causes of failures. The anatomical variations between root canals and the diffi culties of achieving microbial disinfection are reported as two of the main causes. However, in the dental offi ces of both general practitioners and specialists, it is very common that the causes of indications for endodontic retreatment are technical failures due ...

  13. 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.

  14. Raising the Bar with Trades Staffing Guidelines.

    Science.gov (United States)

    Weidner, Theodore J.

    2000-01-01

    Examines the APPA's Trades Staffing Guidelines Task Force for college campus building maintenance and presents descriptions of the proposed guideline levels and a matrix of indicators for the Trades Staffing Guidelines. The levels and matrix are intended to mimic features of the custodial staffing guidelines. (GR)

  15. Endodontic retreatment. Aspects of decision making and clinical outcome.

    Science.gov (United States)

    Kvist, T

    2001-01-01

    Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with periapical radiolucencies. Descriptive studies have demonstrated that clinicians' decision making regarding such teeth are subject to substantial variation. A coherent model to explain the observed variation has not been produced. In the present thesis a "Praxis Concept theory" was proposed. The theory suggests that dentists perceive periapical lesions of varying sizes as different stages on a continuous health scale. Interindividual variations can then be regarded as the result of the choice of different cut-off points on the continuum for prescribing retreatment. In the present study experiments among novice and expert decision makers gave evidence in favour of the theory. Data also suggested that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of original treatment. From a prescriptive point of view, the presence of a persistent periapical radiolucency has often been used as a criterion of endodontic "failure" and as an indication for endodontic retreatment. As an alternative decision strategy, the use of decision analysis has been proposed. Logical display of decision alternatives, values of probabilities, utility values (U-values) of the different outcomes and calculation of optimal decision strategy are features of this theory. The implementation of this approach is impeded by the uncertainty of outcome probabilities and lack of investigations concerning U-values. U-values of two periapical health states in root filled teeth (with and without a periapical lesion respectively) were investigated in a group of 82 dental students and among 16 Swedish endodontists. Two methods were used to elicit U-values: Standard gamble and Visual Analogue Scale. Large interindividual variation for both health states were recorded. The difference in U-values between the two health states was found to be statistically significant

  16. Health Promotion and Wellness Staffing Methods

    National Research Council Canada - National Science Library

    Thomsen, Kim

    1999-01-01

    ... injuries, and decrease the number of hospital visits. The Army does not have standardized staffing guidelines or models while the mechanisms to determine requirements are fragmented and inconsistent...

  17. Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees.

    Science.gov (United States)

    Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti

    2015-08-01

    This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.

  18. 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

  19. Staffing for Cyberspace Operations: Summary of Analysis

    Science.gov (United States)

    2016-08-01

    I N S T I T U T E F O R D E F E N S E A N A L Y S E S Staffing for Cyberspace Operations: Summary of Analysis Thomas H. Barth Jerome J. Burke...7013 (a)(16) [Jun 2013]. Staffing for Cyberspace Operations: Summary of Analysis Thomas H. Barth Jerome J. Burke Stanley A. Horowitz Mark F. Kaye...civilian employment. 1 Thomas H. Barth et al., “(U) Staffing for Cyberspace Operations,” IDA Paper P

  20. 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

  1. How Book Publishers are Staffing for Multimedia.

    Science.gov (United States)

    Protsik, Ralph

    1995-01-01

    Examines how book publishers are staffing for multimedia developments. Discussion includes competition from software developers, costs, partnerships, professional organizations as the most innovative electronic publishers, cultural problems, human resource polices, hiring, conflict between print and technology staff, marketing, outside…

  2. Human Resources Staffing Plan for the Tank Farm Contractor

    International Nuclear Information System (INIS)

    BOSLEY, J.W.

    2000-01-01

    The Human Resources Staffing Plan quantified the equivalent staffing needs required for the Tank Farm Contractor (TFC) and its subcontractors to execute the readiness to proceed baseline between FY 2000-2008. The TFC staffing needs were assessed along with the staffings needs of Fluor Hanford and the privatization contractor. The plan then addressed the staffing needs and recruitment strategies required to execute the baseline

  3. Human Resources Staffing Plan for the Tank Farm Contractor

    Energy Technology Data Exchange (ETDEWEB)

    BOSLEY, J.W.

    2000-04-22

    The Human Resources Staffing Plan quantified the equivalent staffing needs required for the Tank Farm Contractor (TFC) and its subcontractors to execute the readiness to proceed baseline between FY 2000-2008. The TFC staffing needs were assessed along with the staffings needs of Fluor Hanford and the privatization contractor. The plan then addressed the staffing needs and recruitment strategies required to execute the baseline.

  4. A grid to facilitate physics staffing justification.

    Science.gov (United States)

    Klein, Eric E

    2009-12-03

    Justification of clinical physics staffing levels is difficult due to the lack of direction as how to equate clinical needs with the staffing levels and competency required. When a physicist negotiates staffing requests to administration, she/he often refers to American College of Radiology staffing level suggestions, and resources such as the Abt studies. This approach is often met with questions as to how to fairly derive the time it takes to perform tasks. The result is often insufficient and/or inexperienced staff handling complex and cumbersome tasks. We undertook development of a staffing justification grid to equate the clinical needs to the quantity and quality of staffing required. The first step is using the Abt study, customized to the clinical setting, to derive time per task multiplied by the anticipated number of such tasks. Inclusion of vacation, meeting, and developmental time may be incorporated along with allocated time for education and administration. This is followed by mapping the tasks to the level of competency/experience needed. For example, in an academic setting the faculty appointment levels correlate with experience. Non-staff personnel, such as IMRT QA technicians or clerical staff, should also be part of the equation. By using the staffing justification grid, we derived strong documentation to justify a substantial budget increase. The grid also proved useful when our clinical demands changed. Justification for physics staffing can be significantly strengthened with a properly developed data-based time and work analysis. A staffing grid is presented, along with a development methodology that facilitated our justification. Though our grid is for a large academic facility, the methodology can be extended to a non-academic setting, and to a smaller scale. This grid method not only equates the clinical needs with the quantity of staffing, but can also help generate the personnel budget, based on the type of staff and personnel required

  5. Endodontic retreatment: an online study guide.

    Science.gov (United States)

    2008-05-01

    The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will cover retreatment rationale, corrosion of silver points, retreatment techniques, removal of posts, and possible complications during retreatment.

  6. 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.

  7. Retreatment or radiographic monitoring in endodontics.

    Science.gov (United States)

    Van Nieuwenhuysen, J P; Aouar, M; D'Hoore, W

    1994-03-01

    The aim of this clinical study was to assess 1032 endodontically treated roots in relation to: (i) the success rate of retreatment (612 roots)--only cases that had recall examinations of 6 months or longer were evaluated; (ii) the influence of various factors on the technical and clinical results of the retreatment; and (iii) the consequences of radiographic monitoring of 420 asymptomatic roots when the root filling was radiographically deficient (short, overextended and/or permeable root fillings). Technical assessment of the retreatment showed that the root was adequately sealed in 52.3% of cases, the root filling was improved in 33.8%, was identical with the initial treatment in 11.1% and was worse than the first treatment in 2.8% of the canals. Clinical assessment of the retreatment of symptomatic roots showed that 71.8% of the retreatments were judged successful, 18.9% showed some healing and 9.3% had failed. The initial size of the periapical lesion, the use of rubber dam, the root filling technique and the apical level of the root filling had a statistically significant influence on the result of the retreatment. Monitoring radiographically (median time span 6 years) led to maintenance of the status quo in 94.8% of cases, healing in 2.4% and failure in 2.8% of the canals. Retreatment is clearly indicated when periapical radiolucency, clinical signs and/or symptoms are present with relative success of up to 91%. When no or little radiographic evidence of periapical pathology was present, when clinical signs and symptoms were absent or when the root filling was radiographically deficient, radiographic monitoring led to complications in only a limited number of cases. clinical decision, endodontic retreatment, radiographic evaluation.

  8. 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.

  9. Selection and development of international indicators on staffing

    NARCIS (Netherlands)

    van Amelsvoort, H.W.C.H.; Hendriks, Maria A.; Scheerens, Jaap

    2000-01-01

    International comparisons of indicators on staffing are regarded as a useful information base to policymakers. Politically relevant staffing indicators in relation to the costs, planning and quality of education deal with training, working conditions, staff characteristics, and stability and

  10. Selective Root Retreatment: A Novel Approach.

    Science.gov (United States)

    Nudera, William J

    2015-08-01

    Root canal retreatment is traditionally considered an "all or none" treatment approach. It is typically recommended that all restorative and obturation materials be removed from all roots regardless of the presence or absence of periapical pathosis. In contrast, surgical endodontics is not viewed as an "all or none" treatment approach. Traditionally, only the diseased root(s) is addressed via root-end resection and root-end filling. The use of cone-beam computed tomographic imaging allows for a more accurate evaluation of the periapical status of individual roots associated with multirooted teeth. This information has introduced a novel and conservative treatment alternative for previously endodontically treated teeth with multiple roots presenting with post-treatment disease. This new approach is termed selective root retreatment. Advanced imaging allows the clinician to make predictable treatment decisions with respect to the presence or absence of periapical pathosis of individual roots as opposed to making assumptions about the tooth as a whole. Selective root retreatment combines the approach of nonsurgical retreatment with the selectivity of surgical root resection. In this manner, retreatment could be limited to a single root or roots clearly showing periapical pathosis while leaving the root(s) with no visible or perceived pathosis untouched. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. 42 CFR 9.9 - Facility staffing.

    Science.gov (United States)

    2010-10-01

    ... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate... issues related to captive nonhuman primates. Experience in these areas dealing specifically with...

  12. 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…

  13. 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.

  14. 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…

  15. Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy.

    Science.gov (United States)

    Sedgley, C M; Wagner, R

    2003-11-01

    To describe a case where a second orthograde retreatment was successful in the management of an infected mandibular right first molar that previously had received both orthograde and retrograde treatments. Periapical surgery is unlikely to be successful unless the root canal system has been adequately debrided and sealed. A case is described where orthograde endodontic treatment, retreatment and apicectomy were unsuccessful in the management of and infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. Teh second retreatment included 12 months of intracanal calcium hydroxide placement to promote apexification, thus allowing subsequent controlled obturation with gutta percha and AH26. At a 5-year review following completion of treatment, the tooth remained asymptomatic and was in normal function. Orthograde retreatment is a treatment option to manage refractory lesions in teeth that have previously received endodontic treatment, retreatment and apicectomy. Orthograde retreatment using long-term intracanal calcium hydroxide can help promote root-end closure of a resected apex.

  16. 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

  17. Computerized nursing staffing: a software evaluation.

    Science.gov (United States)

    Pereira, Irene Mari; Gaidzinski, Raquel Rapone; Fugulin, Fernanda Maria Togeiro; Peres, Heloísa Helena Ciqueto; Lima, Antônio Fernandes Costa; Castilho, Valéria; Mira, Vera Lúcia; Massarollo, Maria Cristina Komatsu Braga

    2011-12-01

    The complexity involved in operationalizing the method for nursing staffing, in view of the uncountable variable related to identifying the workload, the effective working time of the staff, and the Technical Security Index (TSI) revealed the need to develop a software program named: Computerized Nursing Staffing (DIPE, in Portuguese acronyms). This exploratory, descriptive study was performed with the objective to evaluate the technical quality and functional performance of DIPE. Participants were eighteen evaluators, ten of whom where nurse faculty or nurse hospital unit managers, and eight health informatics experts. The software evaluation was performed according to norm NBR ISO/IEC 9126-1, considering the features functionality, reliability, usability, efficiency, and maintainability. The software evaluation reached positive results and agreement among the evaluators for all the evaluated features. The reported suggestions are important for proposing further improving and enhancing the DIPE.

  18. 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.

  19. 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

  20. 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

  1. 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

  2. Role of Madden-Julian Oscillation in Modulating Monsoon Retreat

    Science.gov (United States)

    Singh, Madhu; Bhatla, R.

    2018-01-01

    The Madden-Julian oscillation (MJO) is the major fluctuation in tropical weather on a seasonal scale. The impact of MJO on different epochs, viz., onset, advance and active break is well known. There can be several MJO events in a season and it may enhance/suppress the retreat process. The present study aims to find the MJO-modulated retreat of monsoon. The results suggest that the fastest retreat of monsoon occurred in the years 2007 and 2008, while slowest retreat of monsoon occurred in the year 1979. The retreat features of the Indian summer monsoon (ISM) are investigated with the MJO phase and amplitude variations. The daily MJO indices for the retreat period 1979-2016 are used. The results reveal that the MJO strength decreases during the transition phase (i.e., summer monsoon to winter monsoon transition). The monsoon retreat is most favored by strong MJO phase 4 and phase 5. The fastest retreat of monsoon occurred in the years 2007 and 2008, while the slowest retreat of monsoon occurred in the year 1979. There exists a weak positive correlation between the MJO amplitude and the retreat period of monsoon. The monsoon retreat is most favored by strong MJO phase 4 and phase 5. The MJO amplitude variations during MJO phases 1-8 suggest that the MJO amplitude decreases with increase in retreat period. The MJO-modulated retreat results in slow retreat of monsoon, whereas fast and normal retreat of monsoon is seen on rare occasions. Weak MJO events lead to normal retreat of monsoon.

  3. Reasons for Retreatment of Amalgam and Composite Restorations among the Patients Referring to Tabriz Faculty of Dentistry

    Directory of Open Access Journals (Sweden)

    Siavash Savadi Oskoee

    2007-06-01

    Full Text Available

    Background and aims. Retreatment of existing restorations not only requires a lot of money and time but also there is a danger of weakening tooth structure and irritating the pulp. Since awareness of the reasons for the retreatment of teeth will save the teeth from possible future failure, the aim of this study was to assess the reasons for retreatment of amalgam and composite restorations in patients referring to Tabriz Faculty of Dentistry.

    Materials and methods. In this descriptive study, the subjects had previously received an amalgam or a composite restoration in the Operative Department by dental students and were judged to need retreatment in their second visit. A total of 300 defective teeth were selected by simple random sampling method. The data was collected through examination and questionnaires and analyzed using chi-square test.

    Results. There was a statistically significant association between the type of the restorative material and the reason for retreatment (p=0.001.

    Conclusion. Although the reasons for the retreatment of amalgam and composite restorations were different, recurrent caries was the main reason for the retreatment for both restorative materials.

  4. Reasons for Retreatment of Amalgam and Composite Restorations among the Patients Referring to Tabriz Faculty of Dentistry.

    Science.gov (United States)

    Kimyai, Soodabeh; Mehdipour, Masomeh; Savadi Oskoee, Siavash; Alizadeh Oskoee, Parnian; Abbaszadeh, Armin

    2007-01-01

    Retreatment of existing restorations not only requires a lot of money and time but also there is a danger of weakening tooth structure and irritating the pulp. Since awareness of the reasons for the retreatment of teeth will save the teeth from possible future failure, the aim of this study was to assess the reasons for retreatment of amalgam and composite restorations in patients referring to Tabriz Faculty of Dentistry. In this descriptive study, the subjects had previously received an amalgam or a composite restoration in the Operative Department by dental students and were judged to need retreatment in their second visit. A total of 300 defective teeth were selected by simple random sampling method. The data was collected through examination and questionnaires and analyzed using chi-square test. There was a statistically significant association between the type of the restorative material and the reason for retreatment (p=0.001). Although the reasons for the retreatment of amalgam and composite restorations were different, recurrent caries was the main reason for the retreatment for both restorative materials.

  5. 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.

  6. Endodontic retreatment strategies used by general dental practitioners.

    Science.gov (United States)

    Kvist, Thomas; Heden, Gunnar; Reit, Claes

    2004-04-01

    Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of "failures." The "Praxis Concept" (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden. In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal-retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction. The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC. The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.

  7. X-Line Retreat During Magnetic Reconnection

    Science.gov (United States)

    Oka, Mitsuo; Fujimoto, M.; Shinohara, I.

    2008-03-01

    In many astro- and space- physics situations, we observe energy release processes in vicinities of an obstacle. In the Earth's magnetotail, an Earthward plasma flow hits the magnetosphere which might end up with magnetic field pile-up and/or dipolarization of the magnetosphere. During solar flares, in view of magnetic reconnection model, a downward plasma jet collides with a magnetic flux tube at the bottom of the solar corona.In order to study energe release processes in these situations, we have set up a hard wall (symmetric boundary) to model either dipole magnetic field in the Earth's magnetosphere or magnetic loops in the solar corona. For simplicity, we have neglected any density gradient or magnetic field strucures. The initial configuration of the current sheet is therefore of a Harris-type. After initiating magnetic reconnection by a magnetic field purturbation, its time evolution is studied by means of full particle, PIC simulation.The prominent feature in our simulation is a slow motion of the X-point directing away from the wall, which we call `X-line Retreat'. Our preliminary results show retreat speed to be about 0.1 times the Alfven speed measured at the boundaries. In our talk, we will discuss the mechanism and cause of the X-line retreat as well as the structures of the diffusion region. Implication on particle acceleration will also be addressed.

  8. Writing Retreat Increases Productivity And Community For Women Geoscientists

    Science.gov (United States)

    O'Connell, S.; Holmes, M.

    2011-12-01

    Five, weeklong geoscientist writing retreats have been completed with an NSF ADANCE PAID grant. During the five nights and four and a half days, eight to twenty-four academics have gathered in a rural setting outside of Boston to get to focus on writing papers and proposals while getting to know each other. Participants range in age and experience from graduate students to emeritus professors. Over twenty papers and proposals acknowledge their production, in part to this writing retreat. Impact extends beyond papers as informal mentoring and discussions at meals and in the evenings centers on succeeding in academia. Research and teaching are foremost in the conversation. Post-docs learn strategies for applying for jobs and grants, and senior professors discuss strategies for working with academic administrations, running departments and mentoring students. They also learn new technologies and perspectives from younger participants. Particularly helpful are discussions on work-life balance. Networking opportunities extend beyond the retreat as participants join each other at their home institutions to give seminars, develop research projects and mentor each other's students. All weeks follow the same format. Participants arrive Sunday and meet during an evening welcome reception. Monday is devoted to writing. Tuesday a writing coach is available. In the morning, using examples from the scientific literature, she discusses strategies and techniques for writing clearly at a group session. During the afternoon, participants work with the coach individually or in small groups to improve their own writing projects. Wednesday evening a skill session is offered on a topic of interest. These have included undergraduate research, NSF funding, productive techniques for dealing with conflict, and generational characteristics and attitudes, which can hamper communication. A Thursday evening wrap-up session prepares participants for Friday's departure. We believe that this model

  9. Patterns of retreatment with radiotherapy in a large academic centre

    International Nuclear Information System (INIS)

    Khor, Richard; Ball, David; Duchesne, Gillian; Bressel, Mathias; Tai, Keen Hun; Tedesco, Jo; Gill, Suki; Fitzpatrick, Claire; Foroudi, Farshad; Rose, William

    2013-01-01

    To characterise retreatment rates with radiotherapy at a large multifacility academic radiotherapy centre and assess the effect of distance on retreatment rate. Electronic administrative records were reviewed for patients receiving radiotherapy between 1998 and 2010 at regional and metropolitan facilities. Course-level data were reconstructed from electronic administrative databases. Intent of therapy, treatment dates and diagnosis were available for analysis. Retreatment characteristics were derived, including proportion of patients receiving retreatment, proportion of total radiotherapy prescriptions dedicated to retreatment and retreatment per treating facility. Travel distance for each patient to their treatment centre was estimated, and retreatment rates were reported as a function of increasing distance. A total of 48,200 patients were treated with 66,277 treatment courses during the study period. Retreatment courses constituted 25.2% of all courses prescribed. During the study period, 20.4% of all patients received at least one treatment course. Of these, the average number of retreatment courses prescribed was 1.84. Patients treated with radical intent had a retreatment rate of 13% compared with 45% for those treated initially with palliative intent. Retreatment rates in individual tumour sites ranged from 1.3 to 44.4%. The retreatment rate for those living less than 100km from treatment facility was 24.8%, and 20.5% for those living more than 100km from treatment centre (P<0.001) Retreatment accounted for over one quarter of radiotherapy courses, with the rate influenced by casemix and follow-up duration. With increasing distance from treatment centre, a decrease in retreatment rate was observed.

  10. Efficacy of protaper instruments during endodontic retreatment

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Fariniuk

    2017-01-01

    Full Text Available Introduction: The effectiveness of ProTaper Universal and ProTaper Retreatment rotary instruments was compared to the Hedström files in the removal of filling material from root canals. Materials and Methods: Thirty-six extracted human mandibular premolars with a single straight root canal were shaped and filled with gutta-percha and AH Plus. The specimens were stored for 6 months at 37°C and at 100% relative humidity, and then randomly divided into three groups: PTU - removal of filling material performed with ProTaper Universal instruments; PTR - removal of filling material performed with ProTaper Retreatment instruments; HF – removal of filling material performed with Gates-Glidden burs, Hedström files and solvent. After the filling material removal and diaphanization, the specimens were longitudinally sectioned and images of the canal surfaces were scanned. The remaining areas of filling material were measured (Image Tool 3.0, and data was analyzed statistically (Kruskal-Wallis and Dunn tests. The time required for filling removal in each group was also recorded (one-way ANOVA and Tukey's HSD test. Results: All groups presented remnants of filling material; PTU had the smallest amount and HF group presented the highest mean value (P< 0.05 in all the thirds. The cervical third had the smallest amount of material when compared with the other thirds (P< 0.05. HF group required a longer mean time, presenting significant difference (P< 0.05. Conclusion: Considering the time required and the amount of the filling removal, ProTaper Retreatment were not superior to ProTaper Universal, but both rotary instruments were more effective and less time-consuming than Hedström manual files.

  11. Evaluation of surgical retreatment of mandibular fractures.

    Science.gov (United States)

    Yamamoto, Marcos Kazuo; D'Avila, Ricardo Pimenta; Luz, João Gualberto de Cerqueira

    2013-01-01

    Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment. The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures. From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery. The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient. It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  12. 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

  13. 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.

  14. The Size and Scope of Collegiate Athletic Training Facilities and Staffing.

    Science.gov (United States)

    Gallucci, Andrew R; Petersen, Jeffrey C

    2017-08-01

      Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified.   To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition.   Cross-sectional study.   Web-based survey.   Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs.   Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students.   The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft 2 (290.3 ± 411 m 2 ) for the central athletic training facility, 1013 ± 1521 ft 2 (94 ± 141 m 2 ) for satellite athletic training facilities, 1272 ± 1334 ft 2 (118 ± 124 m 2 ) for game-day athletic training facilities, 388 ± 575 ft 2 (36 ± 53 m 2 ) for athletic training offices, and 424 ± 884 ft 2 (39 ± 82 m 2 ) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P training staffing and facilities. The results (1) suggest that the ATs were satisfied with their facilities and (2) highlight the differences in resources among competition levels.

  15. Efficacy of protaper instruments during endodontic retreatment.

    Science.gov (United States)

    Fariniuk, Luiz Fernando; Azevedo, Marco Antonio Diniz; Carneiro, Everdan; Westphalen, Vânia Portela Ditzel; Piasecki, Lucila; da Silva Neto, Ulisses Xavier

    2017-01-01

    The effectiveness of ProTaper Universal and ProTaper Retreatment rotary instruments was compared to the Hedström files in the removal of filling material from root canals. Thirty-six extracted human mandibular premolars with a single straight root canal were shaped and filled with gutta-percha and AH Plus. The specimens were stored for 6 months at 37°C and at 100% relative humidity, and then randomly divided into three groups: PTU - removal of filling material performed with ProTaper Universal instruments; PTR - removal of filling material performed with ProTaper Retreatment instruments; HF - removal of filling material performed with Gates-Glidden burs, Hedström files and solvent. After the filling material removal and diaphanization, the specimens were longitudinally sectioned and images of the canal surfaces were scanned. The remaining areas of filling material were measured (Image Tool 3.0), and data was analyzed statistically (Kruskal-Wallis and Dunn tests). The time required for filling removal in each group was also recorded (one-way ANOVA and Tukey's HSD test). All groups presented remnants of filling material; PTU had the smallest amount and HF group presented the highest mean value (PRetreatment were not superior to ProTaper Universal, but both rotary instruments were more effective and less time-consuming than Hedström manual files.

  16. 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.

  17. The Value of Retreats in Orthodox Life: A Workshop Handbook.

    Science.gov (United States)

    Counelis, James Steve

    This handbook was prepared for the guidance of participants in a workshop designed to help teach Greek Orthodox lay persons the basic elements for creating religious retreats. Part 1 of this document teach Greek Orthodox lay persons the basic elements for creating religious retreats. Part 1 of this document defines the meanings of the terms…

  18. Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment.

    Science.gov (United States)

    Salehrabi, Robert; Rotstein, Ilan

    2010-05-01

    Teeth undergoing initial endodontic therapy have a very high survival rate. Some teeth that continue to show signs of pathosis after the initial therapy will require nonsurgical (orthograde) retreatment. Outcome assessment of endodontic retreatment is crucial for appropriate case selection and treatment planning. However, reports on outcomes of orthograde endodontic retreatment performed by endodontists are limited in number, and the reported data vary. In this study, outcomes of orthograde endodontic retreatment performed on 4744 teeth were assessed during a period of 5 years. Data were obtained from retreatments that were performed by endodontists participating in the Delta Dental Insurance plan that insures approximately 15 million individuals in the USA. Overall, 89% of teeth were retained in the oral cavity 5 years after the endodontic retreatment. Four percent of all teeth underwent apical surgery that occurred mostly within 2 years from completion of orthograde retreatment. Eleven percent of teeth were extracted at the end of the 5-year observation period. It appears that orthograde endodontic retreatment yields high incidence of tooth retention after 5 years. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Academic Writing Retreat: A Time for Rejuvenated and Focused Writing

    Science.gov (United States)

    Swaggerty, Elizabeth A.; Atkinson, Terry S.; Faulconer, Johna L.; Griffith, Robin R.

    2011-01-01

    The purpose of this article is to describe the impact of a three-day academic writing retreat on the writing lives of four female university faculty members. Goals of the retreat included rejuvenating their writing lives, focusing their research agendas, improving their writing, and engaging in concentrated blocks of writing and collaborative…

  20. Monastic retreat and pastoral care in the Dutch Reformed tradition ...

    African Journals Online (AJOL)

    It focuses on aspects of retreat such as the role of holy places in the monastic traditions (e.g., monasteries, cathedrals, retreat centers) and the experience of silence, solitude, regeneration, divine presence and spiritual formation. Proceeding from an epistemological reflection on the subject as described in a previous article, ...

  1. Sector of West Antarctic Ice Sheet in "Irreversible Retreat"

    Science.gov (United States)

    Showstack, Randy

    2014-05-01

    A large sector of the West Antarctic Ice Sheet "has gone into a state of irreversible retreat," according to glaciologist Eric Rignot, lead author of the paper "Widespread rapid grounding line retreat of Pine Island, Thwaites, Smith, and Kohler Glaciers in West Antarctica from 1992 to 2011," which has been accepted for publication in Geophysical Research Letters (GRL).

  2. 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.

  3. Managerial implications of calculating optimal nurse staffing in medical units.

    Science.gov (United States)

    Bordoloi, S K; Weatherby, E J

    2000-07-01

    A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, Alaska. We also indicate several managerial implications on how our results and their sensitivity analyses can be used effectively in decision making in a variety of categories.

  4. Managerial implications of calculating optimum nurse staffing in medical units.

    Science.gov (United States)

    Bordoloi, S K; Weatherby, E J

    1999-01-01

    A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, Alaska. We also indicate several managerial implications on how our results and their sensitivity analyses can be used effectively in decision making in a variety of categories.

  5. Provider staffing effect on a decision aid intervention.

    Science.gov (United States)

    Ersek, Mary; Sefcik, Justine S; Lin, Feng-Chang; Lee, Tae Joon; Gilliam, Robin; Hanson, Laura C

    2014-02-01

    This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision aid regarding feeding options in dementia on the frequency of surrogate-provider discussions and on surrogates' decisional conflict. We compared these outcomes for facilities that had no NPs/PAs, part-time-only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% vs. 51%, p vs. 41%, p vs. -0.047, p = .008, and -0.30 vs. -0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision making in nursing homes.

  6. Evaluation of the Success Rate of Nonsurgical Single Visit Retreatment

    Science.gov (United States)

    Ashraf, Hengameh; Milani, Amin Salem; Shakeri Asadi, Shahla

    2007-01-01

    INTRODUCTION: Advantages of endodontic treatments over tooth extraction have increased the demands for these treatments. Success rate of these treatments is generally lower than the primary root canal therapies. Recently, single visit treatments have gained more popularity. But, the influence of completing retreatment in a single appointment on success of the treatment is still a controversy. The aim of this study was evaluating the most common causes of failures and determining the success rate of completing retreatments in single appointment. MATERIALS AND METHODS: Hundred and twenty four patients who had single appointment retreatment within past 4 years in postgraduate ward of Shahid Beheshti Dental School were selected and clinical and radiographic examinations were carried out. The data were analyzed by SPSS using Chi-square and Exact Fisher tests. RESULTS: Success rate and uncertain cases were shown to be 50.7% and 34.2%, respectively and failure rate was 15.1%. Presence of periradicular lesion or history of swelling prior to retreatment had significant effect on the success of single visit retreatments (pretreatments was significantly higher in cases referred for restorative purposes compared with retreatments for nonrestorative purposes (pretreatments is up to 84.9% which is considerably higher in cases referred for restorative purposes. So based on the results of this study single appointment retreatment of symptom less teeth is recommended. PMID:24327818

  7. 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.

  8. Seaweed communities in retreat from ocean warming.

    Science.gov (United States)

    Wernberg, Thomas; Russell, Bayden D; Thomsen, Mads S; Gurgel, C Frederico D; Bradshaw, Corey J A; Poloczanska, Elvira S; Connell, Sean D

    2011-11-08

    In recent decades, global climate change [1] has caused profound biological changes across the planet [2-6]. However, there is a great disparity in the strength of evidence among different ecosystems and between hemispheres: changes on land have been well documented through long-term studies, but similar direct evidence for impacts of warming is virtually absent from the oceans [3, 7], where only a few studies on individual species of intertidal invertebrates, plankton, and commercially important fish in the North Atlantic and North Pacific exist. This disparity of evidence is precarious for biological conservation because of the critical role of the marine realm in regulating the Earth's environmental and ecological functions, and the associated socioeconomic well-being of humans [8]. We interrogated a database of >20,000 herbarium records of macroalgae collected in Australia since the 1940s and documented changes in communities and geographical distribution limits in both the Indian and Pacific Oceans, consistent with rapid warming over the past five decades [9, 10]. We show that continued warming might drive potentially hundreds of species toward and beyond the edge of the Australian continent where sustained retreat is impossible. The potential for global extinctions is profound considering the many endemic seaweeds and seaweed-dependent marine organisms in temperate Australia. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Endodontic procedures for retreatment of periapical lesions.

    Science.gov (United States)

    Del Fabbro, Massimo; Corbella, Stefano; Sequeira-Byron, Patrick; Tsesis, Igor; Rosen, Eyal; Lolato, Alessandra; Taschieri, Silvio

    2016-10-19

    When primary root canal therapy fails, periapical lesions can be retreated with or without surgery. Root canal retreatment is a non-surgical procedure that involves removal of root canal filling materials from the tooth, followed by cleaning, shaping and obturating of the canals. Root-end resection is a surgical procedure that involves exposure of the periapical lesion through an osteotomy, surgical removal of the lesion, removal of part of the root-end tip, disinfection and, commonly, retrograde sealing or filling of the apical portion of the remaining root canal. This review updates one published in 2008. To assess effects of surgical and non-surgical therapy for retreatment of teeth with apical periodontitis.To assess effects of surgical root-end resection under various conditions, for example, when different materials, devices or techniques are used. We searched the following electronic databases: the Cochrane Oral Health Trials Register (to 10 February 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE Ovid (1946 to 10 February 2016) and Embase Ovid (1980 to 10 February 2016). We searched the US National Registry of Clinical Trials (ClinicalTrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 10 February 2016). We placed no restrictions regarding language and publication date. We handsearched the reference lists of the studies retrieved and key journals in the field of endodontics. We included randomised controlled trials (RCTs) involving people with periapical pathosis. Studies could compare surgery versus non-surgical treatment or could compare different types of surgery. Outcome measures were healing of the periapical lesion assessed after one-year follow-up or longer; postoperative pain and discomfort; and adverse effects such as tooth loss, mobility, soft tissue recession, abscess, infection, neurological damage or loss of root sealing material

  10. 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.

  11. 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

  12. Monastic retreat and pastoral care in the Dutch Reformed tradition

    Directory of Open Access Journals (Sweden)

    C.H. (Kaaiman Schutte

    2006-10-01

    Full Text Available Of late, there has been a growing interest in retreat among clergy and members of congregations in the Dutch Reformed tradition in South Africa. The article investigates the relevance of the monastic traditions for this growing interest in Reformed circles. It focuses on aspects of retreat such as the role of holy places in the monastic traditions (e.g., monasteries, cathedrals, retreat centers and the experience of silence, solitude, regeneration, divine presence and spiritual formation. Proceeding from an epistemological reflection on the subject as described in a previous article, the aim of this article is to explore the “action of retreat” as a narrative research journey and pilgrimage in order to investigate the relevance of the Benedictine, Franciscan and Taizé monastic-mystic traditions (seen as an associative/mystic spirituality for retreat in the Dutch Reformed tradition (which is seen as a disassociative/rational/ dogmatic spirituality.

  13. 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 ...

  14. Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy

    Science.gov (United States)

    Sugiyama, M; Suzuki, Y; Abe, N; Masaki, T; Mori, T; Atomi, Y

    2004-01-01

    Background: Endoscopic sphincterotomy (ES) carries a substantial risk of recurrent choledocholithiasis but retreatment with endoscopic retrograde cholangiopancreatography (ERCP) is safe and feasible. However, long term results of repeat ERCP and risk factors for late complications are largely unknown. Aims: To investigate the long term outcome of repeat ERCP for recurrent bile duct stones after ES and to identify risk factors predicting late choledochal complications. Methods: Eighty four patients underwent repeat ERCP, combined with ES in 69, for post-ES recurrent choledocholithiasis. Long term outcomes of repeat ERCP were retrospectively investigated and factors predicting late complications were assessed by multivariate analysis. Results: Complete stone clearance was achieved in all patients. Forty nine patients had no visible evidence of prior sphincterotomy. Two patients experienced early complications. During a follow up period of 2.2–26.0 years (median 10.9 years), 31 patients (37%) developed late complications, including stone recurrence (n = 26), acute acalculous cholangitis(n = 4), and acute cholecystitis (n = 1). There were neither biliary malignancies nor deaths attributable to biliary disease. Multivariate analysis identified three independent risk factors for choledochal complications: interval between initial ES and repeat ERCP ⩽5 years, bile duct diameter ⩾15 mm, and periampullary diverticulum. Choledochal complications were successfully treated with repeat ERCP in 29 patients. Conclusions: Choledochal complications after repeat ERCP are relatively frequent but are endoscopically manageable. Careful follow up is necessary, particularly for patients with a dilated bile duct, periampullary diverticulum, or early recurrence. Repeat ERCP is a reasonable treatment even for recurrent choledocholithiasis after ES. PMID:15542528

  15. [Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?

    Science.gov (United States)

    Palmero-Martí, José Luis; Panach-Navarrete, Jorge; Valls-González, Lorena; Ganau-Ituren, Amparo; Pastor-Lence, Juan Carlos; Benedicto-Redón, Antonio

    2017-06-01

    To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student's t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. The groups were homogeneous for both age and gender (p>0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 - -10.63, plithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context.

  16. 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.

  17. Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug.

    Science.gov (United States)

    Mente, Johannes; Leo, Meltem; Michel, Annemarie; Gehrig, Holger; Saure, Daniel; Pfefferle, Thorsten

    2015-05-01

    This controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy. The treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test. Twenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as "success," and 3 teeth were considered (17%) "failure." The chi-square test confirmed that the preoperative factor "number of roots" had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0-1.76; P = .03). The factor "tooth location" was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0-2.14; P = .05). The results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  18. Comparisons of the Retreatment Efficacy of Calcium Silicate and Epoxy Resin-based Sealers and Residual Sealer in Dentinal Tubules.

    Science.gov (United States)

    Kim, Hyunsuk; Kim, Euiseong; Lee, Seung-Jong; Shin, Su-Jung

    2015-12-01

    The aim of this study was to evaluate the retreatment efficacy and amount of residual sealer in a single canal filled with either EndoSequence BC (Brasseler, Savannah, GA) or AH Plus (Dentsply DeTrey, Konstanz, Germany). Canal obturation with gutta-percha and sealer was performed in 28 human teeth using the continuous wave technique. Group 1 (n = 13) used AH Plus sealer, and group 2 (n = 15) used EndoSequence BC sealer. After 7 days, the root fillings were removed using Gates Glidden drills and a nickel-titanium rotary system. Retreatment time was measured in seconds. Canal cleanliness was examined by scanning electron microscopy. The remaining debris in the canal space and penetration into dentinal tubules were evaluated by confocal microscopy. Retreatment time was compared using the Student t test, and differences in sealer penetration and remaining debris between the groups were analyzed using the Mann-Whitney U test (P < .05). There was no significant difference between the 2 groups in the amount of dentin penetration, amount of debris, or retreatment time. With respect to penetration depth, the AH Plus group showed a slightly higher percentage than the BC group, with a significant difference only in the portion 6 mm from the apex (P < .05). Scanning electron microscopic images showed significant debris remaining on canal walls in both groups, whereas canal patency in retreatment was achieved in every specimen. The present study shows that EndoSequence BC sealer and AH Plus sealer have similar efficacy in dentin penetration and retreatment efficacy. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

    Science.gov (United States)

    Baggett, Margarita; Batcheller, Joyce; Blouin, Ann Scott; Behrens, Elizabeth; Bradley, Carol; Brown, Mary J; Brown, Diane Storer; Bolton, Linda Burnes; Borromeo, Annabelle R; Burtson, Paige; Caramanica, Laura; Caspers, Barbara A; Chow, Marilyn; Christopher, Mary Ann; Clarke, Sean P; Delucas, Christine; Dent, Robert L; Disser, Tony; Eliopoulos, Charlotte; Everett, Linda Q; Garcia, Amy; Glassman, Kimberly; Goodwin, Susan; Haagenson, Deb; Harper, Ellen; Harris, Kathy; Hoying, Cheryl L; Hughes-Rease, Marsha; Kelly, Lesly; Kiger, Anna J; Kobs-Abbott, Ann; Krueger, Janelle; Larson, Jackie; March, Connie; Martin, Deborah Maust; Mazyck, Donna; Meenan, Penny; McGaffigan, Patricia; Myers, Karen K; Nell, Kate; Newcomer, Britta; Cathy, Rick; O'Rourke, Maria; Rosa, Billy; Rose, Robert; Rudisill, Pamela; Sanford, Kathy; Simpson, Roy L; Snowden, Tami; Strickland, Bob; Strohecker, Sharon; Weems, Roger B; Welton, John; Weston, Marla; Valentine, Nancy M; Vento, Laura; Yendro, Susan

    2014-01-01

    The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research

  20. 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.

  1. Cluster approach to staffing in the agricultural sector

    Directory of Open Access Journals (Sweden)

    Belaia Nataliia Vladimirovna

    2013-08-01

    Full Text Available The state of agricultural sector influences every person, determines the potential of national economy and politics. That is why the development of agricultural sector has always been one of the most urgent tasks for Russia and its regions. For the last few years the large-scale government support of the agricultural sector has been maintained which made the problem of peopleware of agricultural sector to be very significant. Staffing is known as fundamental principle of peopleware. Altai region is one of the farm production leaders, and problems of agricultural staffing are becoming more and more important.

  2. 77 FR 40638 - Syniverse Technologies, Inc., Including On-Site Leased Workers From Insight Global Stone Staffing...

    Science.gov (United States)

    2012-07-10

    ... Insight Global Stone Staffing, and Randstad Formerly Known as Sapphire Technologies, Watertown, MA... workers from Insight Global, Stone Staffing, Randstad formerly known as Sapphire Technologies, Watertown... telecommunication services. The company reports that workers leased from Insight Global, Stone Staffing, Randstad...

  3. Technical Staffing Crises and Managing Systems Projects

    Science.gov (United States)

    Davis, Charles K.

    2007-01-01

    Case method teaching is not limited to larger, complex cases. It is often useful to supplement classroom discussions with short cases, ones that have been targeted for one or two discussion points that challenge student thinking beyond the usual lecture or textbook. These shorter cases are called "minicases." The objective of a minicase is to…

  4. Staffing and Technology Maximize Dorm Security.

    Science.gov (United States)

    George, Stephen C.

    1996-01-01

    Loyola University of Chicago uses uniformed guards and electronic monitoring to prevent unauthorized entry into its 11 residence halls. Access to all residence halls is regulated by bar-code readers. Student ID cards also have color-coded stickers corresponding to specific residence halls. (MLF)

  5. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review.

    Science.gov (United States)

    Torabinejad, Mahmoud; Corr, Robert; Handysides, Robert; Shabahang, Shahrokh

    2009-07-01

    The purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which modality offers more favorable outcomes. The study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles. A significantly higher success rate was found for endodontic surgery at 2-4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval (P retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4-6 years (83.0%; P endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome.

  6. Forecasting Stability or Retreat in Emerging Democratic Regimes

    Directory of Open Access Journals (Sweden)

    Snigdha Dewal

    2013-05-01

    Full Text Available Drawing on the literatures on elite transitions, factionalism and the new institutionalism, this paper hypothesizes that the stability of partially democratic and emerging democratic regimes is dependent on the willingness of elites to make credible commitments to cooperate and comply with democratic rules. That willingness (or lack thereof can be signaled by the presence of cooperative or conflict-precipitating events and actions in the periods around elections. We identify and analyze a variety of intra-elite interactions and demonstrate that conflict-precipitating events significantly increase the odds of a democratic retreat in the months before or just after an election, while cooperative events can balance them and prevent retreat. Using event data collected from 40 low- and middle-income countries for two-year periods around national elections between 1991 and 2007 we show that the imbalance of conflict-precipitating over cooperative events is far greater in cases of retreat from democracy. Furthermore, international intervention and pressure had a negative relationship with democratic stability. A logistic regression model accurately identified democratic retreat in 79 percent of the cases examined. Factor analysis revealed several common patterns of intra-elite conflict that can lead to democratic retreat, or conversely, patterns of cooperative events that bolster democratic consolidation. Finally, the data strongly argues for a model of democratic development that depends on open-ended elite maneuvering and the emergence of elite agreements, rather than a model where strong prior institutional constraints determine elite actions.

  7. Benefits of Attending a Weekend Childhood Cancer Survivor Family Retreat.

    Science.gov (United States)

    Bashore, Lisa; Bender, Joyce

    2017-09-01

    To explore the long-term benefits to families of childhood cancer survivors who attended a weekend childhood cancer survivor family retreat. Descriptive-qualitative study including families who had attended the weekend retreat at least once but not in the past 12 months, and who attend a large pediatric hematology and oncology cancer survivorship program in Texas. A semistructured interview guide was used during three audio-taped focus groups to explore the benefits of having attended a weekend retreat. Descriptive qualitative analysis was used to analyze the focus groups' transcripts. Seven families participated in the focus groups, and the themes identified were reconnecting (with others or family), putting life in perspective, and changing outlook on life. Retreats offer families of cancer survivors opportunities to reconnect with others and their own family members in a therapeutic environment. These reconnections in a therapeutic environment enriched the families' positive outlooks on life and changed their perspectives. Families of childhood cancer survivors report a lack of support following the completion of therapy. Retreats in a nonclinical therapeutic setting optimize family-perceived support, relationship building, and reconnecting survivor families. © 2017 Sigma Theta Tau International.

  8. Relationship Between Staffing and Utilization of Special Collections ...

    African Journals Online (AJOL)

    Findings showed that, there was a gross under-utilization of special collections by users in the libraries studied. A further analysis revealed that significant relationships between staffing with utilization of special collections information resources existed. Based on the findings, the study concluded that, there was gross ...

  9. 5 CFR 9701.363 - Special staffing payments.

    Science.gov (United States)

    2010-01-01

    ... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363 Special... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special staffing payments. 9701.363 Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT...

  10. Staffing UK University Campuses Overseas: Lessons from MNE Practice

    Science.gov (United States)

    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…

  11. The labor market effects of California's minimum nurse staffing law.

    Science.gov (United States)

    Munnich, Elizabeth L

    2014-08-01

    In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.

  12. 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.

  13. 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

  14. 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

  15. Endodontic retreatment in case of failure. Case report.

    Science.gov (United States)

    Mărgărit, Ruxandra; Andrei, Oana Celia

    2011-01-01

    In medical practice, clinicians come across an increased number of endodontic treatments, which, like other dental treatments, can fail. The increase in the number of endodontic treatment resulted in an increased number of failures, their management raising complex and serious endodontic problems. The endodontic retreatment of a failure is required by the increased desire to preserve the tooth on the dental arch, thus preventing the need for dental extraction that may have adverse consequences in terms of functional and psychological effect on patients. This article presents two clinical cases that required endodontic retreatment in order to avoid the complications that could ultimately require tooth extraction. The teeth in question (a mandibular first molar and an upper central incisor) having a special importance, and a physiognomic role, the endodontic retreatment consisted in covering them in porcelain fused to the metal crowns.

  16. 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

  17. 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

  18. 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.,…

  19. 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

  20. 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

  1. Singapore's Global Schoolhouse Strategy: Retreat or Recalibration?

    Science.gov (United States)

    Waring, Peter

    2014-01-01

    In 2002 a high-level economic review committee recommended that Singapore position itself as a "global schoolhouse". An ambitious target was set to attract 150,000 international students to Singapore by 2015 and to lift the education sector's contribution to GDP from 1.9% to 5% in the same timeframe. The global schoolhouse was viewed as…

  2. Ultrastructural examination of failed molar retreatment with secondary apical periodontitis: an examination of endodontic biofilms in an endodontic retreatment failure.

    Science.gov (United States)

    Carr, Gary B; Schwartz, Richard S; Schaudinn, Christoph; Gorur, Amita; Costerton, J William

    2009-09-01

    A light and electron microscope examination of the resected root tip of a failing endodontically re-treated lower molar was examined. The tooth had been initially treated 10 years ago and then re-treated 2 years ago. The resected root tip was sectioned axially, and thin sections were examined through the entire length of the specimen. Thin sections were examined with a transmission electron microscope. The thin sections were randomly chosen along the isthmus areas between the mesiobuccal and mesiolingual canals. Our findings suggest that a complex, variable, multispecies biofilm was present the entire length of the specimen.

  3. Retreatability of Root Canals Obturated using Mineral Trioxide ...

    African Journals Online (AJOL)

    2018-04-04

    Apr 4, 2018 ... Background: The aim of this study was to compare the retreatment time and the removal efficiency of different root canal sealers using WaveOne Gold reciproc file system by measuring required time. Materials and Methods: Forty‑five mandibular premolars were prepared and randomly divided into three ...

  4. Board of visitors committee to hold planning retreat

    OpenAIRE

    Hincker, Lawrence

    2008-01-01

    The Academic Affairs Committees of the Virginia Tech Board of Visitors will hold a planning retreat in open session on Saturday, Sept 13 from 9:30 a.m. to noon in the Duck Pond Room at the Inn at Virginia Tech.

  5. Healing of apical periodontitis through modern endodontic retreatment techniques.

    Science.gov (United States)

    Ray, Jarom J; Kirkpatrick, Timothy C

    2013-01-01

    The presence of apical periodontitis in teeth which have undergone initial root canal treatment is largely attributed to bacteria residing in or invading from the apical root canal space. Bacteria-associated apical periodontitis will not heal spontaneously, nor will systemic antibiotics eradicate the infection. Only endodontic retreatment, endodontic surgery, or extraction will control the bacterial etiology. Modern retreatment is an effective means of addressing apical periodontitis. A mandibular premolar with apical periodontitis, apical root resorption, and overfilled gutta percha was retreated with post removal, retrieval of gutta percha from beyond the apex, ultrasonic irrigation and disinfection, and placement of a collagen internal matrix to facilitate a well-controlled MTA apical fill. The magnification and illumination imparted by the operating microscope was integral to achievement of treatment objectives. The patient's symptoms were resolved and complete osseous healing occurred. During treatment planning, clinicians should consider the capability of modern endodontic techniques to overcome technical challenges, often allowing the natural dentition to be preserved and restored to function days after retreatment.

  6. The challenge of re-treatment pulmonary tuberculosis at two ...

    African Journals Online (AJOL)

    Background With an annual tuberculosis (TB) incidence of about 350 cases per 100,000 of the population, Uganda is a high burden country. Moreover, it is evident that some TB patients have been treated for a previous episode of the disease. Objective To highlight the burden of re-treatment pulmonary TB and examine ...

  7. Scientists Discover New Possibilities at Scientific Investigators Retreat | Poster

    Science.gov (United States)

    By Nancy Parrish, Staff Writer; photos by Richard Frederickson, Staff Photographer Scientists who attended the 2015 NCI Intramural Scientific Investigators Retreat on Jan. 13 had a chance to discuss research results with other investigators from across the National Cancer Institute. And this year, they could also explore new possibilities for the future of their research.

  8. 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.

  9. Health Care Evolution Is Driving Staffing Industry Transformation.

    Science.gov (United States)

    Faller, Marcia; Gogek, Jim

    2016-01-01

    The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.

  10. 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

    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 each groups. The volume of filling material before and after retreatment were evaluated in cm3 using the computed tomography (CT) scanner proprietary software. Results: Maximum amount of filling material removed during retreatment with ProTaper retreatment system with solvent and minimum with hand retreatment system with solvent. Conclusions: None of the technique was 100% effective in removing the filling materials, but the ProTaper retreatment system with solvent was better. PMID:24554852

  11. 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.

  12. Retreatability of three calcium silicate-containing sealers and one epoxy resin-based root canal sealer with four different root canal instruments.

    Science.gov (United States)

    Donnermeyer, David; Bunne, Clarissa; Schäfer, Edgar; Dammaschke, Till

    2018-03-01

    The objective of the study was to compare the retreatability of three calcium silicate-containing sealers (BioRoot RCS, MTA Fillapex, Endo C.P.M.) and an epoxy resin-based sealer (AH Plus) with different root canal instruments (Hedström files, Reciproc R40, Mtwo retreatment file R 25/.05 + Mtwo 40/.06, and F6 SkyTaper) concerning sealer remnants and retreatment time. Root canals of 192 teeth were instrumented with Reciproc R40. All root canals were obturated using the single-cone technique with Reciproc R40 gutta-percha and one of the sealers (n = 48 per sealer). Two months later, retreatment was performed using one of the mentioned instruments (n = 12 per instrument and sealer). The roots were split longitudinally, and both halves were investigated using light microscopy. The percentage of sealer remnants covering the root canal wall was evaluated using the software ImageJ. The time required for retreatment was recorded. Statistical analysis was performed using two-way ANOVA and Student-Newman-Keuls post hoc test. Regarding the percentage of root canal filling remnants as well as retreatment time, two-way ANOVA indicated that the results were significantly affected by the sealer (p instrument used (p instruments allowed significantly faster retreatment than the other instruments (p instruments was superior compared to hand instrumentation. Engine-driven NiTi instruments are better suited to remove root canal fillings than stainless steel Hedström files.

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Lukina, Galina

    2017-01-01

    OBJECTIVE: Several aspects of rituximab (RTX) retreatment in rheumatoid arthritis (RA) need to be further elucidated. The aim of this study was to describe the effect of repeated courses of RTX on disease activity and to compare 2 retreatment strategies, fixed-interval versus on-flare retreatment...

  18. Nurse Staffing Patterns and Patient Experience of Care: An Empirical Analysis of U.S. Hospitals.

    Science.gov (United States)

    Oppel, Eva-Maria; Young, Gary J

    2017-08-14

    To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility. The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. An observational research design was used entailing a pooled, cross-sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix-percentage of registered nurses; staffing flexibility-percentage of part-time nurses). All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns. © Health Research and Educational Trust.

  19. 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.

  20. Decadal-scale coastal cliff retreat in southern and central California

    Science.gov (United States)

    Young, Adam P.

    2018-01-01

    Airborne LiDAR data collected in 1998 and 2009-2010 were used to measure coastal cliff erosion and retreat between the Mexico/California border and Bodega Head, California. Cliff erosion was detected along 44% of the 595 km of shoreline evaluated, while the remaining cliffs were relatively stable. The mean cliff top retreat rate was 0.12 m/yr, while mean retreat averaged over the entire cliff face was 0.04 m/yr. The maximum cliff top and face retreat rates were 4.2 and 3.8 m/yr, respectively. Historical ( 1930s to 1998) and recent retreat rates were significantly inversely correlated for areas with large historical or recent cliff retreat, such that locations with elevated historical retreat had low levels of recent retreat and locations with elevated recent retreat were preceded by low rates of historical retreat. The strength of this inverse correlation increased with cliff change magnitudes up to r2 of 0.91 for cliff top retreat rates > 2.9 m/yr. Mean recent retreat rates were 52-83% lower than mean historical retreat rates. Although beaches can protect cliffs against wave-driven erosion, cliffs fronted by beaches retreated 49% more than cliffs without beaches. On average, unarmored cliff faces retreated 0.05 m/yr between 1998 and 2009-2010, about three times faster than artificially armored cliffs. Alongshore metrics of wave-cliff impact, precipitation, and cliff hardness were generally not well correlated with recent cliff changes. A cliff hazard metric is used to detect cliff steepening and areas prone to future cliff top failures.

  1. An Innovative Approach to Staffing a Simulation Center in a College of Health Professions.

    Science.gov (United States)

    Berro, Elizabeth A; Knoesel, Joanne M

    2016-01-01

    The current limited number of nurse faculty and available clinical sites requires innovative strategies to provide education to current and future nurses. Simulation centers and clinical education laboratories can meet this need, but staffing issues can be problematic. This article describes how an urban university developed a cost-effective model to staff its clinical education laboratory. After two faculty members proposed a pilot program to fully integrate simulation into both the accelerated and traditional undergraduate nursing programs on two campuses, a need was identified for more nursing staff dedicated to the simulation program. Knowing that many recent nurse graduates were available while waiting to obtain their first nursing position, these new nurses were recruited to serve in a volunteer capacity, supporting nursing faculty in the simulation program. The new nurse graduate volunteer position quickly evolved into a paid nurse intern position and has proven to benefit students, faculty, and new nurse graduates. Copyright 2016, SLACK Incorporated.

  2. Nonsurgical endodontic retreatment of geminated teeth: a case report.

    Science.gov (United States)

    Yücel, Ali Cağin; Güler, Eda

    2006-12-01

    The purpose of this case presentation is to describe nonsurgical retreatment of anterior teeth with gemination. A 21-year-old male patient was referred for endodontic treatment of his maxillary left lateral incisor. In the clinical examination, a large crown was observed in the left maxillary incisor region when compared with the right maxillary lateral incisor. In the present case, a tooth gemination of a maxillary lateral incisor has been described. A periapical radiograph showed that the tooth had partially separated two crowns having a single root and one root canal, but the access cavity of the distal crown had not been opened, and the root canal had been obturated with single cone technique. Nonsurgical endodontic retreatment was decided for geminated lateral incisor. At the 6-month follow-up, the tooth was asymptomatic and there was no radiolucency around the apical region.

  3. [Re-treatments of recurrence after pelvic floor repair surgery].

    Science.gov (United States)

    Fan, S X; Wang, F M; Lin, L S; Song, Y F

    2017-06-25

    Objective: To analyze re-treatments of recurrence after the pelvic floor repair surgery. Methods: The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above), who had received the pelvic floor repair surgery from January 2011 to January 2016. Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy, respectively. Results: Among 81 recurrent patients who were followed up for a median of 35 months (10- 69 months), 78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100% (78/78); 3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback, and 1 case among the three cases had the vaginal foreign body sensation, the subjective satisfaction was 2/3. The methods of surgical operation for the 78 recurrent patients included: total pelvic floor reconstructive surgery (55 cases; 3 of which involve trachelectomy), anterior pelvic reconstructive surgery (2 cases), posterior pelvic reconstructive surgery (3 cases), Y-mesh sacral colpopexy (2 cases), colpocleisis (11 cases), vaginal hysterectomy combined posterior fornix forming (3 cases), and vaginal hysterectomy combined posterior pelvic reconstructive surgery(2 cases). Conclusion: The extent of recurrence, the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery, and then an appropriately individualized re-treatment protocol could be designed for each of the patients.

  4. 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

  5. Prevalence of Treponemaspp. in endodontic retreatment-resistant periapical lesions

    Directory of Open Access Journals (Sweden)

    Tiago Pereira ROSA

    2015-01-01

    Full Text Available This study investigated the presence of the Treponema species in longstanding endodontic retreatment-resistant lesions of teeth with apical periodontitis, the association of this species with clinical/radiographic features, and the association among the different target species. Microbial samples of apical lesions were collected from twenty-five adult patients referred to endodontic surgery after unsuccessful root canal retreatment. Nested-PCR and conventional PCR were used for Treponema detection. Twenty-three periradicular tissue samples showed detectable levels of bacterial DNA. Treponema species were detected in 28% (7/25 of the cases. The most frequently detected species were T. socranskii (6/25, followed by T. maltophilum (3/25, T. amylovorum (3/25, T. lecithinolyticum(3/25, T. denticola (3/25, T. pectinovorum (2/25 and T. medium(2/25. T. vicentii was not detected in any sample. Positive statistical association was found between T. socranskiiand T. denticola,and between T. maltophilumand T. lecithinolyticum. No association was detected between the presence of any target microorganism and the clinical or radiographic features. Treponemaspp.are present, in a low percentage, in longstanding apical lesions from teeth with endodontic retreatment failure.

  6. Retreatment Predictions in Odontology by means of CBR Systems

    Directory of Open Access Journals (Sweden)

    Livia Campo

    2016-01-01

    Full Text Available The field of odontology requires an appropriate adjustment of treatments according to the circumstances of each patient. A follow-up treatment for a patient experiencing problems from a previous procedure such as endodontic therapy, for example, may not necessarily preclude the possibility of extraction. It is therefore necessary to investigate new solutions aimed at analyzing data and, with regard to the given values, determine whether dental retreatment is required. In this work, we present a decision support system which applies the case-based reasoning (CBR paradigm, specifically designed to predict the practicality of performing or not performing a retreatment. Thus, the system uses previous experiences to provide new predictions, which is completely innovative in the field of odontology. The proposed prediction technique includes an innovative combination of methods that minimizes false negatives to the greatest possible extent. False negatives refer to a prediction favoring a retreatment when in fact it would be ineffective. The combination of methods is performed by applying an optimization problem to reduce incorrect classifications and takes into account different parameters, such as precision, recall, and statistical probabilities. The proposed system was tested in a real environment and the results obtained are promising.

  7. Effects of coastal managed retreat on mercury biogeochemistry

    International Nuclear Information System (INIS)

    Sizmur, Tom; Godfrey, Adam; O'Driscoll, Nelson J.

    2016-01-01

    We investigated the impact of managed retreat on mercury (Hg) biogeochemistry at a site subject to diffuse contamination with Hg. We collected sediment cores from an area of land behind a dyke one year before and one year after it was intentionally breached. These sediments were compared to those of an adjacent mudflat and a salt marsh. The concentration of total mercury (THg) in the sediment doubled after the dyke was breached due to the deposition of fresh sediment that had a smaller particle size, and higher pH. The concentration of methylmercury (MeHg) was 27% lower in the sediments after the dyke was breached. We conclude that coastal flooding during managed retreat of coastal flood defences at this site has not increased the risk of Hg methylation or bioavailability during the first year. As the sediment becomes vegetated, increased activity of Hg-methylating bacteria may accelerate Hg-methylation rate. - Highlights: • We collected cores behind a dyke before and after it was intentionally breached. • Mercury concentration in inundated sediment doubled after the dyke was breached. • Methylmercury concentration decreased in inundated sediment by 27% after breaching. • The freshly deposited sediment adsorbed more Hg and decreased its bioavailability. • Coastal managed retreat did not increase risk of Hg methylation during first year. - Mercury concentration doubled in sediments after coastal flooding but methylmercury concentration deceased.

  8. Retreatment Predictions in Odontology by means of CBR Systems.

    Science.gov (United States)

    Campo, Livia; Aliaga, Ignacio J; De Paz, Juan F; García, Alvaro Enrique; Bajo, Javier; Villarubia, Gabriel; Corchado, Juan M

    2016-01-01

    The field of odontology requires an appropriate adjustment of treatments according to the circumstances of each patient. A follow-up treatment for a patient experiencing problems from a previous procedure such as endodontic therapy, for example, may not necessarily preclude the possibility of extraction. It is therefore necessary to investigate new solutions aimed at analyzing data and, with regard to the given values, determine whether dental retreatment is required. In this work, we present a decision support system which applies the case-based reasoning (CBR) paradigm, specifically designed to predict the practicality of performing or not performing a retreatment. Thus, the system uses previous experiences to provide new predictions, which is completely innovative in the field of odontology. The proposed prediction technique includes an innovative combination of methods that minimizes false negatives to the greatest possible extent. False negatives refer to a prediction favoring a retreatment when in fact it would be ineffective. The combination of methods is performed by applying an optimization problem to reduce incorrect classifications and takes into account different parameters, such as precision, recall, and statistical probabilities. The proposed system was tested in a real environment and the results obtained are promising.

  9. Re-treatment and prognosis of recurrent or metastatic thymoma

    International Nuclear Information System (INIS)

    Wu Kailiang; Jiang Guoliang; Mao Jingfang; Fu Xiaolong; Qian Hao

    2007-01-01

    Objective: To analyze the treatment results of 48 patients with recurrent or metastatic thymoma. Methods: Forty-eight patients with pathologically confirmed recurrent or metastatic thymoma were included in this study. The overall survival and re-treatment survival were calculated. The factors of prognosis were analyzed by Cox regression model. Results: Recurrence and metastasis was found in 27 and 26 patients, respectively. All recurrence was located in the mediastinum. Tumor resection, or surgery followed by radiotherapy, radiotherapy alone, radiotherapy combined with chemotherapy or chemotherapy alone was given to 1, 7, 10, 4 and 5 patients with recurrent tumor, radiotherapy alone, radiotherapy combined with chemotherapy or chemotherapy alone was given to 9, 4 and 12 patients with metastatic tumor. The 5- year and 10-year overall survival rates were 55% and 31% ,respectively. The corresponding re-treatment overall survival was 38% and 25%, respectively. Multivariate statistical analysis showed that no factor was independent prognostic factors. Conclusions: The re-treatment overall survival hints that patients with recurrent or metastatic thymoma should receive active salvage treatment. (authors)

  10. Impact of nonphysician staffing on outcomes in a medical ICU.

    Science.gov (United States)

    Gershengorn, Hayley B; Wunsch, Hannah; Wahab, Romina; Leaf, David; Brodie, Daniel; Li, Guohua; Factor, Phillip

    2011-06-01

    As the number of ICU beds and demand for intensivists increase, alternative solutions are needed to provide coverage for critically ill patients. The impact of different staffing models on the outcomes of patients in the medical ICU (MICU) remains unknown. In our study, we compare outcomes of nonphysician provider-based teams to those of medical house staff-based teams in the MICU. We conducted a retrospective review of 590 daytime (7:00 am-7:00 pm) admissions to two MICUs at one hospital. In one MICU staffed by nurse practitioners and physician assistants (MICU-NP/PA) there were nonphysicians (nurse practitioners and physicians assistants) during the day (7:00 am-7:00 pm) with attending physician coverage overnight. In the other MICU, there were medicine residents (MICU-RES) (24 h/d). The outcomes investigated were hospital mortality, length of stay (LOS) (ICU, hospital), and posthospital discharge destination. Three hundred two patients were admitted to the MICU-NP/PA and 288 to the MICU-RES. Mortality probability model III (MPM(0)-III) predicted mortality was similar (P = .14). There was no significant difference in hospital mortality (32.1% for MICU-NP/PA vs 32.3% for MICU-RES, P = .96), MICU LOS (4.22 ± 2.51 days for MICU-NP/PA vs 4.44 ± 3.10 days for MICU-RES, P = .59), or hospital LOS (14.01 ± 2.92 days for MICU-NP/PA vs 13.74 ± 2.94 days for MICU-RES, P = .86). Discharge to a skilled care facility (vs home) was similar (37.1% for MICU-NP/PA vs 32.5% for MICU-RES, P = .34). After multivariate adjustment, MICU staffing type was not associated with hospital mortality (P = .26), MICU LOS (P = .29), hospital LOS (P = .19), or posthospital discharge destination (P = .90). Staffing models including daytime use of nonphysician providers appear to be a safe and effective alternative to the traditional house staff-based team in a high-acuity, adult ICU.

  11. When caring stops, staffing doesn't matter: part II.

    Science.gov (United States)

    Douglas, Kathy

    2011-01-01

    Response to a column on caring and staffing struck a cord with Nursing Economic$ readers worldwide. Measuring caring is complicated and a healthy debate exists over how exactly to do it. The extraordinary work of Dr. Jean Watson is an excellent resource for understanding how to measure and monitor caring. Beneath the instruments for measuring caring sits foundational work that can help us clarify and understand the topic of caring and just where it sits in our philosophies, intentions, patient care models, and care delivery systems.

  12. 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.

  13. Radiotherapy facilities, equipment, and staffing in Poland: 2005–2011

    Science.gov (United States)

    Reinfuss, Marian; Byrski, Edward; Malicki, Julian

    2013-01-01

    Background and purpose To evaluate the current status of radiotherapy facilities, staffing, and equipment, treatment and patients in Poland for the years 2005–2011 following implementation of the National Cancer Programme. Methods A survey was sent to the radiotherapy centres in Poland to collect data on available equipment, staffing, and treatments in the years 2005–2011. Results In 2011, 76,000 patients were treated with radiotherapy at 32 centres vs. 63,000 patients at 23 centres in 2005. Number of patients increased by 21%. In 2011, there were 453 radiation oncologists – specialists (1 in 168 patients), 325 medical physicists (1 in 215 patients), and 883 radiotherapy technicians (1 in 86 patients) vs. 320, 188, and 652, respectively, in 2005. The number of linear accelerators increased by 60%, from 70 units in 2005 to 112 in 2011. The current linac/patient ratio in Poland is 1 linac per 678 patients. Waiting times from diagnosis to the start of treatment has decreased. Conclusion Compared to 2005, there are more treatment facilities, more and better equipment (linacs), and more cancer care specialists. There are still large differences between the 16 Polish provinces in terms of equipment availability and ease of access to treatment. However, radiotherapy services in Poland have improved dramatically since the year 2005. PMID:24416548

  14. 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.

  15. Salt Marshes as Monitors of Late Holocene Outlet Glacier Retreat

    Science.gov (United States)

    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.

  16. The solutions to your problems in endodontic retreatment and microsurgery

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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)

  19. 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,…

  20. 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…

  1. The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes

    Science.gov (United States)

    Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert

    2011-01-01

    Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…

  2. 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...

  3. Outcome of orthograde endodontic retreatment - a two-year follow-up

    OpenAIRE

    Nešković Jelena; Živković Slavoljub; Medojević Milica; Maksimović Miloš

    2016-01-01

    Introduction. Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. Objective. The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Methods. Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All t...

  4. 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.

  5. 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.

  6. Impact of different file systems on the amount of apically extruded debris during endodontic retreatment

    OpenAIRE

    Uzunoglu, Emel; Turker, Sevinc Aktemur

    2016-01-01

    Objective: The goal of present study was to determine the effect of different nickel?titanium file systems on the amount of apically extruded debris during endodontic retreatment: D-RaCe retreatment systems, EdgeFile XR retreatment rotary files, and Reciproc R40. Materials and Methods: Thirty-six single-rooted prepared mandibular premolar teeth were filled with Gutta-percha and AH Plus sealer. The teeth were then randomly assigned into three groups (n = 12) for retreatment. The endodontic ret...

  7. Risk-Adjusted Staffing to Improve Patient Value.

    Science.gov (United States)

    Pappas, Sharon; Davidson, Nan; Woodard, Jim; Davis, Jennifer; Welton, John M

    2015-01-01

    The presence of hospital-acquired conditions, infections, or other adverse events are a reflection of inadequate patient safety and can have short and long-term impacts of quality of life for patients as well as financial implications for the hospital. Using unit-level information to develop a tool, the Patient Risk Assessment Profile, nurses on an inpatient surgical unit proactively assessed patient risk to guide staffing decisions and nurse-patient assignment with the goal to improve patient value, reduce adverse events, and avoid unnecessary hospital costs. Findings showed decreased adverse event rates for patient falls, catheter-acquired urinary tract infection, central line-acquired blood stream infection, and pressure ulcer prevalence after the intervention was implemented. In addition, end-of-shift over-time and patient cost per case decreased as well yielding an operational impact in hospital financial performance.

  8. 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)

  9. 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 Retreatment files. Also, canals obturated with GuttaCore were retreated more efficiently and

  10. 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.

  11. The influence of staffing and timetabling on achieving competence in surgical extractions.

    Science.gov (United States)

    Moore, U; Durham, J; Corbett, I; Thomson, P

    2009-02-01

    Competence based education is becoming more important in dentistry and medicine. In dentistry clinical skills are assessed using longitudinal assessments or structured objective clinical tests. We have previously presented the assessment of competence in surgical extractions however the success rate for this was poor. The opportunity to alter staffing levels and timetabling arose and we present the influence of this on the achievement of competence. The competence assessments and portfolios of two consecutive years of dental undergraduates were examined after completing their surgical extraction course. The first cohort received 9 sessions of teaching spread over 2 years with one staff supervisor per session. The second cohort received 10 sessions with varying numbers of staff supervisors. The first cohort required 210 staff sessions and performed 275 surgical extractions (mean 4), and 23% achieved competence. The second cohort required 240 staff sessions and performed 403 surgical extractions (mean 6), and 66% achieved competence. Thirty six extra sessions were provided for students in the second cohort who failed to complete their competence during the allocated blocks and following this 99% of the second cohort achieved competence. These differences are significant (P timetabling changes which focus student experience and learning.

  12. Comparative Evaluation of Stress developed on Rotary Retreatment Instruments during Retrieval of Gutta-percha.

    Science.gov (United States)

    Sihivahanan, Dhanasekaran; Reddy, T Vinay Kumar; Thomas, Anchu Rachel; Senthilnathan, Natarajan; Sivakumar, Murali; Shivanna, Sushmita

    2017-06-01

    The aim of the study is to compare the maximum stress distribution on the rotary retreatment instruments within the root canal at cervical, middle, and the apical one-third during retreatment of gutta-percha. A human mandibular premolar was scanned, and three-dimensional geometry of the root was reconstructed using finite element analysis (FEA) software package (ANSYS). The basic model was kept unchanged; tooth models were created using the same dimensions and divided into two groups as follows: Group I: ProTaper Universal retreatment system and group II: Mtwo rotary retreatment system. The stress distribution on the surface and within the retreatment files was analyzed numerically in the FEA package (ANSYS). The FEA analysis revealed that the retreatment instruments received the greatest stress in the cervical third, followed by the apical third and the middle third. The stress generated on the ProTaper Universal retreatment system was less when compared with the Mtwo retreatment files. The study concludes that the retreatment instruments undergo higher stress in the cervical third region, and further in vivo and in vitro studies are necessary to evaluate the relationship between instrument designs, stress distribution, residual stresses after use, and the torsional fracture of the retreatment instrument. The stress developed on the rotary retreatment instruments during retrieval of gutta-percha makes the instrument to get separated. There is no instrument system, i.e., suitable for all clinical situations and it is important to understand how the structural characteristics could influence the magnitude of stresses on the instrument to prevent its fracture in use.

  13. The writing retreat: a high-yield clinical faculty development opportunity in academic writing.

    Science.gov (United States)

    Cable, Christian T; Boyer, Debra; Colbert, Colleen Y; Boyer, Edward W

    2013-06-01

    The need for consistent academic productivity challenges junior clinician-scholars, who often lack the aptitude to ensure efficient production of manuscripts. To solve this problem, an academic division of a major medical center developed an off-site writing retreat. The purpose of the retreat was not to teach writing skills, but to offer senior mentor assistance with a focus on the elements of manuscript writing. The retreat paired senior faculty members with junior staff. Senior faculty identified manuscript topics and provided real-time writing and editing supervision. Team-building exercises, midcourse corrections, and debriefing interviews were built into the retreat. The number of manuscripts and grant proposals generated during the 2008-2011 retreats was recorded, and the program was evaluated by using unstructured debriefing interviews. An average of 6 to 7 faculty members and fellows participated in each retreat. During the past 4 years, participants produced an average of 3 grant proposals and 7 manuscripts per retreat. After the writing retreat, each fellow and junior faculty member produced an average of 4 scholarly products per year, compared to fewer than 2 for prior years' retreats. Participant feedback indicated the success of the retreat resulted from protected time, direct mentorship by the scholars involved, and pairing of authors, which allows for rapid production of manuscripts and accelerated the editing process. More than 80% of mentors returned each year to participate. The writing retreat is a feasible, effective strategy to increase scholarship among faculty, acceptable to mentees and mentors, and sustainable over time.

  14. 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

  15. 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

  16. How Does Rurality Influence the Staffing of Social Service Departments in Nursing Homes?

    Science.gov (United States)

    Roberts, Amy Restorick; Bowblis, John R

    2017-01-09

    Social service departments in nursing homes (NHs) are staffed by qualified social workers (QSWs) and paraprofessionals. Due to greater workforce challenges in rural areas, this article aims to describe the staffing levels and composition of these departments by rurality. Certification and Survey Provider Enhanced Reports data from 2009 to 2015 are used to examine the effect of rurality on social service staffing using random-effects linear panel regressions. The average NH employed 1.8 full-time equivalents (FTEs), with approximately two thirds of social services staffed by QSWs. Large NHs had more staff, but employed fewer staff hours per resident day. Staffing levels were lower and QSWs made up a smaller percentage of staff in rural areas. National trends indicate variability in staffing by NH size and degree of rurality. Very low staffing within rural NHs is a concern, as staff may have less time to respond to residents' needs and these NHs may utilize fewer QSWs. © 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.

  17. 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.

  18. [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

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

    Science.gov (United States)

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

    2012-01-05

    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.

  20. 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

  1. 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.

  2. Efficacy of two rotary retreatment systems in removing Gutta-percha and sealer during endodontic retreatment with or without solvent: A comparativein vitrostudy.

    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.

  3. 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.

  4. Outcome of orthograde endodontic retreatment - a two-year follow-up

    Directory of Open Access Journals (Sweden)

    Nešković Jelena

    2016-01-01

    Full Text Available Introduction. Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. Objective. The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Methods. Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI. All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2 while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5. Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. Results. Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. Conclusion. Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions.

  5. Outcome of orthograde endodontic retreatment--A two-year follow-up.

    Science.gov (United States)

    Nesković, Jelena; Zivković, Slavoljub; Medojević, Milica; Maksimović, Milos

    2016-01-01

    Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions.

  6. The Rhetoric of Strategic Retreat: Carter and the Panama Canal Debate.

    Science.gov (United States)

    Sudol, Ronald A.

    1979-01-01

    Discusses President Carter's televised address on the Panama Canal Treaties in terms of five "topoi" for a rhetoric of retreat: timeliness, urgency, value, advantage, and shrewdness. Compares his failure to employ the commonsense arguments that a policy of retreat requires in the televised speech with his more successful impromptu…

  7. 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

  8. A Numerical Model of Retreating Alluvial Fan Coasts

    Science.gov (United States)

    Hicks, M.; Dickson, M.; Coco, G.

    2006-12-01

    A numerical model has been developed that simulates the wave-driven retreat of partially-consolidated alluvial- fan shores over millennium time-scales. It has been developed to reproduce the shore profiles and coastal erosion rates observed along the Pleistocene glacial-outwash fan built by the Waitaki River on the east coast of New Zealand's South Island. This cliffed shore is currently fronted by a narrow sand-and-gravel beach. The nearshore seabed is formed in Pleistocene substrate and has only a thin and patchy cover of sand. The motivation is to examine the sensitivity of the erosion rates to wave-climate change, sea-level rise, and river sediment supplies. The model is forced by two wave conditions that, when randomly sampled, represent the storm-wave and normal-swell climates of the prototype coast. These each operate for a fixed proportion of the model's yearly time-step. Morphological change is driven by a series of coupled process models. These include scour of the nearshore seabed by shoaling waves, cross-shore exchanges of sand and gravel between the nearshore and beach, berm construction during normal wave conditions, berm overtopping by storm waves with consequent beach stripping and scour of the exposed sub-aerial substrate and cliff-toe notch-cutting, gravity-failure of the cliffs and talus construction between storm events, and beach sediment abrasion. The scour, notching, and transport models are generally based on energetics principles and are calibrated with linear scaling coefficients to match field observations from the prototype coast. Negative feedback regulates the rate of cliff erosion through the protection that is afforded by cliff and substrate material added to the beach. The starting model condition is a sloping alluvial fan inundated by the sea-level rise that followed the last glacial epoch, and the model is run for 6000 years to the present assuming a stable sea level. Initially, the gentle slope of the alluvial fan results in

  9. Living at the margin of the retreating Fennoscandian Ice Sheet

    DEFF Research Database (Denmark)

    Möller, Per; Östlund, Oluf; Barnekow, Lena

    2013-01-01

    total 6 m2) are interpreted as resulting from short-stay hunter-gatherer camps. Radiocarbon dating on burnt bones suggest an age of occupancy at ~10,700 cal. yr BP, which is more or less contemporary with 'Komsa Phase' sites on the north coast of Norway (~300-360 km northwards). The Aareavaara site...... should thus be the oldest known archaeological site to date in northern Sweden. A palaeoenvironmental reconstruction, based on pollen analysis of sediment cores from two nearby lakes and radiocarbon dating of macrofossils for construction of time/depth sedimentation curves, suggests a deglaciation age...... of the area corresponding to occupation by early man (~10,700 cal. yr BP). Aareavaara was at the time of deglaciation situated in a transitional zone between subaqueous and subaerial ice-margin retreat from the northeast towards the southwest, with higher hills and plateaux forming an archipelago...

  10. Homeless Caseload is Associated with Behavioral Health and Case Management Staffing in Health Centers.

    Science.gov (United States)

    Jones, Emily B; Zur, Julia; Rosenbaum, Sara

    2017-07-01

    Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms.

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

    DEFF Research Database (Denmark)

    Levy, L. B.; Larsen, Nicolaj 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...... factor in ice retreat. The late retreat at Isua is in contrast to the early retreat observed in the Godthåbsfjord area and is probably related to the lack of fjords extending to the present Isua ice margin. Our data are not consistent with current ice sheet models that overestimate the middle Holocene...

  12. Comparative study of apically extruded debris using one manual and two rotary instrumentation techniques for endodontic retreatment

    Directory of Open Access Journals (Sweden)

    Alper Kustarci

    2012-03-01

    Conclusion: All retreatment techniques produced extruded debris during endodontic retreatment; however, both rotary NiTi systems were associated with less apical extrusion than manual instrumentation with Hedström files.

  13. Avoiding crisis: right-sizing staffing for the future.

    Science.gov (United States)

    Best, Michele L

    2002-01-01

    Workforce issues, especially recruitment and retention of qualified laboratory staff, are major strategic issues that will continue to face laboratory managers over the next 10 years. Major factors affecting the laboratory labor market in the next decade include increased health-care and laboratory testing needs of an aging population, the graying of the laboratory workforce as baby boomers retire, and new technology development. At least two of these factors will increase the demand for qualified laboratory professionals. Vacancy rates for laboratory professionals are increasing at a significant rate and will continue over the next 10 years. Planning will require creativity in staff recruitment and retention strategies and in human resources. Laboratorians no longer will have the luxury of using medical technologists for nonspecialized testing assignments and will need to develop more creative recruiting approaches using fewer highly qualified testing personnel. This article proposes a staffing deployment model that will use medical technologist education and skills more appropriately, will improve retention of medical technologists, and will alleviate the shortage of medical technologists by reducing dependence on them as routine laboratory testing personnel.

  14. 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.

  15. 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...

  16. Optimizing Fire Department Operations Through Work Schedule Analysis, Alternative Staffing, and Nonproductive Time Reduction

    Science.gov (United States)

    2014-09-01

    fatigue attributed to work-related stressors .19 On the other hand, research has shown that the 48/96 schedule exacerbates sleep deprivation issues...health and wellness initiatives, brown-out, fire department funding, peak-usage staffing, four-person staffing, schedule modification, sleep deprivation ...to a significant sleep deprivation risk that impacts the employee’s ability to function at peak levels.7 The 10/14-hour schedule produces better

  17. Minimum Nurse Staffing Legislation and the Financial Performance of California Hospitals

    Science.gov (United States)

    Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

    2012-01-01

    Objective To estimate the effect of minimum nurse staffing ratios on California acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. Study Design The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. PMID:22150627

  18. Association between patient classification systems and nurse staffing costs in intensive care units: An exploratory study.

    Science.gov (United States)

    Stafseth, Siv K; Tønnessen, Tor Inge; Fagerström, Lisbeth

    2018-04-01

    Nurse staffing costs represent approximately 60% of total intensive care unit costs. In order to analyse resource allocation in intensive care, we examined the association between nurse staffing costs and two patient classification systems: the nursing activities score (NAS) and nine equivalents of nursing manpower use score (NEMS). A retrospective descriptive correlational analysis of nurse staffing costs and data of 6390 patients extracted from a data warehouse. Three intensive care units in a university hospital and one in a regional hospital in Norway. Nurse staffing costs, NAS and NEMS. For merged data from all units, the NAS was more strongly correlated with monthly nurse staffing costs than was the NEMS. On separate analyses of each ICU, correlations were present for the NAS on basic costs and external overtime costs but were not significant. The annual mean nurse staffing cost for 1% of NAS was 20.9-23.1 euros in the units, which was comparable to 53.3-81.5 euros for 1 NEMS point. A significant association was found between monthly costs, NAS, and NEMS. Cost of care should be based on individual patients' nursing care needs. The NAS makes nurses' workload visible and may be a helpful classification system in future planning and budgeting of intensive care resources. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. [Structure of nurse labor market and determinants of hospital nurse staffing levels].

    Science.gov (United States)

    Park, Bohyun; Seo, Sukyung; Lee, Taejin

    2013-02-01

    To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

  20. 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.

  1. 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.

  2. Minimum nurse staffing legislation and the financial performance of California hospitals.

    Science.gov (United States)

    Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

    2012-06-01

    To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

  3. Community health centers employ diverse staffing patterns, which can provide productivity lessons for medical practices.

    Science.gov (United States)

    Ku, Leighton; Frogner, Bianca K; Steinmetz, Erika; Pittman, Patricia

    2015-01-01

    Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served. Project HOPE—The People-to-People Health Foundation, Inc.

  4. 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.

  5. Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis.

    Science.gov (United States)

    Caster, Andrew I; Friess, David W; Schwendeman, Frank J

    2010-01-01

    To analyze the risk for clinically significant epithelial ingrowth after primary laser in situ keratomileusis (LASIK) and flap-lift retreatment LASIK. Private practice, Beverly Hills, California, USA. All cases of primary and flap-lift retreatment LASIK performed by the same surgeon in a single surgical center between January 2004 and June 2007 were retrospectively reviewed. Cases that subsequently developed clinically significant epithelial ingrowth, defined as epithelial ingrowth impeding on the visual axis and negatively affecting uncorrected or corrected distance visual acuity, were identified and analyzed. Clinically significant epithelial ingrowth occurred in none of the 3866 primary LASIK cases and in 15 (2.3%) of the 646 flap-lift retreatment cases (P<.0001). Clinically significant ingrowth was more frequent when flap-lift retreatment was performed 3 or more years after primary LASIK (7.7% versus 1.0%) (P = .0001). Patient age and sex did not have a statistically significant effect on the epithelial ingrowth rate. There was a nonsignificant trend toward increased epithelial ingrowth after flap-lift retreatment of Automated Corneal Shaper (ACS) microkeratome flaps. Flap-lift retreatment performed 3 or more years after primary LASIK led to a higher risk of clinically significant epithelial ingrowth than primary LASIK or earlier flap-lift retreatment. The author has no financial or proprietary interest in any material or method mentioned. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. Improving cancer surgery in Ontario: recommendations from a strategic planning retreat.

    Science.gov (United States)

    Gagliardi, Anna; Ashbury, Fredrick D; George, Ralph; Irish, Jonathan; Stern, Hartley S

    2004-08-01

    The Ministry of Health and Long-Term Care mandated a rapid and thorough change in the delivery of cancer services in Ontario to integrate ambulatory services offered by Cancer Care Ontario (CCO) with the inpatient services of affiliated hospitals. The CCO Surgical Oncology Program held a strategic planning retreat to establish the basis upon which to implement surgery-specific changes. Participants completed a pre-retreat survey. Based on survey results, the retreat was organized around 4 themes: role of the Surgical Oncology Program; knowledge transfer; funding for cancer surgery; and research priorities. These topics were discussed in small breakout groups and by the entire assembly. Retreat participants (n = 55) included hospital CEOs, vice-presidents of cancer services, surgeons from cancer centres and community hospitals, academic chairs of surgery, clinician researchers and managers from CCO. Responses to the pre-retreat survey (n = 38) and recommendations made by retreat participants showed strong support for the Surgical Oncology Program to take a leadership role in the development and monitoring of quality indicators, research related to cancer surgery and the creation of regional communities of practice. Funding mechanisms for cancer surgeons and hospitals performing cancer surgery were also highlighted. The Surgical Oncology Program used the results to develop a strategic plan that was approved by retreat participants and the board of the CCO. The program has embarked on a multifaceted approach to facilitate, monitor and report on the organization and delivery of cancer surgery in Ontario.

  8. Impact of different file systems on the amount of apically extruded debris during endodontic retreatment.

    Science.gov (United States)

    Uzunoglu, Emel; Turker, Sevinc Aktemur

    2016-01-01

    The goal of present study was to determine the effect of different nickel-titanium file systems on the amount of apically extruded debris during endodontic retreatment: D-RaCe retreatment systems, EdgeFile XR retreatment rotary files, and Reciproc R40. Thirty-six single-rooted prepared mandibular premolar teeth were filled with Gutta-percha and AH Plus sealer. The teeth were then randomly assigned into three groups (n = 12) for retreatment. The endodontic retreatment was performed as follows: D-RaCe, EdgeFile XR, Reciproc 40. Debris extruded apically during the retreatment was collected into preweighed Eppendorf tubes. An incubator was used to store tubes at 70(°) C for 5 days. The initial weight was subtracted from final weight of the Eppendorf tubes to calculate the weight of the dry extruded debris for each group. The data obtained were evaluated using Welch analysis of variance and Games-Howell post-hoc tests (P extruded debris during endodontic retreatment.

  9. 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

  10. Short-term retreat statistics of a slowly eroding coastal cliff

    Directory of Open Access Journals (Sweden)

    A. P. Young

    2011-01-01

    Full Text Available The frequency, spatial distribution, and dimensions of coastal cliff retreats, a basic statistic underlying cliff top hazard assessment, are presented for 7.1 km of unprotected and slowly retreating coastal cliffs near Point Loma in San Diego, California, US. Using 8 airborne light detection and ranging (lidar surveys collected over 5.5 years, 130 individual cliff edge failures (primarily rockfalls, block falls, and topples were detected. Footprint areas varied from 3 to 268 m2, maximum landward retreats from 0.8 to 10 m, and alongshore lengths from 2 to 68 m. The failures with the largest landward retreats were also relatively long, and 13% of the slides accounted for 50% of the lost cliff area over the study period. On this short (5.5 years time scale, "no change" was the most common observation (84% of the cliff edge. Probability distributions of non-zero cliff retreat during each time interval usually had a single peak between 1 and 2.5 m. Intervals with high mean retreat had elevated numbers of failure in all class sizes, and also contained the largest individual retreats. Small and medium slides tended to reoccur preferentially (relative to randomly near previous small and medium slides, forming short-term hot spots, while large slides were less likely to reoccur near previous large slides. Cumulative distributions of landslide failure parameters (area, mean retreat, maximum retreat, and length follow an inverse power-law for medium to large size events, similar to previously reported distributions of coastal and inland landsliding.

  11. Staffing requirements for future small and medium reactors

    International Nuclear Information System (INIS)

    McQuade, D.

    2001-01-01

    As power generators around the world grapple with the challenges of the environment, deregulation, competitions and changing prices of fuels, the economics of running a future power plant are influenced significantly by the component of labour costs. These costs, from plant staff, corporate support and purchased services, will affect the overall plant economics. To achieve improved efficiency and effectiveness of organization structures and staff, vendors and utilities are working jointly to apply lessons learned for future designs. This paper will examine the experience gained to date with Canadian CANDU 6 type reactors both in Canada and abroad. The strategies which have been very successful will be reviewed, together with the results of collaboration between Atomic Energy of Canada and the utilities. An assessment of the staffing numbers is provided as a comparison between current number at a Canadian utility and the projected number from a future plant with the improvements in the design. The influence to the overall plant economics are discussed with some broad generalities that look at the effects of increasing and reducing staff levels showing the probable impact on capacity factor. The lessons from other plants can contribute significantly to the performance improvement process. The paper points to the need for a balanced approach in the future for the distribution of operating maintenance and administration (OM and A) cost between nuclear safety studies; maintenance programs and staff training. In the future, utilities, together with the designers, will have to greatly improve plant maintenance and training. The improved design features detailed in the paper will support this strategy by utilizing operational experience. (author)

  12. 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.

  13. Retreatment of Chronic Hepatitis C Infection with Telaprevir : Turkey Experience.

    Science.gov (United States)

    Pekgöz, M; Gürel, S; Kiyici, M; Gülten, M; Dolar, E; Nak, S G

    2016-03-01

    Patients with genotype 1 chronic hepatitis C virus (HCV) who do not have a sustained virologic response to therapy with peginterferon alfa and ribavirin have a low likelihood of success with retreatment. Voluntary patients aged 18 and older with genotype-1 chronic HCV and with no exclusion criteria were -included. Treatment was organized as following: telaprevir was administered at a dose of 750 mg every 8 hours ; Peg-IFN α-2a was administered at a dose of 180 mcg per week and ribavirin was -administered at a dose of 1000-1200 mg per day. HCV-RNA levels were measured before treatment, at 4, 12, 24 weeks of treatment, after treatment and after 24 weeks of treatment. Sustained virologic response was defined as undetectable HCV-RNA after 24 weeks of treatment. Sustained virologic response was obtained in 37 patients (74%). Breakthrough (BT) or early relapse was seen in 6 patients (12%) in total. Treatment had to be discontinued because of treatment related adverse events in 7 patients (14%). Triple combination therapy including telaprevir is significantly better than classical Peg-IFN α and ribavirin therapy in patients with chronic hepatitis-C infection. © Acta Gastro-Enterologica Belgica.

  14. 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 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 (2006-2016) 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. 75% 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Hydrography and circulation in the northwestern Bay of Bengal during the retreat of southwest monsoon

    Digital Repository Service at National Institute of Oceanography (India)

    Murty, V.S.N.; Sarma, Y.V.B.; Babu, M.T.; Rao, D.P.

    The distribution of temperature and salinity in the upper 500 m of the northwestern Bay of Bengal, adjoining the East Coast of India, during the retreat of southwest monsoon (September) of 1983 is presented. This study reveals coastal upwelling...

  16. Endodontic retreatment of maxillary first molar: the importance of the fourth canal

    Directory of Open Access Journals (Sweden)

    Alfredo Iandolo

    2016-06-01

    Conclusions: The endodontic retreatment of this right maxillary first molar was performed with the proper protocols and sophisticated tools, with which we can achieve success in the short- and long-term treatments.

  17. Root canal retreatment using reciprocating and continuous rotary nickel-titanium instruments

    Science.gov (United States)

    de Souza, Patricia Fonseca; Oliveira Goncalves, Leonardo Cantanhede; Franco Marques, Andre Augusto; Sponchiado Junior, Emilio Carlos; Roberti Garcia, Lucas da Fonseca; de Carvalho, Fredson Marcio Acris

    2015-01-01

    Objective: The complete filling material removal during endodontic retreatment is a clinical procedure difficult to achieve. The aim of this study was to evaluate the efficacy of reciprocating and continuous rotary nickel-titanium instruments used in root canal retreatment. Materials and Methods: Forty freshly extracted human premolars were cleaned and shaped by the crown-down technique, followed by filling by the lateral compaction technique. The teeth were randomly separated into two groups (n = 20), according to the system used for filling material removal: G1 - Reciproc and G2 - ProTaper Universal Retreatment System. The teeth were photographed under operating microscope at ×8 magnification; and the total area of the root canal and remaining filling material were quantified. Results: No statistically significant difference (P > 0.05) in residual filling material was observed between groups; however, the time required for filling removal was significantly shorter for Reciproc system (P retreatment was faster when reciprocating motion was used. PMID:26038656

  18. Retreatment of a 6-Canalled Mandibular First Molar with Four Mesial Canals: A Case Report

    OpenAIRE

    Aminsobhani, Mohsen; Shokouhinejad, Noushin; Ghabraei, Sholeh; Bolhari, Behnam; Ghorbanzadeh, Abdollah

    2010-01-01

    Successful root canal treatment requires adequate knowledge regarding morphologic variations in root canal system of teeth. This report describes a six-canalled mandibular first molar with four mesial root canals requiring endodontic retreatment. The two additional canals in the mesial root were found during retreatment with the aid of illumination and magnification. In conclusion, the possibility of atypical morphology and additional canals should never be overlooked.

  19. Endodontic Re-Treatment of Maxillary Second Molar with Two Separate Palatal Roots: A Case Report

    Science.gov (United States)

    Ghoddusi, Jamileh; Mesgarani, Abbas; Gharagozloo, Salman

    2008-01-01

    Maxillary second molar with two palatal roots is a rare dental anatomy. The diagnosis and treatment of exceeded root may create challenge for clinicians. The authors discuss the retreatment of a maxillary second molar in which exceeded root was undiagnosed in previous treatment. The case report underlines the importance of complete knowledge about root canal morphology which achieved by careful clinical and radiographic examination. In retreatment procedures clinicians should consider missed canals. PMID:24146676

  20. Endodontic Re-Treatment of Maxillary Second Molar with Two Separate Palatal Roots: A Case Report

    OpenAIRE

    Ghoddusi, Jamileh; Mesgarani, Abbas; Gharagozloo, Salman

    2008-01-01

    Maxillary second molar with two palatal roots is a rare dental anatomy. The diagnosis and treatment of exceeded root may create challenge for clinicians. The authors discuss the retreatment of a maxillary second molar in which exceeded root was undiagnosed in previous treatment. The case report underlines the importance of complete knowledge about root canal morphology which achieved by careful clinical and radiographic examination. In retreatment procedures clinicians should consider missed ...

  1. Reconsidering the Significance of Subaerial Processes in Streambank Retreat

    Science.gov (United States)

    Wynn, T. M.; Henderson, M. B.; Staley, N. A.

    2006-12-01

    Subaerial processes, such as freeze-thaw cycling and desiccation cracking, increase streambank retreat by reducing soil strength and directly inducing soil erosion. To date, the effects of subaerial processes have been largely dismissed in stream channel erosion models, both at the reach-scale and watershed-scale. Results from recent field and modeling research in southwestern Virginia indicate subaerial processes are a dominant erosion process in small headwater streams in the mid-Atlantic US. In situ tests of streambank soil erodibility (k) showed the median k in the winter was 1.4 times greater than in spring or fall and 75 percent greater than in summer (p=0.024). The median summer k was 37 percent higher than in spring/fall. Regression analysis using measurements of streambank surface moisture content and temperature indicated over 70 percent of the variance in k measurements was explained by the number of freeze-thaw cycles occurring in the 30 days prior to field testing. In comparing both watershed-scale (SWAT and GWLF) and reach-scale (CONCEPTS) model estimates of streambank soil loss to field measurements using erosion pins, the models failed to simulate significant erosion rates that occurred during January 2006. This inconsistency was attributed to the lack of subaerial process routines in the models. A history of poor agricultural and silvicultural practices and the widespread presence of small mill dams in the Piedmont and Appalachian mountains in the 1800s created floodplain soils composed largely of silts. Considering the susceptibility of silty soils to degradation by freeze-thaw cycling and the temperate climate of the mid-Atlantic with cold winters and hot summers, subaerial processes may be a significant mechanism for stream channel degradation in the region.

  2. Irradiation and Bevacizumab in High-Grade Glioma Retreatment Settings

    Energy Technology Data Exchange (ETDEWEB)

    Niyazi, Maximilian; Ganswindt, Ute; Schwarz, Silke Birgit [Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Munich (Germany); Kreth, Friedrich-Wilhelm; Tonn, Joerg-Christian [Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich (Germany); Geisler, Julia; Fougere, Christian la [Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich (Germany); Ertl, Lorenz; Linn, Jennifer [Department of Neuroradiology, Ludwig-Maximilians-University Munich, Munich (Germany); Siefert, Axel [Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Munich (Germany); Belka, Claus, E-mail: claus.belka@med.uni-muenchen.de [Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Munich (Germany)

    2012-01-01

    Purpose: Reirradiation is a treatment option for recurrent high-grade glioma with proven but limited effectiveness. Therapies directed against vascular endothelial growth factor have been shown to exert certain efficacy in combination with chemotherapy and have been safely tested in combination with radiotherapy in a small cohort of patients. To study the feasibility of reirradiation combined with bevacizumab treatment, the toxicity and treatment outcomes of this approach were analyzed retrospectively. Patients and Methods: After previous treatment with standard radiotherapy (with or without temozolomide) patients with recurrent malignant glioma received bevacizumab (10 mg/kg intravenous) on Day 1 and Day 15 during radiotherapy. Maintenance therapy was selected based on individual considerations, and mainly bevacizumab-containing regimens were chosen. Patients received 36 Gy in 18 fractions. Results: The data of the medical charts of the 30 patients were analyzed retrospectively. All were irradiated in a single institution and received either bevacizumab (n = 20), no additional substance (n = 7), or temozolomide (n = 3). Reirradiation was tolerated well, regardless of the added drug. In 1 patient treated with bevacizumab, a wound dehiscence occurred. Overall survival was significantly better in patients receiving bevacizumab (p = 0.03, log-rank test). In a multivariate proportional hazards Cox model, bevacizumab, Karnovsky performance status, and World Health Organization grade at relapse turned out to be the most important predictors for overall survival. Conclusion: Reirradiation with bevacizumab is a feasible and effective treatment for patients with recurrent high-grade gliomas. A randomized trial is warranted to finally answer the question whether bevacizumab adds substantial benefit to a radiotherapeutic retreatment setting.

  3. [Evaluation of the efficiency of different instrumentation for root canal retreatment using micro-computed tomography].

    Science.gov (United States)

    Guo, Jing; Yin, Kaifeng; Yang, Haibing; Han, Xuan; Wang, Yan

    2012-06-01

    To establish the three-dimensional model of human permanent premolars based on Micro-computed tomography (Micro-CT) data, and evaluate the efficiency quantitatively of two different instrumentations for root canal retreatment. Forty extracted permanent premolars for the reason of orthodontic treatment were collected, prepared by using ProTaper Ni-Ti files and filled by cold gutta pertscha lateral condensation technique. The subjects were scanned by Micro-CT. Forty teeth were randomly divided into two groups and retreated by K-Flexo files and ProTaper Universal retreatment system respectively. Then all subjects were scanned again, and the mean percentage of remaining filling materials and the scores of remaining filling materials presented in upper, middle and apical 1/3 of the canal were calculated. Mean percentage of the remaining filling materials by K-Flexo files was lower than that by ProTaper Universal retreatment system (P=0.005). The scores demonstrated that K-Flexo files had greater efficiency than ProTaper Universal retreatment system when retreating the apical 1/3 of canal (P<0.05). This study shows that both techniques could not remove filling materials completely.

  4. Recent acceleration in coastal cliff retreat rates on the south coast of Great Britain

    Science.gov (United States)

    Hurst, Martin D.; Rood, Dylan H.; Ellis, Michael A.; Anderson, Robert S.; Dornbusch, Uwe

    2016-11-01

    Rising sea levels and increased storminess are expected to accelerate the erosion of soft-cliff coastlines, threatening coastal infrastructure and livelihoods. To develop predictive models of future coastal change we need fundamentally to know how rapidly coasts have been eroding in the past, and to understand the driving mechanisms of coastal change. Direct observations of cliff retreat rarely extend beyond 150 y, during which humans have significantly modified the coastal system. Cliff retreat rates are unknown in prior centuries and millennia. In this study, we derived retreat rates of chalk cliffs on the south coast of Great Britain over millennial time scales by coupling high-precision cosmogenic radionuclide geochronology and rigorous numerical modeling. Measured 10Be concentrations on rocky coastal platforms were compared with simulations of coastal evolution using a Monte Carlo approach to determine the most likely history of cliff retreat. The 10Be concentrations are consistent with retreat rates of chalk cliffs that were relatively slow (2-6 cmṡy-1) until a few hundred years ago. Historical observations reveal that retreat rates have subsequently accelerated by an order of magnitude (22-32 cmṡy-1). We suggest that acceleration is the result of thinning of cliff-front beaches, exacerbated by regional storminess and anthropogenic modification of the coast.

  5. 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.

  6. Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.

    Science.gov (United States)

    Martsolf, Grant R; Auerbach, David; Benevent, Richele; Stocks, Carol; Jiang, H Joanna; Pearson, Marjorie L; Ehrlich, Emily D; Gibson, Teresa B

    2014-11-01

    Inpatient quality deficits have important implications for the health and well-being of patients. They also have important financial implications for payers and hospitals by leading to longer lengths of stay and higher intensity of treatment. Many of these costly quality deficits are particularly sensitive to nursing care. To assess the effect of nurse staffing on quality of care and inpatient care costs. Longitudinal analysis using hospital nurse staffing data and the Healthcare Cost and Utilization Project State Inpatient Databases from 2008 through 2011. Hospital discharges from California, Nevada, and Maryland (n=18,474,860). A longitudinal, hospital-fixed effect model was estimated to assess the effect of nurse staffing levels and skill mix on patient care costs, length of stay, and adverse events, adjusting for patient clinical and demographic characteristics. Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs. The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.

  7. Physician staffing for the practice of psychosomatic medicine in general hospitals: a pilot study.

    Science.gov (United States)

    Kunkel, Elisabeth J S; Del Busto, Elena; Kathol, Roger; Stern, Theodore A; Wise, Thomas N; Stoddard, Frederick R; Straus, Joshua; Saravay, Stephen M; Muskin, Philip R; Dresner, Nehama; Harrington, Colin J; Weiner, Joseph; Barnhill, John; Becker, Madeleine; Joseph, Robert C; Oyesanmi, Olugbenga; Fann, Jesse R; Colon, Eduardo; Epstein, Steven; Weinrieb, Robert

    2010-01-01

    The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients. The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services. Program directors of seven academic Psychosomatic Medicine (PM) programs in the Northeast were surveyed to establish current staffing patterns and patient volumes. Survey data were reviewed and analyzed along with data from the literature and The Academy of Psychosomatic Medicine (APM) fellowship directory. Staffing patterns varied widely, both in terms of the number and disciplines of staff providing care for medical and surgical inpatients. The ratio of initial consultations performed per hospital bed varied from 1.6 to 4.6. Although staffing patterns vary, below a minimum staffing level, there is likely to be significant human and financial cost. Efficient sizing of a PM staff must be accomplished in the context of a given institution's patient population, the experience of providers, the presence/absence and needs of trainees, and the financial constraints of the department and institution. National survey data are needed to provide benchmarks for both academic and nonacademic PM services.

  8. Toward cost-effective staffing mixes for Veterans Affairs substance use disorder treatment programs.

    Science.gov (United States)

    Im, Jinwoo J; Shachter, Ross D; Finney, John W; Trafton, Jodie A

    2015-11-23

    In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically. We used a stepwise method to derive prediction functions for benefits and costs based on patients' treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping. Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients' outcomes, and improved net benefits are estimated from $1472 to $17,743 per patient.

  9. 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 Endodontic Journal. Published by John Wiley & Sons Ltd.

  10. 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.

  11. National assessment of shoreline change part 4: historical coastal cliff retreat along the California coast

    Science.gov (United States)

    Hapke, Cheryl J.; Reid, David

    2007-01-01

    Coastal cliff retreat, the landward migration of the cliff face, is a chronic problem along many rocky coastlines in the United States. As coastal populations continue to grow and community infrastructures are threatened by erosion, there is increased demand for accurate information regarding trends and rates of coastal cliff retreat. There is also a need for a comprehensive analysis of cliff retreat that is consistent from one coastal region to another. To meet these national needs, the U.S. Geological Survey is conducting an analysis of historical coastal cliff retreat along open-ocean rocky coastlines of the conterminous United States and parts of Hawaii, Alaska, and the Great Lakes. One purpose of this work is to develop standard repeatable methods for mapping and analyzing coastal cliff retreat so that periodic updates of coastal erosion can be made nationally that are systematic and internally consistent. This report on the California Coast is an accompaniment to a report on long-term sandy shoreline change for California. This report summarizes the methods of analysis, interprets the results, and provides explanations regarding long-term rates of cliff retreat. Neither detailed background information on the National Assessment of Shoreline Change Project nor detailed descriptions of the geology and geomorphology of the California coastline are presented in this report. The reader is referred to the shoreline change report (Hapke et al., 2006) for this type of background information. Cliff retreat evaluations are based on comparing one historical cliff edge digitized from maps, with a recent cliff edge interpreted from lidar (Light Detection and Ranging) topographic surveys. The historical cliff edges are from a period ranging from 1920-1930, whereas the lidar cliff edges are from either 1998 or 2002. Long-term (~70-year) rates of retreat are calculated using the two cliff edges. The rates of retreat presented in this report represent conditions from the 1930

  12. 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

  13. Global Warming, Climate Change and Glacier Retreat of Nepal Himalayas

    Science.gov (United States)

    Shrestha, S.; Hisaki, Y.

    2007-12-01

    Global average air temperature near the earth surface rose 0.74¡¾0.18¨¬C during the twentieth century. The Intergovernmental Panel on Climate Change (IPCC) concludes that observed increased globally averaged temperatures since mid-twentieth century is very likely due to the observed increment in anthropogenic greenhouse gas concentrations, which leads to warming of the surface and lower atmosphere by increasing the greenhouse effect. Climate models referred by IPCC project that global surface temperature are likely to be increase by 1.1 to 6.4¨¬C between 1990 and 2100. An increase in global temperature is expected to cause other changes including glacier retreat, sea level rise, increase intensity of extreme weather events and change in the pattern of precipitation, etc. The Nepal Himalaya revealed 3,252 glaciers and 2,323 lakes, which are 3,500 m above the sea level. They cover an area of 5,323 km2 with an estimated ice reserve of 481 km3. The average temperature in Nepal is rising by 0.5¨¬C per decade, and because of this reason, big glacial lakes in the country are at high risk of flooding from glacial lake bursts, which would have an adverse effect, such as huge loss of life and property. Nepal is facing a disturbance in mountain climate, flash floods, cloudbursts, erratic weather patterns and so on. The death of number of people due to floods and landslides is increasing annually. It is reported that more than 164 people already died because of floods and landslides during the current year, 2007 rainy season. Nepal does emit negligible greenhouse gases compare to developed and industrialized countries, however, country and people are facing the consequences of actions of other developed and industrialized countries. Study shows the¡¡disasters in current years and possible hazards in future due to the probable causes of global warming and recommends some suggestions for controlling of green house gases emission.

  14. 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

  15. Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms.

    Science.gov (United States)

    Ernst, M; Kriston, L; Groth, M; Frölich, A M; Fiehler, J; Buhk, J-H

    2018-03-22

    Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions. Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed. Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, "very certain"). Confidence was statistically significantly higher in cases that were generally rated as "worse." The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence. Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist. © 2018 by American Journal of Neuroradiology.

  16. 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

  17. 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

  18. 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

  19. 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.

  20. Determinants and Effects of Nurse Staffing Intensity and Skill Mix in Residential Care/Assisted Living Settings

    Science.gov (United States)

    Stearns, Sally C.; Park, Jeongyoung; Zimmerman, Sheryl; Gruber-Baldini, Ann L.; Konrad, Thomas R.; Sloane, Philip D.

    2007-01-01

    Purpose: Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes.…

  1. 75 FR 45166 - Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing...

    Science.gov (United States)

    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...

  2. Guam Medical Staffing Plan Needs Improvement to Ensure Eligible Beneficiaries Will Have Adequate Access to Health Care

    Science.gov (United States)

    2012-05-16

    Commandant of the Marine Corps submits updated force projections and the Secretary of Defense submits a master plan to Congress. Guam Realignment...are responsible for medical personnel assets. 5 NMW personnel used the following formula to determine physician staffing requirements...Okinawa discussed staffing requirements for multiple specialties, including pediatrics , psychiatry, psychology, and emergency room care. NMW

  3. 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...

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

    Science.gov (United States)

    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 < 0.05). Both continuous rotation and reciprocating motion showed similar effectiveness in terms of root canal filling material removal. Using ProTaper Universal retreatment instruments with reciprocating motion of ATR motor and conventional rotary motion have similar efficacy in root canal filling removal.

  5. Effectiveness of traditional meditation retreats: A systematic review and meta-analysis.

    Science.gov (United States)

    Khoury, Bassam; Knäuper, Bärbel; Schlosser, Marco; Carrière, Kimberly; Chiesa, Alberto

    2017-01-01

    An increasing number of studies are investigating traditional meditation retreats. Very little, however, is known about their effectiveness. To evaluate the effectiveness of meditation retreats on improving psychological outcomes in general population. A systematic review of studies published in journals or as dissertations in PSYCINFO, PUBMED, CINAHL or Web of Science from the first available date until October 22, 2016. A total of 20 papers (21 studies, N=2912) were included. Effect-size estimates of outcomes combined suggested that traditional meditation retreats are moderately effective in pre-post analyses (n=19; Hedge's g=0.45; 95% CI [0.35, 0.54], pmeditation styles. Results suggested large effects on measures of anxiety, depression and stress, and moderate effects on measures of emotional regulation and quality of life. As to potential mechanisms of actions, results showed large effects on measures of mindfulness and compassion, and moderate effects on measures of acceptance. In addition, changes in mindfulness levels strongly moderated clinical effect sizes. However, heterogeneity was significant among trials, probably due to differences in study designs, types and duration of the retreats and assessed outcomes, limiting therefore the implications of the results. Meditation retreats are moderately to largely effective in reducing depression, anxiety, stress and in ameliorating the quality of life of participants. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 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.

  7. Orthograde endodontic retreatment of teeth with individual cast posts: report of two cases.

    Science.gov (United States)

    Ramić, Bojana; Stojanac, Igor; Premović, Milica; Drobac, Milan; Petrović, Ljubomir

    2012-01-01

    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. 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. 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.

  8. 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.

  9. 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.

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

    Science.gov (United States)

    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…

  11. Library/Media Centers in U.S. Public Schools: Growth, Staffing, and Resources. Executive Summary

    Science.gov (United States)

    Tuck, Kathy D.; Holmes, Dwight R.

    2016-01-01

    This study analyzes data collected between 2000 and 2013 from the annual National Center for Education Statistics (NCES) Common Core of Data (CCD) Local Education Agency (School District) Universe Survey; the NCES Schools and Staffing Survey (SASS); and the U.S. Census Bureau Small Area Income and Poverty Estimates Survey (SAIPE). The findings…

  12. 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

  13. 76 FR 14101 - Commercial Furniture Group, Inc., Including On-Site Leased Workers From Staffing Solutions...

    Science.gov (United States)

    2011-03-15

    ... Furniture Group, Inc., Including On-Site Leased Workers From Staffing Solutions; Morristown, TN; Commercial Furniture Group, Inc., Chicago, IL; Amended Certification Regarding Eligibility To Apply for Worker... Adjustment Assistance on May 5, 2010, applicable to workers of Commercial Furniture Group, Inc., including on...

  14. Physical Attacks: An Analysis of Teacher Characteristics Using the Schools and Staffing Survey

    Science.gov (United States)

    Williams, Thomas O., Jr.; Ernst, Jeremy V.

    2016-01-01

    This study investigated physical attacks as reported by public school teachers on the most recent Schools and Staffing Survey (SASS) from the National Center for Education Statistics administered by the Institute of Educational Sciences. For this study, characteristics of teachers who responded affirmatively to having been physically attacked in…

  15. 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,…

  16. A Staffing Profile of United States Online Database Producers: A Model and Discussion of Educational Implications.

    Science.gov (United States)

    Lowry, Glenn R.

    1983-01-01

    Reports results of survey of United States online database producers designed to determine number of personnel employed in intellectual production of databases and provide basis for generation of people employed in frequently recurring staff categories. Implications for education based on needs suggested by staffing patterns are examined.…

  17. 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...

  18. 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...

  19. 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...

  20. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    Science.gov (United States)

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  1. 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

  2. 38 CFR 58.10 - VA Form 10-3567-State Home Inspection Staffing Profile.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief... Profile. ER06JA00.000 ER06JA00.001 ER06JA00.002 ...

  3. 45 CFR 1321.9 - Organization and staffing of the State agency.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Organization and staffing of the State agency. 1321.9 Section 1321.9 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.9...

  4. 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…

  5. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    Science.gov (United States)

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  6. 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

  7. NİKEL-TİTANYUM DÖNER ALET SİSTEMLERİ İLE RETREATMENT Retreatment with Nickel-Titanium Rotary Instruments

    OpenAIRE

    YILMAZ, Ayça; HELVACIOĞLU YİĞİT, Dilek

    2014-01-01

    özGünümüzde nikel-titanyum döner alet sistemleri endodonti pratiğinde rutin olarak kullanılmaktadır. Bu tekniklerin şekillendirmedeki başarıları birçok çalışma ile gösterilmiştir. Endodontik tedavinin en zor işlemlerinden biri olan retreatment uygulamalarında öncelikle şekillendirme için üretilen nikel-titanyum döner alet sistemleri kullanılmış, fakat yaşanan sorunlar firmaları retreatment işlemine özel nikel-titanyum sistemler üretmeye yöneltmiştir. Bu makalede güncel nikel-titanyum retreatm...

  8. Modelling river bank retreat by combining fluvial erosion, seepage and mass failure

    Science.gov (United States)

    Dapporto, S.; Rinaldi, M.

    2003-04-01

    Streambank erosion processes contribute significantly to the sediment yielded from a river system and represent an important issue in the contexts of soil degradation and river management. Bank retreat is controlled by a complex interaction of hydrologic, geotechnical, and hydraulic processes. The capability of modelling these different components allows for a full reconstruction and comprehension of the causes and rates of bank erosion. River bank retreat during a single flow event has been modelled by combining simulation of fluvial erosion, seepage, and mass failures. The study site, along the Sieve River (Central Italy), has been subject to extensive researches, including monitoring of pore water pressures for a period of 4 years. The simulation reconstructs fairly faithfully the observed changes, and is used to: a) test the potentiality and discuss advantages and limitations of such type of methodology for modelling bank retreat; c) quantify the contribution and mutual role of the different processes determining bank retreat. The hydrograph of the event is divided in a series of time steps. Modelling of the riverbank retreat includes for each step the following components: a) fluvial erosion and consequent changes in bank geometry; b) finite element seepage analysis; c) stability analysis by limit equilibrium method. Direct fluvial shear erosion is computed using empirically derived relationships expressing lateral erosion rate as a function of the excess of shear stress to the critical entrainment value for the different materials along the bank profile. Lateral erosion rate has been calibrated on the basis of the total bank retreat measured by digital terrestrial photogrammetry. Finite element seepage analysis is then conducted to reconstruct the saturated and unsaturated flow within the bank and the pore water pressure distribution for each time step. The safety factor for mass failures is then computed, using the pore water pressure distribution obtained

  9. Comparative assessment of the incidence of vertical root fractures between conventional versus surgical endodontic retreatment.

    Science.gov (United States)

    Karygianni, L; Krengel, M; Winter, M; Stampf, S; Wrbas, K T

    2014-11-01

    Vertical root fractures (VRFs) are a common cause of tooth loss. Little evidence exists though, relating the incidence of VRFs to the type of endodontic retreatment. This retrospective study aimed at evaluating the impact of conventional versus surgical endodontics on root canal-filled teeth with VRFs. Over a period of 13 years, 200 endodontically retreated teeth from 192 patients with VRFs were extracted and further examined. VRFs were assessed in relation to age, gender, tooth group, clinical signs, extension on the root surface, patency, as well as type of endodontic retreatment and restoration. Statistical analysis was conducted using a Cox PH Model, Chi-squared, Wilcoxon rank-sum, and Log rank tests at a significance level of 5 %. The majority of teeth with VRFs (62.31 %) had undergone the combination of conventional root canal retreatment and apical surgery. Women (64.06 %) presented VRFs more frequently than men (35.94 %) at the mean age of 51.1 and 55.1 years, respectively. Maxillary first (17.5 %) and second (16.5 %) premolars, restored by a resin-based material without a post (56.28 %) were more susceptible to VRFs. Apically initiated (84.1 %) VRFs could be diagnosed more easily on radiographs. The type of endodontic treatment strongly correlated with VRFs. The prevalence of VRFs in teeth having undergone both conventional and surgical endodontic retreatment could be attributed, among others, to additive dentin damage related to the aforementioned endodontic procedures. The possible involvement of endodontic retreatment in the multifactorial etiology of VRFs needs to be taken into consideration in clinical practice.

  10. Outcome of nonsurgical retreatment and endodontic microsurgery: a meta-analysis.

    Science.gov (United States)

    Kang, Minji; In Jung, Hoi; Song, Minju; Kim, Sue Youn; Kim, Hyeon-Cheol; Kim, Euiseong

    2015-04-01

    The purpose of this study was to evaluate and compare the clinical and radiographic outcomes of nonsurgical endodontic retreatment and endodontic microsurgery by a meta-analysis. Electronic databases including PubMed, Embase, Medline, and The Cochrane Library were searched, and the references of related articles were manually searched to identify all the clinical studies that evaluated the clinical and radiographic outcomes after retreatment or microsurgery. The first and second screening processes were conducted by three reviewers independently. The final studies were selected after strict application of the inclusion and exclusion criteria. The random effects meta-analysis model with the DerSimonian-Laird pooling method was performed. The weighted pooled success rates and 95 % confidence interval estimates of the outcome were calculated. Additionally, the effects of the follow-up period and study quality were investigated by a subgroup analysis. Endodontic microsurgery and nonsurgical retreatment have stable outcomes presenting 92 and 80 % of overall pooled success rates, respectively. The microsurgery group had a significantly higher success rate than the retreatment group. When the data were organized and analyzed according to their follow-up periods, a significantly higher success rate was found for the microsurgery group in the short-term follow-up (less than 4 years), whereas no significant difference was observed in the long-term follow-up (more than 4 years). Endodontic microsurgery was confirmed as a reliable treatment option with favorable initial healing and a predictable outcome. Clinicians may consider the microsurgery as an effective way of retreatment as well as nonsurgical retreatment depending on the clinical situations.

  11. Do the Sealer Solvents Used Affect Apically Extruded Debris in Retreatment?

    Science.gov (United States)

    Çanakçi, Burhan Can; Er, Ozgur; Dincer, Asiye

    2015-09-01

    We evaluated apically extruded debris in the retreatment of root canals filled with different root canal sealers and gutta-percha using different solvents. Ninety human mandibular central and lateral teeth were prepared using the Reciproc #25 .08 nickel-titanium system (VDW GmbH, Munich, Germany) and were divided randomly into 6 groups. In groups 1, 2, and 3, root canals were filled with epoxy resin-based sealer and gutta-percha, and in groups 4, 5, and 6, root canals were filled with zinc oxide-eugenol-based sealer and gutta-percha. Each tooth was placed in a glass vial experimental apparatus. All root canal fillings were removed with the ProTaper Retreatment nickel-titanium system (Dentsply Maillefer, Ballaigues, Switzerland). During the retreatment procedure, in group 1, Resosolv (Pierre Rolland, Merignac, France) was used; in group 4, Endosolv E (Septodont, Paris, France) was used; and in groups 2 and 5, Guttasolv (Septodont) was used as the solvent. In the control groups (groups 3 and 6), no solvent was used. Reciproc #40 .06 was used for the final preparation. The times required for retreatments were recorded. The weight of the extruded debris and the time required for retreatment were decreased significantly in the groups in which a solvent that was intended specifically for the root canal sealer was used (groups 1 and 4). In the Guttasolv groups (groups 2 and 5), the amount of apically extruded debris and the time required decreased for both root canal sealers. The amount of apically extruded debris and the duration of retreatment were reduced by the use of a solvent specific to the sealer compared with a gutta-percha solvent or no solvent. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. 3D modeling of continuous retreat of Thwaites Glacier, West Antarctica, under enhanced basal melting

    Science.gov (United States)

    Yu, H.; Rignot, E. J.; Seroussi, H. L.; Morlighem, M.

    2017-12-01

    Thwaites Glacier (TG) is the broadest and second largest ice stream in West Antarctica. Satellite observations have revealed rapid grounding line retreat and mass loss of TG in the past few decades, which has been attributed to enhanced ocean heat advection in the Amundsen Sea Embayment. As TG is resting on a retrograde bed, it has the potential to rapidly collapse according to the marine ice sheet instability theory. Here, we use the UCI/JPL Ice Sheet System Model (ISSM) to simulate the grounding line migration and mass loss of TG for the next 100 years in response to enhanced basal melting. Three models with varying levels of complexity (full-Stokes, higher-order and shallow-shelf approximation) are used and basal melt rate under ice shelf is parameterized as a function of depth. We show that the grounding line of TG will retreat rapidly along the eastern side of the glacier at a speed of 500-1000 m/yr while it will remain relatively stable on the western side due to the presence of a subglacial ridge. TG will continue to lose mass at a rapid rate (50-100 Gt/yr). If the grounding line retreats over this subglacial ridge, the retreat will become unstoppable. We also show that the full-Stokes model exhibits a higher rate of retreat than other models ( 10%). The difference is more significant when the grounding line is on a subglacial ridge, when full-Stokes can retreat over the ridge decades ahead of other models.This work has been performed at UC Irvine and Caltech's Jet Propulsion Laboratory under a contract with NASA's Cryospheric Science Program

  13. Coastal retreat and/or advance adjacent to defences in England and Wales

    OpenAIRE

    Brown, S.; Barton, M.E.; Nicholls, R.J.

    2011-01-01

    Retreat and advance of shoreline position occurs naturally, and also as a result of defences which are constructed to prevent erosion and flooding. Retreat more commonly manifests itself down-drift of defences due to sediment deficit causing the coast to become ‘set-back’. Advance normally develops due to sediment accumulation up-drift of a barrier inhibiting longshore drift, resulting in the coast becoming ‘set-forward’. Many examples of set-backs and set-forwards are recorded, but their loc...

  14. Different Patterns of Restoration Provision Between Initial Endodontic Treatment and Retreatment: A Retrospective Clinical Study.

    Science.gov (United States)

    Agrafioti, Anastasia; Giannakoulas, Dimitrios G; Kournetas, Nikos; Grigoriou, Stamatina; Kontakiotis, Evangelos G

    The aim of this study was to investigate the relationship between type of endodontic treatment and choice of definitive restoration and to show the prevalence of endodontic treatment options according to patient age and type of tooth. Data were collected from the archive system of the School of Dentistry, National and Kapodistrian University of Athens in Athens, Greece. The sample included endodontically treated teeth being restored definitively at the time of data collection. Statistically significant difference was found regarding the type of restoration between initial endodontic treatments and retreatments (P Endodontic retreatment seemed to have a significant effect on the choice of definitive restoration of the tooth.

  15. Modelling the dynamics of palaeo ice-stream retreat in Marguerite Bay, Antarctica

    Science.gov (United States)

    Jamieson, S. S.; Vieli, A.; Livingstone, S. J.; Stokes, C. R.; O'Cofaigh, C.; Hillenbrand, C.

    2010-12-01

    The aim is to use numerical models of ice stream behaviour to understand the processes that triggered and controlled the retreat of the Marguerite Bay palaeo ice stream after the Last Glacial Maximum (LGM). This is important because at present a number of marine-based ice streams in Antarctica are rapidly losing mass. Given the consequences of this mass loss for future sea-level rise, it is crucial to improve our understanding and predictive abilities of grounding line retreat of marine-based ice streams. Because contemporary records of grounding line retreat are very short (decades) and may not be representative of behaviour on century or millennial timescales, we focus on the longer-term post-LGM retreat dynamics of the palaeo ice stream as recorded in the marine-geophysical record. Our approach combines numerical modelling with geomorphological mapping in order to understand the processes that triggered and controlled the hypothesized rapid retreat of the Marguerite Bay palaeo ice-stream. Here we describe the numerical model, modelling approach and results of sensitivity testing to understand the behaviour of the Marguerite Bay palaeo ice stream. High-resolution bathymetric data of the Marguerite Bay area has enabled detailed geomorphological mapping and provides a record of grounding line retreat. These mapping data, set into a chronological framework of deglaciation, are used to constrain a 1-dimensional flowline model of the Marguerite palaeo- ice-stream. The numerical model includes basal, lateral and longitudinal stresses and a robust treatment of grounding-line motion through the use of a constantly adjusting spatial grid. We subject the model to a range of external forcing including changes in sea-level, temperature and accumulation in order to reproduce the geomorphological evidence and therefore understand the dynamics of ice stream retreat in this area. We find that slow-downs or re-stabilisations of the grounding line occur in areas of reverse bed

  16. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison

    Science.gov (United States)

    Oltra, Enrique; Cox, Timothy C.; LaCourse, Matthew R.; Johnson, James D.

    2017-01-01

    Objectives Recently, bioceramic sealers like EndoSequence BC Sealer (BC Sealer) have been introduced and are being used in endodontic practice. However, this sealer has limited research related to its retreatability. Hence, the aim of this study was to evaluate the retreatability of two sealers, BC Sealer as compared with AH Plus using micro-computed tomographic (micro-CT) analysis. Materials and Methods Fifty-six extracted human maxillary incisors were instrumented and randomly divided into 4 groups of 14 teeth: 1A, gutta-percha, AH Plus retreated with chloroform; 1B, gutta-percha, AH Plus retreated without chloroform; 2A, gutta-percha, EndoSequence BC Sealer retreated with chloroform; 2B, gutta-percha, EndoSequence BC Sealer retreated without chloroform. Micro-CT scans were taken before and after obturation and retreatment and analyzed for the volume of residual material. The specimens were longitudinally sectioned and digitized images were taken with the dental operating microscope. Data was analyzed using an ANOVA and a post-hoc Tukey test. Fisher exact tests were performed to analyze the ability to regain patency. Results There was significantly less residual root canal filling material in the AH Plus groups retreated with chloroform as compared to the others. The BC Sealer samples retreated with chloroform had better results than those retreated without chloroform. Furthermore, patency could be re-established in only 14% of teeth in the BC Sealer without chloroform group. Conclusion The results of this study demonstrate that the BC Sealer group had significantly more residual filling material than the AH Plus group regardless of whether or not both sealers were retreated with chloroform. PMID:28194360

  17. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison

    Directory of Open Access Journals (Sweden)

    Enrique Oltra

    2017-02-01

    Full Text Available Objectives Recently, bioceramic sealers like EndoSequence BC Sealer (BC Sealer have been introduced and are being used in endodontic practice. However, this sealer has limited research related to its retreatability. Hence, the aim of this study was to evaluate the retreatability of two sealers, BC Sealer as compared with AH Plus using micro-computed tomographic (micro-CT analysis. Materials and Methods Fifty-six extracted human maxillary incisors were instrumented and randomly divided into 4 groups of 14 teeth: 1A, gutta-percha, AH Plus retreated with chloroform; 1B, gutta-percha, AH Plus retreated without chloroform; 2A, gutta-percha, EndoSequence BC Sealer retreated with chloroform; 2B, gutta-percha, EndoSequence BC Sealer retreated without chloroform. Micro-CT scans were taken before and after obturation and retreatment and analyzed for the volume of residual material. The specimens were longitudinally sectioned and digitized images were taken with the dental operating microscope. Data was analyzed using an ANOVA and a post-hoc Tukey test. Fisher exact tests were performed to analyze the ability to regain patency. Results There was significantly less residual root canal filling material in the AH Plus groups retreated with chloroform as compared to the others. The BC Sealer samples retreated with chloroform had better results than those retreated without chloroform. Furthermore, patency could be re-established in only 14% of teeth in the BC Sealer without chloroform group. Conclusion The results of this study demonstrate that the BC Sealer group had significantly more residual filling material than the AH Plus group regardless of whether or not both sealers were retreated with chloroform.

  18. 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.

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

    Science.gov (United States)

    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…

  20. 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

  1. 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

  2. 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 ...

  3. Comparing ranibizumab monotherapy and combination with single photodynamic therapy in wet AMD: retreatment and morphologic results.

    Science.gov (United States)

    Hatz, Katja; Schneider, Ulrike; Henrich, Bernhard; Braun, Beatrice; Sacu, Stefan; Prünte, Christian

    2017-06-26

    To evaluate retreatment indications/morphologic responses to ranibizumab monotherapy and combination with verteporfin photodynamic therapy (PDT). A total of 40 patients received 3 monthly intravitreal ranibizumab 0.3 mg injections combined with either PDT or sham PDT at baseline (1:1) followed by as-needed ranibizumab based on predetermined vision/anatomical criteria. Retreatment criteria were visual acuity (VA) loss (59%/58%), central retinal thickness (CRT) increase (27%/26%), or both (14%/16%). One month before retreatment, intraretinal cysts (IRC) were present in 84%/74%, subretinal fluid (SRF) in 70%/63%, and at least one of them in 84%/89% of eyes. A significant decrease in mean leakage area, IRC, and SRF as well as a reduction in presence of hemorrhages and hard exudates occurred in both treatment groups at 12 months (compared to baseline). Retreatment indications were mostly based on VA loss, probably due to the quantitative optical coherence tomography criterion. Intraretinal cysts and SRF were earlier predictors for recurring choroidal neovascularization (CNV) activity than CRT/VA changes. Both treatment strategies were equally potent in reducing CNV activity.

  4. 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.

  5. Southern Ocean warming and Wilkes Land ice sheet retreat during the mid-Miocene

    NARCIS (Netherlands)

    Sangiorgi, F.; Bijl, P.K.; Passchier, S.; Salzmann, U.; Schouten, S.; McKay, R.M.; Cody, R.D.; Pross, J.; van de Flierdt, T.; Bohaty, S.M.; Levy, R.; Williams, T.; Escutia, C.; Brinkhuis, H.

    2018-01-01

    Observations and model experiments highlight the importance of ocean heat in forcing icesheet retreat during the present and geological past, but past ocean temperature data arevirtually missing in ice sheet proximal locations. Here we document paleoceanographicconditions and the (in)stability of

  6. The Benefits and Challenges of Academic Writing Retreats: An Integrative Review

    Science.gov (United States)

    Kornhaber, Rachel; Cross, Merylin; Betihavas, Vasiliki; Bridgman, Heather

    2016-01-01

    The immediate drivers to increase publication outputs in higher education are government and research funding, organisational status, performance expectations and personal career aspirations. Writing retreats are one of a range of strategies used by universities to boost publication output. The aims of this integrative review were to synthesise…

  7. Iceland rising : Solid Earth response to ice retreat inferred from satellite radar interferometry and visocelastic modeling

    NARCIS (Netherlands)

    Auriac, A.; Spaans, K.H.; Sigmundsson, F.; Hooper, A.; Schmidt, P.; Lund, B.

    2013-01-01

    A broad uplift occurs in Iceland in response to the retreat of ice caps, which began circa 1890. Until now, this deformation signal has been measured primarily using GPS at points some distance away from the ice caps. Here, for the first time we use satellite radar interferometry (interferometric

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Guidelines for equipment and staffing of radiotherapy facilities in the European countries

    DEFF Research Database (Denmark)

    Dunscombe, Peter; Grau, Cai; Defourny, Noémie

    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...... 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...

  16. Industrial Fuel Gas Demonstration Plant Program: staffing plan. Deliverable No. 34

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-05-01

    This report describes the staffing plans of each industrial team member during final design and construction of the IFGDP. The internal organization of each team member, including the delegation of authority and responsibility within the structure, is discussed. The primary function of the various organizational units are also identified. In addition, a brief summary of the Phase II role of each industrial partner is included. The overall Phase II organization chart is attached.

  17. 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.

  18. 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)

  19. Evaluation of a Peer-Staffed Hotline for Families Who Received Genetic Testing for Risk of Breast Cancer

    National Research Council Canada - National Science Library

    Coyne, James

    2004-01-01

    This project proposed to develop, implement, and evaluate a peer-staffed toll-free hotline for individuals at high risk of developing hereditary breast cancer, either through family history or known BRCA1/2 mutations...

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

    NARCIS (Netherlands)

    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.

  1. [Relationship between nurse staffing and nursing outcomes: a narrative review of literature].

    Science.gov (United States)

    Petrucci, Cristina; Calandro, Maria Teresa; Tresulti, Federica; Baldacchini, Antonio; Lancia, Loreto

    2015-01-01

    The measurement of nursing sensitive outcomes represents a fundamental element in "Health Management" in order to assess the suitability and quality of care given, particoulaly in hospitals for the acutely ill. To highlight how some variables connected with nurse-staffing can determine the quality of processes and the care outcomes. A narrative review of international literature has been carried out on investigating possible correlation between nurse-staffing characteristics and care outcomes regarding patients, taking into account primary and secondary sources, written either in English or Italian, without time limits. The bibliographical research strategies used, have brought about the restitution of no. 4244 articles were retrived, of these 56 were analyzed. Articles were categorized into 3 specific areas: 1) Which aspects determine the efficacy and quality of nursing care; 2) The direct effects of nursing care on care outcomes; 3) The indirect effects of nursing care on care outcomes. Results confirm the existence of a noticeable relationship between the main components of nurse-staffing and the direct and indirect outcomes on patients health. Longitudinal studies shound be carried out highlighting the results obtained up till now even more and assist in accurately measuring the importance of possible predictive variables on care outcomes correlated to nursing care.

  2. 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.

  3. 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.

  4. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Implementation of a Team-based Physician Staffing Model at an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Jose V. Nable

    2014-09-01

    Full Text Available Introduction: There is scant literature regarding the optimal resident physician staffing model of academic emergency departments (ED that maximizes learning opportunities. A department of emergency medicine at a large inner-city academic hospital initiated a team-based staffing model. Its pre-interventional staffing model consisted of residents and attending physicians being separately assigned patients, resulting in residents working with two different faculty providers in the same shift. This study aimed to determine if the post-interventional team-based system, in which residents were paired with a single attending on each shift, would result in improved residents’ learning and clinical experiences as manifested by resident evaluations and the number of patients seen. Methods: This retrospective before-and-after study at an academic ED with an annual volume of 52,000 patients examined the mean differences in five-point Likert-scale evaluations completed by residents assessing their ED rotation experiences in both the original and team-based staffing models. The residents were queried on their perceptions of feeling part of the team, decision-making autonomy, clinical experience, amount of supervision, quality of teaching, and overall rotational experience. We also analyzed the number of patients seen per hour by residents. Paired sample t-tests were performed. Residents who were in the program in the year preceding and proceeding the intervention were eligible for inclusion. Results: 34 of 38 eligible residents were included (4 excluded for lack of evaluations in either the pre- or post-intervention period. There was a statistically significant improvement in resident perception of the quality and amount of teaching, 4.03 to 4.27 (mean difference=0.24, p=0.03. There were non-statistically significant trends toward improved mean scores for all other queries. Residents also saw more patients following the initiation of the team-based model

  8. 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

  9. Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: an optimized prediction model.

    Science.gov (United States)

    Wang, X-M; Yin, S-H; Du, J; Du, M-L; Wang, P-Y; Wu, J; Horbinski, C M; Wu, M-J; Zheng, H-Q; Xu, X-Q; Shu, W; Zhang, Y-J

    2017-07-01

    Retreatment of tuberculosis (TB) often fails in China, yet the risk factors associated with the failure remain unclear. To identify risk factors for the treatment failure of retreated pulmonary tuberculosis (PTB) patients, we analyzed the data of 395 retreated PTB patients who received retreatment between July 2009 and July 2011 in China. PTB patients were categorized into 'success' and 'failure' groups by their treatment outcome. Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors. We also created an optimized risk score model to evaluate the predictive values of these risk factors on treatment failure. Of 395 patients, 99 (25·1%) were diagnosed as retreatment failure. Our results showed that risk factors associated with treatment failure included drug resistance, low education level, low body mass index (6 months), standard treatment regimen, retreatment type, positive culture result after 2 months of treatment, and the place where the first medicine was taken. An Optimized Framingham risk model was then used to calculate the risk scores of these factors. Place where first medicine was taken (temporary living places) received a score of 6, which was highest among all the factors. The predicted probability of treatment failure increases as risk score increases. Ten out of 359 patients had a risk score >9, which corresponded to an estimated probability of treatment failure >70%. In conclusion, we have identified multiple clinical and socio-demographic factors that are associated with treatment failure of retreated PTB patients. We also created an optimized risk score model that was effective in predicting the retreatment failure. These results provide novel insights for the prognosis and improvement of treatment for retreated PTB patients.

  10. Re-treatment after full-course radiotherapy: is it a viable option?

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, F.A. [Netherlands Cancer Inst., Amsterdam (Netherlands). Div. of Experimental Therapy

    1999-07-01

    Re-irradiation of previously treated areas may become necessary for recurrent cancer, new primary tumours (common in head and neck cancer patients), or nodal and metastatic disease. Factors that should be taken into account in the decision to re-treat include: (1) Previously treated volume (how much overlap is there with new treatment fields) and dose fractionation schedule; (2) which critical tissues or organs are at risk; (3) how much time has elapsed since first treatment; (4) whether there are any practical alternatives to re-irradiation? Rapidly proliferating tissues generally recover well from the initial radiotherapy and will tolerate re-irradiation to almost full doses. Some slowly proliferating tissues are also capable of partial proliferative and functional recovery, although this takes several months and some residual damage remains. Preclinical data demonstrate that re-irradiation with reduced doses is possible in lung and spinal cord after intervals of 3-6 months. Other slowly proliferating organs, e.g. the kidneys, do not appear to be capable of recovery, even after low, subtolerance doses. The largest clinical experience of re-irradiation is for head and neck cancers. A review of this literature reveals that the most frequent normal tissue complication seen is trismus (lockjaw), which occurs in 16 to 30% of re-treated cases, with lower incidences of soft tissue or bone necrosis and fibrosis. Myelitis is rarely reported, even in the re-treatment situation. In general the highest incidence of local control for the lowest incidence of serious complications is achieved for combinations of external beam and brachytherapy, and for small, well-differentiated, new primary tumours rather than recurrent disease. Re-treatment with total doses <55 Gy gives very poor local control rates. Re-treatment schedules with curative intent require a high re-treatment dose, which is accompanied by an increased risk of normal tissue damage. To minimize serious complications

  11. Re-treatment after full-course radiotherapy: is it a viable option?

    International Nuclear Information System (INIS)

    Stewart, F.A.

    1999-01-01

    Re-irradiation of previously treated areas may become necessary for recurrent cancer, new primary tumours (common in head and neck cancer patients), or nodal and metastatic disease. Factors that should be taken into account in the decision to re-treat include: (1) Previously treated volume (how much overlap is there with new treatment fields) and dose fractionation schedule; (2) which critical tissues or organs are at risk; (3) how much time has elapsed since first treatment; (4) whether there are any practical alternatives to re-irradiation? Rapidly proliferating tissues generally recover well from the initial radiotherapy and will tolerate re-irradiation to almost full doses. Some slowly proliferating tissues are also capable of partial proliferative and functional recovery, although this takes several months and some residual damage remains. Preclinical data demonstrate that re-irradiation with reduced doses is possible in lung and spinal cord after intervals of 3-6 months. Other slowly proliferating organs, e.g. the kidneys, do not appear to be capable of recovery, even after low, subtolerance doses. The largest clinical experience of re-irradiation is for head and neck cancers. A review of this literature reveals that the most frequent normal tissue complication seen is trismus (lockjaw), which occurs in 16 to 30% of re-treated cases, with lower incidences of soft tissue or bone necrosis and fibrosis. Myelitis is rarely reported, even in the re-treatment situation. In general the highest incidence of local control for the lowest incidence of serious complications is achieved for combinations of external beam and brachytherapy, and for small, well-differentiated, new primary tumours rather than recurrent disease. Re-treatment with total doses <55 Gy gives very poor local control rates. Re-treatment schedules with curative intent require a high re-treatment dose, which is accompanied by an increased risk of normal tissue damage. To minimize serious complications

  12. 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

  13. The last ice-sheet advance and retreat across the Antarctic continental shelf: Synchrony or diachrony?

    Science.gov (United States)

    Hillenbrand, C.; Livingstone, S. J.; O'Cofaigh, C.; Stokes, C. R.; Vieli, A.; Jamieson, S.; Smith, J.; Kuhn, G.; Melles, M.; Graham, A. G.; Larter, R. D.

    2012-12-01

    Over the last few decades, numerous studies from various sectors of the Antarctic continental shelf have reconstructed the spatial extent of grounded ice-sheet advance during the last glacial period and the timing of its retreat. Most reconstructions were based on the bathymetric mapping of subglacial bedforms on the seabed and the palaeoenvironmental interpretation and dating of sub-seafloor sediments in cores. In addition, surface exposure age dating on rocks from the hinterland using cosmogenic isotopes and ice-sheet models were used to constrain the last ice-sheet advance and retreat. Different regional reconstructions provided consistent results for several study areas. In contrast, recent circum-Antarctic reviews that compiled the spatial and temporal information about maximum ice-sheet advance and retreat from these regional studies came to conflicting conclusions regarding i) the maximum extent of grounded ice, and ii) the synchronous/diachronous behaviour of the northern and southern hemispheric ice sheets and the individual drainage sectors within the Antarctic Ice Sheet, respectively. Resolving these conflicts is essential for identifying the main drivers of Antarctic ice-sheet retreat, evaluating the contribution of Antarctic ice-sheet melting to global sea-level rise over the last ~20 ka, understanding the dynamics of individual drainage sectors within the Antarctic Ice Sheet, and locating possible glacial refuges for benthic organisms on the Antarctic shelf. Here we will present examples of circum-Antarctic reconstructions and discuss possible reasons for conflicting conclusions. In some cases, apparent discrepancies can simply be explained by the ambiguity of terms such as "Last Glacial Maximum", which can refer either to a particular time slice (e.g. 23-19 ka BP) or to the time when grounded ice reached its last maximum extent in a particular sector of the Antarctic continental shelf, and "deglaciation", which can refer either to the time of

  14. Evolutionary, multi-scale analysis of river bank line retreat using continuous wavelet transforms: Jamuna River, Bangladesh

    OpenAIRE

    Mount, Nick J.; Tate, Nicholas J.; Sarker, Maminul H.; Thorne, Colin R.

    2013-01-01

    In this study continuous wavelet transforms are used to explore spatio-temporal patterns of multi-scale bank line retreat along a 204 km reach of the Jamuna River, Bangladesh. A sequence of eight bank line retreat series, derived from remotely-sensed imagery for the period 1987-1999, is transformed using the Morlet mother wavelet. Bank erosion is shown to operate at several characteristic spatial and temporal scales. Local erosion and bank line retreat are shown to occur in short, well def...

  15. Ecohealth students: Bringing excitement and forging connections ...

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

    2011-05-09

    May 9, 2011 ... Olson and Lemire and other students are already capturing some of the energy and excitement generated at the Forum. The student section of EcoHealth is holding a retreat in August 2009. As well, a new social networking application called Ning, similar to Facebook, has been customized to form an ...

  16. Organisational quality, nurse staffing and the quality of chronic disease management in primary care: observational study using routinely collected data.

    Science.gov (United States)

    Griffiths, Peter; Maben, Jill; Murrells, Trevor

    2011-10-01

    An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient

  17. Endodontic Retreatment of a Mandibular Second Molar with four Separate Roots: A Case Report.

    Science.gov (United States)

    Idris, Mohamed; Sakkir, Nasil; Kj, Nandakishore; Kini, Annapurna

    2014-03-01

    Aberrations in the root canal anatomy are a commonly occurring phenomenon. Although the mandibular second molar is commonly a bi-rooted tooth with an uncomplicated endodontic anatomy, variations have to be considered every time endodontic therapy is performed. This case report describes the non-surgical endodontic retreatment performed on a mandibular second molar with four seperate roots and canals. ProTaper Universal rotary nickel-titanium instruments (Dentsply Maillefer, Ballaigues, Switzerland) for treatment and retreatment were used to remove the old gutta percha and to clean and shape all root canals, followed by the complete obturation of root canal system. Post-operative CBCT scan was taken to confirm the quality of the performed treatment.

  18. A Case of Successful Retreatment of a Maxillary Lateral Incisor with a Supernumerary Root

    Directory of Open Access Journals (Sweden)

    Mohsen Aminsobhani

    2016-03-01

    Full Text Available Knowledge about the morphology of the root canal system is a pre-requisite for achieving a successful outcome in root canal treatment. In this report, a patient with a maxillary lateral incisor which had previously undergone orthograde endodontic retreatment for two times is discussed. The tooth had been misdiagnosed with a palatal groove or a root fracture, its prognosis had been determined to be poor and extraction was advised by a practitioner. During our evaluation, an unrecognized supernumerary root and root canal were detected and the tooth was maintained successfully with orthograde endodontic retreatment. The use of cone beam computed tomography (CBCT and magnification were of significance in the treatment process of this case.Key words: Tooth, Supernumerary; Incisor; Maxilla; Root Canal Therapy

  19. Endodontic retreatment of a maxillary second molar with three separate buccal roots.

    Science.gov (United States)

    Jafarzadeh, Hamid; Javidi, Maryam; Zarei, Mina

    2006-12-01

    A rare case of a four-rooted maxillary second molar in a 39-year-old male patient is reported. After clinical and radiographic examination, two separate mesio-buccal roots were detected, and a treatment plan consisting treatment of the mesio-buccal roots and retreatment of the disto-buccal and palatal roots was made to resolve the previous treatment failure. The tooth was treated by orthograde endodontic retreatment in two visits. Mesio-buccal canals that were located in the separate mesio-buccal roots (which were missed in previous treatment) were found and treated. The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with full clinical and radiographic examination, in order to increase the ability of clinicians to treat difficult cases.

  20. 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

    We present observations of the long-term recession of surging outlets of Icelandic ice caps in response to 20th century climate. In August 1998, synthetic aperture radar (SAR) data, covering the western part of Vatnajokull and the northern part of Myrdalsjokull in southern Iceland, were acquired...... reconstruction of the margin at that time. The data offer a unique opportunity to estimate the area decrease of these ice caps in the 20th century. The influence of the fluctuations of the surge type outlets, constituting most of W-Vatnajokull area and a good part of N-Myrdalsjokull area, is minimal, since...... of the outlets of western Vatnajokull since maximum Neoglacial extent of each outlet, is log km(2) (6.7%) corresponding to an average retreat of 850 in over a 130 km long margin. In the same period the outlet Slettjokull, in N-Myrdalsjokull, has decreased by 33 km(2) (20%) corresponding to an average retreat...

  1. Millennial Rates of Sea Cliff Retreat Derived From Cosmogenic 10Be and Coastal Platform Morphology

    Science.gov (United States)

    Hurst, M. D.; Ellis, M. A.; Rood, D. H.

    2014-12-01

    Observation of cliff erosion are often limited to relatively short timescales (a few decades), which are within the timeframe of anthropogenic modification of the coast and may be shorter than the recurrence interval for erosion events. Here we present long-term (centennial-millennial) averaged rates of sea cliff retreat for chalk cliffs in SE England derived from cosmogenic isotopes and coastal morphology. We determine long-term rates of sea cliff erosion from 10Be measured from in situ flint samples collected from three transects across the coastal platform in East Sussex. A numerical model of 10Be accumulation on an evolving coastal profile allows estimation of cliff retreat rate averaged over several hundred years. The model accounts for variation in 10Be accumulation with tides and sea-level rise, and takes into account platform downwear and topographic shielding by adjacent cliffs. Additionally, we use high-resolution (1m) multibeam bathymetry to map the extent of the coastal platform based on the surface texture in order to infer the position of the coast at ~8 ka. The difference in position to the current coastline provides estimates of Holocene-averaged rates of cliff erosion for all chalk cliffed coastline in the region. Comparison to historic records of cliff retreat reveals key similarities and differences between long and short-term signals. In certain locations, there are significant discrepancies (either faster or slower) between historic records and long-term rates of retreat. Each type of discrepancy may be the result of human interaction with the coastal environment, whether that interaction is local or non-local, and it is worthwhile noting that sites of relatively low historic rates of erosion are likely subject to high-magnitude, low-frequency failure events that could have devastating effects on human lives and infrastructure in areas that are considered to be low risk.

  2. The effect of reciprocation versus rotational movement on the incidence of root defects during retreatment procedures.

    Science.gov (United States)

    Üstün, Y; Topçuoğlu, H S; Düzgün, S; Kesim, B

    2015-10-01

    To compare the incidence of dentinal defects caused by reciprocating and rotary techniques during retreatment procedures. One hundred and twenty extracted mandibular premolars with single canals were selected. Twenty teeth were left unprepared. The root canals in the remaining 100 teeth were prepared with K-files up to size 35 and filled with Gutta-percha and AH Plus sealer using a passive cold lateral compaction technique. Twenty canals were filled and received no further treatment. Eighty teeth were divided into four groups (n = 20 in each) to undergo the removal of the root filling. In groups 1 and 2, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were not refilled. In groups 3 and 4, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were then refilled using a conventional cold lateral compaction technique. The roots were sectioned horizontally at 3, 6 and 9 mm from the root apex and observed under a stereomicroscope at 20× magnification. Defects were categorized as no defect, incomplete defect and fracture. The differences between the groups were analysed using the chi-square exact test (P = 0.05). No defects were observed in the unprepared and filled groups, in contrast to the experimental groups. In the coronal thirds, groups 2 and 4 had more dentinal defects than groups 1 and 3 (P 0.05). Both nickel-titanium systems were associated with dentinal defects during retreatment procedures in extracted premolar teeth. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  3. 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

  4. Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy

    OpenAIRE

    Asnaashari, Mohammad; Ashraf, Hengameh; Daghayeghi, Amir Houshang; Mojahedi, Seyed Masoud; Azari-Marhabi, Saranaz

    2017-01-01

    Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment.

  5. 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.

  6. Nonsurgical endodontic retreatment of a mandibular first molar with five canals: 1-year follow-up.

    Science.gov (United States)

    Parekh, Deepak J; R, Sathyanarayanan

    2012-03-01

    Mandibular first molars have highly variable root canal morphology. According to previous studies, the occurrence of middle mesial canals ranges from 1% to 15%. In this case, nonsurgical endodontic retreatment of a mandibular first molar with a middle mesial canal is attempted. The authors describe the diagnosis and clinical management of a mandibular first molar with three mesial root canals, drawing particular attention to radiographic interpretation and access refinements.

  7. Efficacy of 2 reciprocating systems compared with a rotary retreatment system for gutta-percha removal.

    Science.gov (United States)

    Rios, Marcos de Azevêdo; Villela, Alexandre Mascarenhas; Cunha, Rodrigo Sanches; Velasco, Rafael Cortez; De Martin, Alexandre Sigrist; Kato, Augusto Shoji; Bueno, Carlos Eduardo da Silveira

    2014-04-01

    The maximum removal of root canal filling material is essential for successful endodontic retreatment. The purpose of this study was to assess the efficacy of 2 reciprocating systems (Reciproc [VDW, Munich, Germany] and WaveOne [Dentsply Maillefer, Ballaigues, Switzerland]) compared with a nickel-titanium (NiTi) rotary system (ProTaper Universal Retreatment [Dentsply Maillefer]) in the removal of root canal filling material. Sixty root canals of extracted human maxillary incisors were prepared using the NiTi ProTaper rotary system with the complementary use of a #40 K-type file and then obturated. The specimens were divided into 3 groups (n = 20) according to the system used for filling removal: group 1: instrument R25 of the Reciproc system, group 2: primary instrument of the WaveOne system, and group 3: NiTi rotary instruments of the ProTaper Universal Retreatment system. The teeth were cleaved longitudinally and photographed under a dental operating microscope with 5 × magnification. Images were transferred to a computer, and residual filling material was quantified using Image Tool software (University of Texas Health Science Center, San Antonio, TX). Results were compared using 1-way analysis of variance (P .05) in residual filling material was observed among the groups, with 4.30% in group 1, 2.98% in group 2, and 3.14% in group 3. The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper Universal retreatment system for gutta-percha and sealer removal. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  8. 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.

  9. Signatures of ice flow, retreat and meltwater delivery in the Gulf of Bothnia

    Science.gov (United States)

    Greenwood, Sarah; Clason, Caroline; Nyberg, Johan; Hell, Benjamin; Öiås, Hans; Holmlund, Per; Jakobsson, Martin

    2014-05-01

    The Gulf of Bothnia has variably played host to the main ice divide of the Fennoscandian ice sheet, ice stream onset, trunk and retreat zones, marine ice sheet decay into the large proglacial Baltic Ice Lake, and the subsequent development of an 'inland' marine basin. It is likely to have acted as both source and depocentre for the delivery of ice, water and sediment in both subglacial and ice-marginal domains. These domains and dynamics have been largely inferred from terrestrial, peripheral evidence. The submerged terrain has been little investigated and its glacial geological archives are virtually unknown. In recent years large swathes of high resolution multibeam echo-sounding data (5-10 metre grid cells) from the Baltic Sea and Gulf of Bothnia have been collected for the Swedish Maritime Administration. These data reveal, with unprecedented clarity, glacial landforms associated with the flow and retreat of ice in these basins. Multiple generations of glacial lineations associated with Baltic and Finnish ice streams are resolved, and indicate their shifting geometry and evolving dynamics. Grounding line deposits at a variety of scales allow us to characterise the style and possible rates of retreat. Our data further offer a detailed view of a dynamic subglacial hydrological system on a sediment substrate: its locally varying patterns of incision and sediment deposition, the extent and connectivity of channelised networks, and the intimate relationship between meltwater landforms, ice-marginal deposits and subglacial bedforms. Here we present these data and explore some of their implications for processes of landform creation, large-scale sediment redistribution in the Bothnian and Baltic basins, the coupling between the glacial hydrological system and ice flow/retreat dynamics, and the regional palaeo-ice sheet history.

  10. Endoscopic retreatment of Zenker's diverticulum using novel endoscopic scissors - The Clutch Cutter device.

    Science.gov (United States)

    González, Nicolás; Debenedetti, Dardo; Taullard, Andrés

    2017-09-01

    Treatment of Zenker's diverticulum by flexible endoscopy consists of the myotomy of the cricopharyngeal muscle and is considered to be feasible, effective and safe. This report describes the novel use of a Clutch Cutter® device to perform flexible endoscopic retreatment of a symptomatic recurrence after previous treatment using a Needle knife in a 68 year old woman with symptoms of dysphagia for solids.

  11. Local Recurrence After Primary Proton Beam Therapy in Uveal Melanoma: Risk Factors, Retreatment Approaches, and Outcome.

    Science.gov (United States)

    Seibel, Ira; Cordini, Dino; Rehak, Matus; Hager, Annette; Riechardt, Aline I; Böker, Alexander; Heufelder, Jens; Weber, Andreas; Gollrad, Johannes; Besserer, Angela; Joussen, Antonia M

    2015-10-01

    To evaluate the risk factors, recurrence rates, retreatments, and long-term patient outcomes following proton beam therapy for uveal melanoma. Retrospective interventional case series. All patients treated with primary proton beam therapy for uveal melanoma at the oncology service at Charité-Berlin and Helmholtz-Zentrum-Berlin between May 1998 and December 2008 were reviewed for local recurrence. Of 982 patients, 982 eyes matched the inclusion criteria. The data were obtained from electronic health records, operative reports, discharge letters, and radiation planning. Comparisons of fundus photographs and ultrasound measurements were performed to assess the growth pattern of the tumor and to determine the success of retreatment, in the case that a globe-retaining therapy was undertaken. Of 982 patients, 35 patients (3.6%) developed local recurrence. The median follow-up was 60.7 months (6.0-170.4 months). Local control rate was 96.4% and the overall eye retention rate was 95.0% in this cohort. Local recurrence was correlated with a higher risk for metastasis and reduced survival. Largest tumor diameter was identified as the sole statistically significant risk factor for local recurrence (P = .00001). All globe-retaining retreatment approaches for local recurrence, including proton beam therapy, brachytherapy, and transpupillary thermotherapy used for recurrences at the tumor margins, showed good local tumor control and similar metastasis-free survivals. This study showed that each globe-retaining retreatment approach can result in satisfying local tumor control. In case of early detection of local recurrence, preservation of the globe can be warranted. Therefore, regularly performed follow-ups should be ensured. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Self-reported mindfulness and cortisol during a Shamatha meditation retreat.

    Science.gov (United States)

    Jacobs, Tonya L; Shaver, Phillip R; Epel, Elissa S; Zanesco, Anthony P; Aichele, Stephen R; Bridwell, David A; Rosenberg, Erika L; King, Brandon G; Maclean, Katherine A; Sahdra, Baljinder K; Kemeny, Margaret E; Ferrer, Emilio; Wallace, B Alan; Saron, Clifford D

    2013-10-01

    Cognitive perseverations that include worry and rumination over past or future events may prolong cortisol release, which in turn may contribute to predisease pathways and adversely affect physical health. Meditation training may increase self-reported mindfulness, which has been linked to reductions in cognitive perseverations. However, there are no reports that directly link self-reported mindfulness and resting cortisol output. Here, the authors investigate this link. In an observational study, we measured self-reported mindfulness and p.m. cortisol near the beginning and end of a 3-month meditation retreat (N = 57). Mindfulness increased from pre- to post-retreat, F(1, 56) = 36.20, p mindfulness was inversely related to p.m. cortisol at pre-retreat, r(53) = -.31, p mindfulness was associated with pre to postchange in p.m. cortisol, β = -.37, t(49) = 2.30, p mindfulness were associated with decreases in p.m. cortisol, whereas smaller increases (or slight decreases) in mindfulness were associated with an increase in p.m. cortisol. These data suggest a relation between self-reported mindfulness and resting output of the hypothalamic-pituitary-adrenal system. Future work should aim to replicate this finding in a larger cohort and determine stronger inference about causality by using experimental designs that include control-group conditions. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  13. Investigation of cultivable bacteria isolated from longstanding retreatment-resistant lesions of teeth with apical periodontitis.

    Science.gov (United States)

    Signoretti, Fernanda G C; Gomes, Brenda P F A; Montagner, Francisco; Jacinto, Rogério C

    2013-10-01

    The objective of this research was to investigate the presence of viable bacteria in tissue samples from persistent apical lesions and to correlate the microbiological findings with the histopathological diagnosis of the lesion. Twenty persistent apical lesions associated with well-performed endodontic retreatment were collected. Tissue samples were processed through culture techniques including serial dilution, plating, aerobic and anaerobic incubation, and biochemical tests for microbial identification followed by histopathological diagnosis. Cysts were more frequently diagnosed (13/20). Strict anaerobic species predominated in both cysts (80.4% of the species detected) and granulomas (65% of the species detected). Viable gram-positive bacteria were frequently recovered from apical lesions (cysts = 70.6%, granulomas = 84.4%). Gemella morbillorum and Propionibacterium acnes were the most frequently recovered species from cysts and granulomas, respectively. At least 1 gram-positive bacterial species was present in almost every sample (cysts = 12/13, granulomas = 7/7). No significant correlation was found between histologic findings and bacterial species. In conclusion, although cysts were more frequent than granulomas in cases of failure of endodontic retreatment, bacteria were isolated from both types of lesions, with a predominance of gram-positive species, suggesting that these species can survive outside the root canal and might be related to the persistence of the pathological process even after accurate endodontic retreatment. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Comparative SEM evaluation of three solvents used in endodontic retreatment: an ex vivo study.

    Science.gov (United States)

    Scelza, Miriam F Zaccaro; Coil, Jeffrey M; Maciel, Ana Carolina de Carvalho; Oliveira, Lílian Rachel L; Scelza, Pantaleo

    2008-01-01

    This study compared, by scanning electron microscopy (SEM), the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10), orange oil (n=10), eucalyptol (n=10) and control (n=10). Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05). However, the control group had fewer dentinal tubules free of filling material (p<0.05). Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.

  15. [The application of desocclusol and manual mechanical method in endodontic retreatment].

    Science.gov (United States)

    Zhao, Ai-min; Zhang, Hai-liang; Ou, Xiao-yan

    2011-12-01

    To investigate the clinical method to remove a gutta-percha and root canal sealers. 168 root canals which had been filled with gutta-percha were selected,all root canals needed endodontic retreatment.The root canal fillings were removed and the root canal was re-prepared with the method of desocclusol and manual mechanical method. Then the root canal was filled again with lateral condensation technique. With manual mechanical method and desocclusol,all original root canal fillings were removed completely. The combined method could effectively prevent the formation of step,root canal-side wear,broken equipment or other complications during the course of retreatment.The success rate of retreatment was 89.3%. Combined manual mechanical method with desocclusol could improve the success rate of recanalization of the root canal and saved time and effort. It is a method which could reduce the intensity and improve the efficiency of dentists, and worthy of wide clinical application.

  16. The effect of chloroform, orange oil and eucalyptol on root canal transportation in endodontic retreatment.

    Science.gov (United States)

    Karataş, Ertuğrul; Kol, Elif; Bayrakdar, İbrahim Şevki; Arslan, Hakan

    2016-04-01

    The purpose of the present study was to assess the effect of solvents on root canal transportation in endodontic retreatment. Sixty extracted human permanent mandibular first molars with curved root canals were selected. All of the root canals were prepared using Twisted File Adaptive instruments (SybronEndo, Orange, CA, USA) and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the cold lateral compaction technique. The teeth were assigned to four retreatment groups as follows (n = 15): eucalyptol, chloroform, orange oil and control. The canals were scanned using cone-beam computed tomography scanning before and after instrumentation. The chloroform group showed a significantly higher mean transportation value than the orange oil and control groups at the 3 and 5 mm levels (P = 0.011 and P = 0.003, respectively). There was no significant difference among the orange oil, eucalyptol and control groups in terms of canal transportation (P > 0.61). The chloroform led to more canal transportation than the eucalyptol and orange oil during endodontic retreatment. © 2015 Australian Society of Endodontology.

  17. Factors influencing root canal retreatment strategies by general practitioners and specialists in Australia.

    Science.gov (United States)

    Wenteler, G L; Sathorn, C; Parashos, P

    2015-05-01

    To evaluate the effect of tooth radiographic features on root canal retreatment strategies used by general dental practitioners and dental specialists in Australia. A descriptive survey study comprising a web-based questionnaire was sent to general dental practitioners and specialists. The questionnaire diagrammatically represented six different clinical scenarios with variables including type of coronal restoration, quality of root filling and the size and presence of a periapical radiolucency. Treatment options included no treatment, orthograde retreatment, periapical surgery and replacement with an implant. For each of the six scenarios, the participant was asked to select a minimum size cut-off point where treatment would be initiated and also indicate the preferred treatment option. A total of 639 questionnaires were submitted online. In teeth without a cast core restoration, the quality of root filling influenced the selection of no treatment as an option (P retreatment strategies according to quality of root filling and type of coronal restoration. Whilst all clinical scenarios could be managed by contemporary endodontic techniques, teeth were still treatment planned for extraction and replacement with an implant. This may be due to the fact that implants are heavily marketed by the dental industry and with more stringent outcome criteria applied to the assessment of root canal treatment compared with implant placement, evidence-based decision-making may be distorted. Future emphasis should be placed on changing practitioners' attitudes towards the retention of salvageable teeth by contemporary endodontic measures. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  18. Comparative sem evaluation of three solvents used in endodontic retreatment: an ex vivo study

    Directory of Open Access Journals (Sweden)

    Miriam F. Zaccaro Scelza

    2008-02-01

    Full Text Available This study compared, by scanning electron microscopy (SEM, the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10, orange oil (n=10, eucalyptol (n=10 and control (n=10. Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05. However, the control group had fewer dentinal tubules free of filling material (p<0.05. Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.

  19. 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.

  20. 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

    2017-11-01

    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.

  1. 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.

  2. Effect of solvents on apically extruded debris and irrigant during root canal retreatment using reciprocating instruments.

    Science.gov (United States)

    Keskin, C; Sariyilmaz, E; Sariyilmaz, O

    2017-11-01

    To evaluate the effect of several solvents on the weight of apically extruded debris and irrigant during retreatment using a novel agar gel model. Orange oil, turpentine oil and chloroform were used as solvents. Eighty single straight-rooted extracted human mandibular premolar teeth with a single root canal were divided into four groups (n = 20). All specimens were root canal-filled and weighed prior to their insertion into a prepared 1.5% agar gel model. The mean initial weights were measured by subtracting the weight of the specimen from the weight of the test apparatus and recorded. Following the removal of the coronal 4 mm of root filling, the test solvent was applied onto the root filling. No solvent was used in the control group. A Reciproc R25 instrument was used to remove the root filling in all groups. Apically extruded debris and test solvent were collected during retreatment procedures. The mean weights of apically extruded debris and irrigant were calculated by subtracting the mean initial weights from the weights of test apparatus without the Teflon tape and the specimen following the retreatment procedures. Data were statistically analysed using one-way analysis of variance. Use of solvents resulted in significantly less extruded debris and irrigant compared to the control group (P extruded significantly more debris than orange oil and turpentine oil (P extruded debris and irrigant when compared to no solvent. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    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.

  4. Prevalence of Treponema spp. in endodontic retreatment-resistant periapical lesions.

    Science.gov (United States)

    Rosa, Tiago Pereira; Signoretti, Fernanda Graziela Corrêa; Montagner, Francisco; Gomes, Brenda Paula Figueiredo de Almeida; Jacinto, Rogério Castilho

    2015-01-01

    This study investigated the presence of the Treponema species in longstanding endodontic retreatment-resistant lesions of teeth with apical periodontitis, the association of this species with clinical/radiographic features, and the association among the different target species. Microbial samples of apical lesions were collected from twenty-five adult patients referred to endodontic surgery after unsuccessful root canal retreatment. Nested-PCR and conventional PCR were used for Treponema detection. Twenty-three periradicular tissue samples showed detectable levels of bacterial DNA. Treponema species were detected in 28% (7/25) of the cases. The most frequently detected species were T. socranskii (6/25), followed by T. maltophilum (3/25), T. amylovorum (3/25), T. lecithinolyticum (3/25), T. denticola (3/25), T. pectinovorum (2/25) and T. medium (2/25). T. vicentii was not detected in any sample. Positive statistical association was found between T. socranskii and T. denticola, and between T. maltophilum and T. lecithinolyticum . No association was detected between the presence of any target microorganism and the clinical or radiographic features. Treponema spp. are present, in a low percentage, in longstanding apical lesions from teeth with endodontic retreatment failure.

  5. Pre-hospital severe traumatic brain injury - comparison of outcome in paramedic versus physician staffed emergency medical services.

    Science.gov (United States)

    Pakkanen, Toni; Virkkunen, Ilkka; Kämäräinen, Antti; Huhtala, Heini; Silfvast, Tom; Virta, Janne; Randell, Tarja; Yli-Hankala, Arvi

    2016-04-29

    Traumatic brain injury (TBI) is one of the leading causes of death and permanent disability. Emergency Medical Services (EMS) personnel are often the first healthcare providers attending patients with TBI. The level of available care varies, which may have an impact on the patient's outcome. The aim of this study was to evaluate mortality and neurological outcome of TBI patients in two regions with differently structured EMS systems. A 6-year period (2005 - 2010) observational data on pre-hospital TBI management in paramedic-staffed EMS and physician-staffed EMS systems were retrospectively analysed. Inclusion criteria for the study were severe isolated TBI presenting with unconsciousness defined as Glasgow coma scale (GCS) score ≤ 8 occurring either on-scene, during transportation or verified by an on-call neurosurgeon at admission to the hospital. For assessment of one-year neurological outcome, a modified Glasgow Outcome Score (GOS) was used. During the 6-year study period a total of 458 patients met the inclusion criteria. One-year mortality was higher in the paramedic-staffed EMS group: 57 % vs. 42 %. Also good neurological outcome was less common in patients treated in the paramedic-staffed EMS group. We found no significant difference between the study groups when considering the secondary brain injury associated vital signs on-scene. Also on arrival to ED, the proportion of hypotensive patients was similar in both groups. However, hypoxia was common in the patients treated by the paramedic-staffed EMS on arrival to the ED, while in the physician-staffed EMS almost none of the patients were hypoxic. Pre-hospital intubation by EMS physicians probably explains this finding. The results suggest to an outcome benefit from physician-staffed EMS treating TBI patients. ClinicalTrials.gov ID NCT01454648.

  6. Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Health Administration.

    Science.gov (United States)

    Echevarria, Kelly; Groppi, Julie; Kelly, Allison A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

    2017-11-01

    The development and validation of a staffing calculator and its use in creating staffing guidance for antimicrobial stewardship programs (ASPs) in Veterans Health Administration (VHA) facilities are described. The Tools and Resources Work Group of the Antimicrobial Stewardship Task Force and PBM Clinical Pharmacy Practice Office of the Department of Veterans Affairs developed, tested, and validated a staffing calculator to track patient care and ASP management activities needed to maintain a comprehensive ASP. Time spent on activities was based on time-in-motion tracking studies and input from experienced antimicrobial stewards. The staffing calculator was validated across VHA facilities of varying sizes and complexities to determine the number of needed clinical pharmacist full-time equivalents (FTEs) to implement and maintain ASPs per 100 occupied beds. A total of 12 facilities completed the staffing calculator for 1 calendar week. The median number of occupied beds was 226. Most facilities had at least 100 occupied beds, and 6 of the 12 were considered high complexity facilities. The median calculated FTE personnel requirement was 2.62, or 1.01 per 100 occupied beds. The majority of FTE time (70%) was spent on patient care activities and 30% on program management activities, including infectious diseases or ASP rounds. The final recommendations indicated that in order to implement and manage a robust ASP, a pharmacist FTE investment of 1.0 per 100 occupied beds would be needed. A staffing calculator to account for the time needed to implement ASP activities and provide staffing guidance across a large health-care system was validated. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. 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.

  8. Cost-effectiveness of retreatment with varenicline after failure with or relapse after initial treatment for smoking cessation

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. Quantitative evaluation of debris extruded apically by using ProTaper Universal Tulsa rotary system in endodontic retreatment.

    Science.gov (United States)

    Huang, Xiangya; Ling, Junqi; Wei, Xi; Gu, Lisha

    2007-09-01

    This study evaluated the amount of apical debris during endodontic retreatment by using the ProTaper Universal Tulsa rotary files. Forty-five extracted human anterior teeth were root filled before randomly assigned to 3 groups. In group A, gutta-percha was removed by using the ProTaper Universal Tulsa retreatment system, and canals were re-prepared with ProTaper rotary files. In group B, gutta-percha was removed by using Hedström files with chloroform, and canals were reshaped with ProTaper rotary files. In group C, the same method as that in group B was used for gutta-percha removal, and canals were reshaped with K-flex files. Apical debris was collected and compared among 3 groups. Although all retreatment techniques resulted in apical extrusion, the ProTaper Universal Tulsa rotary technique in group A produced significantly less amount of apical extrusion than other 2 methods (P endodontic retreatment.

  11. Historical aerial imagery reveals rapid frontal retreat following the 1920’s warming in southeast Greenland

    DEFF Research Database (Denmark)

    Bjørk, Anders Anker; Kjær, Kurt H.; Korsgaard, Niels Jákup

    in the similarity of the retreat following the early century warming and the latest decade, with a majority of the 132 glaciers exhibiting larger retreat rates in the early period. Furthermore, during the mid century cooling glaciers in southeast Greenland showed a surprisingly rapid response to the cooling...... demonstrate decadal sensitivity to temperature changes with rapid retreat following the early century warming (1919-1932) and glacial advance during a minor, but profound mid century cooling (1955-1972) succeeded by the present warming again leading to massive retreat. One significant finding lies......, indicating that stabilization and subsequent advance can occur with a short cooling period. Marine terminating glaciers originating from the GIS experienced the largest frontal fluctuations often out of sync with local glaciers and ice caps indicating a larger coherence with ocean temperatures, whereas local...

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

    Directory of Open Access Journals (Sweden)

    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’.

  13. Adjunctive role of photodynamic therapy in the nonsurgical endodontic retreatment of a molar with grade II furcation involvement

    Directory of Open Access Journals (Sweden)

    Preeti Jain Pruthi

    2014-01-01

    Full Text Available Endodontic therapy has a high survival rate, but in cases of post-treatment pathosis, retreatment may be required. This case report presents a similar case of endodontic failure which resulted in a coexistent periradicular-periodontal lesion. The case was managed by nonsurgical endodontic retreatment followed by photodynamic therapy in the periodontal region. Satisfactory results were obtained when the case was followed up clinically and radiographically for 18 months.

  14. Evaluation of the accuracy of two apex locators in endodontic treatment and retreatments: an ex vivo study

    Directory of Open Access Journals (Sweden)

    Yasser Samadi

    2016-03-01

    Full Text Available Introduction: Working length determination is important in successful endodontic treatment and retreatment.This study evaluated the accuracy of two electronic apex locators Root ZX and Raypex®6 (EALs in determining the electronic working length (EWL of the root canals in endodontic treatment and retreatment. Materials and Methods: Access cavities were prepared on forty extracted, single-rooted human teeth and the actual working length (AWL of the canals was determined. In the first phase of the study, primary EWL of un-instrumented teeth was measured and compared between two EALs. In phase II, all of the teeth were pre-flared and divided into the control(n=10 and the retreatment groups (n=30. Canals in the retreatment group were obturated by the lateral condensation technique using Gutta percha and sealer. After 15 days, gutta-percha was removed, and then the secondary EWL was recorded and compared between the two devices, in treatment and retreatment groups. Data were analysed by paired t-test and t-test. Results: Significant differences were found between both EALs in treatment and retreatment phases of the study (p<0.001.both EALs showed increased accuracy in retreatment group (p<0.001. However, no statistically significant differences were found between the control and retreatment groups in the second phase of the study for Root ZX (p = 0.929, and Raypex®6 (p=0.937. Conclusion: Accuracy of the two EALs was similar and acceptable. EWLs determined by Root ZX were closer to the AWL. The EWL determination after pre-flaring improved the accuracy of EALs and root canal obturation remnant materials did not have any clear effect on the accuracy of these EALs.

  15. 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 NiTi systems was not significant (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.

  16. Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

    Science.gov (United States)

    Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum

    2017-01-01

    Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight

  17. 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)

  18. 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.

  19. Judgment of the Quality of Restorative Care as Predictors of Restoration Retreatment: Findings from the National Dental PBRN

    Science.gov (United States)

    Riley, J.L.; Gilbert , G.H.; Ford, G.W.; Fellows, J.L.; Rindal, B.; Gordan, V.V.

    2016-01-01

    The primary aim of this study was to test the hypothesis that a patient’s subjective assessments of the dentist’s technical competence, quality of care, and anticipated restoration longevity during a restorative visit are predictive of restoration outcome. This prospective cohort study involved 3,326 patients who received treatment for a defective restoration in a permanent tooth, participated in a baseline patient satisfaction survey, and returned for follow-up. Of the 4,400 restorations that were examined by 150 dentists, 266 (6%) received additional treatment after baseline. Reporting satisfaction with the technical skill of the dentist or quality of the dental work at baseline was not associated with retreatment after baseline. However, patients’ views at baseline that the fee was reasonable (odds ratio [OR], 1.6) was associated with retreatment after baseline, whereas satisfaction at baseline with how long the filling would last (OR, 0.6) was associated with less retreatment. These findings suggest that retreatment occurs more often for patients who at baseline are satisfied with the cost or who at baseline have less confidence in the restoration. The authors found no associations between restoration retreatment and the patients’ baseline evaluations of the technical skills of their dentists or perceptions of quality care. Knowledge Transfer Statement: Dental patients’ ratings of their dentist’s skills were not related to a restoration needing retreatment. Patients focus on other aspects of the dental visit when making this judgment. PMID:28529977

  20. 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

  1. 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

  2. [Danish emergency departments are not staffed by consultants 24/7].

    Science.gov (United States)

    Mackenhauer, Julie; Møller, Cecilie; Fjældstad, Alexander; Østervig, Rebecca; Kole, Ayhan Al; Folkestad, Lars; Hallas, Peter; Brabrand, Mikkel; Møllekær, Anders; Kirkegaard, Hans

    2013-02-18

    The Danish health care system is undergoing a major reorganisation, resulting in fewer emergency departments (ED) with consultants in attendance 24/7. This questionnaire-based study evaluates the status of the reorganisation with emphasis on physician attendance and recruitment. 76% of the EDs are not staffed by consultants 24/7, 51% report difficulties in recruiting qualified personnel and 33% report problems connected to retaining them. 71% believe that a specialty in emergency medicine could help solve these problems. Danish EDs do not comply with the visions of the reorganisation plan.

  3. Using a nursing productivity committee to achieve cost savings and improve staffing levels and staff satisfaction.

    Science.gov (United States)

    McKenna, Erin; Clement, Kristina; Thompson, Elizabeth; Haas, Kathy; Weber, William; Wallace, Michelle; Stauffer, Cindy; Frailey, Jan; Anderson, Aimee; Deascenti, Missy; Hershiser, Lisa; Roda, Patricia Inama

    2011-12-01

    Challenged by rising costs, higher registered nurse vacancy rates and declining staff morale, a Nursing Productivity Committee was formed to analyze productive and nonproductive hours and seek improvements in our staffing models and scheduling processes. The changes implemented led to lower nurse to patient ratios, better control of labor costs, elimination of agency staff, greater staff satisfaction, and introduction of new technologies. Nurse managers, nursing supervisors, and frontline staff are now more knowledgeable and empowered to use creative solutions to manage their budgets and schedules in these times of fluctuating census and varying vacancy rates.

  4. The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.

    Science.gov (United States)

    Davies, A; Patel, S; Foschi, F; Andiappan, M; Mitchell, P J; Mannocci, F

    2016-07-01

    Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots (P periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management (P = 0.01). Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review

  5. 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.

  6. Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables.

    Science.gov (United States)

    Mitchell, Christine C; Ashley, Stanley W; Zinner, Michael J; Moore, Francis D

    2007-04-01

    To develop a model to predict future staffing for the surgery service at a teaching hospital. Tertiary hospital. A computer model with potential future variables was constructed. Some of the variables were distribution of resident staff, fellows, and physician extenders; salary/wages; work hours; educational value of rotations; work units, inpatient wards, and clinics; future volume growth; and efficiency savings. Outcomes Number of staff to be hired, staffing expense, and educational impact. On a busy general surgery service, we estimated the impact of changes in resident work hours, service growth, and workflow efficiency in the next 5 years. Projecting a reduction in resident duty hours to 60 hours per week will require the hiring of 10 physician assistants at a cost of $1 134 000, a cost that is increased by $441 000 when hiring hospitalists instead. Implementing a day of didactic and simulator time (10 hours) will further increase the costs by $568 000. A 10% improvement in the efficiency of floor care, as might be gained by advanced information technology capability or by regionalization of patients, can mitigate these expenses by as much as 21%. On the other hand, a modest annual growth of 2% will increase the costs by $715 000 to $2 417 000. To simply replace residents with alternative providers requires large amounts of human and fiscal capital. The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates.

  7. Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

    Science.gov (United States)

    Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

    2017-06-01

    To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals. © Health Research and Educational Trust.

  8. 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)

  9. [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.

  10. 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)

  11. [Effects of cost saving strategies and staffing levels on patient and nurse outcomes. A literature review].

    Science.gov (United States)

    Schubert, Maria; Schaffert-Witvliet, Bianca; De Geest, Sabina

    2005-10-01

    The effects of cost saving strategies and changes in staffing levels and skill mix in the inpatient care setting on patient and nurse outcomes have not yet been examined in Switzerland. In 2002 the Swiss Federal Office of Health mandated the Institute of Nursing Science at the University of Basel to conduct a literature review to examine the evidence available on this topic. The literature research and analysis cover the period from 1991 to 2003. Sixty publications out of a total of 260 reviewed abstracts were included and analyzed. The results show that in the inpatient care settings in Switzerland as well as in other countries positions for registered nurses have been reduced and/or the qualification and skill mix in care teams have been downgraded. Given the present health care situation where the intensity and complexity of caring for hospitalized patients is increasing, an imbalance occurs between the need for high quality care and the possibilities to offer this care. This affects patients' and nurses outcomes. The international results show a significant relationship between lower staffing levels and skill mix in care teams and higher complication, "failure-to-rescue", and mortality rates in patients, as well as a lower job satisfaction, and higher fluctuation, burnout and work-related injury rates in nursing personnel. Thus, nursing care within hospitals represents not only a cost factor but also an important quality factor which is essential in order to be able to realize good patient's outcomes.

  12. 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.

  13. 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 (pretreatment tip proved to be an efficient method of removing obturated

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Contributions of culture and antimicrobial susceptibility tests to the retreatment of patients with pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    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.

  17. Incidence of Dentinal Defects and Vertical Root Fractures after Endodontic Retreatment and Mechanical Cycling.

    Science.gov (United States)

    De Carlo Bello, Mariana; Pillar, Rafael; Mastella Lang, Pauline; Michelon, Carina; Abreu da Rosa, Ricardo; Souza Bier, Carlos Alexandre

    2017-01-01

    The aim of this study was to evaluate the incidence of dentinal defects and vertical root fractures (VRFs) after endodontic retreatment and mechanical cycling (MC). Two hundred mandibular premolars were selected. Forty teeth were left unprepared (control group). The remaining 160 root canals were prepared with ProTaper instruments and filled by using two different techniques [eighty with lateral compaction (LC) and eighty with single-cone (SC)]. Forty canals from each group (LC and SC) received no further treatment. The remaining eighty teeth were divided into two groups (LCR and SCR) ( n =40) in order to undergo the removal of the root filling, re-preparation and refilling with lateral compaction and single-cone, respectively. All of the teeth were subjected to MC (1000000 cycles, 130 N, 2.2 Hz and 37 ° C). The roots were sectioned at 3, 6 and 9 mm from the apex and observed under 20× magnification. The defects were classified as: no defect, VRF and other defects . Statistical analysis was performed using the Fisher's Exact test and the Chi -Squared tests ( α =0.05). MC alone did not promote any other defects or VRFs. Experimental groups presented higher dentinal defects than the control group ( P =0.021). Retreatment groups did not present a higher amount of dentinal defects than the groups that were subjected to the first treatment ( P >0.05). Endodontic treatment and retreatment, regardless of the filling technique and MC, did not influence the occurrence of dentinal defects or VRFs in the human premolars.

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

    Science.gov (United States)

    MORGENTAL, Renata Dornelles; dos SANTOS, Régis Burmeister; RÖSING, Cassiano Kuchenbecker; CHANIN, Taís do Amaral; de FIGUEIREDO, José Antônio Poli

    2012-01-01

    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. PMID:22666838

  19. Efficacy of passive ultrasonic irrigation in removing root filling material during endodontic retreatment

    Directory of Open Access Journals (Sweden)

    Carina MICHELON

    Full Text Available Abstract Introduction The aim of endodontic retreatment is to remove the previous root filling materials completely to allow for the subsequent steps of cleaning, canal shaping and filling replacement. Objective To evaluate the efficacy of passive ultrasonic irrigation (PUI in the removal of residual root filling material after removing the bulk of the root filling with nickel-titanium rotary instruments. Material and method Eighteen mesial isthmus-containing roots of human mandibular molars were prepared and filled. The root canal filling was removed with the ProTaper Retreatment system and K-files. The specimens were randomized into 2 groups (n = 9, both irrigated with 2.5% NaOCl and 17% EDTA. In the conventional group, an irrigation syringe was used. In the PUI group, the PUI technique was used. The roots were sectioned longitudinally and evaluated under stereomicroscopy. Student’s t test was used to compare groups and the general linear model was used to compare the apical, cervical, and middle root thirds within each group, in regard to the percentages of remaining residual filling material. Result There was no statistically significant intergroup difference, irrespective of which root third was evaluated (P > 0.05. In the PUI group, the apical third showed a significantly higher percentage of residual filling material, in comparison with the cervical (P = 0.038 and middle (P = 0.029 thirds. Conclusion The PUI technique was not more effective than the conventional irrigation technique in removing residual root filling material during endodontic retreatment in root canals with a complex anatomy.

  20. Exploring tidewater glacier retreat using past and current observations at Columbia Glacier, Alaska. (Invited)

    Science.gov (United States)

    O'Neel, S.; Pfeffer, W. T.; Howat, I. M.; Conway, H.; Columbia Glacier Consortium

    2010-12-01

    Since fulfilling Austin Post’s prediction of impending retreat in the late 1970s, Columbia Glacier has repeatedly surprised both casual and careful observers with its ability for rapid change. Over the last three decades, Columbia Glacier has lost approximately 18 km of its original 66 km length, while thinning by approximately 50% at the present terminus. The total ice volume lost to the Gulf of Alaska Estimates upwards of 120 km3 constrain the total ice volume lost to the Gulf of Alaska. Recently, the terminus supported a ~1.5 km long floating tongue for over than a year, contradicting the common assumption that the mechanical properties of temperate ice prohibit flotation over sustained time intervals. The rich history of study offers an opportunity to better understand tidewater glacier retreat, and a valuable analog to the dynamic instability underway at several ice sheet outlet glaciers. Current research aims to improve processing resolution of existing aerial photographic data, while complimenting the 30-year photogrammetric record with a suite of field observations. Recent instrumentation includes: oblique time lapse and still imagery, semi-permanent GPS, airborne radar, mass balance, passive seismology and LiDAR. This presentation will focus on innovative methods developed in recent field seasons, sharing insight each has provided into the retreat process . 1The Columbia Glacier Consortium consists of: Fabian Walter (SIO), Kenichi Matsuoka (NPI), Ben Smith (UW), Ethan Welty (CU-Boulder), Chris Larsen (UAF), Dave Finnegan (CRREL), Dan McNamara (USGS), Yushin Ahn (OSU), Julie Markus (OSU), Adam LeWinter (EIS).

  1. 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....

  2. Quality assurance in radiotherapy: the importance of medical physics staffing levels. Recommendations from an ESTRO/EFOMP joint task group.

    Science.gov (United States)

    Belletti, S; Dutreix, A; Garavaglia, G; Gfirtner, H; Haywood, J; Jessen, K A; Lamm, I L; Mijnheer, B; Noël, A; Nüsslin, F; Rosenow, U; Schneider, P; Seelentag, W; Sheriff, S; Svensson, H; Thwaites, D

    1996-10-01

    The safe application of ionising radiation for diagnosis and therapy requires a high level of knowledge of the underlying processes and of quality assurance. Sophisticated modern equipment can be used effectively for complicated diagnostic and therapeutic techniques only with adequate physics support. In the light of recent analyses and recommendations by national and international societies a joint working group of representatives from ESTRO (European Society for Therapeutic Radiology and Oncology) and from EFOMP (European Federation of Organisations for Medical Physics) was set up to assess the necessary staffing levels for physics support to radiotherapy. The method used to assess the staffing levels, the resulting recommendations and examples of their practical application are described.

  3. Soft cliff retreat adjacent to coastal defences, with particular reference to Holderness and Christchurch Bay, UK

    OpenAIRE

    Brown, Sally

    2008-01-01

    Coastal defences reduce sediment input and modify the sediment budget, usually resulting in a sediment deficit down-drift and an accumulation up-drift. This process results in set-back adjacent to defences. Three types of set-back were identified and these occur due to the:• terminal groyne effect, where defences stop or dramatically reduce erosion, induce a sediment deficit down-drift and cause an increase in retreat rate;• perceived terminal groyne effect, where defences stop or dramaticall...

  4. Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy.

    Science.gov (United States)

    Asnaashari, Mohammad; Ashraf, Hengameh; Daghayeghi, Amir Houshang; Mojahedi, Seyed Masoud; Azari-Marhabi, Saranaz

    2017-01-01

    Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment. Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm 2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression. Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation

  5. 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...

  6. Nonsurgical Endodontic Retreatment of Maxillary Second Molar with Two Palatal Root Canals: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahsa Eskandarinezhad

    2012-04-01

    Full Text Available Successful endodontic treatment requires thorough knowledge regarding each root canal system of any tooth and probability of extra canals should be considered. Second maxillary molar with two palatal root canals is not frequent and its incidence reported in literatures is about 0.4–2%. The present case report describes non-surgical retreatment of maxillary second molar with two palatal root canals. Radiographic interpretation is difficult in this region; so, very careful examination of pulpal space and using supportive devices such as loupe and operating microscope is recommended to discover any unusual anatomic features like extra canals.

  7. Microsurgical endodontic retreatment of a maxillary molar with a separated file: a case report.

    Science.gov (United States)

    Kahler, B

    2011-03-01

    A separated instrument complicated orthograde endodontic retreatment of a maxillary molar tooth with apical periodontitis. The tooth was treated utilizing microsurgical techniques that employed an operating microscope, ultrasonics, micro-instrumentation and mineral trioxide aggregate as a root-end filling material. Healing was evident at a 12-month review appointment. Microsurgical techniques have significantly improved the outcomes for healing of periapical lesions when compared to traditional approaches to endodontic surgery. Success rates have been shown to be comparable with conventional orthograde treatment. © 2010 Australian Dental Association.

  8. Surgical management of an endodontic retreatment failure of a mandibular first molar

    Directory of Open Access Journals (Sweden)

    Kinjal M Gathani

    2016-01-01

    Full Text Available One of the common endodontic iatrogenic mishaps is the extrusion of obturation material which has a negative effect on the long-term prognosis of the tooth. Surgical endodontics has enabled us to save teeth with persistent infections and extrusions when orthograde treatment has been unsuccessful. Apicoectomy of the molars is not frequently performed even though its success rate can reach that of anteriors and premolars. This case report describes the orthograde and surgical management of a mandibular first molar with external root resorption, instrument separation in the canal, and extruded obturation material, which had been unresponsive to endodontic retreatment.

  9. The Seventh Annual Ion Channel Retreat Vancouver, Canada, June 29-July 1, 2009.

    Science.gov (United States)

    Brugger, Saranna; Kennedy, Susannah; King, Noel

    2010-02-01

    Seven years ago, Aurora Biomed Inc. (Vancouver, BC) recognized the need to create a forum for scientific discourse spanning the spectrum of ion channel disciplines. Since then, researchers from both academia and industry have been invited each year to share their knowledge on the advancement of ion channel research and technology, drug discovery, and safety pharmacology. Aurora Biomed's 2009 Retreat continued this tradition by covering a variety of topics including Ion Channels as Disease and Pain Targets, TRP Ion Channels, Ion Channel Screening Technologies, Ion Channels in Safety Pharmacology, Structure & Function of Ion Channels, Ion Channels in Disease Pathology, and New Horizons in Life Sciences.

  10. Extremely low glacial headwall retreat rates quantified using debris-covered glaciers in the Transantarctic Mountains

    Science.gov (United States)

    Mackay, S. L.; Marchant, D. R.

    2017-12-01

    The McMurdo Dry Valleys (MDV) region of Antarctica is considered to be one of the most geomorphically stable regions on Earth. The extreme landscape stability is attributed primarily to persistent cold-polar desert conditions, and has enabled the multi-million-year preservation of near-surface terrestrial archives that are critical to our understanding of Antarctic ice sheet dynamics and climate change over at least the last 14 Ma. Correct interpretation of these archives requires well-constrained estimates of the rate of landscape alteration and erosion. Previous studies using tephrochronology of in situ ash deposits and terrestrial cosmogenic nuclides from bedrock and regolith on ridge crests, valley bottoms, and other low-angled, sub-horizontal surfaces have yielded inferred erosion rates of 5×10-5 to 9×10-4mm a-1 . However, estimates for erosion of cliff faces in topographically complex terrain that dominates the upland region of the MDV are largely unknown. Here we measure, for the first time in the MDV, the average rate of erosion and headwall-retreat for near-vertical glaciated cirques. To accomplish this, we analyze the sediment flux through the Mullins and Friedman glaciers; these are cold-based, topographically constrained, and slow-moving debris-covered alpine glaciers that collect and transport debris sourced entirely from rockfall at the headwall cirque. Using data from 15 km of ground penetrating radar profiles, 12 shallow ice cores, and 180 shallow surface excavations, we compile an estimated total sediment load for each glacier. We then combine this sediment load with measurements of the debris source area and a glacial chronology based on cosmogenic nuclide dating and measured ice flow velocities. Results indicate average headwall erosion rates of 1×10-3-5×10-3 mm a-1 and slope-adjusted headwall retreat rates of 9×10-4-4×10-3 mm a-1 over the past 225 ka. These values are the lowest yet reported and are several orders of magnitude lower than

  11. 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

  12. The retreat of Arctic sea ice: flash-back on the latest decades

    International Nuclear Information System (INIS)

    Salas y Melia, D.

    2010-01-01

    The melting of the world's ice and snow, including Arctic sea ice is probably one of the most striking pictures of ongoing climate change. Arctic sea ice cover is now observed in real-time by satellite, and its changes in time are probably more visible to the general public than long term temperature or precipitation changes. However, the interpretation of the current retreat of Arctic sea ice is not straightforward. This article reviews progress in the scientific understanding of recent trends in sea ice due to recent observations and breakthroughs in sea ice modelling. (author)

  13. Phytoplankton distribution in the Western Arctic Ocean during a summer of exceptional ice retreat

    Science.gov (United States)

    Coupel, P.; Jin, H. Y.; Ruiz-Pino, D.; Chen, J. F.; Lee, S. H.; Li, H. L.; Rafizadeh, M.; Garçon, V.; Gascard, J. C.

    2011-07-01

    A drastic ice decline in the Arctic Ocean, triggered by global warming, could generate rapid changes in the upper ocean layers. The ice retreat is particularly intense over the Canadian Basin where large ice free areas were observed since 2007. The CHINARE 2008 expedition was conducted in the Western Arctic (WA) ocean during a year of exceptional ice retreat (August-September 2008). This study investigates whether a significant reorganization of the primary producers in terms of species, biomass and productivity has to be observed in the WA as a result of the intense ice melting. Both pigments (HPLC) and taxonomy (microscopy) acquired in 2008 allowed to determine the phytoplanktonic distribution from Bering Strait (65° N) to extreme high latitudes over the Alpha Ridge (86° N) encompassing the Chukchi shelf, the Chukchi Borderland and the Canadian Basin. Two different types of phytoplankton communities were observed. Over the ice-free Chukchi shelf, relatively high chl-a concentrations (1-5 mg m-3) dominated by 80 % of diatoms. In the Canadian Basin, surface waters are oligotrophic (poverty (Canadian Basin) and the richness (Chukchi shelf) of the WA, we explore the role of the nutrient-rich Pacific Waters, the bathymetry and two characteristics linked to the intense ice retreat: the stratification and the Surface Freshwater Layer (SFL). The freshwater accumulation induced a strong stratification limiting the nutrient input from the subsurface Pacific waters. This results in a biomass impoverishment of the well-lit layer and compels the phytoplankton to grow in subsurface. The phytoplankton distribution in the Chukchi Borderland and north Canadian Basin, during the summer of exceptional ice retreat (2008), suggested when compared to in-situ data from a more ice covered year (1994), recent changes with a decrease of the phytoplankton abundance while averaged biomass was similar. The 2008 obtained phytoplankton data in the WA provided a state of the ecosystem which

  14. Open label study to evaluate the efficacy of re-treatment with etanercept in patients with psoriasis.

    Science.gov (United States)

    Abuchar, Adriana; Vitiello, Magalys; Ricotti, Carlos; Grant, Annika; Dehesa, Luis; Kerdel, Francisco

    2012-08-01

    Etanercept has been used to treat chronic plaque psoriasis. Previously reported data demonstrated that some patients experienced secondary failure and frequently rotational-switch therapy is used. The re-treatment with etanercept as part of the rotational therapy could be considered as another safe and efficient therapeutic approach. To evaluate the efficacy of the re-treatment with etanercept in patients with a history of etanercept use with good response and secondary loss of efficacy. This is an open label prospective study involving 20 patients with moderate to severe plaque psoriasis, who had been initially treated with etanercept and were re-treated after a variable interval with 50 mg BIW for 12 weeks. At week 12 of etanercept re-treatment, 13 of 20 patients (65%) achieved a PGA score of 2 or less and 40% (8 of 20), achieved a PGA score of 0 to 1. Etanercept was well tolerated and no serious adverse events were reported. Our study involved a small number of patients. Failure of etanercept was establish by patient's history. However we were able to correlate such failure from our medical records in 17 patients. Re-treatment with etanercept, after secondary loss of efficacy should be considered in patients with psoriasis if satisfactory therapy cannot be achieved with other therapeutic regimens.

  15. Comparison of different retreatment techniques and root canal sealers: a scanning electron microscopic study

    Directory of Open Access Journals (Sweden)

    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.

  16. A team-based approach to qualitative inquiry: the collaborative retreat.

    Science.gov (United States)

    Lordly, Daphne; Maclellan, Debbie; Gingras, Jacqui; Brady, Jennifer

    2012-01-01

    A team of researchers undertook a collaborative qualitative study to explore beginning dietitians' life experiences and the meaning ascribed to those experiences in the context of dietetic practice. Data were collected using Seidman's three-step in-depth phenomenological interviewing method with 12 beginning dietitians who were graduates of the three participating dietetic programs. We outline the collaborative research process and highlight a writing and data analysis technique described as the collaborative retreat, a face-to-face, two-day gathering that facilitated the researchers' collective decision-making and organization, discussion, and analysis of this complex qualitative data set. Use of a listening guide aided researchers' understanding and interpretation of participant voices. Researchers concluded that the overall collaborative qualitative research process was positive and self-fulfilling, and that it resulted in multiple benefits for them individually and the research project collectively. Researchers were able to work through methodological and theoretical issues as these arose, with the assistance of technology, writing, listening, and dialogue. Relationship building and relationship maintenance emerged as factors critical to the success of the research process. Collaborative research teams that are committed to listening, writing, and dialogue will find that the collaborative retreat can be a productive site of knowledge generation and mentorship.

  17. 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.

  18. 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

  19. Re-treatment decisions for failed posterior fillings by Finnish general practitioners.

    Science.gov (United States)

    Heinikainen, Mia; Vehkalahti, Miira; Murtomaa, Heikki

    2002-06-01

    To evaluate treatment decisions of general dental practitioners (GDPs) in the private and public sector in cases of re-treatment of failed posterior fillings. A questionnaire on six cases from 400 GDPs, selected by stratified randomisation by gender, and main occupation (public vs. private sector). Others were all full-time dental teachers (DTs; n=47) representing clinical disciplines other than surgery and orthodontics. Restorative cases were described in detail, including figures drawn on four subcases involving the first permanent upper molar where the filling to be replaced increased in size from occlusal filling to the entire clinical crown. For each case, respondents chose the optimal treatment from eight alternatives, later re-classified as amalgam restoration, direct composite restoration, prosthetic restoration (indirect composite, cast gold inlay/onlay, ceramic inlay/onlay, ceramic crown, or bridge construction following tooth extraction). For re-treatment of the occlusal filling, composite restoration was preferred both by GDPs (92%) and DTs (83%). For three-surface fillings, prosthetic restorations were dominant in the private sector (OR=2.3; 95% CI: 1.4, 3.8; Pamalgam and 2% gold; the rest chose composites. Treatment decisions were similar in public and private sectors for cases with the smallest and largest fillings. Wide variation in cases of medium-sized restorations indicated a lack of generally accepted guidelines of good clinical practice and of evidence-based treatment practice.

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

    Science.gov (United States)

    Cardoso, Miguel Agostinho Beco Pinto; Noites, Rita Brandão; Martins, Miguel André Duarte; Paulo, Manuel Pedro da Fonseca

    2016-05-01

    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.

  1. Endodontic retreatment of a mandibular first molar with five root canal systems: an important clinical lesson.

    Science.gov (United States)

    Hasan, Muhammad; Umer, Fahad

    2014-03-20

    The objective of root canal treatment is to perform complete debridement of the root canals and subsequent obturation to facilitate healing of periapical pathosis. However, this process becomes complicated with the presence of additional root canal systems. The purpose of the present article is to report successful non-surgical retreatment of a mandibular first molar with five canals. This case report discusses the clinical management of a previously root filled mandibular firstmolar with two missed canal systems; distolingual and an additional mesial canal known as the middle mesial canal. The post-treatment radiographs show successful obturation to length in all canals. The middle mesial canal was found to be associated with mesiolingual canal and categorised as confluent. The configuration of canals in the mesial root was type XV, based on the classification given by Sert and Bayirli. This case report highlights the importance of knowledge and its application in the management of abnormal anatomic variants which play a crucial role in the success of endodontic retreatment.

  2. A practitioner's guide to gutta-percha removal during endodontic retreatment.

    Science.gov (United States)

    Virdee, S S; Thomas, M B M

    2017-02-24

    Endodontic retreatment can be a challenging task that can result in many complications if not approached cautiously. Many of these difficulties revolve around regaining access to the pulp chamber through extensive coronal restorations and removing residual root filling material, the commonest being gutta-percha (GP), from within obturated canals. This can often be an untidy, time consuming process that places teeth at a greater risk of iatrogenic injury and inhibits the operator achieving the necessary chemical disinfection required to eliminate the persistent apical disease. Therefore the following article aims to aid practitioners, particularly those who are unfamiliar, with accessing and removing GP from endodontically treated teeth. The outlined systematic approach is accessible in general practice, where the vast majority of endodontic treatment is conducted, requires basic equipment and with the correct experience can be applied to both straight and curved canals. By overcoming this initial stage of retreatment, subsequent chemical disinfection, which is critical to success, can be carried out to a higher standard reducing risks of re-infection.

  3. Missed canal systems are the most likely basis for endodontic retreatment of molars.

    Science.gov (United States)

    Witherspoon, David E; Small, Joel C; Regan, John D

    2013-02-01

    Unfortunately, a small percentage of endodontically treated teeth do not respond favorably to non-surgical root canal treatment. Failure to cate and treat an additional nal system is cited as the principle basis for endodontic retreatment. The aim of this retrospective clinical study was to identify the incidence of additional or missed canal systems in molar retreatment cases in a private practice setting. Missed canals were identified in 64 of the 133 previously treated teeth (48%). Of the total missed canals, 11% involved a maxillary second molar and 44% involved a maxillary first molar. For the maxillary first molars, 93% of all missed canal were identified in the mesiobuccal root. In the mandibular second molars, 29% of missed canals were identified in the distal and 71% were identified in the mesial root. In the mandibular first molars, 86% of missed canals were identified in the distal and 14% were identified in the mesial root. The results of the current study support the findings of previous studies and confirm the importance of locating, instrumenting and obturating the endodontic treatment. Given that failure to locate all canal systems of a tooth contributes significantly to unsuccessful endodontic treatment, all measures available to the clinician to maximize canal identification should be used.

  4. Regenerative Endodontic Treatment as a Retreatment Option for a Tooth with Open Apex - A Case Report.

    Science.gov (United States)

    Miltiadous, Maria-Elpida A; Floratos, Spyros G

    2015-10-01

    Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis.

  5. Orbital, mediastinal, and cervicofacial subcutaneous emphysema after endodontic retreatment of a mandibular premolar: a case report.

    Science.gov (United States)

    An, Gregory K; Zats, Boris; Kunin, Marc

    2014-06-01

    Subcutaneous emphysema (SCE) rarely occurs from endodontic treatment. Most reported cases of iatrogenic SCE occur in the cervicofacial region. Only a few cases have been reported of SCE extending into the mediastinum or orbital spaces. In the present report, we describe a concomitant occurrence of orbital, mediastinal, and cervicofacial SCE immediately after endodontic retreatment. A 33-year-old woman presented to the hospital with acute swelling of the right side of her face and neck. Earlier in the day, she began experiencing rapid swelling while undergoing endodontic retreatment of a mandibular right first premolar by her general dentist. The dentist immediately referred the case to an oral surgeon who then ordered additional tests and radiographic studies at the hospital. From there, the patient received consultation and comprehensive treatment by a multidisciplinary team of medical and dental staff. Physical examination, laboratory tests, and computed tomographic studies confirmed a diagnosis of SCE. Extensive air pockets were detected within the orbital, mediastinum, and cervicofacial spaces. The patient was admitted to the hospital and underwent treatment and observation for massive SCE with likely secondary infection. On the fifth day, she was discharged after showing dramatic improvement. SCE may go undetected or misdiagnosed. Complications may be fatal. Therefore, clinicians should apply preventive measures and know how to identify and manage SCE. We review reports of SCE in the last century, discuss etiology and differential diagnosis, and present recommendations for prevention and management of SCE. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. Southern Ocean warming and Wilkes Land ice sheet retreat during the mid-Miocene.

    Science.gov (United States)

    Sangiorgi, Francesca; Bijl, Peter K; Passchier, Sandra; Salzmann, Ulrich; Schouten, Stefan; McKay, Robert; Cody, Rosemary D; Pross, Jörg; van de Flierdt, Tina; Bohaty, Steven M; Levy, Richard; Williams, Trevor; Escutia, Carlota; Brinkhuis, Henk

    2018-01-22

    Observations and model experiments highlight the importance of ocean heat in forcing ice sheet retreat during the present and geological past, but past ocean temperature data are virtually missing in ice sheet proximal locations. Here we document paleoceanographic conditions and the (in)stability of the Wilkes Land subglacial basin (East Antarctica) during the mid-Miocene (~17-13.4 million years ago) by studying sediment cores from offshore Adélie Coast. Inland retreat of the ice sheet, temperate vegetation, and warm oligotrophic waters characterise the mid-Miocene Climatic Optimum (MCO; 17-14.8 Ma). After the MCO, expansion of a marine-based ice sheet occurs, but remains sensitive to melting upon episodic warm water incursions. Our results suggest that the mid-Miocene latitudinal temperature gradient across the Southern Ocean never resembled that of the present day. We demonstrate that a strong coupling of oceanic climate and Antarctic continental conditions existed and that the East Antarctic subglacial basins were highly sensitive to ocean warming.

  8. [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.

  9. River piracy and drainage basin reorganization led by climate-driven glacier retreat

    Science.gov (United States)

    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.

  10. The future of ice sheets and sea ice: between reversible retreat and unstoppable loss.

    Science.gov (United States)

    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.

  11. 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.

  12. Strategic foresight, leadership, and the future of rural healthcare staffing in the United States.

    Science.gov (United States)

    Reimers-Hild, Connie

    2018-04-10

    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.

  13. 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.

  14. Determinants and effects of nurse staffing intensity and skill mix in residential care/assisted living settings.

    Science.gov (United States)

    Stearns, Sally C; Park, Jeongyoung; Zimmerman, Sheryl; Gruber-Baldini, Ann L; Konrad, Thomas R; Sloane, Philip D

    2007-10-01

    Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes. We obtained longitudinal data for 1,894 residents of 170 residential care/assisted living facilities participating in the Collaborative Studies of Long-Term Care. Descriptive statistics assessed the levels of direct care staff (registered nurse, licensed practical nurse, personal care aide). Regression analyses evaluated the relationship between two staffing measures (intensity measured as care hours per resident and skill mix measured as the percentage of total care hours by licensed nurses), facility characteristics, and four health outcomes (mortality, nursing home transfer, hospitalization, and incident morbidity). Care hours per resident decreased with facility size (economies of scale) only for very small facilities and increased with dementia prevalence (case-mix effect). Licensed staff accounted for a greater proportion of total hours in nonprofit settings. Health outcomes did not vary by total care hours per resident, but hospitalization rates were significantly lower in facilities with higher proportions of skilled staff hours; this effect was stronger as dementia case mix increased. Current staffing levels for the outcomes analyzed meet most residents' needs. Reduced hospitalization in relation to greater use of licensed staff suggests that increased use of these workers might result in reductions in acute care expenditures.

  15. 9 CFR 310.1 - Extent and time of post-mortem inspection; post-mortem inspection staffing standards.

    Science.gov (United States)

    2010-01-01

    ... 288 4 4 2 289 to 316 5 4 2 317 to 343 5 5 2 (3) Swine Inspection. The following inspection staffing standards are applicable to swine slaughter configurations. The inspection standards for all slaughter lines..., liver, heart, lungs, and mediastinal lymph nodes. In addition, for one- and two-inspector lines, the...

  16. 75 FR 69468 - Progressive Furniture, Inc., Including On-Site Leased Workers From Onin Staffing, a Subsidiary of...

    Science.gov (United States)

    2010-11-12

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,756] Progressive Furniture, Inc., Including On-Site Leased Workers From Onin Staffing, a Subsidiary of Sauder Furniture, Claremont, NC; Notice of Affirmative Determination Regarding Application for Reconsideration On July 19, 2010...

  17. 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

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-81,067] Johnson Controls, Inc... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson... subject firm. The company reports that workers leased from AZ Quality were employed on-site at the Hudson...

  18. 77 FR 19719 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, IBM...

    Science.gov (United States)

    2012-04-02

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation... Staffing, Fort Smith, Arkansas. The workers are engaged in the production of refrigerators and trash... trash compactors to Mexico. The amended notice applicable to TA-W-74,593 is hereby issued as follows...

  19. 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...

  20. Design Effects and Generalized Variance Functions for the 1990-91 Schools and Staffing Survey (SASS). Volume I. User's Manual.

    Science.gov (United States)

    Salvucci, Sameena; And Others

    This user's manual summarizes the results and use of design effects and generalized variance functions (GVF) to approximate standard errors for the 1990-91 Schools and Staffing Survey (SASS). It is Volume I of a two-volume publication that is part of the Technical Report series of the National Center for Education Statistics (NCES). The SASS is a…

  1. The Impact of Office Automation on the Roles and Staffing Patterns of Office Employees: A Case Study.

    Science.gov (United States)

    Goodrich, Elizabeth A.

    1989-01-01

    The study examined impact of office automation on the roles and staffing patterns of office employees at the National Institute of Neurological and Communicative Disorders and Stroke. Results of an interview study indicate that automation has had a favorable impact on the way work is accomplished and on the work environment. (Author/CH)

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

    Science.gov (United States)

    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.

  3. 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.

  4. 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...

  5. 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

  6. 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.

  7. Analysis of patients with decompression illness transported via physician-staffed emergency helicopters

    Directory of Open Access Journals (Sweden)

    Yasumasa Oode

    2015-01-01

    Full Text Available Context: There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI. Aims: To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters. Settings and Design: A retrospective medical chart review in a single hospital. Materials and Methods: A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Student′s t-test. Results: A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO 2 , statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%. There were no relationships between an improvement in subjective symptoms and the SpO 2 . Conclusion: Improvements in the subjective symptoms and/or SpO 2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids.

  8. Historical aerial imagery reveals rapid frontal retreat following the 1920’s warming in southeast Greenland

    DEFF Research Database (Denmark)

    Bjørk, Anders Anker; Kjær, Kurt H.; Korsgaard, Niels Jákup

    The Greenland ice sheet (GIS) is undergoing massive changes in its frontal positions, velocity structure, and overall mass balance. Since 2000, marine and terrestrial terminating glaciers in southeast Greenland have experienced dramatic frontal retreat and dynamic thinning in response to increased...... sea surface and air temperatures. However, little is known about the long term glacier history prior to the satellite era. Here we show a unique record of the frontal history of 132 glaciers in southeast Greenland based on historical aerial and satellite imagery from 1933 to 2010. Our results...... demonstrate decadal sensitivity to temperature changes with rapid retreat following the early century warming (1919-1932) and glacial advance during a minor, but profound mid century cooling (1955-1972) succeeded by the present warming again leading to massive retreat. One significant finding lies...

  9. Comparison of Endodontic Retreatment in Teeth Obturated With Resilon or Gutta-Percha: A Review of Literature.

    Science.gov (United States)

    Soares, Ciro; Maia, Conceição; Vale, Fábio; Gadê-Neto, Cícero; Carvalho, Lilian; Oliveira, Hanieri; Carvalho, Rejane

    2015-01-01

    Retreatment of endodontically treated teeth is a challenge that requires complete removal of the previous filling material. Several techniques are indicated for this procedure. The present review tries to identify the most efficient method for extirpation of Resilon (RS) root fillings and to compare the speed and efficacy of RS and gutta-percha (GP) root filling removal. Three trained evaluators conducted a search through three major databases (PubMed, Cochrane Library and Lilacs) over the articles published in the period from 2001 to 2014. The search keywords were Epiphany Sealer, Resilon, Retreatment and Removal Procedure. Twelve articles were included in the final sample (three in vitro studies and nine randomized trials). The ProTaper (manual or rotatory) system in combination with chemical solvents is the most efficient method for removing Resilon root filling. Retreatment of Resilon is more rapid and associated with less remnants of debris.

  10. 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.

  11. A prospective study assessing the effect of coronal tooth structure loss on the outcome of root canal retreatment.

    Science.gov (United States)

    Al-Nuaimi, N; Patel, S; Austin, R S; Mannocci, F

    2017-12-01

    To evaluate the outcome of secondary root canal treatment (retreatment) on posterior teeth in relation to the residual volume of coronal tooth structure, measured with an intraoral scanner, using periapical radiography and cone beam computed tomography (CBCT). A total of 137 posterior teeth in 121 patients were assessed clinically and radiographically using periapical radiographs and CBCT scans at baseline and 1 year after root canal retreatment. The increase or decrease in the size of preoperative periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two pre-calibrated examiners. A clinical impression was obtained for each tooth after completion of root canal retreatment, before the placement of the temporary restoration and following cast restoration placement to produce two casts. All casts were scanned using an intraoral digital scanner and the three-dimensional volume of remaining tooth structure calculated. Teeth were also classified according to the number of remaining coronal walls before core build-up. χ 2 test was used to determine the association between the outcome of root canal retreatments and the volume of remaining coronal tooth structure. At the 1-year recall, teeth retaining less than 30% of their original tooth structure volume had a significantly higher proportion of unfavourable outcomes (χ 2 , P < 0.05, odds ratio [OR], 2.58; 95% CI, 1.026-6.487). The loss of tooth structure volume is an objective parameter that can be used to predict the probability of success of root canal retreatments. At 1-year follow-up, the percentage of unfavourable outcomes of root canal retreated teeth was significantly higher when less than 30% of the original tooth tissue structure was present at baseline. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  12. Penetrability of AH plus and MTA fillapex after endodontic treatment and retreatment: a confocal laser scanning microscopy study.

    Science.gov (United States)

    Kok, Daniela; Rosa, Ricardo Abreu da; Barreto, Mirela Sangoi; Busanello, Fernanda Hoffmann; Santini, Manuela Favarin; Pereira, Jefferson Ricardo; Só, Marcus Vinícius Reis

    2014-06-01

    The aim of the study was to assess the penetrability of two endodontic sealers (AH Plus and MTA Fillapex) into dentinal tubules, submitted to endodontic treatment and subsequently to endodontic retreatment. Thirty ex vivo incisors were prepared using ProTaper rotary system up to F3 instrument and divided in three groups according to the endodontic sealer used for root canal filling: AH Plus (AHP), MTA Fillapex (MTAF), and control group (CG) without using EDTA previously to the root canal filling. Rhodamine B dye (red) was incorporated to the sealers in order to provide the fluorescence which will enable confocal laser scanning microscopy (CLSM) assessment. All specimens were filled with gutta-percha cones using the lateral compaction technique. The specimens were submitted to endodontic retreatment using ProTaper Retreatment system, re-prepared up to F5 instruments and filled with gutta-percha cones and the same sealer used during endodontic retreatment. Fluorescein dye (green) was incorporated to the sealer in order to distinguish from the first filling. The roots were sectioned 2 mm from the apex and assessed by CLSM. No difference was found between the two experimental groups (P > 0.05). On the other hand, in the control group the sealers were not capable to penetrate into dentinal tubules after endodontic treatment (P > 0.05). In retreatment cases, none of the sealers were able to penetrate into dentin tubules. It can be concluded that sealer penetrability is high during endodontic treatment. However, MTA Fillapex and AH Plus do not penetrate into dentinal tubules after endodontic retreatment. © 2014 Wiley Periodicals, Inc.

  13. 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.

  14. The effectiveness of manual and mechanical instrumentation for the retreatment of three different root canal filling materials.

    Science.gov (United States)

    Somma, Francesco; Cammarota, Giuseppe; Plotino, Gianluca; Grande, Nicola M; Pameijer, Cornelis H

    2008-04-01

    The aim of this study was to compare the effectiveness of the Mtwo R (Sweden & Martina, Padova, Italy), ProTaper retreatment files (Dentsply-Maillefer, Ballaigues, Switzerland), and a Hedström manual technique in the removal of three different filling materials (gutta-percha, Resilon [Resilon Research LLC, Madison, CT], and EndoRez [Ultradent Products Inc, South Jordan, UT]) during retreatment. Ninety single-rooted straight premolars were instrumented and randomly divided into 9 groups of 10 teeth each (n = 10) with regards to filling material and instrument used. For all roots, the following data were recorded: procedural errors, time of retreatment, apically extruded material, canal wall cleanliness through optical stereomicroscopy (OSM), and scanning electron microscopy (SEM). A linear regression analysis and three logistic regression analyses were performed to assess the level of significance set at p = 0.05. The results indicated that the overall regression models were statistically significant. The Mtwo R, ProTaper retreatment files, and Resilon filling material had a positive impact in reducing the time for retreatment. Both ProTaper retreatment files and Mtwo R showed a greater extrusion of debris. For both OSM and SEM logistic regression models, the root canal apical third had the greatest impact on the score values. EndoRez filling material resulted in cleaner root canal walls using OSM analysis, whereas Resilon filling material and both engine-driven NiTi rotary techniques resulted in less clean root canal walls according to SEM analysis. In conclusion, all instruments left remnants of filling material and debris on the root canal walls irrespective of the root filling material used. Both the engine-driven NiTi rotary systems proved to be safe and fast devices for the removal of endodontic filling material.

  15. 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.

  16. Evaluation of the bank stability and toe erosion model (BSTEM) for predicting lateral retreat on composite streambanks

    Science.gov (United States)

    Midgley, Taber L.; Fox, Garey A.; Heeren, Derek M.

    2012-04-01

    Streambank erosion is known to be a major source of sediment in streams and rivers. The Bank Stability and Toe Erosion Model (BSTEM) was developed in order to predict streambank retreat due to both fluvial erosion and geotechnical failure. However, few, if any, model evaluations using long-term streambank retreat data have been performed. The objectives of this research were to (1) monitor long-term composite streambank retreat during a hydraulically active period on a rapidly migrating stream, (2) evaluate BSTEM's ability to predict the measured streambank retreat, and (3) assess the importance of accurate geotechnical, fluvial erosion, and near-bank pore-water pressure properties. The Barren Fork Creek in northeastern Oklahoma laterally eroded 7.8 to 20.9 m along a 100-m length of stream between April and October 2009 based on regular bank location surveys. The most significant lateral retreat occurred in mid- to late-May and September due to a series of storm events, and not necessarily the most extreme events observed during the monitoring period. BSTEM (version 5.2) was not originally programmed to run multiple hydrographs iteratively, so a subroutine was written that automatically input the temporal sequence of stream stage and to lag the water table in the near-bank ground water depending on user settings. Eight BSTEM simulations of the Barren Fork Creek streambank were performed using combinations of the following input data: with and without a water table lag; default BSTEM geotechnical parameters (moderate silt loam) versus laboratory measured geotechnical parameters based on direct shear tests on saturated soil samples; and default BSTEM fluvial erosion parameters versus field measured fluvial erosion parameters from submerged jet tests. Using default BSTEM input values underestimated the actual erosion that occurred. Lagging the water table predicted more geotechnical failures resulting in greater streambank retreat. Using measured fluvial and

  17. Modeling the rate and style of Arctic coastal retreat along the Beaufort Sea, Alaska

    Science.gov (United States)

    Barnhart, K. R.; Anderson, R. S.; Overeem, I.; Wobus, C. W.; Clow, G. D.; Urban, F. E.; Stanton, T. P.

    2010-12-01

    In Arctic landscapes, modern surface warming has significantly altered geomorphic process rates. Along the Beaufort Sea coastline bounding Alaska’s North Slope, the mean annual coastal erosion rate has doubled from ~7 m/yr for 1955-1979 to ~14 m/yr for 2002-2007 (Mars and Houseknecht, 2007). Locally the erosion rate can reach 30 m/yr, with short-term rates that are far greater than this. A robust understanding of the processes that govern the rate of coastal erosion is required in order to predict the response of the coast and its adjacent landscape to a rapidly changing climate, with implications for sediment and carbon fluxes, oilfield infrastructure, and animal habitat. Constrained by time-lapse imagery, and by measurements of both the oceanic and atmospheric conditions, we have developed a numerical model to capture the evolution of the permafrost bluffs on the North Slope. During the sea ice-free season, relatively warm waters melt a notch into the ice-rich silt that comprises the 4-m tall bluffs. The bluffs ultimately fail by toppling of polygonal blocks bounded by mechanically weak ice-wedges that are spaced roughly 10-20 m apart. The toppled blocks then temporarily armor the coast against further attack. The annual retreat rate is controlled by the length of the sea ice-free season, water and air temperatures, and the wave history. Honoring the high ice content of the bluff materials, we employ a positive degree day algorithm to govern subaerial melt, and an iceberg melting algorithm to determine rate of notch incision. In the iceberg melting algorithm, the local instantaneous melt rate goes as the product of the temperature difference between seawater and bluff material, the sea state, captured by the ratio of wave height to wave period, and the ratio of ice surface roughness to wave height to the 0.2 power (Kubat et al., 2007). The calculated instantaneous melt rate is adjusted to account for the ambient temperature of the permafrost and the presence of

  18. The Timing of Arctic Sea Ice Advance and Retreat as an Indicator of Ice-Dependent Marine Mammal Habitat

    Science.gov (United States)

    Stern, H. L.; Laidre, K. L.

    2013-12-01

    The Arctic is widely recognized as the front line of climate change. Arctic air temperature is rising at twice the global average rate, and the sea-ice cover is shrinking and thinning, with total disappearance of summer sea ice projected to occur in a matter of decades. Arctic marine mammals such as polar bears, seals, walruses, belugas, narwhals, and bowhead whales depend on the sea-ice cover as an integral part of their existence. While the downward trend in sea-ice extent in a given month is an often-used metric for quantifying physical changes in the ice cover, it is not the most relevant measure for characterizing changes in the sea-ice habitat of marine mammals. Species that depend on sea ice are behaviorally tied to the annual retreat of sea ice in the spring and advance in the fall. Changes in the timing of the spring retreat and the fall advance are more relevant to Arctic marine species than changes in the areal sea-ice coverage in a particular month of the year. Many ecologically important regions of the Arctic are essentially ice-covered in winter and ice-free in summer, and will probably remain so for a long time into the future. But the dates of sea-ice retreat in spring and advance in fall are key indicators of climate change for ice-dependent marine mammals. We use daily sea-ice concentration data derived from satellite passive microwave sensors to calculate the dates of sea-ice retreat in spring and advance in fall in 12 regions of the Arctic for each year from 1979 through 2013. The regions include the peripheral seas around the Arctic Ocean (Beaufort, Chukchi, East Siberian, Laptev, Kara, Barents), the Canadian Arctic Archipelago, and the marginal seas (Okhotsk, Bering, East Greenland, Baffin Bay, Hudson Bay). We find that in 11 of the 12 regions (all except the Bering Sea), sea ice is retreating earlier in spring and advancing later in fall. Rates of spring retreat range from -5 to -8 days/decade, and rates of fall advance range from +5 to +9

  19. The Effect of Four Years of Participation in a Tibetan Buddhist Retreat on Perceptions of Physiological and Psychological Well-Being.

    Science.gov (United States)

    MacLachlan, Malcom; McAuliffe, Eilish; Page, Richard C.; Altschul, Deborah B.; Tabony, Rebecca

    1999-01-01

    Assesses the effect of participation in a Tibetan retreat at a center in Scotland over a four-year period using the General Health Questionnaire-60 and the Perceived Stress Scale. Residence at the retreat center did not show any harmful or beneficial effects on the participants' levels of stress and general health as measured by these scales.…

  20. 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.

  1. Disease Activity-Guided Rituximab Therapy in Rheumatoid Arthritis The Effects of Re-Treatment in Initial Nonresponders Versus Initial Responders

    NARCIS (Netherlands)

    Thurlings, Rogier M.; Vos, Koen; Gerlag, Daniëlle M.; Tak, Paul P.

    2008-01-01

    Objective. To explore the efficacy of re-treatment with rituximab in patients with rheumatoid arthritis (RA) who were initial nonresponders to treatment, and to evaluate the effects of rituximab in RA when re-treatment is given in a standardized way based on the Disease Activity Score in 28 joints

  2. Predicting Land-Ice Retreat and Sea-Level Rise with the Community Earth System Model

    Energy Technology Data Exchange (ETDEWEB)

    Lipscomb, William [Los Alamos National Laboratory

    2012-06-19

    Coastal stakeholders need defensible predictions of 21st century sea-level rise (SLR). IPCC assessments suggest 21st century SLR of {approx}0.5 m under aggressive emission scenarios. Semi-empirical models project SLR of {approx}1 m or more by 2100. Although some sea-level contributions are fairly well constrained by models, others are highly uncertain. Recent studies suggest a potential large contribution ({approx}0.5 m/century) from the marine-based West Antarctic Ice Sheet, linked to changes in Southern Ocean wind stress. To assess the likelihood of fast retreat of marine ice sheets, we need coupled ice-sheet/ocean models that do not yet exist (but are well under way). CESM is uniquely positioned to provide integrated, physics based sea-level predictions.

  3. Impacts of Aerosols on the Retreat of the Sierra Nevada Glaciers in California

    Science.gov (United States)

    El-Askary, H. M.; Li, J.; Ta, T. N.; Jong, A.; Zhang, X.

    2015-12-01

    Natural dust aerosol is an active component of the climate system and plays multiple roles in physical climate and bio-geo-chemical exchanges between the atmosphere, land surface and ocean. Aerosol deposition on snow is amongst the different causes of glacier retreat around the world as well as the reduction of snow albedo. We have observed a long range transport of dust and pollution aerosols from China to the U.S. In this paper we compared summer and winter seasons glacier changes between 2000 and 2013, and how the dust aerosol change over this 13 years. Multiple images, acquired from Landsat-5 TM, Landsat-7 ETM+ and Landsat-8 OLI were used in the study. The change detection analysis was employed to identify the glacier changes for two seasons. The results suggest that the glacier decreased dramatically over 13 years in both seasons.

  4. Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report.

    Science.gov (United States)

    Al-Tammami, Musaed Fahad; Al-Nazhan, Saad A

    2017-02-01

    A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

  5. Advance, Retreat, and Halt of Abrupt Gravel-Sand Transitions in Alluvial Rivers

    Science.gov (United States)

    Blom, Astrid; Chavarrías, Víctor; Ferguson, Robert I.; Viparelli, Enrica

    2017-10-01

    Downstream fining of bed sediment in alluvial rivers is usually gradual, but often an abrupt decrease in characteristic grain size occurs from about 10 to 1 mm, i.e., a gravel-sand transition (GST) or gravel front. Here we present an analytical model of GST migration that explicitly accounts for gravel and sand transport and deposition in the gravel reach, sea level change, subsidence, and delta progradation. The model shows that even a limited gravel supply to a sand bed reach induces progradation of a gravel wedge and predicts the circumstances required for the gravel front to advance, retreat, and halt. Predicted modern GST migration rates agree well with measured data at Allt Dubhaig and the Fraser River, and the model qualitatively captures the behavior of other documented gravel fronts. The analysis shows that sea level change, subsidence, and delta progradation have a significant impact on the GST position in lowland rivers.

  6. Late Proterozoic and Paleozoic Tides, Retreat of the Moon, and Rotation of the Earth

    Science.gov (United States)

    Sonett; Kvale; Zakharian; Chan; Demko

    1996-07-05

    The tidal rhythmites in the Proterozoic Big Cottonwood Formation (Utah, United States), the Neoproterozoic Elatina Formation of the Flinders Range (southern Australia), and the Lower Pennsylvanian Pottsville Formation (Alabama, United States) and Mansfield Formation (Indiana, United States) indicate that the rate of retreat of the lunar orbit is dxi/dt approximately k2 sin(2delta) (where xi is the Earth-moon radius vector, k2 is the tidal Love number, and delta is the tidal lag angle) and that this rate has been approximately constant since the late Precambrian. When the contribution to tidal friction from the sun is taken into account, these data imply that the length of the terrestrial day 900 million years ago was approximately18 hours.

  7. Attempts to retreat from a dead-ended long capillary by backward swimming in Paramecium

    Directory of Open Access Journals (Sweden)

    Itsuki eKunita

    2014-06-01

    Full Text Available We have observed how the ciliate Paramecium attempts to retreat from the dead-end of a long capillary that is too narrow for turning. After many trial-and-error episodes of short-term backward swimming (SBS, which is the conventional avoidance behavior exhibited in free swimming when an obstacle is faced, long-term backward swimming (LBS that lasted five to ten times longer was developed. LBS may have a beneficial effect for complete withdrawal from the capillary space, although in our experiment it was impossible for the organism to do so due to the capillary length. In order to identify a physically possible mechanism for LBS, we propose model equations for the membrane potential of Hodgkin-Huxley type, which describe the control of ciliary movement. The physiological implications and physical mechanism of the development of LBS are discussed.

  8. Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report

    Directory of Open Access Journals (Sweden)

    Musaed Fahad Al-Tammami

    2017-02-01

    Full Text Available A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

  9. The Role of Regional Conferences in Research Resident Career Development: The California Psychiatry Research Resident Retreat.

    Science.gov (United States)

    Besterman, Aaron D; Williams, Jody K; Reus, Victor I; Pato, Michele T; Voglmaier, Susan M; Mathews, Carol A

    2017-04-01

    For psychiatry research resident career development, there is a recognized need for improved cross-institutional mentoring and networking opportunities. One method to address this need is via regional conferences, open to current and recently graduated research residents and their mentors. With this in mind, we developed the biennial California Psychiatry Research Resident Retreat (CPRRR) and collected feedback from participants to 1) Assess resident satisfaction, 2) Determine the utility of the retreat as a networking and mentorship tool, and 3) Identify areas for improvement. We gathered survey data from resident attendees at the two first CPRRRs. We analyzed the data to look for trends in satisfaction as well as areas that need improvement. Thirty-two residents from five California training programs attended the CPRRR in 2013 while 33 attended from six programs in 2015. The residents were from all years of training, but concentrated in their second and third years. Approximately 41% and 49% of the attendees were female and 53% and 39% had an MD/PhD in 2013 and 2015, respectively. Twenty-four and 32 residents provided anonymous feedback in 2013 and 2015, respectively. Mean feedback scores were very high (> 4/5) for overall satisfaction, peer- and faculty-networking, the keynote speaker and the flash talks for both years. Mean feedback scores for the ethics debates and mentoring sessions were somewhat lower (≤ 4/5), however, both showed significant improvement from 2013 to 2015. The CPRRRs appear to be an effective mechanism for providing psychiatry research residents with a meaningful cross-institutional opportunity for networking and mentorship. Feedback-driven changes to the CPRRRs improved participant satisfaction for several components of the conference. Future efforts will be aimed at broadening mentorship and networking opportunities, optimizing teaching approaches for research ethics, and considering different feedback-gathering approaches to allow for

  10. Confocal microscopy assessment of filling material remaining on root canal walls after retreatment.

    Science.gov (United States)

    Rached-Júnior, F A; Sousa-Neto, M D; Bruniera, J F B; Duarte, M A H; Silva-Sousa, Y T C

    2014-03-01

    The percentage of Endofill remaining on canal walls after retreatment with different techniques was evaluated using confocal microscopy and qualitative analysis of the interface between the filling material/dentine. Sixty-four root canals of incisors were prepared with ProTaper, filled with gutta-percha and Endofill mixed with 0.1% rhodamine B. The roots were thermocycled and distributed into groups according to the method of evaluation: GI - direct viewing (DV) and GII - operating microscope (OM) and according to the removal technique: A) ProTaper retreatment (PR), B) PR/xylol, C) ultrasound and D) ultrasound/xylol. The root canals were then refilled with gutta-percha and AH Plus with 0.1% fluorescein and sectioned at 2, 4 and 6 mm from the apex. The percentage of remaining Endofill was analysed by confocal microscopy. Additionally, 16 roots were prepared with a ProTaper F5 instrument and were filled with Endofill + 0.1% rhodamine B/gutta-percha (negative control group) (n = 8), and the positive control group (n = 8) were filled with AH Plus with 0.1% fluorescein/gutta-percha. Three-way anova demonstrated differences in the method of evaluation, removal techniques and their interaction (P  0.05). Qualitative analysis detected that ultrasound had lower remaining Endofill than PR, particularly when combined with xylol. Operating microscope resulted in lower residual sealer, regardless of the removal technique. None of the protocols was associated with complete removal of the filling material; however, the use of ultrasound/xylol under an OM provided better results. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  11. Quantification of Lipoteichoic Acid Contents and Cultivable Bacteria at the Different Phases of the Endodontic Retreatment.

    Science.gov (United States)

    Barbosa-Ribeiro, Marlos; De-Jesus-Soares, Adriana; Zaia, Alexandre A; Ferraz, Caio C R; Almeida, José F A; Gomes, Brenda P F A

    2016-04-01

    The infectious content of root canals, including bacteria and lipoteichoic acid (LTA), cause injuries to the periapical tissues. The purpose of this clinical study was to quantify the levels of both LTA and cultivable bacteria at the different phases of endodontic retreatment (ER) of teeth with post-treatment apical periodontitis. It also aimed to investigate the presence of gram-positive microorganisms before and after chemomechanical preparation (CMP) and intracanal medication (ICM). Twenty infected root canals of single-rooted teeth were randomly assigned into 2 groups according to the chemical substance used for CMP (n = 10 per group): chlorhexidine (CHX) group, 2% CHX gel, and the sodium hypochlorite (NaOCl) group, 6% NaOCl. Root canal samples were taken using paper points before (S1) and after CMP (S2) and after 30 days of ICM with calcium hydroxide + 2% CHX gel (S3). Microorganisms were identified by the culture technique using biochemical tests. Cultivable bacteria were determined by counting the colony-forming unit. LTA levels were measured using the enzyme-linked immunosorbent assay (pg/mL). A total of 70 gram-positive species, out of 102 species isolated, were found in the root canals (54 in S1, 4 in S2, and 12 in S3). Enterococcus faecalis was the most frequent isolated taxon in all phases of the ER. LTA (574.0 ± 94.7) and cultivable bacteria (101.2 ± 79.2) were present in all S1 samples. CMP decreased the overall levels of cultivable bacteria by 99.4% and LTA by 24.8% (P bacteria was 99.5% and on LTA it was 38.6% (P .05). The reduction rates of bacteria were higher than the LTA. Moreover, gram-positive microorganisms were present in all phases of the endodontic retreatment. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. Alcon CustomCornea wavefront-guided retreatments after laser in situ keratomileusis.

    Science.gov (United States)

    Chalita, Maria Regina; Xu, Meng; Krueger, Ronald R

    2004-01-01

    To evaluate the outcome of wavefront-guided ablations for the correction of residual myopia and astigmatism after standard laser in situ keratomileusis (LASIK). Twenty nine eyes of 26 patients who underwent wavefront-guided LASIK retreatment with Alcon CustomCornea (Alcon Laboratories Inc, Fort Worth, Tex) were evaluated. Complete ophthalmologic examination, corneal topography, and wavefront measurements were performed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and wavefront analysis were evaluated preoperatively, 1 week, 3 months, and 6 months after surgery. Wavefront measurements were assessed using the LADARWave device. Statistical analysis was performed using the McNemar test and percentages of success. One week postoperatively, UCVA was > or =20/40 in 100% of eyes (> or =20/20 in 31%) and BSCVA was > or =20/40 in 100% (> or =20/20 in 73%). Wavefront analysis showed a decrease in total aberrations, high order aberrations, defocus, coma, spherical aberration, and other terms of higher order aberrations at 1-week follow-up. Three months postoperatively, UCVA was > or =20/40 in 100% of eyes (> or =20/20 in 38%) and BSCVA was > or =20/40 in 100% (> or =20/20 in 81%). Six months postoperatively, UCVA was > or =20/40 in 100% of eyes (> or =20/20 in 60%) and BSCVA was > or =20/40 in 100% (> or =20/20 in 90%). Wavefront analysis showed decrease in total aberration, high order aberration, defocus, coma, and spherical aberration. Wavefront-guided LASIK retreatment in post-LASIK eyes represents a good option for laser vision correction. All eyes showed reduction in pre-existing total aberrations. Some high order aberration components decreased in this initial series. Further follow-up is necessary to assess the initial predictability of wavefront-guided LASIK upgrade.

  13. Corneal wavefront-guided LASIK retreatments for correction of highly aberrated corneas following refractive surgery.

    Science.gov (United States)

    Alió, Jorge; Galal, Ahmed; Montalbán, Raúl; Piñero, David

    2007-10-01

    To investigate the safety and efficacy of customized corneal wavefront-guided retreatment in symptomatic patients with highly aberrated corneas following LASIK. This prospective study included 75 eyes of 59 patients with significant visual symptoms who underwent LASIK for the correction of residual refractive error. Ablation profiles were calculated using CSO corneal topography and ESIRIS/Schwind laser platform. Eyes were divided into two groups: those with significant night vision symptoms (37 eyes; night symptoms group) and those with decentration, irregular ablation profile, and flap complications (38 eyes; corneal complications group). Corneal topography and aberrations, visual acuity, point spread function (PSF), refractive outcome, and subjective symptoms were evaluated preoperatively, and 1, 3, and 6 months postoperatively. Mean uncorrected visual acuity was 20/32 preoperatively and 20/25 at 6 months postoperatively in the night symptoms group and 20/40 preoperatively and 20/30 at 6 months postoperatively in the corneal complications group. Mean best spectacle-corrected visual acuity was 20/25 both preoperatively and 6 months postoperatively in both groups (t test, P = .219 and P = .149 for the night symptoms and corneal complications groups, respectively). Safety index was 1.1 in both groups, and efficacy index was 0.93 and 0.92, respectively. Statistically significant improvement of total corneal higher order aberrations, tilt, and improvement of spherical aberrations and coma were observed, with corresponding improvement of PSF. Corneal wavefront-guided LASIK retreatment with CSO topography, ORK-W software, and ESIRIS/Schwind laser platform is safe and effective for treating symptomatic patients affected by corneal higher order aberrations or corneal irregularities following LASIK surgery.

  14. Biomechanical Weakening of Different Re-treatment Options After Small Incision Lenticule Extraction (SMILE).

    Science.gov (United States)

    Kling, Sabine; Spiru, Bogdan; Hafezi, Farhad; Sekundo, Walter

    2017-03-01

    To determine the corneal weakening induced by different re-treatment options after small incision lenticule extraction (SMILE) and investigate the potential of corneal cross-linking (CXL) to reestablish the original corneal stress resistance. A total of 96 freshly enucleated porcine corneas were used. The initial refractive correction was defined to be -11.00 diopters (D) and the required enhancement to be -3.00 D. Three different re-treatment options were analyzed: -3D Re-SMILE, -3D photorefractive keratectomy (PRK) on top of the SMILE cap, and cap-to-flap conversion and -3D excimer ablation on the stromal bed (LASIK). The control condition did not receive any treatment. Subsequently, accelerated CXL (9 mW/cm 2 , 10 min) was performed in two groups with currently common enhancement techniques: following cap-to-flap conversion (-3D LASIK enhancement) and in controls. Biomechanical properties were measured with stress-strain extensometry ranging from 1.27 to 12.5 N. The Re-SMILE and PRK enhancement did not significantly reduce the overall elastic modulus of the cornea compared to controls (24.7 ± 2.23 and 22.7 ± 2.61 versus 23.8 ± 3.35 MPa, P ≥ .176), whereas LASIK enhancement did (22.2 ± 3.37 MPa, P = .048). CXL treatment significantly increased the elastic modulus compared to all non-cross-linked conditions (P ≤.001). Refractive surgery decreased the overall elastic modulus by 7%, whereas CXL increased it by 20%. In enhancement, the corneal biomechanical integrity is less affected with both Re-SMILE and PRK enhancement. Corneal weakening through laser refractive surgery is small compared to the stiffening effect after CXL. [J Refract Surg. 2017;33(3):193-198.]. Copyright 2017, SLACK Incorporated.

  15. Origin of oroclines in Paleozoic Australia: the role of inherited plate boundary irregularities and trench retreat

    Science.gov (United States)

    Rosenbaum, G.; Shaanan, U.; Hoy, D.; Abdullah, R.

    2015-12-01

    Paleozoic Australia is made of a series of orogenic belts that include the Delamerian, Lachlan and New England orogens, as well as the poorly defined Thomson Orogen. The origin of these belts has been attributed to subduction and accretionary processes along the ~N-S-striking (present coordinates) plate boundary of Gondwana. However, recent studies show that orogenic segments are strongly contorted, thus raising questions about the geodynamic origin of eastern Australia and Paleozoic plate tectonics in general. Results from the New England Orogen revealed that oroclinal bending has occurred simultaneously with basin formation and trench retreat. Geochronological provenance studies of detrital zircon show that these basins were situated in a back-arc position, indicating that back-arc extension may have played a crucial role in oroclinal bending. In addition, geochronological data of detrital zircon show that terranes that were once considered to be exotic were actually derived from local sources. The collective geological evidence suggests that deformation and oroclinal bending were driven by subduction-related processes possibly acting on inherited irregularities in the orientation of the plate boundary. The irregular geometries were further accentuated by trench migration (retreat and advance) that led to subduction segmentation, oroclinal bending, and alternating episodes of contraction and (back-arc) extension. In search of inherited plate boundary irregularities in Paleozoic Australia, we have studied the ~E-W boundary between the Lachlan and Thomson orogens. This lithospheric-scale boundary may reflect the original geometry of the plate boundary, which might have accommodated hundreds of km of dextral offset. This boundary may be part a much larger orogenic curvature, hitherto not recognised, and the development of which may have played a fundamental role in the formation of the smaller-scale oroclines in the Lachlan and New England orogens.

  16. "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.

  17. 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

  18. 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

  19. 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

  20. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. 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

  4. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

    Science.gov (United States)

    Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter

    2014-05-24

    Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared

  5. 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.

    Directory of Open Access Journals (Sweden)

    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

  6. Clinical and Patient-centered Outcomes of Nonsurgical Root Canal Retreatment in First Molars Using Contemporary Techniques.

    Science.gov (United States)

    He, Jianing; White, Robert K; White, Cathy A; Schweitzer, Jordan L; Woodmansey, Karl F

    2017-02-01

    There have been many recent technical advances in modern endodontics that have the potential to affect treatment outcomes. Reports on treatment outcomes using contemporary techniques are relatively scarce, especially in the field of nonsurgical retreatment. The purpose of this study was to determine the success of nonsurgical root canal retreatment in molars using contemporary endodontic techniques. Sixty-three patients referred for retreatment in first molars were enrolled in the study. The retreatment procedures were performed by endodontic residents using a semistandardized treatment protocol. Patients were followed-up at 6, 12, and 24 months. Treatment outcomes were categorized into healed, healing, or nonhealing based on clinical and radiographic criteria. Healed and healing were considered as successes, and nonhealing was considered a failure. Outcomes were also evaluated using patient-centered criteria that included oral health-related quality of life scores and subjective chewing ability. Fifty-two of the 63 patients were available for final analysis. Five cases (9.6%) were determined to be nonhealing at the last follow-up with new or persistent periapical lesions. Thirty-seven (71.2%) patients had complete resolution of apical periodontitis, and the remaining 10 (19.2%) remained asymptomatic and showed radiographic evidence of healing. Oral health-related quality of life scores and chewing ability improved significantly over time (P endodontic retreatment using contemporary techniques significantly improved patients' quality of life and chewing ability over time, with a success rate of 90.4% after 2 years. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. 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

  8. Customer Perception of a Supermarket Nutrition Centre Staffed by a Registered Dietitian.

    Science.gov (United States)

    Evans, KATE; Taper, JANETTE; Quintal, DEBORAH

    2000-01-01

    The purpose of this study was to examine consumers' attitudes toward a supermarket nutrition centre staffed full time by a registered dietitian. A questionnaire was administered over three consecutive days in that store and in a control store that was similar to the experimental site in every way, except for the absence of a nutrition centre. Participants were chosen randomly at timed intervals in specific areas of the store. Of 428 customers approached, 232 agreed to participate in the survey. At the experimental site, 75% of the participants were extremely satisfied with the registered dietitian's services and 69% ranked having a registered dietitian on staff in any store as extremely important, compared to 31% at the control site (p importance of 13 required and optional services offered by the supermarkets, 15% of participants at the experimental site ranked having a registered dietitian on staff in the top five, compared with 4% at the control site (p service. There may therefore be an expanded role for registered dietitians in the supermarket setting.

  9. Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries?

    Science.gov (United States)

    Mark, Barbara A; Hughes, Linda C; Belyea, Michael; Chang, Yunkyung; Hofmann, David; Jones, Cheryl B; Bacon, Cynthia T

    2007-01-01

    Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.

  10. The Nuclear Education and Staffing Challenge: Rebuilding Critical Skills in Nuclear Science and Technology

    International Nuclear Information System (INIS)

    Wogman, Ned A.; Bond, Leonard J.; Waltar, Alan E.; Leber, R E.

    2005-01-01

    The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory where 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of Nuclear Legacies, Global Security, Nonproliferation, Homeland Security and National Defense, Radiobiology and Nuclear Energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. This paper presents the current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs

  11. Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

    Science.gov (United States)

    Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto

    2016-01-01

    Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

  12. The Nuclear Education and Staffing Challenge: Rebuilding Critical Skills in Nuclear Science and Technology

    International Nuclear Information System (INIS)

    Wogman, Ned A.; Bond, Leonard J.; Waltar, Alan E.; Leber, R E.

    2005-01-01

    The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory were 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of Nuclear Legacies, Global Security, Nonproliferation, Homeland Security and National Defense, Radiobiology and Nuclear Energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. This paper presents the current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs

  13. The nuclear education and staffing challenge: Rebuilding critical skills in nuclear science and technology

    International Nuclear Information System (INIS)

    Wogman, N.A.; Bond, L.J.; Waltar, A.E.; Leber, R.E.

    2005-01-01

    The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory where 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of nuclear legacies, global security, nonproliferation, homeland security and national defense, radiobiology and nuclear energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. Current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs are presented. (author)

  14. Analysis of patients with bodyboarding injuries transported by physician-staffed emergency helicopter

    Directory of Open Access Journals (Sweden)

    Kazuhiko Omori

    2015-01-01

    Full Text Available Context: There have been no reports that have studied the characteristics specific to bodyboard injuries. Aims: To clarify characteristics to bodyboard injuries. Settings and Design: A retrospective medical chart review. Materials and Methods: A medical chart review was retrospectively performed for all patients with spinal cord injuries transported via physician-staffed emergency helicopters between January 2009 and October 2013. The subjects were divided into two groups based on whether they had a spinal cord injury induced by bodyboarding (Bodyboard group, n = 14 or not (Control group, n = 14. Statistical Analysis Used: Using a χ2 -test, Mann-Whitney U-test and non-paired Student′s t-test. Results: All but one of the subjects had spinal canal stenosis. The age of the patients in the Bodyboard group was younger than that of the Control group. The ratio of males and Glasgow Coma Scale of the Bodyboard group were higher than those on the Control group. The spinal cord injury induced by bodyboarding typically occurred after impacts of the head or face with the sea bottom while the subject was being buffeted by the waves. The severity of the spinal cord injury in the Bodyboard group was lower than that in the Control group. Conclusion: Bodyboarding tended to induce spinal cord injuries after the head or face collided with the sea bottom, and was more common in middle-aged males during the summer season, and was associated with a favorable outcome.

  15. PROBLEMS OF TRANSPORT COMPLEX STAFFING OF UKRAINIAN SSR IN 1960-1980

    Directory of Open Access Journals (Sweden)

    Anatoliy Gorban

    2016-11-01

    Full Text Available In the article the staffing problems of transport complex in the period of its fundamental technical change and intensive development of 1960–1980-ies are described. The main purpose of this article is to analyze the peculiarities of personnel potential development of transport complex of the Ukrainian SSR in the years of the intensive development of transport sectors, figure out the social component of the measures to improve the efficiency of transport networks. Methodology. In this article we used the method of analysis. The qualitative personnel structure, training of skilled workers in the educational institutions and other forms of improvement of personal skills of transport workers are analyzed. The causes of staff turnover and low labour discipline are studied. Practical implementation. This article shows the possible opportunities for the modern transport complex of Ukraine, how to be successful and competitive in the market. The historical background of this article can be very useful for present managers of the transport complex. Results. The author makes a general conclusion that the main causes of personnel fluctuation in transport brunches are low wages, pour conditions of work and lack of accomodations for the staff. The social and practical measures to improve effectiveness of work with personnel of all brunches of transport system are characterized.

  16. Ant colony optimization and event-based dynamic task scheduling and staffing for software projects

    Science.gov (United States)

    Ellappan, Vijayan; Ashwini, J.

    2017-11-01

    In programming change organizations from medium to inconceivable scale broadens, the issue of wander orchestrating is amazingly unusual and testing undertaking despite considering it a manual system. Programming wander-organizing requirements to deal with the issue of undertaking arranging and in addition the issue of human resource portion (also called staffing) in light of the way that most of the advantages in programming ventures are individuals. We propose a machine learning approach with finds respond in due order regarding booking by taking in the present arranging courses of action and an event based scheduler revives the endeavour arranging system moulded by the learning computation in perspective of the conformity in event like the begin with the Ander, the instant at what time possessions be free starting to ended errands, and the time when delegates stick together otherwise depart the wander inside the item change plan. The route toward invigorating the timetable structure by the even based scheduler makes the arranging method dynamic. It uses structure components to exhibit the interrelated surges of endeavours, slip-ups and singular all through different progression organizes and is adjusted to mechanical data. It increases past programming wander movement ask about by taking a gander at a survey based process with a one of a kind model, organizing it with the data based system for peril assessment and cost estimation, and using a choice showing stage.

  17. 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…

  18. Evaluation of Horizon Multimedia Learning Materials for Students with Learning Difficulties and Disabilities.

    Science.gov (United States)

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

    This paper describes the different methods used to evaluate individually configurable multimedia materials developed for the Horizon project, a program designed to increase employment opportunities for students with disabilities or learning difficulties. The project established a working cafe/restaurant in East London staffed by the students. Part…

  19. 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.

  20. 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.

  1. 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

  2. Endodontic retreatment vs dental implants of teeth with an uncertain endodontic prognosis: 1-year results from a randomised controlled trial.

    Science.gov (United States)

    Esposito, Marco; Tallarico, Marco; Trullenque-Eriksson, Anna; Gianserra, Rodolfo

    To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown. Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigators, were randomly allocated to endodontic retreatment (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 20 patients) according to a parallel group design at two different centres. Patients were followed to 1 year after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink esthetic score (PES) for the soft tissues and the white esthetic score (WES) for the tooth/crown recorded by independent assessors. No patient dropped out and no complications occurred during the entire follow-up; however, one endodontically retreated tooth (5%) and one implant (5%) fractured, the difference for treatment failures being not statistically significant (difference in proportions = 0; 95% CI -0.14 to 0.14; P Fisher's exact test) = 1.000). The mean marginal bone levels at endo retreatment/implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group, which was statistically significantly different (mean difference = 2.11 mm; 95% CI: 1.68 to 2.55; P (t-test) endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening. Two of the

  3. Scanning electron microscopy with energy dispersive X-ray spectrophotometry analysis of reciprocating and continuous rotary nickel-titanium instruments following root canal retreatment.

    Science.gov (United States)

    Kalyoncuoğlu, Elif; Keskin, Cangül; Uzun, İsmail; Bengü, Aydın S; Guler, Buğra

    2016-01-01

    This study aimed to evaluate superficial defects and the composition of Reciproc R25 and ProTaper Retreatment file systems (Dentsply Maillefer, Ballaigues, Switzerland) used for retreatment. A total of 100 maxillary incisor teeth were randomly divided into the following two groups: Reciproc R25 (n = 25) and ProTaper Retreatment instrument (n = 75) groups. The nickel-titanium (Ni-Ti) compositions of the files before and after use were analyzed using energy dispersive X-ray spectrophotometry (EDX). Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze the data. ProTaper Retreatment instrument group showed a significantly higher number of defects than the Reciproc group (P < 0.05). No instrument fracture was detected. The presence of debris was observed in both groups before use, although the level was significantly higher in the ProTaper Retreatment group, which consisted of metals (P < 0.05). There was no significant difference between new and used instruments with regard to Ni-Ti composition (P < 0.05). EDX analysis showed that both the Reciproc and ProTaper Retreatment instruments had a Ni-Ti composition that was within the standards specified by the American Society of Testing and Materials. This study confirmed the use of both the Reciproc R25 file and ProTaper Retreatment file system for root canal filling removal in straight root canals as a safe procedure. (J Oral Sci 58, 401-406, 2016).

  4. Late Burdigalian sea retreat from the North Alpine Foreland Basin: new magnetostratigraphic age constraints

    Science.gov (United States)

    Sant, K.; Kirscher, U.; Reichenbacher, B.; Pippèrr, M.; Jung, D.; Doppler, G.; Krijgsman, W.

    2017-05-01

    Accurate reconstruction of the final sea retreat from the North Alpine Foreland Basin (NAFB) during the Burdigalian (Early Miocene) is hampered by a lack of reliable age constraints. In this high resolution magnetostratigraphic study we try to solve a significant age bias for the onset of the Upper Freshwater Molasse (OSM) deposition in the neighboring S-German and Swiss Molasse Basins. We measured > 550 samples from eleven drill cores covering the transition from marine to brackish to freshwater environments in the S-German Molasse Basin. Based on combined bio-, litho- and magnetostratigraphic constraints, the composite magnetostratigraphic pattern of these cores provides two reasonable age correlation options (model 1 and 2). In model 1, the base of the brackish succession lies within Chron C5Cr ( 16.7-17.2 Ma), and the onset of OSM deposition has an age of 16.5 Ma. Correlation model 2 suggests the transition to brackish conditions to be within C5Dr.1r ( 17.7-17.5 Ma), and yields an age around 16.7 Ma for the shift to the OSM. Most importantly, both models confirm a much younger age for the OSM base in the study area than previously suggested. Our results demonstrate a possible coincidence of the last transgressive phase (Kirchberg Fm) with the Miocene Climatic Optimum (model 1), or with the onset of this global warming event (model 2). In contrast, the final retreat of the sea from the study area is apparently not controlled by climate change. Supplementary material B. Profiles of the eleven studied drill cores including lithologies, all magnetostratigraphic data (inclinations), interpreted polarity pattern (this study and Reichenbacher et al., 2013) and magnetic susceptibility (this study). Legend for graphs on page 1. Samples without a stable direction above 200 °C or 20 mT are depicted as +-signs and plotted at 0° inclination. The interpreted normal (black), reversed (white) and uncertain (grey) polarity zones in the polarity columns are based on at least

  5. A millennial-scale record of tidewater glacier advance and retreat, SW Greenland.

    Science.gov (United States)

    Pearce, Danni; Mair, Doug; Rea, Brice; Schofield, Ed; Lea, James; Barr, Iestyn; Kamenos, Nick; Schoenrock, Kate

    2017-04-01

    Tidewater glaciers (TWGs) exert a major control on the short- and long-term mass balance of the Greenland Ice Sheet (GrIS) and have experienced widespread retreat over the last century. However, in many cases inferences on their dynamics, prior to this, are poorly constrained due to a lack of observations and paucity of mapped or mappable deglacial geomorphology. Especially lacking is evidence associated with TWG advance during the Little Ice Age (LIA, AD c. 1300 to 1850). Such data are crucial for numerical model calibration and validation in order to more confidently forward model ice sheet dynamics and projection future sea-level rise. Therefore, empirical data constraints from the palaeo-record, that span such timescales (decadal to millennial), are essential. Kangiata Nunaata Sermia (KNS) is the most dynamic TWG in SW Greenland, located c. 100 km inland from Nuuk, at the head of Godthabsfjord. KNS has received considerable research attention over the last decade but glacial geomorphological and numerical dating investigations have been limited. However, the adjacent topography and geomorphology presents a unique opportunity to reconstruct the advance and retreat dynamics over the LIA. We present detailed glacial geomorphological mapping for KNS, which followed a morphostratigraphic approach, using a combination of aerial photos, Landsat, a DEM and field mapping. This identified a three landsystems, which are associated with the LIA, pre-LIA and neoglacial. From the mapping inferences on rapid changes in meltwater routing have been inferred. When KNS reached its LIA maximum (c. 1761), the calving front was c. >22 km further along the fjord than present and a number of ice-dammed lakes were formed. We present new 14C dating from peat underlying lake sediments associated with an ice-dammed lake and buried palaeosols resulting from meltwater re-routing over topographic spillways. The ages support an early and rapid LIA advance phase, with advance rates being

  6. Timing of Glacial Lake Missoula Outburst Floods and the southwestern Cordilleran Ice Sheet retreat.

    Science.gov (United States)

    Hendy, I. L.; Bervid, H. D.; Carlson, A. E.

    2017-12-01

    Glacial Lake Missoula formed when the Purcell Trench Lobe dammed the Clark Fork River in Montana and catastrophically collapsed repeatedly through the last glacial period as the southern Cordilleran Ice Sheet advanced and retreated. A well-dated 50-kyr jumbo piston core MD02-2496 (48.97˚ N, 127.04˚ W, water depth of 1243 m) collected from the continental slope 75 km off Vancouver Island contains evidence of these floods. The in-situ bulk elemental composition of the 35-m core was determined at 1 mm intervals using an ITRAX X-ray Fluorescence (XRF) Core Scanner (Cox Analytical Instruments) at the Sediment Geochemistry Lab of the College of Earth, Ocean, and Atmospheric Sciences at Oregon State University. With 40 mixed planktonic foraminifera and bulk organic carbon 14C ages, the core provides a high-resolution resolution record of glaciomarine sedimentation during deglaciation. A series of >81 layers of fine-grained sediments with ancient (K/Ar ages of 300 Ma and eNd of -8) shale-like (high Rb counts) composition can be found between 19.6 and 9.2 m below coretop. These layers are interspersed by coarser grained, young (K/Ar ages of 100 Ma and eNd of -3) sediments containing ice-rafted debris (IRD). The composition and age of the layers indicates the sediments originated in Glacial Lake Missoula and were transported by ocean currents 250 miles north along the west coast of North America. The flood layers begin at 19.5 ka with five thin (5 cm thick) appear after 19.3 ka. At 17.1 ka, IRD concentrations increase from 50 grains g-1 from 16.5-16.35 ka, except in flood layers, as the Juan de Fuca Strait deglaciated. Another 16 flood layers occur from 16.3-15.65 ka; however, the base and top of these layers are diffuse rather than abrupt like earlier flood layers suggesting enhanced mixing between flood and melt waters. The final flood layers from 14.9-14.5 ka are thin (<2 cm thick) suggesting that the final floods were small events similar to the initial floods. This

  7. Historical analysis and visualization of the retreat of Findelengletscher, Switzerland, 1859-2010

    Science.gov (United States)

    Rastner, P.; Joerg, P. C.; Huss, M.; Zemp, M.

    2016-10-01

    Since the end of the Little Ice Age around 1850, glaciers in Europe have strongly retreated. Thanks to early topographic surveys in Switzerland, accurate maps are available, which enable us to trace glacier changes back in time. The earliest map for all of Switzerland that is usable for a detailed analysis is the Dufour map from around 1850 with subsequent topographic maps on a 20 year interval. Despite the large public and scientific interest in glacier changes through time, this historic dataset has not yet been fully utilized for topographic change assessment or visualization of historic glacier extents. In this study, we use eleven historical topographic maps and more recent digital datasets for the region of Zermatt to analyze geometric changes (length, area and volume) of Findelengletscher as well as for creating animations of glacier evolution through time for use in public communication. All maps were georeferenced, the contour lines digitized, and digital elevation models (DEMs) created and co-registered. Additional digital data like the SRTM X-band DEM and high resolution laser scanning data were used to extend the analysis until 2010. Moreover, one independent DEM from aerial photogrammetry was used for comparison. During the period 1859-2010, Findelengletscher lost 3.5 km of its length (6.9 km in 2010), 4.42 ± 0.13 km2 of its area (15.05 ± 0.45 km2 in 2010) and 1.32 ± 0.52 km3 of its volume. The average rate of thickness loss is 0.45 ± 0.042 m yr- 1 for the 151 years period. Four periods with high thickness change from - 0.56 m ± 0.28 yr- 1 (1859-1881), - 0.40 ± 0.08 m yr- 1 (1937-1965), - 0.90 ± 0.31 m yr- 1 (1995-2000) and - 1.18 ± 0.02 m yr- 1 (2000-2005) have been identified. Small positive thickness changes were found for the periods 1890-1909 (+ 0.09 ± 0.46 m yr- 1) and 1988-1995 (+ 0.05 ± 0.24 m yr- 1). During its retreat with intermittent periods of advance, the glacier separated into three parts. The above changes are demonstrated

  8. 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

  9. Comparative evaluation of three different rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment: Anin vitrostudy.

    Science.gov (United States)

    Das, Siddhartha; De Ida, Ataide; Das, Subhasis; Nair, Vineet; Saha, Nairita; Chattopadhyay, Sayan

    2017-01-01

    Endodontic retreatment is performed in teeth with endodontic failures. The main goal of retreatment is cleaning and shaping of the root canal with removal of old root filling material. Hand instruments and rotary instruments are mainly used for removing this filling material. To compare the relative efficacy of three rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment. To find out which NiTi system is more efficacious in retreatment and to check out the efficacy of retreatment with and without use of solvent. Sixty freshly extracted, single-rooted human mandibular premolars were instrumented with K-files, and each root canal was filled with gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer using lateral compaction. Specimens were then divided into three experimental groups with twenty specimens each. Groups were then subdivided into ten specimens each. Groups were then retreated either with or without solvent. The removal of gutta-percha was performed using ProTaper retreatment files, Mtwo retreatment files, and R-Endo files after 2 weeks. The amount of root canal filling material remnant in the coronal, middle, and apical thirds was measured using stereomicroscope and computer image analysis program. Data were evaluated statistically using analysis of variance. ProTaper group was found to have less remnant filling material as compared to the other groups in coronal and middle thirds, but a significant difference was observed between ProTaper and Mtwo and Mtwo and R-Endo in the nonsolvent groups ( P retreatment file systems, were found to be effective in the removal of root canal filling material. However, complete removal of gutta-percha from root canals did not occur with any of the experimental groups.

  10. Managing Person-Centered Dementia Care in an Assisted Living Facility: Staffing and Time Considerations.

    Science.gov (United States)

    Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Shah, Avantika S; Schnelle, John F

    2017-06-02

    To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care. Supervisory staff used a standardized observational method to measure ADL care quality and the staff time to provide care during the morning and evening across 12 consecutive months. Staff were given individual feedback about the quality of their care provision following each observation. The average staff time to provide ADL care averaged 35 (± 11) minutes per resident per care episode with bathing and 18 (± 6) minutes/resident/care episode without bathing. Morning ADL care required significantly more staff time than evening care. There was not a significant relationship between residents' levels of cognitive impairment or ADL dependency and the staff time to provide ADL care. Quality ADL care was maintained for 12 months. This study provides novel data related to the amount of staff time necessary to provide quality ADL care for persons with dementia in an assisted living care setting. This study also describes a standardized approach to staff management that was effective in maintaining quality ADL care provision. Assisted living facilities should consider these data when determining the necessary unlicensed staffing level to provide person-centered ADL care and how to effectively manage direct care providers. © 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.

  11. Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis.

    Science.gov (United States)

    Kyeremanteng, Kwadwo; Hendin, Ariel; Bhardwaj, Kalpana; Thavorn, Kednapa; Neilipovitz, Dave; Kubelik, Dalibour; D'Egidio, Gianni; Stotts, Grant; Rosenberg, Erin

    2017-01-01

    With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team. Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping. A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay. An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality

  12. A survey of nurse staffing levels in interventional radiology units throughout the UK

    International Nuclear Information System (INIS)

    Christie, A.; Robertson, I.

    2016-01-01

    Aim: To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. Materials and methods: A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Results: Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. Conclusion: A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. - Highlights: • A significant disparity exists between the level of nursing support provided in-hours and OOH. • This applies to both the availability of a nurse to scrub and to monitor the patient. • Having a dedicated 24/7 nursing rota is mandatory to providing a deliverable OOH service.

  13. Temporal patterns and processes of retreat of drumlin coastal cliffs — Strangford Lough, Northern Ireland

    Science.gov (United States)

    Greenwood, Richard O.; Orford, Julian D.

    2008-02-01

    Monthly measurements of erosion pins at sixteen sites around the very low energy marine environment of Strangford Lough, Northern Ireland, were used to investigate temporal patterns and processes of retreat of low cliffs of glacial material. Erosion rates were extremely varied: the mean was 76 ± 49.03 mm a - 1 . Erosion is strongly seasonal with 86.6% of the total erosion occurring during 'winter' (September to March) periods. This seasonal pattern was most exaggerated in some of the more rapidly-eroding sites on the exposed eastern side of the lough. 'Preparatory processes' - heavy rainfall, desiccation and frost action - reduce the compressive strength of the cliff materials and act as important forcing of the erodibility of the cliffs. Direct wave attack on cliffs around the lough takes place when threshold conditions of wind speed and tidal heights are met (tidal levels > 1.50 m above O.D. with wind speed of 15.4 m s - 1 (30 knots), maintaining for more than 4 h). During the study period eighteen events exceeding the above criteria were identified. Extremely low atmospheric pressure has also been identified as important in raising water levels. Slumps, falls, topples and slides were the forms of cliff failure observed.

  14. Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment.

    Science.gov (United States)

    Fariniuk, Luiz Fernando; Westphalen, Vânia Portela Dietzel; Silva-Neto, Ulisses Xavier da; Carneiro, Everdan; Baratto Filho, Flares; Fidel, Sandra Rivera; Fidel, Rivail Antônio Sérgio

    2011-01-01

    The purpose of this study was to evaluate the efficiency of ProFile, GT, ProTaper, Race and K3 rotary instruments compared with hand K-files for removal of gutta-percha during retreatment. Sixty mandibular premolars were instrumented with GT rotary files and filled by thermomechanical compaction of gutta-percha and AH Plus sealer. The teeth are randomly divided into 6 groups of 10 specimens each. The roots were split longitudinally, digital images were created using a flatbed scanner, and the areas with remaining filling material were demarcated using Image Tool 1.21 software. The results indicate that GT left significantly less (p<0.05) remaining filling material (1.18 ± 1.47) than hand (3.70 ± 3.16) and Hero instruments (2.99 ± 2.58). There was no statistically significant difference (p<0.05) among the others techniques: ProFile (1.99 ± 2.66), ProTaper (2.00 ± 1.99) and K3 (2.71 ± 2.87) when compared with GT. In conclusion, GT, ProFile, ProTaper and K3 were more effective in removing gutta-percha than manual and Hero instruments.

  15. In vitro comparison of different reciprocating systems used during endodontic retreatment.

    Science.gov (United States)

    Zanettini, Paulo Roberto; Barletta, Fernando Branco; de Mello Rahde, Nicole

    2008-12-01

    The present study evaluated the effectiveness of two reciprocating systems for the removal of root-filling material during endodontic retreatment. One hundred extracted mandibular premolars were prepared and root-filled with gutta-percha and sealer. Root fillings were removed with K-files according to the following techniques: Group A--hand instrumentation; Group B--Endo-Gripper system driven by compressed air; Group C--INTRAmatic 29CH + INTRA-LUX 3LD driven by compressed air; Group D--Endo-Gripper system driven by electric engine; Group E--INTRAmatic 29CH + INTRA-LUX 3LD driven by electric engine. The amount of filling debris on root canal walls was assessed radiographically and analysed using Auto CAD 2000 software. One-way anova and Duncan's test revealed statistically significant differences only in the middle third (P = 0.01); the best results being reached in group D. The apical third displayed the greatest amount of filling material debris, regardless of the technique used.

  16. Retreatment and surgical repair of the apical third perforation and osseous defect using mineral trioxide aggregate

    Directory of Open Access Journals (Sweden)

    A Savitha

    2013-01-01

    Full Text Available One of the causes of non-healing periapical pathosis in endodontically treated tooth is root perforation. This can occur pathologically by resorption and caries, iatrogenically during endodontic therapy (zip, strip, furcal perforations. Root perforation results in bacterial contamination, periradicular tissue injury, inflammation, and bone resorption. The purpose of this case report is to describe endodontic retreatment and surgical management of a longstanding periapical lesion on maxillary lateral incisor, associated with perforation and osseous defects using mineral trioxide aggregate (MTA. Although the majority of bone support and root dentin was damaged, an attempt was made to repair the defect and restore the tooth. After the surgical intervention and root canal treatment, the perforation was subsequently sealed with MTA. Later, the root was reinforced with composites and the tooth was restored with direct veneer. Conclusion: Four-and-a-half year (54 months recall examination showed no evidence of periodontal breakdown, no symptoms of further deterioration, and complete healing of periradicular lesions when examined by radiography. This case report presents a treatment strategy that could improve the healing process and beneficial outcomes for patients with perforation and osseous defect.

  17. Evaluation of three different rotary systems during endodontic retreatment - Analysis by scanning electron microscopy.

    Science.gov (United States)

    Vidal, Flávia-Teixeira; Nunes, Eduardo; Horta, Martinho-Campolina-Rebello; Freitas, Maria-Rita-Lopes-da Silva; Silveira, Frank-Ferreira

    2016-04-01

    Endodontic therapy is considered a series of important and interdependent steps, and failure of any of these steps may compromise the treatment outcome. This study aimed to evaluate the effectiveness of three different rotary systems in removing obturation materials during endodontic retreatment using scanning electron microscopy (SEM) analysis. Thirty-six endodontically treated teeth were selected and divided into 3 groups of 10 and 1 control group with 6 dental elements. The groups were divided according to the rotary system used for removing gutta-percha, as follows: G1: ProTaper system; G2: K3 system; G3: Mtwo system; and G4: Control group. Thereafter, the roots were split and the sections were observed under SEM, for analysis and counting of clear dentinal tubules, creating the variable "degree of dentinal tubule patency" (0: intensely clear; 1: moderately clear; 2: slightly clear; 3: completely blocked). The data were subjected to the Friedman and Kruskal-Wallis statistical tests. No differences were observed in the "degree of dentinal tubule patency" neither between the root thirds (to each evaluated group) nor between the groups (to each evaluated third). Nevertheless, when the three root thirds were grouped (providing evaluation of all root extension), the "degree of dentinal tubule patency" was lower in G1 than in G3 (pretreatment.

  18. Particularism and the retreat from theory in the archaeology of agricultural origins.

    Science.gov (United States)

    Gremillion, Kristen J; Barton, Loukas; Piperno, Dolores R

    2014-04-29

    The introduction of new analytic methods and expansion of research into previously untapped regions have greatly increased the scale and resolution of data relevant to the origins of agriculture (OA). As a result, the recognition of varied historical pathways to agriculture and the continuum of management strategies have complicated the search for general explanations for the transition to food production. In this environment, higher-level theoretical frameworks are sometimes rejected on the grounds that they force conclusions that are incompatible with real-world variability. Some of those who take this position argue instead that OA should be explained in terms of local and historically contingent factors. This retreat from theory in favor of particularism is based on the faulty beliefs that complex phenomena such as agricultural origins demand equally complex explanations and that explanation is possible in the absence of theoretically based assumptions. The same scholars who are suspicious of generalization are reluctant to embrace evolutionary approaches to human behavior on the grounds that they are ahistorical, overly simplistic, and dismissive of agency and intent. We argue that these criticisms are misplaced and explain why a coherent theory of human behavior that acknowledges its evolutionary history is essential to advancing understanding of OA. Continued progress depends on the integration of human behavior and culture into the emerging synthesis of evolutionary developmental biology that informs contemporary research into plant and animal domestication.

  19. The Retreat from Locative Overgeneralisation Errors: A Novel Verb Grammaticality Judgment Study

    Science.gov (United States)

    Bidgood, Amy; Ambridge, Ben; Pine, Julian M.; Rowland, Caroline F.

    2014-01-01

    Whilst some locative verbs alternate between the ground- and figure-locative constructions (e.g. Lisa sprayed the flowers with water/Lisa sprayed water onto the flowers), others are restricted to one construction or the other (e.g. *Lisa filled water into the cup/*Lisa poured the cup with water). The present study investigated two proposals for how learners (aged 5–6, 9–10 and adults) acquire this restriction, using a novel-verb-learning grammaticality-judgment paradigm. In support of the semantic verb class hypothesis, participants in all age groups used the semantic properties of novel verbs to determine the locative constructions (ground/figure/both) in which they could and could not appear. In support of the frequency hypothesis, participants' tolerance of overgeneralisation errors decreased with each increasing level of verb frequency (novel/low/high). These results underline the need to develop an integrated account of the roles of semantics and frequency in the retreat from argument structure overgeneralisation. PMID:24830412

  20. Sedimentation and erosion in Lake Diefenbaker, Canada: solutions for shoreline retreat monitoring.

    Science.gov (United States)

    Sadeghian, Amir; de Boer, Dirk; Lindenschmidt, Karl-Erich

    2017-09-15

    This study looks into sedimentation and erosion rates in Lake Diefenbaker, a prairie reservoir, in Saskatchewan, Canada, which has been in operation since 1968. First, we looked at the historical data in all different formats over the last 70 years, which includes data from more than 20 years before the formation of the lake. The field observations indicate high rates of shoreline erosion, especially in the upstream portion as a potential region for shoreline retreat. Because of the great importance of this waterbody to the province, monitoring sedimentation and erosion rates is necessary for maintaining the quality of water especially after severe floods which are more common due to climate change effects. Second, we used Google Maps Elevation API, a new tool from Google that provides elevation data for cross sections drawn between two points, by drawing 24 cross sections in the upstream area extending 250 m from each bank. This feature from Google can be used as an easy and fast monitoring tool, is free of charge, and provides excellent control capabilities for monitoring changes in cross-sectional profiles.

  1. Future increases in Arctic precipitation linked to local evaporation and sea-ice retreat.

    Science.gov (United States)

    Bintanja, R; Selten, F M

    2014-05-22

    Precipitation changes projected for the end of the twenty-first century show an increase of more than 50 per cent in the Arctic regions. This marked increase, which is among the highest globally, has previously been attributed primarily to enhanced poleward moisture transport from lower latitudes. Here we use state-of-the-art global climate models to show that the projected increases in Arctic precipitation over the twenty-first century, which peak in late autumn and winter, are instead due mainly to strongly intensified local surface evaporation (maximum in winter), and only to a lesser degree due to enhanced moisture inflow from lower latitudes (maximum in late summer and autumn). Moreover, we show that the enhanced surface evaporation results mainly from retreating winter sea ice, signalling an amplified Arctic hydrological cycle. This demonstrates that increases in Arctic precipitation are firmly linked to Arctic warming and sea-ice decline. As a result, the Arctic mean precipitation sensitivity (4.5 per cent increase per degree of temperature warming) is much larger than the global value (1.6 to 1.9 per cent per kelvin). The associated seasonally varying increase in Arctic precipitation is likely to increase river discharge and snowfall over ice sheets (thereby affecting global sea level), and could even affect global climate through freshening of the Arctic Ocean and subsequent modulations of the Atlantic meridional overturning circulation.

  2. Double Dens Invaginatus with Multiple Canals in a Maxillary Central Incisor: Retreatment and Managing Complications.

    Science.gov (United States)

    Zoya, Asma; Ali, Sajid; Alam, Sharique; Tewari, Rajendra K; Mishra, Surendra K; Kumar, Ashok; Andrabi, Syed Mukhtar-Un-Nisar

    2015-11-01

    Dens invaginatus is a developmental anomaly that often presents a perplexing challenge to the endodontist. It involves the maxillary central incisor less commonly than the maxillary lateral incisor. Double dens invaginatus is even rarer. Herein a unique case of dens invaginatus in a maxillary central incisor is presented. The tooth had an inadequate previous root canal treatment. On retreatment, multiple canals and double dens invaginatus were found. The invaginations were Oehlers type 3b and type 2. The complex morphology was diagnosed and confirmed with cone-beam computed tomography imaging and managed with a combined surgical and orthograde approach. Four canals and a blind sac along with an open apex were found. There were many intercommunications between the canals. During the treatment, a complication of a separated instrument occurred, which was managed successfully. The 1-year follow-up shows successful outcome of the treatment. Dens invaginatus may be more complicated than it seems. It needs meticulous treatment by a specialist. Failure or a delay in referring the case to a specialty setting may further increase the complications. With the advancements in equipment and materials, it is possible to save even severe cases of dens invaginatus. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  3. 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)

  4. 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.

  5. Sea ice breakup and marine melt of a retreating tidewater outlet glacier in northeast Greenland (81 degrees N)

    DEFF Research Database (Denmark)

    Bendtsen, Jorgen; Mortensen, John; Lennert, Kunuk

    2017-01-01

    Rising temperatures in the Arctic cause accelerated mass loss from the Greenland Ice Sheet and reduced sea ice cover. Tidewater outlet glaciers represent direct connections between glaciers and the ocean where melt rates at the ice-ocean interface are influenced by ocean temperature and circulation...... glacier is a floating ice shelf with near-glacial subsurface temperatures at the freezing point. Melting from the surface layer significantly influenced the ice foot morphology of the glacier terminus. Hence, melting of the tidewater outlet glacier was found to be critically dependent on the retreat....... However, few measurements exist near outlet glaciers from the northern coast towards the Arctic Ocean that has remained nearly permanently ice covered. Here we present hydrographic measurements along the terminus of a major retreating tidewater outlet glacier from Flade Isblink Ice Cap. We show...

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

  8. 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.

  9. 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 (pendodontic therapy achieved a significant further reduction of intracanal microbial load. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. 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.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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)

  14. Apically Extruded Debris after Retreatment Procedure with Reciproc, ProTaper Next, and Twisted File Adaptive Instruments.

    Science.gov (United States)

    Yılmaz, Koray; Özyürek, Taha

    2017-04-01

    The aim of this study was to compare the amount of debris extruded from the apex during retreatment procedures with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (RCP; VDW, Munich, Germany), and Twisted File Adaptive (TFA; SybronEndo, Orange, CA) files and the duration of these retreatment procedures. Ninety upper central incisor teeth were prepared and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the vertical compaction technique. The teeth were randomly divided into 3 groups of 30 for removal of the root filling material with PTN, RCP, and TFA files. The apically extruded debris was collected in preweighed Eppendorf tubes. The time for gutta-percha removal was recorded. Data were statistically analyzed using Kruskal-Wallis and 1-way analysis of variance tests. The amount of debris extruded was RPC > TFA > PTN, respectively. Compared with the PTN group, the amount of debris extruded in the RPC group was statistically significantly higher (P  .05). Within the limitations of this in vitro study, all groups were associated with debris extrusion from the apex. The RCP file system led to higher levels of apical extrusion in proportion to the PTN file system. In addition, there was no significant difference among groups in the duration of the retreatment procedures. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Evaluation of the amount of apically extruded debris during retreatment of root canals filled by different obturation techniques.

    Science.gov (United States)

    Türker, S A; Uzunoğlu, E; Sağlam, B C

    2015-01-01

    To evaluate the amount of apically extruded debris during retreatment (with or without solvent) of root canals filled by two obturation techniques. Forty-eight root canals were prepared using ProTaper Universal F3 and filled with Gutta-percha and AH 26 sealer using single cone or lateral condensation techniques. The root canal fillings were removed using ProTaper Universal Retreatment system with or without solvent, and the canals were further prepared with ProTaper F4. The operating time was measured. The debris extruded was collected into preweighed Eppendorf tubes. The dry weight of the extruded debris was calculated by subtracting the weight of the empty tube from that of the tube containing debris. Statistical analysis was performed with two-way analysis of variance test, with Bonferroni correction at a 95% confidence level. There was no statistically significant difference in the amount of extruded debris between the two obturation techniques (P=0.332). The mean amount of debris was higher in the nonsolvent groups than the solvent groups, particularly with the single cone technique (P=0.013). There was a significant difference between groups with regard to the retreatment time (Pextruded debris were similar in both obturation techniques. A greater amount of apically extruded debris was observed in the nonsolvent groups than the solvent groups.

  16. 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

    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. PMID:23248762

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

    Science.gov (United States)

    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.

  18. Do staffing and workload levels influence the risk of new acquisitions of meticillin-resistant Staphylococcus aureus in a well-resourced intensive care unit?

    Science.gov (United States)

    Kong, F; Cook, D; Paterson, D L; Whitby, M; Clements, A C A

    2012-04-01

    Staffing deficits and workload have may a bearing on transmission of meticillin-resistant Staphylococcus aureus (MRSA) within intensive care units (ICUs). New MRSA acquistions may provide a clearer picture of the relationship between MRSA acquisition and staffing in the ICU setting. To determine whether staffing and bed occupancy rates had an immediate or delayed impact on the number of new MRSA acquisitions in a well-staffed ICU, and whether these variables could be used as predictors of future MRSA acquisitions. Data on new MRSA acquisitions in the ICU of a 796-bed metropolitan Australian hospital between January 2003 and December 2006 were used to build a model to predict the probabilility of actual new MRSA acquisitions in 2007. Cross validation was performed using receiver operator characteristic analysis. Sixty-one new MRSA acquisitions (21 infections, 40 colonizations) were identified in 51 individual weeks over the study period. The number of non-permanent staffing hours was relatively small. The area under the curve in the cross-validation analysis was 0.46 [95% CI 0.25-0.67] which suggests that the model, built on data from 2003-2006, was not able to predict weeks in which new MRSA acquisitions occurred in 2007. The risks posed by high workloads may have been mitigated by good compliance with infection control measures, nurse training and adequate staffing ratios in the ICU. Consequently, staffing policies and the infection control practices in the ICU do not need to be modified to address the rate of new MRSA acquisitions. Copyright © 2011 The Healthcare Infection Society. All rights reserved.

  19. 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…

  20. 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 < 0.05) were seen in almost all measures (n = 37) after 1 week and were sustained at 6 weeks (n = 17). There were statistically significant improvements (p < 0.001) in all anthropometric measures after 1 week, with reductions in abdominal girth (2.7 cm), weight (1.6 kg), and average systolic and diastolic pressure (-16.1 mmHg and -9.3 mmHg, respectively). Statistically significant improvements (p < 0.05) were also seen in psychological and health symptom measures. Urinary pesticide metabolites were detected in pooled urine samples before the retreat and were undetectable after the retreat. Retreat experiences can lead to substantial improvements in multiple dimensions of health and well-being that are maintained for 6 weeks. Further research that includes objective