WorldWideScience

Sample records for twenty-eight year stewardship

  1. DYNASTY-Leading Wine Brand for Twenty-Eight Years in China

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Sino-French Joint Venture Dynasty Winery Co.,Ltd.,since the establishment in 1980,has had a history of steady development of 28 years.In the past 28 years,Dynasty Winery continues the market expansion,and increasing the market share,and strengthening the influence of the brand and the company.Till now,"Dynasty Wine",has become popular among the consumors.

  2. TWENTY EIGHT YEARS OF ICP VEGETATION: AN OVERVIEW OF ITS ACTIVITIES

    Directory of Open Access Journals (Sweden)

    H. Harmens

    2015-04-01

    Full Text Available Here we look back at the activities and achievements in the 28 years of the International Cooperative Programme on the Effects of Air Pollution on Natural Vegetation and Crops (ICP Vegetation. The ICP Vegetation is a subsidiary body of the Working Group on Effects of the UNECE Convention on Long-range Transboundary Air Pollution (LTRAP, established in 1979. An important role of the ICP Vegetation is to provide evidence for air pollution impacts on vegetation in support of policy development and review of the LRTAP Convention and its Protocols. The activities and participation in the ICP Vegetation have grown over the years. The main activities include:Collate evidence of ozone impacts on vegetation, assess spatial patterns and temporal trends across Europe;Develop dose-response relationships, establish critical levels for vegetation and provide European risk maps of ozone impacts;Reviewing the literature on ozone impacts on vegetation and produce thematic scientific reports and policy-relevant brochures;Determine spatial patterns and temporal trends of heavy metals, nitrogen and persistent organic pollutants concentrations in mosses as a biomonitoring tool of atmospheric deposition of these compounds.

  3. Twenty-Eight Years of Poliovirus Replication in an Immunodeficient Individual: Impact on the Global Polio Eradication Initiative.

    Directory of Open Access Journals (Sweden)

    Glynis Dunn

    2015-08-01

    Full Text Available There are currently huge efforts by the World Health Organization and partners to complete global polio eradication. With the significant decline in poliomyelitis cases due to wild poliovirus in recent years, rare cases related to the use of live-attenuated oral polio vaccine assume greater importance. Poliovirus strains in the oral vaccine are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These strains can transmit from person to person leading to poliomyelitis outbreaks and can replicate for long periods of time in immunodeficient individuals leading to paralysis or chronic infection, with currently no effective treatment to stop excretion from these patients. Here, we describe an individual who has been excreting type 2 vaccine-derived poliovirus for twenty eight years as estimated by the molecular clock established with VP1 capsid gene nucleotide sequences of serial isolates. This represents by far the longest period of excretion described from such a patient who is the only identified individual known to be excreting highly evolved vaccine-derived poliovirus at present. Using a range of in vivo and in vitro assays we show that the viruses are very virulent, antigenically drifted and excreted at high titre suggesting that such chronic excreters pose an obvious risk to the eradication programme. Our results in virus neutralization assays with human sera and immunisation-challenge experiments using transgenic mice expressing the human poliovirus receptor indicate that while maintaining high immunisation coverage will likely confer protection against paralytic disease caused by these viruses, significant changes in immunisation strategies might be required to effectively stop their occurrence and potential widespread transmission. Eventually, new stable live-attenuated polio vaccines with no risk of reversion might be required to respond to any poliovirus isolation in the post

  4. Twenty-Eight Years of Poliovirus Replication in an Immunodeficient Individual: Impact on the Global Polio Eradication Initiative.

    Science.gov (United States)

    Dunn, Glynis; Klapsa, Dimitra; Wilton, Thomas; Stone, Lindsay; Minor, Philip D; Martin, Javier

    2015-08-01

    There are currently huge efforts by the World Health Organization and partners to complete global polio eradication. With the significant decline in poliomyelitis cases due to wild poliovirus in recent years, rare cases related to the use of live-attenuated oral polio vaccine assume greater importance. Poliovirus strains in the oral vaccine are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These strains can transmit from person to person leading to poliomyelitis outbreaks and can replicate for long periods of time in immunodeficient individuals leading to paralysis or chronic infection, with currently no effective treatment to stop excretion from these patients. Here, we describe an individual who has been excreting type 2 vaccine-derived poliovirus for twenty eight years as estimated by the molecular clock established with VP1 capsid gene nucleotide sequences of serial isolates. This represents by far the longest period of excretion described from such a patient who is the only identified individual known to be excreting highly evolved vaccine-derived poliovirus at present. Using a range of in vivo and in vitro assays we show that the viruses are very virulent, antigenically drifted and excreted at high titre suggesting that such chronic excreters pose an obvious risk to the eradication programme. Our results in virus neutralization assays with human sera and immunisation-challenge experiments using transgenic mice expressing the human poliovirus receptor indicate that while maintaining high immunisation coverage will likely confer protection against paralytic disease caused by these viruses, significant changes in immunisation strategies might be required to effectively stop their occurrence and potential widespread transmission. Eventually, new stable live-attenuated polio vaccines with no risk of reversion might be required to respond to any poliovirus isolation in the post-eradication era.

  5. Twenty-eight years after the complete ban on the physical punishment of children in Finland: trends and psychosocial concomitants.

    Science.gov (United States)

    Österman, Karin; Björkqvist, Kaj; Wahlbeck, Kristian

    2014-01-01

    In 1983 Finland became the second country in the world, after Sweden, to adopt a law prohibiting all kinds of physical punishment towards children, also by parents. The present investigation was carried out in 2011, 28 years after the law was adopted. Changes in exposure to various types of physical punishment towards respondents born between 1931 and 1996 are presented. A representative sample from Western Finland, consisting of 4,609 respondents (2,632 females, 1,977 males) between 15 and 80 years, filled in a paper-and-pencil questionnaire. A number of psychosocial concomitants were measured. The results showed a significant drop in reports of being slapped and beaten with an object among respondents who were born after the law was adopted. The decline in physical punishment was associated with a similar decline in the number of murdered children. Respondents who had been exposed to higher amounts of physical punishment than average scored significantly higher on alcohol abuse, depression, mental health problems, and schizotypal personality. Divorced respondents had been significantly more physically punished than others. Respondents who had attempted suicide during the last 12 months had been exposed to physical punishment during childhood significantly more often than those who had not attempted suicide.

  6. Twenty-eight-year review of childhood renal diseases from renal biopsy data: A single centre in China.

    Science.gov (United States)

    Jiang, Mengjie; Xiao, Zizheng; Rong, Liping; Xu, Yuanyuan; Chen, Lizhi; Mo, Ying; Sun, Liangzhong; Sun, Wei; Jiang, Xiaoyun

    2016-12-01

    The aim of the present study was to investigate the clinicopathologic characteristics of biopsy-proven childhood renal diseases and to compare the trends and changes during two different time intervals between 1984 and 2011 at the First Affiliated Hospital of Sun Yat-sen University in China. We retrospectively analyzed kidney biopsy data from children with renal diseases and compared the data during two time intervals, namely 1984-1997 and 1998-2011. A total of 1313 children were enrolled in the present study. There were 921 children with primary glomerular disease (PGD) and 312 children with secondary glomerular disease (SGD), accounting for 70.1% and 23.8% of participants, respectively. The major clinical manifestation of PGD was nephrotic syndrome (NS), which accounted for 31.2% of cases, while the main aetiology of SGD was lupus nephritis (40.7%). The main biopsy patterns of PGD were IgA nephritis (27.6%), minimal change disease (24.0%), and mesangial proliferative glomerulonephritis (16.9%). PGD was the major class of disease in both time intervals, but the ratio of PGD decreased over time, while the ratio of SGD and other glomerular diseases increased. PGD was also the major class of disease in each age group; however, the incidence of PGD decreased with increasing age. The incidence patterns of paediatric renal diseases changed over the 28-year period of this study. Our results show that different renal diseases characterize different age intervals. Furthermore, there are several associations between clinical presentation and biopsy features in childhood renal disease. © 2015 Asian Pacific Society of Nephrology.

  7. When I am Twenty-eight

    Institute of Scientific and Technical Information of China (English)

    方朝晖

    2006-01-01

    In fifteen years, I think I’ll be a big fish(大人物). I think I’ll live in New York. I love the city very much, for it is a beautiful city. I think I’ll have a villa and a personal computer, and I’ll have a robot. It can do everything, for example, do the dishes, sweep the floor and so on. I’ll go to Canada on vacation. That’s also a beautiful country. I will have many pets. I don’t have any pets at pre- sent, because my father doesn’t like them at all. At weekends, I’ll wear beautiful clothes. I think my drea...

  8. Familial Sarcoidosis: An Analysis of Twenty-Eight Cases

    Directory of Open Access Journals (Sweden)

    Dildar Duman

    2016-12-01

    Full Text Available Objective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis. Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded. Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method. Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis.

  9. Insight into Sam Francis' painting techniques through the analytical study of twenty-eight artworks made between 1946 and 1992

    Science.gov (United States)

    Defeyt, Catherine; Mazurek, Joy; Zebala, Aneta; Burchett-Lere, Debra

    2016-11-01

    The present paper proposes an overview of the painting materials experimented with over the years by Sam Francis, leading figure of the post-World War II American painting, through the analytical study of an extended number of paint samples supplied by the Sam Francis Foundation. In total, 279 samples taken from twenty-eight artworks made between 1946 and 1992, were analyzed by Raman, FTIR and Py-GC/MS techniques. The obtained results revealed the Francis' preference in terms of pigments, i.e., phthalocyanine blues and greens, and outlined unconventional combination of binder media.

  10. Results of miconazole therapy in twenty-eight patients with paracoccidioidomycosis (South American blastomycosis).

    Science.gov (United States)

    Negroni, R; Rubinstein, P; Herrmann, A; Gimenez, A

    1977-01-01

    Results are presented of treatment with miconazole, orally and intravenously, in patients with paracoccidioidomycosis. Twenty-eight male patients aged from 34 to 66 years and exhibiting various clinical forms of the disease were studied. Twenty-five came from endemic areas in north east Argentina (Chaco, Formosa, Misiones, Corrientes and northern Santa Fe) and the remaining three from Paraguay. Twenty patients were engaged in agricultural work or at woodmills. single or multiple lesions were observed in 24 cases. Thirteen were suffering from infection of the larynx and in two of them a tracheotomy was necessary. Twenty-three showed pulmonary lesions on X-rays. Twelve had ganglionic lesions, eight had cutaneous lesions and one patient had osteoarthritis of the knee. One patient had hepatomegaly which was unrelated to chronic alcoholism. Fourteen patients had received previous treatments such as sulphonamides and amphotericin B (7 cases); sulphonamides (3), sulphonamides and the combination sulfamethoxazole + trimethoprim (3), and one patient had received all three medications. All patients had relapsed before starting miconazole therapy. Diagnosis was established by the presence of P. brasiliensis in all cases, recovered either from cutaneous or mucosal biopsy samples or from the sputum. Complement fixation tests were positive in all patients at the onset of the treatment and the immunodiffusion reactions showed precipitation bands in 27/28 patients. Skin tests with P. brasiliensis antigens proved to be positive in 18 cases and negative in 10. The erythrocyte sedimentation rate was markedly accelerated in 22 patients (greater than 20 mm in the first hour).(ABSTRACT TRUNCATED AT 250 WORDS) Images p24-a Fig 1 Fig 2 PMID:122643

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

    Directory of Open Access Journals (Sweden)

    Alan P. Johnson

    2015-10-01

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

  12. [Twenty-eight days repeated dose toxicity test of N-(fluorodichloromethylthio)phthalimide in rats].

    Science.gov (United States)

    Matsushima, Y; Tsuda, M; Naito, K; Saitoh, M; Isama, K; Ikarashi, Y; Kawasaki, Y; Momma, J; Kitajima, S; Kaniwa, M

    1995-01-01

    N-(Fluorodichloromethylthio)phthalimide (Fluor-folpet) has been widely used as an anti-mold and anti-bacterial agent. In this study, 28 days repeated-dose oral toxicity study of fluor-folpet was carried out in Slc:Wistar rats. An oral toxicity study for fluor-folpet, the twenty-eight days test, repeated-dose, oral administration, was performed as follows: Five week-old rats, male and female, 10 rats, each/group, were treated with intragastric administration of fluor-folpet with a dose of 0 (1% Sodium CMC, control), 20, 80 and 320 mg/kg, body weight. Recovery test, for 14 days after the last treatment, was examined for the control and the 320 mg/kg groups. The 320 mg/kg groups, both males and females, showed significantly reduced their body-weight gain compared with the control group. In the 320 mg/kg group, five out of 20 male rats and four out of 20 female rats died from dyspnea during the treatment period. In the female rats in the 320 mg/kg group, serum ChE level was decreased to 50% of control level and gamma-GT was increased in a dose-dependent manner, but these serum levels recovered after 14 days non-treatment period. No histopathological change, relating to the treatment, in liver was observed. Increased weight of the kidney and vacuolation in renal tubules were found in both sexes of 320 mg/kg group. Hyperkeratosis and hyperplasia of the stomach epithelium were observed at the dose more than 80 mg/kg in male, and more than 20 mg/kg in female. A supplemental study, repeated-dose, oral administration in rats carried out to examine the dyspnea revealed that severe acute toxic damages in epithelium of nasal cavity and meatus nasopharyngeus were induced by intragastric administration of fluor-folpet. Fluor-folpet is shown to be cytotoxic. In conclusion, the no-observed-effect level (NOEL) for fluor-folpet was not found under the experimental conditions employed in this repeated-dose toxicity study.

  13. Implementation and first-year results of an antimicrobial stewardship program at a community hospital.

    Science.gov (United States)

    Bartlett, James M; Siola, Patricia L

    2014-06-01

    The implementation of an antimicrobial stewardship program (ASP) at a small community hospital affiliated with an accountable care organization (ACO) is described, including a report on first-year program outcomes. With no infectious diseases (ID)-trained pharmacists on staff, a 155-bed hospital formed an ASP by restructuring its clinical pharmacy services. One full-time pharmacist led the program; nine full- or part-time pharmacists-none of whom had residency training-shared ASP responsibilities on a weekly rotation. Under a contract with a private medical group, an ID physician reviewed cases with ASP pharmacists for up to two hours each weekday. ASP interventions and tracking and reporting of outcomes were done primarily by pharmacists. Monitoring of pharmacy purchases in the first year of the program indicated an annualized 26% decrease in overall antimicrobial expenditures from prior-year spending, with a nearly 18% decrease in defined daily doses per 1000 patient-days. Total first-year direct cost savings attributed to the ASP were estimated at $145,353. Pharmacist-initiated conversions of patients from i.v. to oral antimicrobial therapy increased by 688% (p < 0.0001). Overall, the rate of ID physician acceptance of ASP-recommended interventions (mainly streamlining of therapy, limiting the duration of therapy to a specific stop date, and discontinuation of nonindicated drugs) was 74%. An ASP was implemented at a small ACO-affiliated community hospital by a team of pharmacists without specialized ID training. During the first year of the program, antimicrobial expenditures were reduced and there was a significant increase in pharmacist-initiated i.v.-to-oral conversions. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Visit ALEPH experiment on the LEP collider by twenty-eight young scientists chosen to represent their respective countries

    CERN Multimedia

    Laurent Guiraud

    1998-01-01

    Following an international meeting of secondary school pupils on the theme of "Future Scientists: Women and Men" in Paris on 23 and 24 April. The aim of this meeting, which was organised by UNESCO, was to encourage young people, and girls in particular, to choose scientific studies and careers. Twenty-eight young scientists chosen to represent their respective countries visited the CERN site this week following an international meeting of secondary school pupils on the theme of "Future Scientists: Women and Men" in Paris on 23 and 24 April. The aim of this meeting, which was organised by UNESCO, was to encourage young people, and girls in particular, to choose scientific studies and careers.

  15. Antimicrobial stewardship.

    Science.gov (United States)

    Allerberger, F; Mittermayer, H

    2008-03-01

    The aim of antimicrobial management or stewardship programmes is to ensure proper use of antimicrobial agents in order to provide the best treatment outcomes, to lessen the risk of adverse effects (including antimicrobial resistance), and to promote cost-effectiveness. Increasingly, long-term sustainability is found to be the major focus of antimicrobial stewardship. Implementing structural measures in healthcare institutions is therefore a major, but not the sole, focus of attention in promoting prudent use of antibiotics. The problem of antimicrobial resistance requires common strategies at all levels--for the prescribers and at ward, departmental, hospital, national and international levels.

  16. Twenty-eight Cases of Neuritis of Lateral Cutaneous Nerve of Thigh Treated by Acupuncture and Point-Injection

    Institute of Scientific and Technical Information of China (English)

    廖明扬

    2001-01-01

    @@Neuritis of lateral cutaneous nerve of thigh, also called meralgia paresthetica, is a commonly encountered disease in clinical practice. The author has treated 28 cases of meralgia paresthetica since 1996 by acupuncture plus point-injection with satisfactory results. A report follows. Clinical Data Among the 28 cases, 13 were male and 15 female. Their age ranged from 24 to 72 years, most of the patients being 35 to 50 years; the duration of illness varied from one month to ten years and 6 cases were affected on left side, 8 cases on right side and 14 cases on both sides.

  17. Assessing Environmental Stewardship Motivation

    Science.gov (United States)

    Bramston, Paul; Pretty, Grace; Zammit, Charlie

    2011-01-01

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

  18. Chapter Twenty Chapter Twenty Eight

    African Journals Online (AJOL)

    User

    It is also true that each culture affects their writers' language and style differently in works ... Thus it calls for a cautious and positive use of words .... Memory is also fragrance from withered flowers. Memory is also the music from broken guitars.

  19. FY 2015 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-04-01

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

  20. FY 2016 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-03-01

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

  1. US Forest Service Stewardship Contracting

    Data.gov (United States)

    US Forest Service, Department of Agriculture — A map service on the www depicting the locations of activities within the Stewardship Contracting Project Boundary. Activities are implemented through stewardship...

  2. Sustained reduction in antibiotic consumption in a South African public sector hospital; Four year outcomes from the Groote Schuur Hospital antibiotic stewardship program

    Directory of Open Access Journals (Sweden)

    T H Boyles

    2017-02-01

    Full Text Available Background. Overuse of antibiotics has driven global bacterial resistance to the extent that we have entered a post-antibiotic era, where infections that were once easily treatable are now becoming untreatable. Efforts to control consumption have focused on antibiotic stewardship programmes (ASPs, aimed at optimising use. Objective. To report antibiotic consumption and cost over 4 years from a public hospital ASP in South Africa (SA. Methods. A comprehensive ASP comprising online education, a dedicated antibiotic prescription chart and weekly dedicated ward rounds was introduced at Groote Schuur Hospital, Cape Town, in 2012. Electronic records were used to collect data on volume and cost of antibiotics and related laboratory tests, and to determine inpatient mortality and 30-day readmission rates. These data were compared with a control period before the intervention. Results. Total antibiotic consumption fell from 1 046 defined daily doses/1 000 patient days in 2011 (control period to 868 by 2013 and remained at similar levels for the next 2 years. This was driven by reductions in intravenous antibiotic use, particularly ceftriaxone. Inflation-adjusted cost savings on antibiotics were ZAR3.2 million over 4 years. Laboratory tests increased over the same period with a total increased cost of ZAR0.4 million. There was no significant change in mortality or 30-day readmission rates. Conclusions. The effects of a comprehensive ASP on medical inpatients at a public sector hospital in SA were durable over 4 years, leading to a reduction in total antibiotic consumption without adverse effect. When increased laboratory costs were offset there was a net cost saving of ZAR2.8 million.

  3. Sustained reduction in antibiotic consumption in a South African public sector hospital; Four year outcomes from the Groote Schuur Hospital antibiotic stewardship program.

    Science.gov (United States)

    Boyles, T H; Naicker, V; Rawoot, N; Raubenheimer, P J; Eick, B; Mendelson, M

    2017-01-30

    Overuse of antibiotics has driven global bacterial resistance to the extent that we have entered a post-antibiotic era, where infections that were once easily treatable are now becoming untreatable. Efforts to control consumption have focused on antibiotic stewardship programmes (ASPs), aimed at optimising use. To report antibiotic consumption and cost over 4 years from a public hospital ASP in South Africa (SA). A comprehensive ASP comprising online education, a dedicated antibiotic prescription chart and weekly dedicated ward rounds was introduced at Groote Schuur Hospital, Cape Town, in 2012. Electronic records were used to collect data on volume and cost of antibiotics and related laboratory tests, and to determine inpatient mortality and 30-day readmission rates. These data were compared with a control period before the intervention. Total antibiotic consumption fell from 1 046 defined daily doses/1 000 patient days in 2011 (control period) to 868 by 2013 and remained at similar levels for the next 2 years. This was driven by reductions in intravenous antibiotic use, particularly ceftriaxone. Inflation-adjusted cost savings on antibiotics were ZAR3.2 million over 4 years. Laboratory tests increased over the same period with a total increased cost of ZAR0.4 million. There was no significant change in mortality or 30-day readmission rates. The effects of a comprehensive ASP on medical inpatients at a public sector hospital in SA were durable over 4 years, leading to a reduction in total antibiotic consumption without adverse effect. When increased laboratory costs were offset there was a net cost saving of ZAR2.8 million.

  4. Embedding Data Stewardship in Geoscience Australia

    Science.gov (United States)

    Bastrakova, I.; Fyfe, S.

    2013-12-01

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

  5. It Takes A Stewardship Village: Is Community-Based Urban Tree Stewardship Effective?

    Directory of Open Access Journals (Sweden)

    Steven E. Boyce

    2010-01-01

    Full Text Available It is believed that involving the public in street tree (i.e. curbside or sidewalk tree stewardship is an essential part of achieving urban forest canopy goals. However, the incremental benefits of such involvement have not been well studied. Because urban forest stewards contend with many factors that can reduce street tree longevity and offset the benefits of stewardship, quantifying and communicating the overall benefits may help spur stewards’ commitment. To assess the net effect of volunteer street tree stewardship, this article summarizes the development of a community-wide street tree stewardship program and the impact of stewardship on street tree mortality rates over a span of five years. Binary yes-or-no data on whether a steward cared for a street tree were collected for 3,083 growth years, 1,036 of which were for street trees assigned to street tree stewards. The street trees tracked encompassed every street tree within the highly urbanized TriBeCa* neighborhood in lower Manhattan. It was found that significant differences in street tree mortality rates were observed when street trees were stewarded. Odds ratios show an expectation of substantially reduced street tree mortality rates when tree stewards are caring for trees. Other factors regarding where the data was collected, especially specific neighborhood characteristics that may have had an effect on the study, are discussed.

  6. FY 2014 - Stockpile and Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-06-01

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

  7. Water Stewardship and Corporate Sustainability

    Directory of Open Access Journals (Sweden)

    Peter JONES

    2014-12-01

    Full Text Available The aim of this paper is to provide an exploratory review of the extent to which some of the world’s leading companies are publicly addressing water stewardship as part of their corporate sustainability strategies. The paper begins with an outline of the growing importance of corporate sustainability and water stewardship. The paper draws its empirical material from the most recent information on sustainability posted on the top twelve ‘Consumer Superbrands’ corporate websites. The findings reveal that a majority of the selected companies address a number of elements concerning water stewardship as part of their more general approach to corporate sustainability. However corporate commitments to water stewardship can be interpreted as being driven as much by business imperatives as by any concerns for environmental sustainability or a desire to maintain the viability and integrity of natural ecosystems. More critically the authors suggest that the selected companies’ commitments to water stewardship are framed within existing business models focused on technological improvements in eco-efficiency and continuing economic growth. The paper provides an accessible review of the water stewardship issues being pursued by some of the world’s leading companies and as such it will interest academics, students, political commentators and business managers interested in water stewardship and corporate sustainability.

  8. Driving product stewardship

    DEFF Research Database (Denmark)

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

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

  9. Antimicrobial stewardship: Limits for implementation

    NARCIS (Netherlands)

    Sinha, Bhanu

    2014-01-01

    Antibiotic stewardship programme (ASP) is a multifaceted approach to improve patients' clinical outcomes, prevent the emergence of antimicrobial resistance, and reduce hospital costs by prudent and focused antimicrobial use. Development of local treatment guidelines according to local ecology, rapid

  10. Water Stewardship and Corporate Sustainability

    OpenAIRE

    Jones, Peter; Comfort, Daphne; David HILLIER

    2014-01-01

    The aim of this paper is to provide an exploratory review of the extent to which some of the world’s leading companies are publicly addressing water stewardship as part of their corporate sustainability strategies. The paper begins with an outline of the growing importance of corporate sustainability and water stewardship. The paper draws its empirical material from the most recent information on sustainability posted on the top twelve ‘Consumer Superbrands’ corporate websites. The findings r...

  11. Antimicrobial stewardship: philosophy versus practice.

    Science.gov (United States)

    Dodds Ashley, Elizabeth S; Kaye, Keith S; DePestel, Daryl D; Hermsen, Elizabeth D

    2014-10-15

    To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.

  12. Antimicrobial stewardship in small animal veterinary practice

    DEFF Research Database (Denmark)

    Guardabassi, Luca; Prescott, John F

    2015-01-01

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

  13. The organisational structure of urban environmental stewardship

    Science.gov (United States)

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

    2012-01-01

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

  14. 2015 National Agenda for Digital Stewardship

    Science.gov (United States)

    2014-09-01

    organizational cataloguing of skills and competencies but with a more direct assessment of existing and needed digital stewardship skills. Scripps...2015 NATIONAL AGENDA FOR DIGITAL STEWARDSHIP September 2014 A report on the challenges, opportunities, gaps, emerging...trends, and key areas for research and development that support the national capacity for digital stewardship. Authored by the NDSA Coordinating

  15. Long-Term Stewardship Program Science and Technology Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Joan McDonald

    2002-09-01

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

  16. Nuclear Stewardship Research

    Energy Technology Data Exchange (ETDEWEB)

    C.W. Beausang

    2005-06-10

    The second year of our research program has been marked by significant success and progress. It has also been marked by significant changes both in the personnel and location of the major experimental research program. This report covers the period roughly from August 2004 through May 2005. During this period our research has focused mainly on applying the surrogate reaction technique and the ''ratio'' method to deduce neutron induced fission cross sections on uranium nuclei.

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

    Science.gov (United States)

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

    2015-09-01

    Antimicrobial stewardship in the UK has evolved dramatically in the last 15 years. Factors driving this include initial central funding for specialist pharmacists and mandatory reductions in healthcare-associated infections (particularly Clostridium difficile infection). More recently, the introduction of national stewardship guidelines, and an increased focus on stewardship as part of the UK five-year antimicrobial resistance strategy, have accelerated and embedded developments. Antimicrobial pharmacists have been instrumental in effecting changes at an organizational and national level. This article describes the evolution of the antimicrobial pharmacist role, its impact, the progress toward the actions listed in the five-year resistance strategy, and novel emerging areas in stewardship in the UK.

  18. NOAA's Scientific Data Stewardship Program

    Science.gov (United States)

    Bates, J. J.

    2004-12-01

    The NOAA mission is to understand and predict changes in the Earth's environment and conserve and manage coastal and marine resources to meet the Nation's economic, social and environmental needs. NOAA has responsibility for long-term archiving of the United States environmental data and has recently integrated several data management functions into a concept called Scientific Data Stewardship. Scientific Data Stewardship a new paradigm in data management consisting of an integrated suite of functions to preserve and exploit the full scientific value of NOAA's, and the world's, environmental data These functions include careful monitoring of observing system performance for long-term applications, the generation of authoritative long-term climate records from multiple observing platforms, and the proper archival of and timely access to data and metadata. NOAA has developed a conceptual framework to implement the functions of scientific data stewardship. This framework has five objectives: 1) develop real-time monitoring of all satellite observing systems for climate applications, 2) process large volumes of satellite data extending up to decades in length to account for systematic errors and to eliminate artifacts in the raw data (referred to as fundamental climate data records, FCDRs), 3) generate retrieved geophysical parameters from the FCDRs (referred to as thematic climate data records TCDRs) including combining observations from all sources, 4) conduct monitoring and research by analyzing data sets to uncover climate trends and to provide evaluation and feedback for steps 2) and 3), and 5) provide archives of metadata, FCDRs, and TCDRs, and facilitate distribution of these data to the user community. The term `climate data record' and related terms, such as climate data set, have been used for some time, but the climate community has yet to settle on a concensus definition. A recent United States National Academy of Sciences report recommends using the

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

    Science.gov (United States)

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

    2017-09-04

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

  20. Stewardship in Community Education: The Merlyn Effect.

    Science.gov (United States)

    Hyatt, Norman F.; Burnside, Joan L.

    Stewardship is the name given to a theory and model for educational leadership and administration developed by the Department of Educational Administration at Brigham Young University in Provo, Utah. In the stewardship theory, the job of the personnel administrator is to make it safe for others to find their own best ways of doing things to…

  1. Core Elements of Outpatient Antibiotic Stewardship.

    Science.gov (United States)

    Sanchez, Guillermo V; Fleming-Dutra, Katherine E; Roberts, Rebecca M; Hicks, Lauri A

    2016-11-11

    The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.

  2. The Six Principles of Facilities Stewardship

    Science.gov (United States)

    Kaiser, Harvey H.; Klein, Eva

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-10-01

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

  4. Environmental stewardship for gold mining in tropical regions

    OpenAIRE

    A.Isahak; S. Surif; Gill, A; J. Phang

    2013-01-01

    Mining has gained strong popularity in recent years due to the increase in global demand for metals and other industrial raw material derived from the ground. However, information and good governance regarding activities related to mining is still very much lacking especially in underdeveloped and developing countries in the tropics. In Malaysia, the importance of environmental stewardship in mining is a new phenomenon. The new National Mineral Policy 2 calls for compliance with existing stan...

  5. Developing Best Practices for Scientific Data Stewardship? (SDS)

    Science.gov (United States)

    Kihn, E.; Redmon, R.

    2008-12-01

    Science Data Stewardship (SDS) is the art of 'maintaining the science integrity and long term utility of scientific records' and ' the actions which maximize the return on investment for archived scientific data'. This paper will present a series of best practices developed under the Electronic Geophysical Year (eGY) for SDS. These practices include areas such as: Storage and Preservation, Ease of Use, Interoperability, Quality Information and Metadata, Data Availability, User Presentation, Attribution and Accountability, and Electronic Data Preservation These practice are of use for anyone concerned with the long term stewardship and preservation of electronic records. This set of practices is currently being extended by the CODATA working group on the eGY. http://www.sciencedatastewardship.org

  6. South Bay Salt Ponds : Initial stewardship plan

    Data.gov (United States)

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

  7. Remote Antimicrobial Stewardship in Community Hospitals

    OpenAIRE

    Zachary H. Wood; Nicolsen, Nicole C.; Nichole Allen; Cook, Paul P.

    2015-01-01

    Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to strea...

  8. A Study on Mars's Stay at Twenty-eight Lunar Mansions, Four-planet Conjunctions and Five-planet Conjunctions during Past Dynasties of China%中国历代荧惑守列宿与四星聚、五星聚考查

    Institute of Scientific and Technical Information of China (English)

    张健

    2012-01-01

    利用授时历法和现代天文计算方法,对中国历代天文志记录的荧惑(火星)守列宿、四星聚、五星聚进行分析研究,结果表明:65条荧惑守列宿,正误率分别为49%和51%.如果把荧惑留、留守、在某宿等运动形态也考虑为守的范围,共有95条,其正误率分别为56%和44%.12条四星聚正误率各占一半,即50%.11条五星聚正误率分别为82%和18%(其中含五星并见).并对错误记录的原因做了初步探讨.%There are a lot of records about planets' motions during past dynasties of China in Tian Wen Zhi. The Mars's stay at twenty-eight lunar mansions, four-planet conjunctions and five-planet conjunctions are studied in this paper with the calculational methods of modern astronomy and Shou-shi Calendar. The results show that there are a lot of mistakes in these records. The proportion of mistakes is 51% in 65 records of Mars's stay at twenty-eight lunar mansions, 50% in 12 records of four-planet conjunctions, and 18% in 11 records of five-planet conjunctions. The main causes of mistakes are also discussed in this paper and they are as follows: (1) There is no unified format of date for the Mars' stay at twenty-eight lunar mansions; (2) There is no unified format of the time duration for the Mars' stay at twenty-eight mansions; (3) There are mistakes in the recorded patterns of Mars' motions; (4) There are also mistakes in the records of four-planet conjunctions and five-planet conjunctions; (5) Mistakes were made in editing and publishing.

  9. Stewardship and cancer screening programs in Italy

    Directory of Open Access Journals (Sweden)

    Cristine Marie Novinskey

    2011-06-01

    Full Text Available As one of the four major functions of health systems, Stewardship is on the health agenda of several countries worldwide. There is, however, little empirical evidence to support or guide its implementation. To help bridge this gap, the paper aims to contribute to the empirical evidence for health system stewardship and, importantly, to offer implementers an explanatory example of what it could mean in practice. It achieves this by analyzing the experience of the Italian Cancer Screening Programs (from 2004-2009 within a comprehensive framework for health system stewardship. The analysis is largely based on primary and secondary qualitative data, using information collected from an in-depth interview, official documents, and scientific and grey literature. We describe the framework and sub-functions of stewardship, identify the stewardship activities that were carried out by the Programs, and reflect upon the operability of the framework as well as the activities that the Programs have not implemented but would benefit from doing so. The general experience and activities of the Italian Cancer Screening Programs fit well into the stewardship framework, despite not having followed it a priori. Overall, the Programs managed to implement most activities under each sub-function. As an empirical case study, they corroborated the theoretical framework and demonstrated how it could be translated into certain activities on an operational platform. Ultimately, the analysis showed that the framework of stewardship is useful for structuring and prioritizing the most important activities of a steward and, thus, provides a good benchmark for implementers.

  10. NASA'S Earth Science Data Stewardship Activities

    Science.gov (United States)

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

    2015-01-01

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

  11. 2015 Stewardship Science Academic Programs Annual

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-02-01

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

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

    Science.gov (United States)

    Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    No name listed on publication

    2011-08-01

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

  14. Of stewardship, motherhood and apple pie.

    Science.gov (United States)

    Livermore, David M

    2014-04-01

    Antibiotic stewardship is universally agreed to be desirable, but optimal models for stewardship remain uncertain. UK stewardship targets the particular antibiotic families-cephalosporins and fluoroquinolones-blamed for the selection of Clostridium-difficile-associated disease. To balance this there have been dramatic increases in the use of penicillin-β-lactamase inhibitor combinations. By channelling selection pressure in this way, we hazard destroying the utility of these antibiotic classes in turn, as happened with gonorrhoea where penicillins, fluoroquinolones and cefixime were sequentially lost as therapies. Strikingly, in context, almost all carbapenemase-producers are highly resistant to penicillin-β-lactamase inhibitor combinations, which may select for them. There is an urgent need to explore an alternative stewardship model, seeking to limit total antibiotic use but to maintain heterogeneity in what is used, avoiding concentrated selection pressure. There is also a great need to improve and accelerate diagnostics for infection and resistance, reducing or removing the need for protracted empirical treatment with broad-spectrum agents.

  15. Carbapenem stewardship: positive impact on hospital ecology

    Directory of Open Access Journals (Sweden)

    Ana Lucia Lei Munhoz Lima

    2011-02-01

    Full Text Available INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test and susceptibilities (McNemar's test were determined. RESULTS: The defined daily doses (DDD of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027. Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

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

    Science.gov (United States)

    Noll, Donald R

    2016-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1999-10-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  19. Data governance and stewardship: designing data stewardship entities and advancing data access.

    Science.gov (United States)

    Rosenbaum, Sara

    2010-10-01

    U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information-an inevitable step in an information age-is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research.

  20. Antibiotic stewardship in the intensive care unit

    OpenAIRE

    Luyt, Charles-Edouard; Bréchot, Nicolas; Trouillet, Jean-Louis; Chastre, Jean

    2014-01-01

    International audience; The rapid emergence and dissemination of antimicrobial-resistant microorganisms in ICUs worldwide constitute a problem of crisis dimensions. The root causes of this problem are multifactorial, but the core issues are clear. The emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Appropriate antibiotic stewardship in ICUs includes not only rapid identification and optimal treatment of bacterial...

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

    Directory of Open Access Journals (Sweden)

    Georgios Chrysos

    2017-01-01

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

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

    Science.gov (United States)

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

    2010-06-01

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

  3. Planetary Stewardship in an Urbanizing World: Beyond City Limits

    National Research Council Canada - National Science Library

    Sybil P. Seitzinger; Uno Svedin; Carole L. Crumley; Will Steffen; Saiful Arif Abdullah; Christine Alfsen; Wendy J. Broadgate; Frank Biermann; Ninad R. Bondre; John A. Dearing; Lisa Deutsch; Shobhakar Dhakal; Thomas Elmqvist; Neda Farahbakhshazad; Owen Gaffney; Helmut Haberl; Sandra Lavorel; Cheikh Mbow; Anthony J. McMichael; Joao M. F. deMorais; Per Olsson; Patricia Fernanda Pinho; Karen C. Seto; Paul Sinclair; Mark Stafford Smith; Lorraine Sugar

    2012-01-01

    ... and impacts of cities globally. The world's multiple and complex environmental and social challenges require interconnected solutions and coordinated governance approaches to planetary stewardship...

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

    Directory of Open Access Journals (Sweden)

    Lora Jean Brake

    2016-03-01

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

  5. Stewardship to tackle global phosphorus inefficiency

    DEFF Research Database (Denmark)

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

    2015-01-01

    The inefficient use of phosphorus (P) in the food chain is a threat to the global aquatic environment and the health and well-being of citizens, and it is depleting an essential finite natural resource critical for future food security and ecosystem function. We outline a strategic framework of 5R...... imports. Their combined adoption facilitated by interactive policies, co-operation between upstream and downstream stakeholders (researchers, investors, producers, distributors, and consumers), and more harmonized approaches to P accounting would maximize the resource and environmental benefits and help...... deliver a more competitive, circular, and sustainable European economy. The case of Europe provides a blueprint for global P stewardship....

  6. National preventive plan: putting stewardship into practice

    Directory of Open Access Journals (Sweden)

    Antonio Federici

    2012-06-01

    Full Text Available According to the WHO-European region Tallin-Charter, Stewardship (S is on the health agenda of many European countries and in particular of those involved in the devolution of powers, as is the case of Italy. Many observers agree that, in such cases, both the configuration and the application of state authority in the health sector should be realigned so as to achieve desired policy objectives.We present an experience of what could be meant by S in practice, applied to the field of planning preventive interventions.The Italian National Preventive Plan 2010-2012 is a comprehensive Plan dealing with many areas of prevention. For all these areas, the main health objectives, the specific regional goals and the intervention - called “central" actions- that the Ministry of Health (MoH is in charge of carrying out in order to support regional preventive programs, are stated in this Plan. In order to carry out its task, the MoH has referred to the model of stewardship and has reconsidered its role. Therefore, the MoH has matched the sub-functions of S according to the model outlined by Travis et al, and the prior actions that have been proposed by local and national governments, as the main aspects of how to deal with the governance of prevention. Overall, we experienced that the S framework is a suitable and helpful tool to tackle what the challenge of national planning, in the scenario of devolution, is. In doing so, we have learnt some practical lessons about the running of the system and about how to plan according to stewardship, in particular.Among these, given that the steward’s most specific responsibility in planning is to assure stewardship, a sound capacity building is needed as a cornerstone in evolving the culture of the NHS. Furthermore, in order to put this effectively into practice, the Steward must be able to measure S functions, and putting in practice a S model needs international comparison and cultural growth....

  7. Accelerator Based Tools of Stockpile Stewardship

    Science.gov (United States)

    Seestrom, Susan

    2017-01-01

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

  8. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

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

  9. Stockpile stewardship past, present, and future

    Energy Technology Data Exchange (ETDEWEB)

    Adams, Marvin L., E-mail: mladams@tamu.edu [Institute for National Security Education and Research, Texas A and M University, College Station, TX 77843-3133 (United States)

    2014-05-09

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

  10. Stockpile stewardship past, present, and future

    Science.gov (United States)

    Adams, Marvin L.

    2014-05-01

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

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

    Science.gov (United States)

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

    2016-12-01

    Amateur naturalists have played an important role in the study and conservation of nature since the 17th century. Today, naturalist groups make important contributions to bridge the gap between conservation science and practice around the world. We examined data from 2 regional naturalist programs to understand participant motivations, barriers, and perspectives as well as the actions they take to advance science, stewardship, and community engagement. These programs provide certification-based natural history and conservation science training for adults that is followed by volunteer service in citizen science, education, and stewardship. Studies in California and Virginia include quantitative and qualitative evaluation data collected through pre- and postcourse surveys, interviews, and long-term tracking of volunteer hours. Motivations of participants focused on learning about the local environment and plants and animals, connecting with nature, becoming certified, and spending time with people who have similar interests. Over half the participants surveyed were over 50 years old, two-thirds were women, and a majority reported household incomes of over $50,000 (60% in California, 85% in Virginia), and citizen science. The primary barrier was lack of time due to the need to work and focus on career advancement. Survey data revealed that participants' ecological knowledge, scientific skills, and belief in their ability to address environmental issues increased after training. Documented conservation actions taken by the participants include invasive plant management, habitat restoration, and cleanups of natural areas and streams. Long-term data from Virginia on volunteer hours dedicated to environmental citizen science show an increase from 14% in 2007 to 32% in 2014. In general, participants in the naturalist programs we examined increased their content knowledge about ecosystems, had greater confidence in conserving them, and continued to engage as citizen

  12. Assessing Stewardship Maturity: Use Case Results and Lessons Learned

    Science.gov (United States)

    Ritchey, N. A.; Peng, G.

    2015-12-01

    Assessing the current stewardship maturity state of datasets is an important part of ensuring and improving the way datasets are documented, preserved, stewarded, and disseminated to users. It is a critical step towards meeting U.S. federal regulations, organizational requirements, and user needs, especially in the area of data quality. Stewardship maturity assessment models provide a uniform framework for a consistent assessment within the context of data management in organizations and portfolios, and stewardship of individual datasets, respectively. A key component of dataset and stewardship models maturity is data quality and documentation of the quality. The Data Stewardship Maturity Matrix(DSMM) developed in partnership with NOAA's National Centers of Environmental Information (NCEI) and the Cooperative Institute for Climate and Satellites-North Carolina (CICS-NC) has been used to assess stewardship maturity of highly-utilized datasets within NCEI. Consistent application of the model across heterogenous data types (satellite, in situ, regional, global, etc.) and across multiple levels of stewardship support has proven beneficial but challenging.This presentation will demonstrate the utility of the DSMM through results from use case studies and its application for documenting data quality, indicate the challenges of consistent implementation and provide recommendations on improved application.

  13. Science-based stockpile stewardship at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-10-01

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

  14. Antibiotic stewardship in the intensive care unit.

    Science.gov (United States)

    Luyt, Charles-Edouard; Bréchot, Nicolas; Trouillet, Jean-Louis; Chastre, Jean

    2014-01-01

    The rapid emergence and dissemination of antimicrobial-resistant microorganisms in ICUs worldwide constitute a problem of crisis dimensions. The root causes of this problem are multifactorial, but the core issues are clear. The emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Appropriate antibiotic stewardship in ICUs includes not only rapid identification and optimal treatment of bacterial infections in these critically ill patients, based on pharmacokinetic-pharmacodynamic characteristics, but also improving our ability to avoid administering unnecessary broad-spectrum antibiotics, shortening the duration of their administration, and reducing the numbers of patients receiving undue antibiotic therapy. Either we will be able to implement such a policy or we and our patients will face an uncontrollable surge of very difficult-to-treat pathogens.

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

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2016-03-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  17. How to educate prescribers in antimicrobial stewardship practices

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  20. Aquaculture Stewardship Council (ASC) ontwikkeltraject meerval : een inventarisatie

    NARCIS (Netherlands)

    Poelman, M.; Rothuis, A.J.; Bosma, R.H.

    2012-01-01

    Om een Aquaculture Stewardship Council (ASC) gecertificeerd product te krijgen is een standaard nodig, waaraan getoetst kan worden. Deze standaard geeft certificeerders een referentiekader. Pas als een standaard aanwezig is, kunnen producten gecertificeerd worden.

  1. Capacity building: a framework for strengthening stewardship in British Columbia

    National Research Council Canada - National Science Library

    Sherlock, C; Webber-Lampa, K

    2009-01-01

    The purpose of this research was to gain an understanding of the current status of capacity building in the stewardship sector in British Columbia in order to identify gaps and recommend next steps...

  2. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

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

  3. Between beneficence and justice: the ethics of stewardship in medicine.

    Science.gov (United States)

    Jansen, Lynn A

    2013-02-01

    In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it has an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society's medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-11-01

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

  5. The Scottish approach to enhancing antimicrobial stewardship.

    Science.gov (United States)

    Nathwani, Dilip; Christie, Peter

    2007-08-01

    In 2002, the Scottish Executive produced the Antimicrobial Resistance Strategy and Scottish Action Plan, which highlighted antimicrobial stewardship as a key objective in combating resistance. An important response, as a part of the Ministerial Healthcare Associated Infection Task Force work programme was the publication of 'Antimicrobial Prescribing Policy and Practice in Scotland: recommendations for good antimicrobial practice in acute hospitals' in 2005. This article briefly reviews the core components of the Scottish approach, reviews progress with some key goals and explores how many of these goals are being taken forward through a cohesive Scottish national multifaceted strategy, which incorporates primary and secondary care. Much of this will spring from the current review of the Scottish Action Plan. While recognizing the significant progress achieved by the Appropriate Antimicrobial Prescribing for Tomorrow's Doctors Project Group in the education of undergraduate medical students, the article also reviews the NHS Education Scotland-supported Scottish National Antimicrobial Prescribing Project, aimed at foundation training doctors in Scotland. We hope that this experience can be shared and further developed with colleagues within the United Kingdom and European Union.

  6. Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship.

    Science.gov (United States)

    Messacar, Kevin; Parker, Sarah K; Todd, James K; Dominguez, Samuel R

    2017-03-01

    New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics.

  7. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    Directory of Open Access Journals (Sweden)

    Kristen Ellis

    2016-01-01

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

  8. Environmental stewardship for gold mining in tropical regions

    Directory of Open Access Journals (Sweden)

    A Isahak

    2013-10-01

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

  9. Impact of an antimicrobial stewardship program on critical haematological patients.

    Science.gov (United States)

    Ruiz-Ramos, Jesus; Frasquet, Juan; Poveda-Andrés, Jose Luis; Romá, Eva; Salavert-Lleti, Miguel; Castellanos, Álvaro; Ramirez, Paula

    2017-07-01

    Antimicrobial Stewardship Programs (ASPs) have appeared as very useful tools in order to improve the use of antimicrobial agents. The objective of this study is to assess the impact of an ASP on haematological patients hospitalized in an Intensive Care Unit (ICU). A quasi-experimental pre-post intervention study, which included haematological patients admitted to an ICU and assessed by the ASP program during 3 years. The impact of the program on patient evolution was assessed by comparison between the previous period and the intervention period in terms of mortality, mean stay, number of re-hospitalizations, and duration of mechanical ventilation for intubated patients. The ASP team assessed 324 antimicrobial agents in 169 patients; they recommended 121 modifications, including 55 treatment discontinuations. Compared with the pre-intervention period, there were no significant differences in the variables assessed. No variation was observed in colonization by multi-resistant bacteria. The implementation of an APS on critical haematological patients will lead to a relevant number of treatment modifications, without any impact on the clinical evolution of patients. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  10. Environmental stewardship for gold mining in tropical regions

    Directory of Open Access Journals (Sweden)

    A.Isahak

    2013-10-01

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

  11. Antibiotic stewardship programs and the internist’s role

    Directory of Open Access Journals (Sweden)

    Massimo Giusti

    2016-12-01

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

  12. 3rd year final contractor report for: U.S. Department of Energy Stewardship Science Academic Alliances Program Project Title: Detailed Measurements of Rayleigh-Taylor Mixing at Large and Small Atwood Numbers

    Energy Technology Data Exchange (ETDEWEB)

    Malcolm J. Andrews

    2006-04-14

    This project had two major tasks: Task 1. The construction of a new air/helium facility to collect detailed measurements of Rayleigh-Taylor (RT) mixing at high Atwood number, and the distribution of these data to LLNL, LANL, and Alliance members for code validation and design purposes. Task 2. The collection of initial condition data from the new Air/Helium facility, for use with validation of RT simulation codes at LLNL and LANL. This report describes work done in the last twelve (12) months of the project, and also contains a summary of the complete work done over the three (3) life of the project. As of April 1, 2006, the air/helium facility (Task 1) is now complete and extensive testing and validation of diagnostics has been performed. Initial condition studies (Task 2) is also comp lete. Detailed experiments with air/helium with Atwood numbers up to 0.1 have been completed, and Atwood numbers of 0.25. Within the last three (3) months we have been able to successfully run the facility at Atwood numbers of 0.5. The progress matches the project plan, as does the budget. We have finished the initial condition studies using the water channel, and this work has been accepted for publication on the Journal of Fluid Mechanics (the top fluid mechanics journal). Mr. Nick Mueschke and Mr. Wayne Kraft are continuing with their studies to obtain PhDs in the same field, and will also continue their collaboration visits to LANL and LLNL. Over its three (3) year life the project has supported two(2) Ph.D.’s and three (3) MSc’s, and produced nine (9) international journal publications, twenty four (24) conference publications, and numerous other reports. The highlight of the project has been our close collaboration with LLNL (Dr. Oleg Schilling) and LANL (Drs. Dimonte, Ristorcelli, Gore, and Harlow).

  13. Integrating Information Networks for Collective Planetary Stewardship

    Science.gov (United States)

    Tiwari, A.

    2016-12-01

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

  14. Impact of Antimicrobial Stewardship Programme on Carbapenem Resistance in Gram Negative Isolates in an Indian Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Namita Jaggi

    2012-01-01

    Full Text Available Problem statement: Increasing Antimicrobial resistance in the World is constantly becoming a Global threat and there is an urgent need to prevent its spread. Various studies of last decade have shown reduced trends of antimicrobial resistance in the pathogens as an outcome of the Antimicrobial Stewardship Programs. In view of this, the present four years’ study was carried out to analyse the impact of Antimicrobial Stewardship Programs on carbapenem resistance in Gram negative isolates in a Tertiary care hospital in India. It involved a retrospective analysis of carbapenem resistance in Gram negatives for one year (July 2007 to June 2008, followed by prospective evaluation of the impact of stewardship interventions on resistance patterns (July 2008 to Jun 2011. Approach: Our study was staged into four parts: (1 July 2007 to June 2008: Resistance patterns of Gram negative isolates-E.coli, Klebsiella, Pseudomonas and Acinetobacter baumannii towards carbapenems were studied. (2 July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. (3 July 2008 to June 2010: The Impact of Phase I intervention programme was assessed subsequently. (4 July 2010 to June 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Results: The percentage resistance towards carbapenems in E.coli, Klebsiella, Pseudomonas and A. baumannii from July 2007-June 2008 was 1.07, 13.1, 21.3 and 12.5% respectively. Phase I intervention programme was initiated in July 2008 and Phase II in July 2010 and a subsequent reduction of 4.03% was observed in the carbapenem resistant Pseudomonas in the last stage of study period following the interventions. However the resistance in the other Gram negatives (E. coli, Klebsiella and A. baumannii rose and then stabilized. Conclusion: An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to control the

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

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    2015-06-01

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

  16. 76 FR 23335 - Wilderness Stewardship Plan/Environmental Impact Statement, Sequoia and Kings Canyon National...

    Science.gov (United States)

    2011-04-26

    ... proper food storage; party size; camping and campsites; human waste management; stock use; meadow... National Park Service Wilderness Stewardship Plan/Environmental Impact Statement, Sequoia and Kings Canyon... Intent to Prepare Environmental Impact Statement for Wilderness Stewardship Plan, Sequoia and...

  17. Another look at education from a Christian stewardship perspective

    Directory of Open Access Journals (Sweden)

    Johannes L. van der Walt

    2012-11-01

    Full Text Available Despite the current postmodern aversion to large-scale philosophies, another look at Christian stewardship education has become necessary. Christian educators need a reminder in the prevailing socio-political conditions in South Africa about the intricacies of their calling and duties towards the upcoming generation. The article commences with a discussion of education in general and then goes on to argue that the ‘thin’, minimalist and universalist language of modern day secular pedagogical theory should be augmented, or preferably replaced, by the ‘thick’, maximalist and particularist language of education theory rooted in the Bible. The article highlights a number of key concepts associated with Christian stewardship education and concludes by observing that, whilst an entire book (once again could have been written on the subject, the discussion of a few key issues with regard to Christian stewardship education can serve as a reminder to Christian educators about their pedagogical responsibilities.

  18. Core Attributes of Stewardship; Foundation of Sound Health System

    Directory of Open Access Journals (Sweden)

    Neelesh Kapoor

    2014-06-01

    Full Text Available Stewardship is not a new concept for public policy, but has not been used to its optimum by the health policy-makers. Although it is being practiced in most successful models of health system, but the onus to this function is still due till date. Lately, few experts in World Health Organization (WHO have realized its importance and have been raising the issue at different platforms to pursue the most important function of the health system i.e. stewardship. These core attributes of stewardship need to be understood in totality for better understanding of the concept. The core attributes required for hassle free functioning of a health system include responsible manager, political will, normative dimension, balanced interventionist and proponents of good governance.

  19. Antimicrobial stewardship in small animal veterinary practice: from theory to practice.

    Science.gov (United States)

    Guardabassi, Luca; Prescott, John F

    2015-03-01

    Despite the increasing recognition of the critical role for antimicrobial stewardship in preventing the spread of multidrug-resistant bacteria, examples of effective antimicrobial stewardship programs are rare in small animal veterinary practice. This article highlights the basic requirements for establishing stewardship programs at the clinic level. The authors provide suggestions and approaches to overcome constraints and to move from theoretic concepts toward implementation of effective antimicrobial stewardship programs in small animal clinics.

  20. Guidance for the knowledge and skills required for antimicrobial stewardship leaders.

    Science.gov (United States)

    Cosgrove, Sara E; Hermsen, Elizabeth D; Rybak, Michael J; File, Thomas M; Parker, Sarah K; Barlam, Tamar F

    2014-12-01

    Antimicrobial stewardship programs are increasingly recognized as critical in optimizing the use of antimicrobials. Consequently, more physicians, pharmacists, and other healthcare providers are developing and implementing such programs in a variety of healthcare settings. The purpose of this guidance document is to outline the knowledge and skills that are needed to lead an antimicrobial stewardship program. It was developed by antimicrobial stewardship experts from organizations that are engaged in advancing the field of antimicrobial stewardship.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-01-07

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

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

    Science.gov (United States)

    Molsher, Robyn; Townsend, Mardie

    2016-03-01

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

  3. Serendipity and Stewardship: Teaching with the Spirit in a Secular Classroom

    Science.gov (United States)

    Hall, Bradford J.

    2009-01-01

    Can one appropriately teach with the spirit in a secular classroom? This chapter addresses the question by exploring how the concepts of serendipity and stewardship encourage a form of spirituality that is inclusive and appropriate for the university setting. Serendipity and stewardship work hand in hand. Stewardship resists the temptation of…

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  6. Stewardship and Accountability: Valued Elements in Maximising Human Potential.

    Science.gov (United States)

    Todd, Sally M.

    1998-01-01

    Explains the application of five principles of stewardship to the education of gifted children: (1) teachers/parents teach correct principles; (2) students set their own goals in harmony with these principles; (3) teachers serve students as a source of help; (4) students ask for and receive help when needed; and (5) students give an accounting of…

  7. Idaho National Laboratory Site Long-Term Stewardship Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    B. E. Olaveson

    2006-07-27

    The U.S. Department of Energy has established long-term stewardship programs to protect human health and the environment at sites where residual contamination remains after site cleanup. At the Idaho National Laboratory Site, Comprehensive Environmental Response, Compensation, and Liability Act (CERLA) long-term stewardship activities performed under the aegis of regulatory agreements, the Federal Facility Agreement and Consent Order for the Idaho National Laboratory, and state and federal requirements are administered primarily under the direction of the Idaho Cleanup Project. It represents a subset of all on-going environmental activity at the Idaho National Laboratory Site. This plan provides a listing of applicable CERCLA long-term stewardship requirements and their planned and completed implementation goals. It proffers the Long-Term Stewardship Environmental Data Warehouse for Sitewide management of environmental data. This plan will be updated as needed over time, based on input from the U.S. Department of Energy, its cognizant subcontractors, and other local and regional stakeholders.

  8. Sharing Responsibility for Data Stewardship Between Scientists and Curators

    Science.gov (United States)

    Hedstrom, M. L.

    2012-12-01

    Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

  9. Designing Program Roadmaps to Catalyze Community Formation: A Case Study of the Long-Term Stewardship Science and Technology Roadmapword

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Brent; Hanson, Duane; Matthern, Gretchen

    2003-02-27

    A number of broad perspective technology roadmaps have been developed in the last few years as tools for coordinating nation-wide research in targeted areas. These roadmaps share a common characteristic of coalescing the associated stakeholder groups into a special-interest community that is willing to work cooperatively in achieving the roadmap goals. These communities are key to roadmap implementation as they provide the collaborative energy necessary to obtain the political support and funding required for identified science and technology development efforts. This paper discusses the relationship between roadmaps and special-interest communities, using the recently drafted Department of Energy's Long-Term Stewardship Science and Technology Roadmap as a case study. Specific aspects this roadmap's design facilitated the development of a long-term stewardship community while specific realities during roadmap development impacted the realization of the design.

  10. Data stewardship - a fundamental part of the scientific method (Invited)

    Science.gov (United States)

    Foster, C.; Ross, J.; Wyborn, L. A.

    2013-12-01

    This paper emphasises the importance of data stewardship as a fundamental part of the scientific method, and the need to effect cultural change to ensure engagement by earth scientists. It is differentiated from the science of data stewardship per se. Earth System science generates vast quantities of data, and in the past, data analysis has been constrained by compute power, such that sub-sampling of data often provided the only way to reach an outcome. This is analogous to Kahneman's System 1 heuristic, with its simplistic and often erroneous outcomes. The development of HPC has liberated earth sciences such that the complexity and heterogeneity of natural systems can be utilised in modelling at any scale, global, or regional, or local; for example, movement of crustal fluids. Paradoxically, now that compute power is available, it is the stewardship of the data that is presenting the main challenges. There is a wide spectrum of issues: from effectively handling and accessing acquired data volumes [e.g. satellite feeds per day/hour]; through agreed taxonomy to effect machine to machine analyses; to idiosyncratic approaches by individual scientists. Except for the latter, most agree that data stewardship is essential. Indeed it is an essential part of the science workflow. As science struggles to engage and inform on issues of community importance, such as shale gas and fraccing, all parties must have equal access to data used for decision making; without that, there will be no social licence to operate or indeed access to additional science funding (Heidorn, 2008). The stewardship of scientific data is an essential part of the science process; but often it is regarded, wrongly, as entirely in the domain of data custodians or stewards. Geoscience Australia has developed a set of six principles that apply to all science activities within the agency: Relevance to Government Collaborative science Quality science Transparent science Communicated science Sustained

  11. Financial model based on a successful implementation of a day-2 intervention by a multidisciplinary Antimicrobial Stewardship-Team on a urology ward

    NARCIS (Netherlands)

    Dik, JH; Hendrix, R; Friedrich, AW; Luttjeboer, J; Lo-Ten-Foe, J. R.; Wilting, K.R.; Nannan Panday, P; Postma, MJ; Sinha, B

    2015-01-01

    Background For more than two years, an Antimicrobial Stewardship-Team (A-Team) is acting successfully at the University Medical Center Groningen, a large academic hospital in the Netherlands. The team performs face-to-face case-audits based on an automatically triggered day-2 bundle. Performance on

  12. Leading By Example: Canada and its Arctic Stewardship Role

    DEFF Research Database (Denmark)

    Burke, Danita Catherine

    2017-01-01

    . This paper explores the origins of Canada’s image as the steward of the Arctic environment which started with the 1970 Arctic Waters Pollution Prevention Act legislation and addresses the central research questions, how did Canada’s role as the steward of the Arctic environment begin and evolve and how...... to examine the circumstances which led to the creation and success of Canada’s stewardship role and its implications for Canadian and international shipping in the Arctic region before any changes are made to the governance of the region through unilateral legislation changes or new international agreements...... important is the Arctic Waters Pollution Prevention Act for international acceptance of Canada’s stewardship role and maritime jurisdiction in the Arctic region?...

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

    Science.gov (United States)

    Allerberger, Franz; Frank, Annegret; Gareis, Roland

    2008-01-01

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

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Science.gov (United States)

    Weiss, Marjorie D

    2013-08-01

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

  16. Intermediation in Open Development: A Knowledge Stewardship Approach

    Directory of Open Access Journals (Sweden)

    Katherine M. A. Reilly

    2016-06-01

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

  17. Penicillin skin testing: potential implications for antimicrobial stewardship.

    Science.gov (United States)

    Unger, Nathan R; Gauthier, Timothy P; Cheung, Linda W

    2013-08-01

    As the progression of multidrug-resistant organisms and lack of novel antibiotics move us closer toward a potential postantibiotic era, it is paramount to preserve the longevity of current therapeutic agents. Moreover, novel interventions for antimicrobial stewardship programs are integral to combating antimicrobial resistance worldwide. One unique method that may decrease the use of second-line antibiotics (e.g., fluoroquinolones, vancomycin) while facilitating access to a preferred β-lactam regimen in numerous health care settings is a penicillin skin test. Provided that up to 10% of patients have a reported penicillin allergy, of whom ~10% have true IgE-mediated hypersensitivity, significant potential exists to utilize a penicillin skin test to safely identify those who may receive penicillin or a β-lactam antibiotic. In this article, we provide information on the background, associated costs, currently available literature, pharmacists' role, antimicrobial stewardship implications, potential barriers, and misconceptions, as well as future directions associated with the penicillin skin test.

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

    Science.gov (United States)

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

    2015-03-01

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

  19. Antimicrobial stewardship in Scotland: impact of a national programme

    Directory of Open Access Journals (Sweden)

    Nathwani Dilip

    2012-02-01

    Full Text Available Abstract Backgound The Scottish Antimicrobial Prescribing Group (SAPG was established by the Scottish Government in 2008 to lead the first national initiative to actively address antimicrobial stewardship. Healthcare associated infection (HAI is a priority in Scotland and the work of SAPG contributes to the national HAI Delivery Plan. SAPG's early work has focused on restricting the use of antibiotics associated with a high risk of Clostridium difficile infection (CDI and development of national prescribing indicators to support reduction of CDI. Findings Scottish Antimicrobial Prescribing Group has developed prescribing indicators for hospital and primary care, which are measured and reported in all 14 NHS board areas. Improvement in compliance with the indicators has been demonstrated with resultant reductions in CDI rates and no adverse effect on mortality or antimicrobial resistance patterns. Conclusions The establishment of a Scottish national antimicrobial stewardship programme has made a significant contribution to the HAI agenda, particularly in relation to CDI. The programme is supported by local antimicrobial teams, a national framework for education, surveillance of antimicrobial use and resistance and sharing of data for improvement. Antimicrobial stewardship has been integrated with other national programmes on patient safety and quality improvement.

  20. Legally invisible: stewardship for Aboriginal and Torres Strait Islander health.

    Science.gov (United States)

    Howse, Genevieve; Dwyer, Judith

    2016-04-01

    The need to improve access to good health care for Aboriginal and Torres Strait Islander people has been the subject of policy debate for decades, but progress is hampered by complex policy and administrative arrangements and lack of clarity about the responsibilities of governments. This study aimed to identify the current legal basis of those responsibilities and define options available to Australian governments to enact enduring responsibility for Aboriginal health care. This study used a framework for public health law research and conducted a mapping study to examine the current legal underpinnings for stewardship and governance for Aboriginal health and health care. More than 200 pieces of health legislation were analysed in the context of the common and statutory law and health policy goals. Very little specific recognition of the needs of Aboriginal people was found, and nothing that creates responsibility for stewardship and governance. The continuing absence of a legislative framework to address and protect Aboriginal health can be traced back to the founding doctrine of terra nullius (unoccupied land). We considered the results applying both a human rights perspective and the perspective of therapeutic jurisprudence. We suggest that national law for health stewardship would provide a strong foundation for progress, and should itself be based on recognition of Australia's First Peoples in the Australian Constitution, as is currently proposed. © 2015 The Authors.

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

    Science.gov (United States)

    Pfaller, Michael A; Castanheira, Mariana

    2016-01-01

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

  2. Combating antimicrobial resistance: antimicrobial stewardship program in Taiwan.

    Science.gov (United States)

    Tseng, Shu-Hui; Lee, Chun-Ming; Lin, Tzou-Yien; Chang, Shan-Chwen; Chuang, Yin-Ching; Yen, Muh-Yong; Hwang, Kao-Pin; Leu, Hsieh-Shong; Yen, Che-Chieh; Chang, Feng-Yee

    2012-04-01

    Multi-drug-resistant organisms are increasingly recognized as a global public health issue. Healthcare-associated infection and antimicrobial resistance are also current challenges to the treatment of infectious diseases in Taiwan. Government health policies and the health care systems play a crucial role in determining the efficacy of interventions to contain antimicrobial resistance. National commitment to understand and address the problem is prerequisite. We analyzed and reviewed the antibiotic resistance related policies in Taiwan, USA, WHO and draft antimicrobial stewardship program to control effectively antibiotic resistance and spreading in Taiwan. Antimicrobial stewardship program in Taiwan includes establishment of national inter-sectoral antimicrobial stewardship task force, implementing antimicrobial-resistance management strategies, surveillance of HAI and antimicrobial resistance, conducting hospital infection control, enforcement of appropriate regulations and audit of antimicrobial use through hospital accreditation, inspection and national health insurance payment system. No action today, no cure tomorrow. Taiwan CDC would take a multifaceted, evidence-based approach and make every effort to combat antimicrobial resistance with stakeholders to limit the spread of multi-drug resistant strains and to reduce the generation of antibiotic resistant bacteria in Taiwan.

  3. The Influence of School Socioeconomic Status on First-Year Teachers' Emotions

    Science.gov (United States)

    Darby, Alexa; Mihans, Richard; Gonzalez, Kirsten; Lyons, Mary; Goldstein, Julie; Anderson, Kelly

    2011-01-01

    This study examined first-year teachers' (FYTs) experiences at high poverty and non-high poverty schools, exploring their emotional responses to critical incidents. Twenty-eight FYTs were interviewed. The results highlighted the influence of FYT's interactions with students, coworkers, administrators, and parents on their emotions. FYTs at high…

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

    Science.gov (United States)

    Cummings, R.; Darch, P.

    2013-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-09-01

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

  6. Lessons Learned in Antibiotic Stewardship: Fluoroquinolone Use in Pediatrics.

    Science.gov (United States)

    Hersh, Adam L; Gerber, Jeffrey S; Hicks, Lauri A; Pavia, Andrew T

    2015-03-01

    The use of fluoroquinolones differs dramatically between adult and pediatric patients. For adults, they are the leading class of antibiotics prescribed in ambulatory care visits whereas in children, they are the least frequently prescribed class. The reasons for this difference in practice likely relate to perceptions of their potential for harm. This highlights the impact of physicians' perception of direct patient harm in antibiotic decision making which has implications for antibiotic stewardship. © The Author 2014. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Yeo Chay Leng

    2012-11-01

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

  9. Perceived Change in Leadership Skills as a Result of the Wilderness Education Association Wilderness Stewardship Course.

    Science.gov (United States)

    Hobbs, Elisabeth; Spencer, Steve

    A study examined the impact of a Wilderness Education Association Wilderness Stewardship course on students' leadership skills development. Twelve students at Western Kentucky University completed the Leadership Skills Inventory (LSI) before and after a 2-week Wilderness Stewardship course that included ten days of field experience in camping,…

  10. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, E.C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.; Overdiek, H.W.; Linden, P.D. van der; Natsch, S.S.; Hertogh, C.M.; Wolfs, T.F.; Schouten, J.A.; Kullberg, B.J.; Prins, J.M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

  11. Current evidence on hospital antimicrobial stewardship objectives : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, Emelie C.; Hulscher, Marlies E J L; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W T Cohen; Overdiek, Hans W P M; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M P M; Wolfs, Tom F W; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

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

    Science.gov (United States)

    Erika s. Svendsen; Lindsay K. Campbell

    2008-01-01

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

  13. 75 FR 48742 - Renewal of the Regional Resource Stewardship Council Charter

    Science.gov (United States)

    2010-08-11

    ... Renewal of the Regional Resource Stewardship Council Charter AGENCY: Tennessee Valley Authority (TVA). ACTION: Notice of Charter Renewal. SUMMARY: Pursuant to the Federal Advisory Committee Act (FACA) (5 U.S.C. Appendix), the TVA Board of Directors has renewed the Regional Resource Stewardship...

  14. Storyline and Associations Pyramid as Methods of Creativity Enhancement: Comparison of Effectiveness in 5-Year-Old Children

    Science.gov (United States)

    Smogorzewska, Joanna

    2012-01-01

    This article presents the results of a study comparing the originality, the length, the number of neologisms and the syntactic complexity of fairy tales created with "Storyline" and "Associations Pyramid." Both methods were developed to enhance children's language abilities and their creative thinking. One hundred twenty eight 5-year-old children…

  15. Enhancing stewardship of community-engaged research through governance.

    Science.gov (United States)

    Oetzel, John G; Villegas, Malia; Zenone, Heather; White Hat, Emily R; Wallerstein, Nina; Duran, Bonnie

    2015-06-01

    We explored the relationship of community-engaged research final approval type (tribal government, health board, or public health office (TG/HB); agency staff or advisory board; or individual or no community approval) with governance processes, productivity, and perceived outcomes. We identified 294 federally funded community-engaged research projects in 2009 from the National Institutes of Health's Research Portfolio Online Reporting Tools, Centers for Disease Control and Prevention's Prevention Research Centers, and Native American Research Centers for Health databases. Two hundred (68.0%) investigators completed a survey about governance processes and productivity measures; 312 partners (77.2% of 404 invited) and 138 investigators (69.0% of 200 invited) completed a survey about perceived outcomes. Projects with TG/HB approval had increased likelihood of community control of resources (odds ratios [ORs] ≥ 4.80). Projects with other approvals had decreased likelihood of development or revision of institutional review board policies (ORs ≤ 0.37), having written agreements (ORs ≤ 0.17), and agreements about publishing (ORs ≤ 0.28), data use (ORs ≤ 0.17), and publishing approval (ORs ≤ 0.14). Community-engaged research projects with TG/HB approval had strong stewardship of project resources and agreements. Governance as stewardship protects community interests; thus, is an ethical imperative for communities, especially native communities, to adopt.

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

    Directory of Open Access Journals (Sweden)

    Franciska von Heland

    2014-07-01

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

  17. Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

    Science.gov (United States)

    Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

    2016-10-04

    Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

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

    Science.gov (United States)

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

    2014-11-01

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

  19. The role of the multidisciplinary team in antifungal stewardship.

    Science.gov (United States)

    Agrawal, Samir; Barnes, Rosemary; Brüggemann, Roger J; Rautemaa-Richardson, Riina; Warris, Adilia

    2016-11-01

    There are a variety of challenges faced in the management of invasive fungal diseases (IFD), including high case-fatality rates, high cost of antifungal drugs and development of antifungal resistance. The diagnostic challenges and poor outcomes associated with IFD have resulted in excessive empirical use of antifungals in various hospital settings, exposing many patients without IFD to potential drug toxicities as well as causing spiralling antifungal drug costs. Further complexity arises as different patient groups show marked variation in their risk for IFD, fungal epidemiology, sensitivity and specificity of diagnostic tests and the pharmacokinetics and pharmacodynamics of antifungal drugs. To address these issues and to ensure optimal management of IFD, specialist knowledge and experience from a range of backgrounds is required, which extends beyond the remit of most antibiotic stewardship programmes. The first step in the development of any antifungal stewardship (AFS) programme is to build a multidisciplinary team encompassing the necessary expertise in the management of IFD to develop and implement the AFS programme. The specific roles of the key individuals within the AFS team and the importance of collaboration are discussed in this article.

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

    Directory of Open Access Journals (Sweden)

    Edwin J.M. Oberjé

    2017-03-01

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

  1. A twenty-eight channel coil array for improved optic nerve imaging

    Science.gov (United States)

    Merrill, Robb Phillip

    The purpose of this work was to design and construct a radio-frequency coil optimized for imaging the Optic Nerve (ON) on a Siemens 3T magnetic resonance imaging (MRI) scanner. The specific goals were to optimize signal sensitivity from the orbit to the optic chiasm and improve SNR over designs currently in use. The constructed coil features two fiberglass formers that can slide over each other to accommodate any arbitrary head size, while maintaining close coupling near the eyes and around the head in general. This design eliminates the air void regions that occur between the coil elements and the forehead when smaller heads are imaged in one-piece, nonadjustable coil formers. The 28 coil elements were placed using a soccer-ball pattern layout to maximize head coverage. rSNR profiles from phantom imaging studies show that the ON coil provides approximately 55% greater rSNR at the region of the optic chiasm and approximately 400% near the orbits compared to the 12-channel commercial coil. The improved rSNR in the optic nerve region allows performance of high resolution DTI, which provides a qualitative measurement for evaluating optic neuritis. Images from volunteer and patient studies with the ON coil reveal plaques that correspond well with the patient disease history of chronic bilateral optic neuritis. Correspondence of image findings with patient disease histories demonstrates that optic neuritis can be visualized and detected in patients using 3T MRI with advanced imaging coils, providing improved patient care.

  2. Ground Reaction Forces Generated by Twenty-eight Hatha Yoga Postures.

    Science.gov (United States)

    Wilcox, Sylvia J; Hager, Ron; Lockhart, Barbara; Seeley, Matthew K

    Adherents claim many benefits from the practice of yoga, including promotion of bone health and prevention of osteoporosis. However, no known studies have investigated whether yoga enhances bone mineral density. Furthermore, none have estimated reaction forces applied by yoga practitioners. The purpose of this study was to collect ground reaction force (GRF) data on a variety of hatha yoga postures that would commonly be practiced in fitness centers or private studios. Twelve female and eight male volunteers performed a sequence of 28 hatha yoga postures while GRF data were collected with an AMTI strain-gauge force platform. The sequence was repeated six times by each study subject. Four dependent variables were studied: peak vertical GRF, mean vertical GRF, peak resultant GRF, and mean resultant GRF. Univariate analysis was used to identify mean values and standard deviations for the dependent variables. Peak vertical and resultant values of each posture were similar for all subjects, and standard deviations were small. Similarly, mean vertical and resultant values were similar for all subjects. This 28 posture yoga sequence produced low impact GRF applied to upper and lower extremities. Further research is warranted to determine whether these forces are sufficient to promote osteogenesis or maintain current bone health in yoga practitioners.

  3. Twenty-eight week toxicity study of perlite powder in mice.

    Science.gov (United States)

    Sakai, T; Nagao, S

    1985-05-01

    Groups of 21 male and 21 female mice were given diets containing 20%, 10%, 1% or 0% (control) perlite for 28 weeks. Appearance, behavior, mortality, and food consumption of mice of treated groups were not affected during the experimental period. Males of the 20% and 10% groups did experience slightly reduced growth rate. No significant drug-related changes were found in urinalysis, hematology, serum chemistry, and organ weight. No differences were found between control and treated groups in autopsy and histopathological findings. Therefore, the maximum no-effect level is considered to be 1% in the diet which developed no toxic changes in any items examined in mice treated orally with perlite for 28 weeks.

  4. Community Energy Systems and the Law of Public Utilities. Volume Twenty-eight. Montana

    Energy Technology Data Exchange (ETDEWEB)

    Feurer, D.A.; Weaver, C.L.

    1981-01-01

    A detailed description is presented of the laws and programs of the State of Montana governing the regulation of public energy utilities, the siting of energy generating and transmission facilities, the municipal franchising of public energy utilities, and the prescription of rates to be charged by utilities including attendant problems of cost allocations, rate base and operating expense determinations, and rate of return allowances. These laws and programs are analyzed to identify impediments which they may present to the implementation of Integrated Community Energy Systems (ICES). This report is one of fifty-one separate volumes which describe such regulatory programs at the Federal level and in each state as background to the report entitled Community Energy Systems and the Law of Public Utilities - Volume One: An Overview. This report also contains a summary of a strategy described in Volume One - An Overview for overcoming these impediments by working within the existing regulatory framework and by making changes in the regulatory programs to enhance the likelihood of ICES implementation.

  5. LECTURES ON ACUPUNCTURE Part Ⅰ Clinical Acupuncture Lecture Twenty-Eight COUGH

    Institute of Scientific and Technical Information of China (English)

    XU Li; SHANG Xiukui; PAN Xingfang

    2002-01-01

    @@ Cough, a main symptom of the lung problems, may result either from invasion of the exogenous factors induced dysfunction of the lungqi in dispersion or from disorders of the lung itself or from dysfunction of other zang-fu organs affecting the lung.

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

    Science.gov (United States)

    Prescott, John F

    2014-07-16

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

  7. The impact of an antimicrobial stewardship programme on the use of antimicrobials and the evolution of drug resistance.

    Science.gov (United States)

    Del Arco, A; Tortajada, B; de la Torre, J; Olalla, J; Prada, J L; Fernández, F; Rivas, F; García-Alegría, J; Faus, V; Montiel, N

    2015-02-01

    Misuse of antibiotics can provoke increased bacterial resistance. There are no immediate prospects of any new broad-spectrum antibiotics, especially any with activity against enterobacteria, coming onto the market. Therefore, programmes should be implemented to optimise antimicrobial therapy. In a quasi-experimental study, the results for the pre-intervention year were compared with those for the 3 years following the application of an antimicrobial stewardship programme. We describe 862 interventions carried out as part of the stewardship programme at the Hospital Costa del Sol from 2009 to 2011. We examined the compliance of the empirical antimicrobial treatment with the programme recommendations and the treatment optimisation achieved by reducing the antibiotic spectrum and adjusting the dose, dosing interval and duration of treatment. In addition, we analysed the evolution of the sensitivity profile of the principal microorganisms and the financial savings achieved. 93 % of the treatment recommendations were accepted. The treatment actions taken were to corroborate the empirical treatment (46 % in 2009 and 31 % in 2011) and to reduce the antimicrobial spectrum taking into account the antibiogram results (37 % in 2009 and 58 % in 2011). The main drugs assessed were imipenem/meropenem, used in 38.6 % of the cases, and cefepime (20.1 %). The sensitivity profile of imipenem against Pseudomonas aeruginosa increased by 10 % in 2011. Savings in annual drug spending (direct costs) of 30,000 Euros were obtained. Stewardship programmes are useful tools for optimising antimicrobial therapy. They may contribute to preventing increased bacterial resistance and to reducing the long-term financial cost of antibiotic treatment.

  8. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Michael P; Springer, Clint

    2013-10-15

    Task A: Examination of the physiological, morphological, and reproductive responses of Panicum virgatum (switchgrass) cultivars identified as potential biofuel producing cultivars as well as naturally-occurring varieties of switchgrass to projected changes in climate for the central portion of the United States. This project was a multi-year project set in a field site located at the Konza Prairie Biological Station near Manhattan, KS USA. At the field site we planted switchgrass collected from regions in Kansas, Oklahoma, and Texas. After a year of establishment we implemented a set of two-year water treatments that examined the responses in physiology, growth and development of switchgrass to predicted changes in precipitation amount for the central United States. After this experiment was completed we performed a second set of experiments that examined the responses of switchgrass physiology, growth, and development to changes in precipitation frequency. We also included in this analysis how genome size of individuals influenced their responses to precipitation frequency changes. Generally, we found switchgrass to be unresponsive to realistic predictions of precipitation changes for the Central Plains of the United States. These studies have provided significant insight into how this important grassland species will respond to future climate change from both an ecological and applied biological perspective. Finally, we provided insight into the mechanism through which this species changes in the face of altered water availability by not supporting the hypothesis that the control of switchgrass responses to changes in precipitation is altered by genome size. Task B: Installation of an extensive green roof system on the Science Center at Saint Joseph's University for research, research-training and educational outreach activities. An experimental green roof system was designed and installed by an outside contractor (Roofmeadows) on the roof of the Science

  9. OPTIMIZING ANTIMICROBIAL PHARMACODYNAMICS: A GUIDE FOR YOUR STEWARDSHIP PROGRAM

    Directory of Open Access Journals (Sweden)

    Joseph L. Kuti, PharmD

    2016-09-01

    Full Text Available Pharmacodynamic concepts should be applied to optimize antibiotic dosing regimens, particularly in the face of some multidrug resistant bacterial infections. Although the pharmacodynamics of most antibiotic classes used in the hospital setting are well described, guidance on how to select regimens and implement them into an antimicrobial stewardship program in one's institution are more limited. The role of the antibiotic MIC is paramount in understanding which regimens might benefit from implementation as a protocol or use in individual patients. This review article outlines the pharmacodynamics of aminoglycosides, beta-lactams, fluoroquinolones, tigecycline, vancomycin, and polymyxins with the goal of providing a basis for strategy to select an optimized antibiotic regimen in your hospital setting.

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

    DEFF Research Database (Denmark)

    Borhan, Mohamad Termizi Bin; Ismail, Zurida

    2011-01-01

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

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

    DEFF Research Database (Denmark)

    Borhan, Mohamad Termizi Bin; Ismail, Zurida

    2011-01-01

    students and promote an understanding of their responsibility to care for the world and its resources. This paper presents the findings from a study conducted to investigate the effect of project-based learning on students’ attitudes and behaviors towards the environment. A total of 173 pre......Environmental stewardship is living responsibly as a caretaker of the environment for the benefit of present and future generations and is quickly becoming one of the most pressing public priorities for communities today. As stewards, we are personally responsible for the care and preservation...... threats to society caused by human activities and the complexity of the topic offers an opportunity to engage students in higher order thinking skills in addition to making learning relevant. For, in the end, as noted by one Senegalese ecologist, we will conserve only what we love, we will love only what...

  12. Nuclear Theory for Astrophysics, Stockpile Stewardship, and Homeland Security

    Science.gov (United States)

    Hayes, Anna

    2004-10-01

    A large number of problems key to astrophysics, stockpile stewardship, and homeland defense rely on knowledge of nuclear physics in regimes inaccessible to experiment. In stellar and nuclear explosions unstable nuclei and nuclear isomers are produced in copious quantities and are used to diagnose the explosion. Similarly, analysis of the unstable nuclei from the debris will be key to attribution in the event of a terrorist domestic nuclear attack. In the case of nuclear non-proliferation a number of new schemes are being considered by the IAEA to address the ever greater needs, including neutrino monitoring of the plutonium content of reactors. For all of these problems detailed nuclear theory is required. In this talk I discuss the theoretical physics needs for the type of problems of overlapping interest to astrophysics and national security.

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

    Science.gov (United States)

    Goff, Debra A

    2012-07-01

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

  14. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-03

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

  15. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Michael; Springer, Clint

    2014-06-18

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

  16. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Michael P.; Springer, Clint J.

    2014-06-05

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

  17. Lessons from White Lake - Connecting Students to their Community through Environmental Stewardship

    Science.gov (United States)

    Tate, Susan

    2014-05-01

    White Lake and its surrounding community have been negatively affected by shoreline degradation and wildlife habitat loss caused primarily by historical logging practices, and reduced water quality from industrial pollution and storm water runoff. This led to the lake being identified as a Great Lakes Area of Concern by the United States Environmental Protection Agency three decades ago. Local community partners have worked diligently in recent years to reverse habitat loss, and repair damaged ecosystems. The "H2O White Lake" (Healthy Habitats On White Lake) project has involved over seven hundred middle school students in grades six through eight over the course of the last five years. Students begin by researching the environmental history of the watershed and then they monitor six tributaries of the lake for nutrient pollution and habitat degradation. Students use the field experience as a community inventory to identify stewardship needs, for which they then identify solutions that take into account land usage and community behaviors. Class projects have focused on stream bank restoration, storm water management, eradication of invasive species, shoreline clean-up, and community outreach and education. This year, the project culminated in the first ever White Lake Environmental Film Festival, for which students had the opportunity to create their own short documentary. This multiple year place based education project allows students to apply their classroom studies of surface water and groundwater dynamics to an authentic, real-world situation, conduct themselves as scientists, and feel valuable through connections with community partners.

  18. Advances in Rapid Identification and Susceptibility Testing of Bacteria in the Clinical Microbiology Laboratory: Implications for Patient Care and Antimicrobial Stewardship Programs

    Science.gov (United States)

    Maurer, Florian P.; Christner, Martin; Hentschke, Moritz; Rohde, Holger

    2017-01-01

    Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e.g. for susceptibility testing, DNA amplification assays), and introduction of novel technologies (e.g. MALDI-TOF) has fundamentally changed approaches towards pathogen identification and characterization. Importantly, these techniques offer increased diagnostic resolution while at the same time shorten the time-to-result, and are thus of obvious importance for antimicrobial stewardship. In this review, we will discuss recent advances in medical microbiology with special emphasis on the impact of novel techniques on antimicrobial stewardship programs. PMID:28458798

  19. Advances in rapid identification and susceptibility testing of bacteria in the clinical microbiology laboratory: implications for patient care and antimicrobial stewardship programs

    Directory of Open Access Journals (Sweden)

    Florian P. Maurer

    2017-03-01

    Full Text Available Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e.g. for susceptibility testing, DNA amplification assays, and introduction of novel technologies (e.g. MALDI-TOF has fundamentally changed approaches towards pathogen identification and characterization. Importantly, these techniques offer increased diagnostic resolution while at the same time shorten the time-to-result, and are thus of obvious importance for antimicrobial stewardship. In this review, we will discuss recent advances in medical microbiology with special emphasis on the impact of novel techniques on antimicrobial stewardship programs.

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

    Data.gov (United States)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-11-01

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

  2. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

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

    2014-01-01

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

  3. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

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

    2014-01-01

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

  4. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

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

    2014-01-01

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

  5. South Bay Salt Pond initial stewardship plan & related Bay Area restoration projects

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Initial Stewardship Plan for the South Bay Salt Pond Restoration Project outlines a process to reduce the salinity of the existing salt ponds and to manage the...

  6. The Proposed Change Strategy to Embed Energy Stewardship into the Army’s Culture

    Science.gov (United States)

    2012-06-02

    3). Remove or do not promote leaders who fail to support energy stewardship. 4). Consider awarding members an “Additional Skill Identifier ( ASI ...designation as an “energy steward-manager.” Assign continuing education credits and promotion points for earning the Energy Stewardship ASI . 5...Harvard Business School Press. Schein, E. (2010). Organizational culture and leadership, 4th ed. San Francisco , CA: Wiley & Sons

  7. How to Pitch an Antibiotic Stewardship Program to the Hospital C-Suite

    OpenAIRE

    Spellberg, Brad; Bartlett, John G.; Gilbert, David N.

    2016-01-01

    Hospitals will soon require antibiotic stewardship programs. Infectious diseases specialists must craft business plans to engage hospital leadership to fund such programs. In this article, we review key cost and revenue elements that should be covered in such plans. Society is placing increasing emphasis on the importance of antimicrobial stewardship programs (ASPs). New regulatory standards require hospitals to implement ASPs. Infectious Diseases (ID) specialists will need to help design and...

  8. A cost-effectiveness analysis of two different antimicrobial stewardship programs.

    Science.gov (United States)

    Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

    2016-01-01

    There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.

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

    OpenAIRE

    Winslow D. Hansen

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jan-Willem Hendrik Dik

    2015-04-01

    Full Text Available IntroductionThere is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs. Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. MethodsA systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list.Results1233 studies were found, of which 149 were read completely. 99 were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n=23, costs for hospital stay (n=18 and/or other costs (n=19. 9 studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19.ConclusionsThis review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.

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

    Science.gov (United States)

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

    2008-01-01

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

  12. Extended Producer Responsibility and Product Stewardship for Tobacco Product Waste.

    Science.gov (United States)

    Curtis, Clifton; Collins, Susan; Cunningham, Shea; Stigler, Paula; Novotny, Thomas E

    2014-09-01

    This paper reviews several environmental principles, including Extended Producer Responsibility (EPR), Product Stewardship (PS), the Polluter Pays Principle (PPP), and the Precautionary Principle, as they may apply to tobacco product waste (TPW). The review addresses specific criteria that apply in deciding whether a particular toxic product should adhere to these principles; presents three case studies of similar approaches to other toxic and/or environmentally harmful products; and describes 10 possible interventions or policy actions that may help prevent, reduce, and mitigate the effects of TPW. EPR promotes total lifecycle environmental improvements, placing economic, physical, and informational responsibilities onto the tobacco industry, while PS complements EPR, but with responsibility shared by all parties involved in the tobacco product lifecycle. Both principles focus on toxic source reduction, post-consumer take-back, and final disposal of consumer products. These principles when applied to TPW have the potential to substantially decrease the environmental and public health harms of cigarette butts and other TPW throughout the world. TPW is the most commonly littered item picked up during environmental, urban, and coastal cleanups globally.

  13. Designing behaviourally informed policies for land stewardship: A new paradigm

    Directory of Open Access Journals (Sweden)

    Don W Hine

    2015-06-01

    Full Text Available This paper argues the case for a new approach to the stewardship of land resources that uses behavioural science theory to support the design and application of policies that facilitate changes in behaviour by those who develop policy and the farmers who implement it. Current approaches have: focused on legally-based expert system; and have been devised by national and international bureaucracies with little or no knowledge of how land owners and managers are motivated, and how they think, behave and operate as stewards of their natural resources. A review of current approaches from the social scientific literature is provided, with a particular focus on principles from social psychology. This is followed by an examination of how these principles can be applied to influence behaviour related to land restoration and soil conservation. Examples of the problems with traditional approaches and the evolution of new approaches with full engagement of farmers as the delivery agents are provided from within the European Union, Iceland and Scotland. In the light of these examples and emerging thinking in other parts of the world, the paper sets out the basis for a new approach based on behavioural science theory and application, reinforcing the arguments already made in the literature for a social license for farming.

  14. Emergence of Global Adaptive Governance for Stewardship of Regional Marine Resources

    Directory of Open Access Journals (Sweden)

    Henrik Österblom

    2013-06-01

    Full Text Available Overfishing has historically caused widespread stock collapses in the Southern Ocean. Until recently, illegal, unreported, and unregulated (IUU fishing threatened to result in the collapse of some of the few remaining valuable fish stocks in the region and vulnerable seabird populations. Currently, this unsustainable fishing has been reduced to less than 10% of former levels. We describe and analyze the emergence of the social-ecological governance system that made it possible to curb the fisheries crisis. For this purpose, we investigated the interplay between actors, social networks, organizations, and institutions in relation to environmental outcomes. We drew on a diversity of methods, including qualitative interviews, quantitative social network and survey data, and literature reviews. We found that the crisis triggered action of an informal group of actors over time, which led to a new organization (ISOFISH that connected two independent networks (nongovermental organizations and the fishing industry, and later (COLTO linked to an international body and convention (CCAMLR. The emergence of the global adaptive governance systems for stewardship of a regional marine resource took place over a 15-year period. We describe in detail the emergence process and illustrate the usefulness of analyzing four features of governance and understanding social-ecological processes, thereby describing structures and functions, and their link to tangible environmental outcomes.

  15. Data Stewardship throughout the Ocean Research Data Life Cycle

    Science.gov (United States)

    Chandler, Cynthia; Groman, Robert; Allison, Molly; Wiebe, Peter; Glover, David

    2013-04-01

    The Biological and Chemical Oceanography Data Management Office (BCO-DMO) works in partnership with ocean science investigators to publish data from research projects funded by the Biological and Chemical Oceanography Sections and the Office of Polar Programs Antarctic Organisms & Ecosystems Program (OPP ANT) at the U.S. National Science Foundation. Since 2006, researchers have been contributing data to the BCO-DMO data system, and it has developed into a rich repository of data from ocean, coastal and Great Lakes research programs. The end goals of the BCO-DMO are to ensure preservation of NSF funded project data and to provide open access to those data; achievement of those goals is attained through successful completion of a series of related phases. BCO-DMO has developed an end-to-end data stewardship process that includes all phases of the data life cycle: (1) providing data management advice to investigators during the proposal writing stage; (2) registering their funded project at BCO-DMO; (3) adding data and supporting documentation to the BCO-DMO data repository; (4) providing geospatial and text-based data access systems that support data discovery, access, display, assessment, integration, and export of data resources; (5) exploring mechanisms for exchange of data with complementary repositories; (6) publication of data sets to provide publishers of the peer-reviewed literature with citable references (Digital Object Identifiers) and to encourage proper citation and attribution of data sets in the future and (7) submission of final data sets for preservation in the appropriate long-term data archive. Strategic development of collaborative partnerships with complementary data management organizations is essential to sustainable coverage of the full data life cycle from research proposal through preservation of the final data products. Development and incorporation of controlled vocabularies, domain-specific ontologies and globally unique, persistent

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

    Science.gov (United States)

    Dixon, Jill; Duncan, Christopher Ja

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dixon J

    2014-05-01

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

  18. Roles of Data Stewardship: The people who put the theory into practice. (Invited)

    Science.gov (United States)

    Parsons, M. A.

    2013-12-01

    To understand something very complex like the Earth system it is helpful to have a model that sketches the major components of the system and their interactions. This helps us to understand the relative importance of those components and their behavior. The same is true, when considering a complex social enterprise such as data stewardship. It is helpful to have a model or a metaphor that allows us to conceive of the entire enterprise, the key players, and their interactions. In the spirit that 'all models are wrong, but some are useful,' this presentation explores several models of data stewardship and how different conceptions of the enterprise define different roles for the participants--be they researchers or data practitioners. The goal is to illustrate how consideration of multiple theories or models of data stewardship can help us better define the actual practice necessary to ensure well-preserved and useful data.

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

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, O. Jr.

    1996-05-01

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

  20. Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement.

    Science.gov (United States)

    Crnich, Christopher J; Jump, Robin; Trautner, Barbara; Sloane, Philip D; Mody, Lona

    2015-09-01

    The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship. Nevertheless, an emerging body of research points towards ways to improve antibiotic prescribing practices in nursing homes. This review summarizes the findings of this research and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    While multiple studies have identified land managers’ preferences for agri-environmental schemes (AES), few approaches exist for integrating different understandings of landscape stewardship into the design of these measures. We compared and contrasted rural land managers’ attitudes toward AES...... in preferences for AES design beyond 2020. We adapted a collaborative and coordinated approach for designing AES to account for the differing interests of land managers based on their understanding of landscape stewardship. We discuss the implications of this approach for environmental policy design...... and their preferences for AES design beyond 2020 across different understandings of landscape stewardship. Forty semi-structured interviews were conducted with similar proportions of small holders, medium holders and large holders in southwest Devon, UK. Overall, respondents most frequently cited concerns related...

  2. Development of Designer Diamond Technology for High Pressure High Temperature Experiments in Support of Stockpile Stewardship Program

    Energy Technology Data Exchange (ETDEWEB)

    Vohra, Yogesh, K.

    2009-10-28

    The role of nitrogen in the fabrication of designer diamond was systematically investigated by adding controlled amount of nitrogen in hydrogen/methane/oxygen plasma. This has led to a successful recipe for reproducible fabrication of designer diamond anvils for high-pressure high-temperature research in support of stockpile stewardship program. In the three-year support period, several designer diamonds fabricated with this new growth chemistry were utilized in high-pressure experiments at UAB and Lawrence Livermore National Laboratory. The designer diamond anvils were utilized in high-pressure studies on heavy rare earth metals, high pressure melting studies on metals, and electrical resistance measurements on iron-based layered superconductors under high pressures. The growth chemistry developed under NNSA support can be adapted for commercial production of designer diamonds.

  3. Urban Ecological Stewardship: Understanding the Structure, Function and Network of Community-based Urban Land Management

    Directory of Open Access Journals (Sweden)

    Lindsay K. Campbell

    2008-01-01

    Full Text Available Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based urban land managers, an assessment was conducted in 2004 by the research subcommittee of the Urban Ecology Collaborative. The goal of the assessment was to better understand the role of stewardship organizations engaged in urban ecology initiatives in selected major cities in the Northeastern U.S.: Boston, New Haven, New York City, Pittsburgh, Baltimore, and Washington, D.C. A total of 135 active organizations participated in this assessment. Findings include the discovery of a dynamic social network operating within cities, and a reserve of social capital and expertise that could be better utilized. Although often not the primary land owner, stewardship groups take an increasingly significant responsibility for a wide range of land use types including street and riparian corridors, vacant lots, public parks and gardens, green roofs, etc. Responsibilities include the delivery of public programs as well as daily maintenance and fundraising support. While most of the environmental stewardship organizations operate on staffs of zero or fewer than ten, with small cohorts of community volunteers, there is a significant difference in the total amount of program funding. Nearly all respondents agree that committed resources are scarce and insufficient with stewards relying upon and potentially competing for individual donations, local foundations, and municipal support. This makes it a challenge for the groups to grow beyond their current capacity and to develop long-term programs critical to resource management and education. It also fragments groups, making it difficult for planners and

  4. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Science.gov (United States)

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  5. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Directory of Open Access Journals (Sweden)

    Charles Hoffmann

    2016-02-01

    Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

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

    Science.gov (United States)

    Andrejewski, Robert G.

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

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

    Directory of Open Access Journals (Sweden)

    Ingrid van Putten

    2014-06-01

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

  8. Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges.

    Science.gov (United States)

    Ibrahim, Omar M; Polk, Ron E

    2014-06-01

    Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes. Interhospital benchmarking of risk adjusted antimicrobial use is possible, although several obstacles remain before it can have an impact on patient care. Many challenges for stewardship programs remain, but the methods and science to support their efforts are rapidly evolving.

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

    Science.gov (United States)

    Heil, Emily L; Johnson, J Kristie

    2016-04-01

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

  10. The farmer as a landscape steward: Comparing local understandings of landscape stewardship, landscape values, and land management actions.

    Science.gov (United States)

    Raymond, Christopher M; Bieling, Claudia; Fagerholm, Nora; Martin-Lopez, Berta; Plieninger, Tobias

    2016-03-01

    We develop a landscape stewardship classification which distinguishes between farmers' understanding of landscape stewardship, their landscape values, and land management actions. Forty semi-structured interviews were conducted with small-holder (100 acres) in South-West Devon, UK. Thematic analysis revealed four types of stewardship understandings: (1) an environmental frame which emphasized the farmers' role in conserving or restoring wildlife; (2) a primary production frame which emphasized the farmers' role in taking care of primary production assets; (3) a holistic frame focusing on farmers' role as a conservationist, primary producer, and manager of a range of landscape values, and; (4) an instrumental frame focusing on the financial benefits associated with compliance with agri-environmental schemes. We compare the landscape values and land management actions that emerged across stewardship types, and discuss the global implications of the landscape stewardship classification for the engagement of farmers in landscape management.

  11. Nature's Trust: A Paradigm for Natural Resources Stewardship

    Science.gov (United States)

    Wood, M. C.; Whitelaw, E.; Doppelt, B.; Burchell, A.

    2007-12-01

    Climate change uncertainty puts a premium on all remaining natural resources. Farmland, air, water, wetlands, wildlife, soils, mineral resources and forests must be protected to ensure that Americans - present citizens and future generations - have the fundamental survival resources they need in a future that holds many unknowns. Moreover, in light of the need to manage resources given climate and particle forcing, government must mitigate dangerous carbon loading of the atmosphere. Confronting climate change and protecting natural resources requires a clear sense of government obligation that is inherent to sovereignty, not a matter of political choice. Our government representatives can and must reframe government's discretion into a trustee obligation to protect Nature and ensure natural resource stewardship. Drawing upon enduring legal principles and court decisions, government can be characterized as a trustee of the natural resources essential to human survival. A trust is a fundamental type of ownership whereby one manages property for the benefit of another. Viewed as a trust, the environment consists of a portfolio of quantified natural assets that government manages. As beneficiaries, citizens hold a common property interest in defined, bounded assets that make up Nature's Trust. Such trust principles form the bedrock of statutory law. Trustees have a fiduciary obligation to protect trust assets and may not allow destruction of property they manage. This session will provide a policy frame for current scientific efforts to address climate change and natural resources loss. Under the Nature's Trust frame, U.S. government leaders and agencies at every level inherit a strict fiduciary obligation to protect our collective natural resources, including our water and the atmosphere, as assets in the trust. Their fiduciary standard of care consists of a proportionate responsibility, which ties directly to "Nature's Mandate" as defined by current climate

  12. STUDY OF MICROBIOLOGICAL SURVEILLANCE AND ANTIBIOTIC STEWARDSHIP IN VENTILATOR ASSOCIATED PNEUMONIA

    Directory of Open Access Journals (Sweden)

    Ajay Kumar

    2016-04-01

    Full Text Available BACKGROUND Ventilator-Associated Pneumonia (VAP continues to be a major problem in critically ill patients. The objective of this research was to know the burden of ventilator-associated pneumonia and effectiveness of antibiotic stewardship in Medical Intensive Care Unit (MICU of our institution. METHODS This prospective observational study was carried out for one year at our institution. It included all patients more than 18 years of age admitted to MICU who underwent invasive mechanical ventilation for more than 48 hours. Among these, patients who developed VAP as per the CPIS score were identified. Laboratory results were correlated with the patient’s clinical condition and adjunct investigations. The presumptive therapy for treatment of hospital acquired pneumonia was based on surveillance by hospital infection control unit. All patients who received empiric antimicrobial therapy were analysed against bacterial sensitivity. RESULTS The VAP rate was 67 cases per 1000 ventilator days. The incidence of early VAP was 47.5% and incidence of late VAP was 52.5%. Gram negative isolates in particular Acinetobacter baumannii were more frequent than the Gram positive isolates in early and late VAP; 95% Acinetobacter baumannii isolates were resistant to Carbapenem and sensitive to only Colistin in 67.6% cases, Colistin and Tigecycline in 24.3% cases and to other antibiotics in 8.1% cases. There were inappropriate empirical antibiotic prescriptions in 80% of instances and required a change of antibiotics after the culture and sensitivity report. CONCLUSIONS In conclusion, this work demonstrates the importance of an active surveillance program in multi-drug resistance outbreak recognition in our ICU and review of antimicrobial use to prevent emergence of antibiotic resistance strains and to preserve existing therapeutic option for caring for such infections.

  13. Ocean Acidification Scientific Data Stewardship: An approach for end-to-end data management and integration

    Science.gov (United States)

    Arzayus, K. M.; Garcia, H. E.; Jiang, L.; Michael, P.

    2012-12-01

    As the designated Federal permanent oceanographic data center in the United States, NOAA's National Oceanographic Data Center (NODC) has been providing scientific stewardship for national and international marine environmental and ecosystem data for over 50 years. NODC is supporting NOAA's Ocean Acidification Program and the science community by providing end-to-end scientific data management of ocean acidification (OA) data, dedicated online data discovery, and user-friendly access to a diverse range of historical and modern OA and other chemical, physical, and biological oceanographic data. This effort is being catalyzed by the NOAA Ocean Acidification Program, but the intended reach is for the broader scientific ocean acidification community. The first three years of the project will be focused on infrastructure building. A complete ocean acidification data content standard is being developed to ensure that a full spectrum of ocean acidification data and metadata can be stored and utilized for optimal data discovery and access in usable data formats. We plan to develop a data access interface capable of allowing users to constrain their search based on real-time and delayed mode measured variables, scientific data quality, their observation types, the temporal coverage, methods, instruments, standards, collecting institutions, and the spatial coverage. In addition, NODC seeks to utilize the existing suite of international standards (including ISO 19115-2 and CF-compliant netCDF) to help our data producers use those standards for their data, and help our data consumers make use of the well-standardized metadata-rich data sets. These tools will be available through our NODC Ocean Acidification Scientific Data Stewardship (OADS) web page at http://www.nodc.noaa.gov/oceanacidification. NODC also has a goal to provide each archived dataset with a unique ID, to ensure a means of providing credit to the data provider. Working with partner institutions, such as the

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

    Science.gov (United States)

    Susan F. Fox

    2016-01-01

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

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

    Science.gov (United States)

    Aspen Institute, 2009

    2009-01-01

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

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

    Science.gov (United States)

    Nancy Roeper; Peter Landres; Don Fisher

    2006-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  18. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R; van Gemert-Pijnen, Julia Ewc

    2014-01-01

    BACKGROUND: Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlie

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

    Directory of Open Access Journals (Sweden)

    Rodrigo Pereira Medeiros

    2014-12-01

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

  20. 'Bedside'-consultatie door multidisciplinair Antibiotica-team: 'Antimicrobial stewardship'-programma in het UMCG

    NARCIS (Netherlands)

    Lo-Ten-Foe, Jerome R; Sinha, Bhanu; Wilting, Kasper R; Veenstra-Kyuchukova, Yanka; Panday, Prashant N; Hendrix, Ron

    2014-01-01

    In 2012, the Dutch Working Party on Antibiotic Policy (SWAB) published a vision document to counteract the rise in antibiotic use and resistance. An Antibiotic Stewardship Programme (ASP) will be implemented by a multidisciplinary antibiotics team (A-team). In 2012 University Medical Centre Groninge

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    Limburg, van Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R.; Gemert-Pijnen, van Julia E.W.C.

    2014-01-01

    Background Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlier

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

    Science.gov (United States)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  5. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R; van Gemert-Pijnen, Julia Ewc

    2014-01-01

    BACKGROUND: Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlie

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  7. 7 CFR 1469.7 - Benchmark condition inventory and conservation stewardship plan.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Benchmark condition inventory and conservation... SECURITY PROGRAM General Provisions § 1469.7 Benchmark condition inventory and conservation stewardship plan. (a) The benchmark condition inventory and associated case file information must include: (1)...

  8. A Unified Framework for Measuring Stewardship Practices Applied to Digital Environmental Datasets

    Directory of Open Access Journals (Sweden)

    Ge Peng

    2015-01-01

    Full Text Available This paper presents a stewardship maturity assessment model in the form of a matrix for digital environmental datasets. Nine key components are identified based on requirements imposed on digital environmental data and information that are cared for and disseminated by U.S. Federal agencies by U.S. law, i.e., Information Quality Act of 2001, agencies’ guidance, expert bodies’ recommendations, and users. These components include: preservability, accessibility, usability, production sustainability, data quality assurance, data quality control/monitoring, data quality assessment, transparency/traceability, and data integrity. A five-level progressive maturity scale is then defined for each component associated with measurable practices applied to individual datasets, representing Ad Hoc, Minimal, Intermediate, Advanced, and Optimal stages. The rationale for each key component and its maturity levels is described. This maturity model, leveraging community best practices and standards, provides a unified framework for assessing scientific data stewardship. It can be used to create a stewardship maturity scoreboard of dataset(s and a roadmap for scientific data stewardship improvement or to provide data quality and usability information to users, stakeholders, and decision makers.

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

    Science.gov (United States)

    Mink, Meridith Beck

    2016-01-01

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

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

    NARCIS (Netherlands)

    Snippert, Tim; Witteveen, Wiebe; Boes, Hans; Voordijk, Hans

    2015-01-01

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

  11. Stewardship as a Means to Create Organizational Reform: A View into Minnesota 4-H Youth Development

    Science.gov (United States)

    Skuza, Jennifer A.; Freeman, Dorothy M.; Bremseth, Tamara J.; Doering, Shirley A.; Quinlan, Robert B.; Morreim, Patricia A.; Deidrick, James C.

    2010-01-01

    Minnesota 4-H Youth Development (MN 4-H) used stewardship as a means to create organizational reform to address the public use of the 4-H name and emblem in terms of risk management, real estate and equipment, and finances. A task force implemented a participatory process with colleagues and stakeholders to build and implement the reform effort.…

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

    Science.gov (United States)

    Heather McMillen; Lindsay Campbell; Erika Svendsen; Renae Reynolds

    2016-01-01

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

  13. Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

    Directory of Open Access Journals (Sweden)

    Stefanie Jane Oliver

    2017-07-01

    Full Text Available BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60% about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

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

    Science.gov (United States)

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

    2017-02-01

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

  15. The Italian Hub of Population Biobanks as a potential tool for improving public health stewardship.

    Science.gov (United States)

    Bravo, Elena; Napolitano, Mariarosaria; Santoro, Filippo; Belardelli, Filippo; Federic, Antonio

    2013-06-01

    In Italy, a country that is experiencing the decentralization of health services from central to regional level of government, the Minister of Health is proposing stewardship as a model of governance for the public health system. Stewardship favors efficiency in the policy decision-making process, based on reciprocal trust, and tends to be more ethical. The embryonic proposal to test stewardship in the field of population-based research was advanced during the launching conference Challenges and Opportunities of the Italian Hub of Population Biobanks (HIBP) held in 2012 in Rome. Resources collected by population biobanks (i.e., blood and its derivatives, and/or DNA isolated from any type of biological samples and relative associated data) have, in fact, a recognized scientific value for the investigation of links between genetics, health and life style, and epidemiological outcomes through population biobank-based studies, and are essential to planning effective and qualified interventions for public health. The current economic crisis requires a strong push to rationalize investment in health policies. In particular, population biobank-based studies require financial commitment, often of long duration, for the realization of their goals. Thus, innovative solutions to allow fast integration of scientific knowledge into political health strategy are required. During the conference in Rome, it was proposed to test the stewardship model by its application to the inter-relationship between population biobank-based studies and disease prevention. Stewardship minimizes barriers to innovation and uses information more effectively to better develop new strategies for prevention and/or treatment. In the months following the conference, the proposal was defined more clearly, and the HIBP network became a potential tool for testing and implementing this model in the Italian Public Health prevention system.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-09-04

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

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

    Science.gov (United States)

    Schotsmans, Paul T

    2003-01-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

  19. Science and technology in the stockpile stewardship program, S & TR reprints

    Energy Technology Data Exchange (ETDEWEB)

    Storm, E

    1998-04-08

    This document reports on these topics: Computer Simulations in Support of National Security; Enhanced Surveillance of Aging Weapons; A New Precision Cutting Tool: The Femtosecond Laser; Superlasers as a Tool of Stockpile Stewardship; Nova Laser Experiments and Stockpile Stewardship; Transforming Explosive Art into Science; Better Flash Radiography Using the FXR; Preserving Nuclear Weapons Information; Site 300Õs New Contained Firing Facility; The Linear Electric Motor: Instability at 1,000 gÕs; A Powerful New Tool to Detect Clandestine Nuclear Tests; High Explosives in Stockpile Surveillance Indicate Constancy; Addressing a Cold War Legacy with a New Way to Produce TATB; JumpinÕ Jupiter! Metallic Hydrogen; Keeping the Nuclear Stockpile Safe, Secure, and Reliable; The Multibeam FabryÐPerot Velocimeter: Efficient Measurements of High Velocities; Theory and Modeling in Material Science; The Diamond Anvil Cell; Gamma-Ray Imaging Spectrometry; X-Ray Lasers and High-Density Plasma

  20. How to Pitch an Antibiotic Stewardship Program to the Hospital C-Suite.

    Science.gov (United States)

    Spellberg, Brad; Bartlett, John G; Gilbert, David N

    2016-10-01

    Hospitals will soon require antibiotic stewardship programs. Infectious diseases specialists must craft business plans to engage hospital leadership to fund such programs. In this article, we review key cost and revenue elements that should be covered in such plans. Society is placing increasing emphasis on the importance of antimicrobial stewardship programs (ASPs). New regulatory standards require hospitals to implement ASPs. Infectious Diseases (ID) specialists will need to help design and implement such programs at hospitals. A critical component of establishing such programs is submitting a business plan to hospital leadership justifying the cost and structure of the ASP and explaining what benefits the hospital will gain in return. In this article, we explore typical elements of such business plans and describe how hospital leadership may evaluate and determine the value of such plans. Understanding hospital costs and revenue models is critical to creating a viable and realistic business plan to support ASPs.

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

    Directory of Open Access Journals (Sweden)

    Vincent Nault

    2008-01-01

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

  2. Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement

    OpenAIRE

    Crnich, Christopher J.; Jump, Robin; Trautner, Barbara; Sloane, Philip D.; Mody, Lona

    2015-01-01

    The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their ad...

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

    OpenAIRE

    2016-01-01

    In 2010, the Clinical and Laboratory Standards Institute (CLSI) lowered the MIC breakpoints for many beta-lactam antibiotics to enhance detection of known resistance among Enterobacteriaceae. The decision to implement these new breakpoints, including the changes announced in both 2010 and 2014, can have a significant impact on both microbiology laboratories and antimicrobial stewardship programs. In this commentary, we discuss the changes and how implementation of these updated CLSI breakpoin...

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

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-13

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

  6. Toxicological evaluation of ammonium perfluorobutyrate in rats: Twenty-eight-day and ninety-day oral gavage studies

    Science.gov (United States)

    Sequential 28-day and 90-day oral toxicity studies were performed in male and female rats with ammonium perfluorobutyrate (NH4+PFBA) at doses up to 150 and 30 mg/kg/d, respectively. Ammonium perfluorooctanoate was used as a comparator at a dose of 30 mg/kg/d in the 28-d study. Fe...

  7. Twenty-eight day Holter monitoring is poorly tolerated and insensitive for paroxysmal atrial fibrillation detection in cryptogenic stroke.

    Science.gov (United States)

    Tu, H T; Spence, S; Kalman, J M; Davis, S M

    2014-05-01

    This pilot study in a prospective cohort of 20 cryptogenic stroke patients showed that a significant proportion has paroxysmal atrial fibrillation undetected by 24-h Holter monitoring. However, longer monitoring with 28-day Holter was poorly tolerated and still insufficiently sensitive for paroxysmal atrial fibrillation detection. Further studies are urgently needed to elucidate the optimal timing, method and duration of cardiac rhythm monitoring following ischaemic stroke.

  8. Twenty-eight divergent polysaccharide loci specifying within and amongst strain capsule diversity in three strains of Bacteroides fragilis

    DEFF Research Database (Denmark)

    Patrick, S.; Blakely, G.W.; Houston, S.

    2010-01-01

    Comparison of the complete genome sequence of Bacteroides fragilis 638R originally isolated in the USA, was made with two previously sequenced strains isolated in the UK (NCTC 9343) and Japan (YCH46). The presence of 10 loci containing genes associated with polysaccharide biosynthesis, each...

  9. Twenty-eight-day repeated inhalation toxicity study of nano-sized lanthanum oxide in male sprague-dawley rats.

    Science.gov (United States)

    Shin, Seo-Ho; Lim, Cheol-Hong; Kim, Yong-Soon; Lee, Yong-Hoon; Kim, Sung-Hwan; Kim, Jong-Choon

    2017-04-01

    Although the use of lanthanum has increased in field of high-tech industry worldwide, potential adverse effects to human health and to the environment are largely unknown. The present study aimed to investigate the potential toxicity of nano-sized lanthanum oxide (La2 O3 ) following repeated inhalation exposure in male Sprague-Dawley rats. Male rats were exposed nose-only to nano-sized La2 O3 for 28 days (5 days/week) at doses of 0, 0.5, 2.5, and 10 mg/m(3) . In the experimental period, we evaluated treatment-related changes including clinical signs, body weight, hematology, serum biochemistry, necropsy findings, organ weight, and histopathology findings. We also analyzed lanthanum distribution in the major organs and in the blood, bronchoalveolar lavage fluids (BALF), and oxidative stress in lung tissues. Lanthanum level was highest in lung tissues and showed a dose-dependent relation. Alveolar proteinosis was observed in all treatment groups and was accompanied by an increase in lung weight; moreover, lung inflammation was observed in the 2.5 mg/m(3) and higher dose groups and was accompanied by an increase in white blood cells. In the BALF, total cell counts including macrophages and neutrophils, lactate dehydrogenase, albumin, nitric oxide, and tumor necrosis factor-alpha increased significantly in all treatment groups. Furthermore, these changes tended to deteriorate in the 10 mg/m(3) group at the end of the recovery period. In the present experimental conditions, we found that the lowest-observed-adverse-effect level of nano-sized La2 O3 was 0.5 mg/m(3) in male rats, and the target organ was the lung. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1226-1240, 2017. © 2016 Wiley Periodicals, Inc.

  10. Twenty-eight divergent polysaccharide loci specifying within and amongst strain capsule diversity in three strains of Bacteroides fragilis

    DEFF Research Database (Denmark)

    Patrick, S.; Blakely, G.W.; Houston, S.

    2010-01-01

    including a putative Wzx flippase and Wzy polymerase, was confirmed in all three strains, despite a lack of cross-reactivity between NCTC 9343 and 638R surface polysaccharide-specific antibodies by immunolabelling and microscopy. Genomic comparisons revealed an exceptional level of polysaccharide...... restriction and modification systems that act to prevent acquisition of foreign DNA. The level of amongst strain diversity in polysaccharide biosynthesis loci is unprecedented....

  11. 76 FR 59183 - Meeting of the Regional Resource Stewardship Council

    Science.gov (United States)

    2011-09-23

    ... (FACA), 5 U.S.C. App. 2. The meeting agenda includes the following: 1. Introductions. 2. TVA Updates... Resource Plan implementation plan for fiscal year 2012, and information about TVA's Recreation...

  12. Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes.

    Science.gov (United States)

    Scales, Kezia; Zimmerman, Sheryl; Reed, David; Beeber, Anna Song; Kistler, Christine E; Preisser, John S; Weiner, Bryan J; Ward, Kimberly; Fann, Amy; Sloane, Philip D

    2017-01-01

    To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). Cross-sectional survey. NHs in North Carolina (N = 31). Nursing staff (n = 182) and medical providers (n = 50). Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties

  13. Non-timber forest products and forest stewardship plans

    Science.gov (United States)

    Becky Barlow; Tanner Filyaw; Sarah W. Workman

    2015-01-01

    To many woodland owners “harvesting” typically means the removal of timber from forests. In recent years many landowners have become aware of the role non-timber forest products (NTFPs) can play in supplemental management strategies to produce income while preserving other forest qualities. NTFPs are a diverse group of craft, culinary, and medicinal products that have...

  14. Clinical and Microbiologic Characteristics of Early-onset Sepsis Among Very Low Birth Weight Infants: Opportunities for Antibiotic Stewardship.

    Science.gov (United States)

    Mukhopadhyay, Sagori; Puopolo, Karen M

    2017-05-01

    Most very low birth weight (VLBW, birth weight onset sepsis (EOS). The objective of this study was to determine the characteristics of VLBW infants with culture-confirmed EOS at a single center during 25 years and to identify opportunities for antibiotic stewardship. Retrospective cohort study includes VLBW infants admitted from 1990 to 2015. EOS was defined as isolation of a pathogen in blood or cerebrospinal fluid culture obtained at labor, preterm rupture of membranes and/or the obstetrical diagnosis of chorioamnionitis were present in 106/109 cases (97%). Obligate anaerobic organisms accounted for 16% of cases. Time to culture positivity was 36 hours for 88% and 48 hours for 98% of cases. From 1999 to 2013, 97% of VLBW infants were evaluated for EOS and 90% administered empiric antibiotics; 22% of these infants were born by cesarean section to mothers with preeclampsia and without preterm labor or chorioamnionitis and had a 12-fold lower incidence of EOS compared with the remaining infants. Decisions to initiate and discontinue empiric antibiotics among VLBW infants can be informed by the delivery characteristics of infected infants and by local microbiologic data.

  15. Army Model and Simulation Stewardship Report FY98

    Science.gov (United States)

    1998-10-01

    capability. 6. BENEFITS TO THE ARMY: This effort is a key component to the Virtual Sealift Emergency Deployment Readiness Exercise ( SEDRE ). With the...reduction in the numbers of SEDREs performed in a year, the Army deployment community needs alternative methods to train and prepare units for actual...deployments. The Virtual SEDRE will simulate and visualize the deployment activities that occur at specific installations and ports and supplement

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

    Directory of Open Access Journals (Sweden)

    Steven B. Scyphers

    2014-09-01

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

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

    Science.gov (United States)

    Ramdeen, S.; Hills, D. J.

    2013-12-01

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

  18. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Micahel P.; Springer, Clint J.

    2014-06-03

    Task A: Examination of the physiological, morphological, and reproductive responses of Panicum virgatum (switchgrass) cultivars identified as potential biofuel producing cultivars as well as naturally-occurring varieties of switchgrass to projected changes in climate for the central portion of the United States. This project was a multi-year project set in a field site located at the Konza Prairie Biological Station near Manhattan, KS USA. The major objective of the study was to understand the physiological and growth responses of the important biofuel grass species, Panicum virgatum (switch grass) to simulated changes in precipitation expected for the Central Plains region of the United States. Population level adaptation to broad-scale regional climates or within-population variation in genome size of this genetically and phenotypically diverse C4 grass species may influence the responses to future precipitation variability associated with climate change. Therefore, we investigated switchgrass responses to water variability between natural populations collected across latitudinal gradient and populations. P. virgatum plants from natural populations originating from Kansas, Oklahoma, and Texas received frequent, small precipitation events (“ambient’) or infrequent, large precipitation events (‘altered”) to simulate contrasting rainfall variability expected from this region. We measured leaf-level physiology, aboveground biomass varied significantly by population origin but did not differ by genome size. Our results suggest that trait variation in P. virgatum is primarily attributed to population-level adaptation across latitudinal gradient, not genome size, and that neither population-level adaptation nor genome size may be important predictors of P. virgatum responses to future climatic conditions. Based solely on the data presented here, the most important consideration when deciding what varieties of switchgrass to cultivate for biofuel feedstocks under

  19. A stewardship intervention program for safe medication management and use of antidiabetic drugs

    Directory of Open Access Journals (Sweden)

    Zhao RY

    2015-07-01

    Full Text Available Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China Background: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs.Methods: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.Results: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart and NovoRapid® (insulin aspart has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011 to 96% (fourth quarter 2011 (P<0.05. The number of medication administration errors related to insulin continuously decreased from 20 (2011 to six (2014. The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27% (P<0.01. Percentage of correct management of

  20. "Nuestra Tierra Dinamica" Global Climate Change STEM Education Fostering Environmental Stewardship

    Science.gov (United States)

    La Grave, M.; de Valenzuela, M.; Russell, R.

    2012-12-01

    CLUB ECO LÓGICO is a democratic and participatory program that provides active citizenship in schools and community, placing climate change into context for the Latino Community. The program's objectives focus on: 1. The Environment. Reducing the school and community impact on the environment through environmental footprint through stewardship actions. 2. Empowerment. Engaging participants through project and service learning and make decisions about how to improve their schools, their homes and their community's environment. 3. Community and Research Partnerships. Fostering collaborations with local community, stakeholders, government, universities, research organizations, and businesses that have expertise in environmental research, management, education and climate change. 4. Awareness. Increasing environmental and climate science knowledge of participants through STEM activities and hands-on access to technology. 5. Research and evaluation. Assessing the relevance of program activities through the engagement of the Latino community in planning and the effectiveness and impact of STEM activities through formative and summative evaluation. To address these objectives, the program has several inter related components in an after school setting: SUN EARTH Connections: Elementary (grades K to 2) students learn the basic climate change concepts through inquiry and hands on STEM activities. Bilingual 8 facilitators adapt relevant NASA educational resources for use in inquiry based, hands on activities. Drama and the arts provide unique experiences as well as play a key role in learning, participation and facilitation. GREEN LABS: Elementary students (grades 3 to 5) participate in stations where each Lab is staffed by at least two professionals: a College level fully bilingual Latin American Professional and a stakeholder representing either a research organization or other relevant environmental organization. Our current Green Lab themes include: Air, Soils, Water

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

    Directory of Open Access Journals (Sweden)

    Alessandra Solazzo

    2015-11-01

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

  2. Educating healthcare professionals in antimicrobial stewardship: can online-learning solutions help?

    Science.gov (United States)

    Rocha-Pereira, Nuno; Lafferty, Natalie; Nathwani, Dilip

    2015-12-01

    Education is widely recognized as one of the cornerstones of successful antimicrobial stewardship programmes. There is evidence of important knowledge flaws around antimicrobial prescribing among both medical students and clinicians. Educational interventions improve antimicrobial prescribing, but traditional tools may be insufficient to deliver training to meet the complex demands of global healthcare professionals working across a diverse range of healthcare and resource settings. The educational solutions increasingly need to be timely, efficient, pragmatic, high quality, aligned to the needs of the professional in a specific context, sustainable and cost-effective. Online learning has been playing a growing role in education about antimicrobial stewardship and the recent phenomenon of massive open online courses (MOOCs) offers novel and additional opportunities to deliver relevant information to a wide range of people. Additional research on MOOCs as an educational approach is needed in order to define their effectiveness, sustainability and the best ways to achieve the intended results. Although the precise value of new online strategies such as MOOCs is ill defined, they certainly will have an important place in increasing awareness and improving antimicrobial prescribing.

  3. Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists.

    Science.gov (United States)

    Bishop, Bryan M

    2016-12-01

    Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.

  4. Long Term Stewardship Challenges at the St. Louis District FUSRAP Sites

    Energy Technology Data Exchange (ETDEWEB)

    Dell' Orco, L.; Chambers, D.

    2002-02-27

    Non-Federally owned radioactively contaminated sites in St. Louis, Missouri are currently being remediated by the St. Louis District Corps of Engineers under the Formerly Utilized Sites Remedial Action Program (FUSRAP). When FUSRAP remediation is complete, inaccessible soils which have levels of contamination greater than unrestricted use standards, will remain. The purpose of this paper is to document the initial challenges facing the project team during its development of the Long Term Stewardship plan for the management of these soils. These soils are located under buildings, roads, railroads and bridges. The Long Term Stewardship plan for the majority of the sites is being developed simultaneously with the remedy selection process. A living document, it will ultimately document the remedial action end state and location of inaccessible soils and implement the plan for ensuring these soils are not a threat to human health and the environment. Although these soils are protective in their current configuration, at some point in time, when activities such as maintenance, utility or property improvement occur, the soils will become accessible and need to be addressed by the federal government. Up until that point in time they will need to be effectively managed to ensure they remain protective. The St. Louis District is in the process of collaboratively developing this plan with its regulators, affected stakeholders and interested parties.

  5. Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals.

    Science.gov (United States)

    Le Coz, P; Carlet, J; Roblot, F; Pulcini, C

    2016-06-01

    In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Vanessa M Adams

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

  7. Hospital-wide rollout of antimicrobial stewardship: a stepped-wedge randomized trial.

    Science.gov (United States)

    Palmay, Lesley; Elligsen, Marion; Walker, Sandra A N; Pinto, Ruxandra; Walker, Scott; Einarson, Thomas; Simor, Andrew; Rachlis, Anita; Mubareka, Samira; Daneman, Nick

    2014-09-15

    Our objective was to rigorously evaluate the impact of an antimicrobial stewardship audit-and-feedback intervention, via a stepped-wedge randomized trial. An effective intensive care unit (ICU) audit-and-feedback program was rolled out to 6 non-ICU services in a randomized sequence. The primary outcome was targeted antimicrobial utilization, using a negative binomial regression model to assess the impact of the intervention while accounting for secular and seasonal trends. The intervention was successfully transitioned, with high volumes of orders reviewed, suggestions made, and recommendations accepted. Among patients meeting stewardship review criteria, the intervention was associated with a large reduction in targeted antimicrobial utilization (-21%, P = .004); however, there was no significant change in targeted antibiotic use among all admitted patients (-1.2%, P = .9), and no reductions in overall costs and microbiologic outcomes. An ICU day 3 audit-and-feedback program can be successfully expanded hospital-wide, but broader benefits on non-ICU wards may require interventions earlier in the course of treatment.

  8. Carbon stewardship: land management decisions and the potential for carbon sequestration in Colorado, USA

    Science.gov (United States)

    Failey, Elisabeth L.; Dilling, Lisa

    2010-04-01

    Land use and its role in reducing greenhouse gases is a key element of policy negotiations to address climate change. Calculations of the potential for enhanced terrestrial sequestration have largely focused on the technical characteristics of carbon stocks, such as vegetation type and management regime, and to some degree, on economic incentives. However, the actual potential for carbon sequestration critically depends on who owns the land and additional land management decision drivers. US land ownership patterns are complex, and consequently land use decision making is driven by a variety of economic, social and policy incentives. These patterns and incentives make up the 'carbon stewardship landscape'—that is, the decision making context for carbon sequestration. We examine the carbon stewardship landscape in the US state of Colorado across several public and private ownership categories. Achieving the full potential for land use management to help mitigate carbon emissions requires not only technical feasibility and financial incentives, but also effective implementing mechanisms within a suite of often conflicting and hard to quantify factors such as multiple-use mandates, historical precedents, and non-monetary decision drivers.

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

    Directory of Open Access Journals (Sweden)

    Karen S. Baker

    2009-10-01

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

  10. A Practical Approach for Demonstrating Environmental Sustainability and Stewardship through a Net Ecosystem Service Analysis

    Directory of Open Access Journals (Sweden)

    Mark Rockel

    2013-05-01

    Full Text Available The increasing pressure on the earth’s resources due to population growth requires that development and resource use be managed to maintain a sustainable environment so as to preserve or enhance human well-being. A practical approach for demonstrating the environmental sustainability of an action (e.g., green business practice through ecosystem service analysis is presented. The overarching premise of the approach is that human well-being is directly related to changes in ecosystems and associated services. The approach evaluates the net change in ecosystem services, and hence human well-being, and is termed a net ecosystem service analysis (NESA. Using this approach, if a net positive change in ecosystem services relative to the baseline condition occurs for an action, that action would be considered potentially sustainable. In addition, if an action creates net ecosystem service value above the baseline condition, it would be considered to embody environmental stewardship. Established ecological and human use quantification methods are incorporated into the analysis. In addition, to demonstrate potential sustainability, the approach must also consider the need to satisfy intergenerational equity objectives. The use of a practical approach from which private business and government representatives can make decisions regarding environmental sustainability and stewardship will provide for improved decision-making based on quantifiable metrics.

  11. Assessing Information Quality: Use Cases for the Data Stewardship Maturity Matrix

    Science.gov (United States)

    Hou, C. Y.; Mayernik, M. S.; Peng, G.; Duerr, R.; Rosati, A.

    2015-12-01

    Information Quality (IQ) is an important characteristic of a data repository. Being recognized for providing "good" or "high" quality information enables trust to be built between the data repository and its communities, and therefore, fosters collaborations and potentially improves the utility of its data holdings. However, currently, a common standard or framework does not exist to allow IQ to be assessed consistently across different data repositories. There are several aspects that need to be considered when evaluating IQ. In particular, the data stewardship practices applied to datasets during the curation process can have significant impact on the accessibility, usability, understandability, and integrity of the datasets over time. The Data Stewardship Maturity Matrix (DSMM) provides a framework for the evaluation of a dataset's quality based on nine distinct categories. For each of the categories, the DSMM provides criteria that can be used to apply a 5-level rating to an individual dataset, ranging from Ad Hoc to Optimal. This presentation introduces the overview of the DSMM and the recommended process for using DSMM to evaluate the quality of a dataset. The presentation will also provide the key findings after applying the DSMM to several datasets, including those from the Advanced Cooperative Arctic Data and Information Service, the National Center for Atmospheric Research, and the Long Term Ecological Research's Santa Barbara Coastal site. The presentation concludes by summarizing the crucial lessons learned and the potential benefits when a data repository uses the DSMM to assess and convey the quality of its datasets.

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

    Directory of Open Access Journals (Sweden)

    Sebastián Villasante

    2015-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Winslow D. Hansen

    2014-12-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany.

    Science.gov (United States)

    Borde, J P; Litterst, S; Ruhnke, M; Feik, R; Hübner, J; deWith, K; Kaier, K; Kern, W V

    2015-02-01

    Prescription of third-generation cephalosporins and fluoroquinolones has been linked to an increasing incidence of gram-negative bacteria producing extended-spectrum beta-lactamases, methicillin-resistant Staphylococcus aureus and nosocomial infection with Clostridium difficile. Antibiotic stewardship (ABS) programmes offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programmes at community hospitals. We implemented an ABS programme at a 200-bed community hospital and aimed at a > 30 % reduction of cephalosporin and fluoroquinolone consumption within 1 year. Pharmacy data were obtained to estimate hospital-wide drug use density expressed in WHO-ATC-defined daily doses (DDD) or hospital-adapted recommended daily doses (RDD) per 1,000 patient days. The effect of the ABS intervention on drug use density was analysed using interrupted time-series analysis for the periods between January 2011 and March 2013 as pre-intervention, and between April 2013 and March 2014 as post-intervention period. The CDI incidence was calculated based on microbiology laboratory data. Cephalosporin use (measured in RDD/1,000 patient days) decreased by 33 %, and fluoroquinolone use decreased by 31 %, respectively. Interrupted time-series analysis confirmed significant changes in the drug use density trends for both cephalosporins and fluoroquinolones after the intervention as well as for total antibiotic use that decreased by 11 % while no significant effect was noted for CDI incidence rates. ABS programmes can be effective in community hospitals and may help establish ecologically advantageous antibiotic strategies when needed.

  16. The role of microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals.

    Science.gov (United States)

    MacKenzie, Fiona M; Gould, Ian M; Bruce, Julie; Mollison, Jill; Monnet, Dominique L; Krcmery, Vladimir; Cookson, Barry; van der Meer, Jos W M

    2007-06-01

    This observational, cross-sectional study describes the role played by clinical microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals. A total of 170 acute care hospitals from 32 European countries returned a questionnaire on antibiotic policies and practices implemented in 2001. Data on antibiotic use, expressed as Defined Daily Doses per 100 occupied bed-days (DDD/100 BD) were provided by 139 hospitals from 30 countries. A total of 124 hospitals provided both datasets. 121 (71%) of Clinical Microbiology departments and 66 (41%) of Pharmacy departments provided out of hours clinical advice. 70 (41%) of microbiology/infectious disease specialists and 28 (16%) of pharmacists visited wards on a daily basis. The majority of laboratories provided monitoring of blood cultures more than once per day and summary data of antibiotic susceptibility testing (AST) for empiric prescribing (86% and 73% respectively). Most of the key laboratory and pharmacy-led initiatives examined did not vary significantly by geographical location. Hospitals from the North and West of Europe were more likely to examine blood cultures more than once daily compared with other regions (p Hospitals in the North were least likely routinely to report susceptibility results for restricted antibiotics compared to those in the South-East and Central/Eastern Europe (p Hospital wards in the North were more likely to hold antibiotic stocks (100%) compared with hospitals in the South-East which were least likely (39%) (p hospital pharmacies in the North were least likely to dispense antibiotics on an individual patient basis (16%) compared with hospital pharmacies from Southern Europe (60%) (p = 0.01). Hospitals that routinely reported susceptibility results for restricted antibiotics had significantly lower median total antibiotic use in 2001 (p Hospitals that provided prescribing advice outside normal working hours had significantly higher antibiotic use

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

    Science.gov (United States)

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

    2013-12-01

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

  18. Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

    Directory of Open Access Journals (Sweden)

    Onalenna Seitio-Kgokgwe

    2016-12-01

    Full Text Available Background In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health interventions. The World Health Organization (WHO identified four functions that health systems need to perform to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a number of studies on health systems functions have been conducted, the stewardship function has received limited attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH undertook its stewardship role. Methods We used the WHO Health Systems Performance Assessment Frame (HSPAF to guide analysis of the stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence through health regulation, and coalition building. Data were abstracted from published and unpublished documents. We interviewed 54 key informants comprising staff of the MoH (N = 40 and stakeholder organizations (N = 14. Data from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic analysis. Results A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas. Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder engagement in the planning processes were weak. Conclusion Problems in the exercise of the stewardship function posed challenges in ensuring accountability and limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System under control of the MoH, attempts to improve service delivery at a national

  19. The Impact of Antibiotic Stewardship Programs in Combating Quinolone Resistance: A Systematic Review and Recommendations for More Efficient Interventions.

    Science.gov (United States)

    Pitiriga, Vasiliki; Vrioni, Georgia; Saroglou, George; Tsakris, Athanasios

    2017-04-01

    Quinolones are among the most commonly prescribed antibiotics worldwide. A clear relationship has been demonstrated between excessive quinolone use and the steady increase in the incidence of quinolone-resistant bacterial pathogens, both in hospital and community sites. In addition, exposure to quinolones has been associated with colonization and infection with healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus and Clostridium difficile in hospitalized patients. Therefore, the management of quinolone prescribing in hospitals through antibiotic stewardship programs is considered crucial. Although suggestions have been made by previous studies on the positive impact of stewardship programs concerning the emergence and spread of multidrug-resistant bacteria at hospital level, the association of quinolone-targeted interventions with reduction of quinolone resistance is vague. The purpose of this article was to evaluate the impact of stewardship interventions on quinolone resistance rates and healthcare-associated infections, through a literature review using systematic methods to identify and select the appropriate studies. Recommendations for improvements in quinolone-targeted stewardship programs are also proposed. Efforts in battling quinolone resistance should combine various interventions such as restriction formulary policies, prospective audits with feedback to prescribers, infection prevention and control measures, prompt detection of low-level resistance, educational programs, and guidelines for optimal quinolone usage. However, the effectiveness of such strategies should be assessed by properly designed and conducted clinical trials. Finally, novel approaches in diagnostic stewardship for rapidly detecting bacterial resistance, including PCR-based techniques, mass spectrometry, microarrays, and whole-genome sequencing as well as the prompt investigation on the clonality of quinolone-resistant strains, will strengthen our

  20. The Marine Stewardship Council (MSC) and the Making of a Market for ‘Sustainable Fish’

    DEFF Research Database (Denmark)

    Ponte, Stefano

    2012-01-01

    Market-based instruments of fishery governance have been promoted in the past two decades on the basis of two widespread expectations: that complying with sustainability standards will lead to environmental benefits; and that certifications will not discriminate against specific social groups......, countries or regions. This paper assesses whether these assumptions hold through the analysis of how the Marine Stewardship Council (MSC) label for capture fisheries has managed ‘supply’, ‘demand’ and ‘civic’ concerns in the market for sustainability certifications. The MSC has created and now dominates...... the market for ‘sustainable fish’, but success has been accompanied by serious challenges. The MSC has so far failed to convincingly show that its certification system has positive environmental impacts, and it has marginalized Southern fisheries, especially in low-income countries. As an institutional...

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

    Directory of Open Access Journals (Sweden)

    Keith G. Tidball

    2009-01-01

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

  2. Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence.

    Science.gov (United States)

    Nicolau, David P; Carmeli, Yehuda; Crank, Christopher W; Goff, Debra A; Graber, Christopher J; Lima, Ana Lucia L; Goldstein, Ellie J C

    2012-01-01

    The group 2 carbapenems (imipenem, meropenem and, more recently, doripenem) have been a mainstay of treatment for patients with serious hospital infections caused by Pseudomonas aeruginosa, Enterobacteriaceae and other difficult-to-treat Gram-negative pathogens as well as mixed aerobic/anaerobic infections. When ertapenem, a group 1 carbapenem, was introduced, questions were raised about the potential for ertapenem to select for imipenem- and meropenem-resistant Pseudomonas. Results from ten clinical studies evaluating the effect of ertapenem use on the susceptibility of Pseudomonas to carbapenems have uniformly shown that ertapenem use does not result in decreased Pseudomonas susceptibility to these antipseudomonal carbapenems. Here we review these studies evaluating the evidence of how ertapenem use affects P. aeruginosa as well as provide considerations for ertapenem use in the context of institutional stewardship initiatives.

  3. Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis.

    Science.gov (United States)

    Miyazaki, Taiga; Kohno, Shigeru

    2015-01-01

    Invasive candidiasis can have a major effect on patient prognosis and medical economics. Quickly eliminating the focus of the infection and administering appropriate antifungal therapy are important. Clinical guidelines for invasive candidiasis have been issued in the USA, Europe and recently in Japan. The purpose of this review is to summarize the current recommendations on how to diagnose and treat invasive candidiasis based on the evidence gathered to date and by referencing guidelines from various countries. Echinocandin antifungals play a central role in the prevention and treatment of invasive candidiasis although a recent increase in echinocandin-resistant Candida glabrata is seen as problematic. In the future, promoting the appropriate use of antifungal agents by antifungal stewardship teams will be necessary to suppress adverse effects, appearance of resistant strains and unnecessary medical expenses, as well as improve positive clinical outcomes and prognoses.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-05

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-09-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    timely non-accounting information (analyst earnings forecasts) increases the ex ante value of the firm and reduces costly earnings management. There is an optimal level of reversible non-discretionary accrual noise introduced through revenue recognition policies. Tight rules-based accounting regulation......, as opposed to leaving firms more choice over non-discretionary accrual policies, may lead firms to rationally respond by inducing costly earnings management. More generally, regulating both earnings persistence and the tightness of admissible auditing policies may not result in less equilibrium earnings......We examine the interaction between discretionary and non-discretionary accruals in a stewardship setting. Contracting includes multiple rounds of renegotiation based on contractible accounting information and non-contractible but more timely non-accounting information. We show that accounting...

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

    DEFF Research Database (Denmark)

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

    timely non-accounting information (analyst earnings forecasts) increases the ex ante value of the firm and reduces costly earnings management. There is an optimal level of reversible non-discretionary accrual noise introduced through revenue recognition policies. Tight rules-based accounting regulation......, as opposed to leaving firms more choice over non-discretionary accrual policies, may lead firms to rationally respond by inducing costly earnings management. More generally, regulating both earnings persistence and the tightness of admissible auditing policies may not result in less equilibrium earnings......We examine the interaction between discretionary and non-discretionary accruals in a stewardship setting. Contracting includes multiple rounds of renegotiation based on contractible accounting information and non-contractible but more timely non-accounting information. We show that accounting...

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

    Science.gov (United States)

    Daniel, Michelle

    2012-01-01

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

  10. The Marine Stewardship Council (MSC) and the Making of a Market for ‘Sustainable Fish’

    DEFF Research Database (Denmark)

    Ponte, Stefano

    2012-01-01

    Market-based instruments of fishery governance have been promoted in the past two decades on the basis of two widespread expectations: that complying with sustainability standards will lead to environmental benefits; and that certifications will not discriminate against specific social groups......, countries or regions. This paper assesses whether these assumptions hold through the analysis of how the Marine Stewardship Council (MSC) label for capture fisheries has managed ‘supply’, ‘demand’ and ‘civic’ concerns in the market for sustainability certifications. The MSC has created and now dominates...... the market for ‘sustainable fish’, but success has been accompanied by serious challenges. The MSC has so far failed to convincingly show that its certification system has positive environmental impacts, and it has marginalized Southern fisheries, especially in low-income countries. As an institutional...

  11. USGS National Hydrography Dataset (NHD) Stewardship Plan Objectives for FY17 from the The National Map - National Geospatial Data Asset (NGDA) National Hydrography Dataset (NHD)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — U.S. Geological Survey, Department of the Interior - The annual National Hydrography Dataset (NHD) stewardship plan is to maintain hydrography data in the NHD over...

  12. USGS Watershed Boundary Dataset (WBD) Stewardship Plan Objectives for FY17 from The National Map - National Geospatial Data Asset (NGDA) Watershed Boundary Dataset (WBD)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — U.S. Geological Survey, Department of the Interior - The annual Watershed Boundary Dataset (WBD) stewardship plan is to maintain watershed boundary data through...

  13. Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy.

    Science.gov (United States)

    Cosgrove, Sara E; Li, David X; Tamma, Pranita D; Avdic, Edina; Hadhazy, Eric; Wakefield, Teresa; Gherna, Michael; Carroll, Karen C

    2016-09-01

    Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced.

  14. Long-Term Stewardship at a Former Uranium Mill Tailings Site in Riverton, Wyoming WM2017-17090

    Energy Technology Data Exchange (ETDEWEB)

    Dam, William [USDOE Office of Legacy Management, Washington, DC (United States); Gil, Dr. April [USDOE Office of Legacy Management, Washington, DC (United States); Johnson, Raymond H. [Navarro Research and Engineering, Oak Ridge, TN (United States); Campbell, Sam [Navarro Research and Engineering, Oak Ridge, TN (United States)

    2017-03-01

    The US Department of Energy Office of Legacy Management (LM) is responsible for maintaining protective public health and environmental conditions at former uranium mill tailings sites nationwide via long-term stewardship. One of these sites, a former uranium mill near Riverton, Wyoming, is within the boundary of the Wind River Indian Reservation and operated from 1958 to 1963. Tailings and contaminated material associated with mill operations were removed and transported to an offsite disposal cell in 1989. The remedial action was completed under Title I of the Uranium Mill Tailings Radiation Control Act of 1978. Milling operations, which included an unlined tailings impoundment and an unlined evaporation pond, contaminated the shallow groundwater, resulting in a downgradient groundwater plume that discharges to the Little Wind River. A natural flushing compliance strategy was implemented in 1998. This strategy allows contaminants of concern to naturally flush from the groundwater, provided that contaminants flush below US Environmental Protection Agency maximum concentration limits within 100 years. As part of the compliance strategy, LM has implemented a groundwater monitoring program along with institutional controls that include the installation of an alternate water supply, continued sampling of private wells, and restrictions on well drilling and gravel pit construction. LM works closely with local stakeholders and community members to ensure that these institutional controls are in place and maintained. The Riverton site provides an interesting case study where contaminant remobilization due to river flooding prompted a reevaluation of the conceptual site model to verify if the current compliance strategy would remain protective of human health and the environment. Concentrations of groundwater contaminants, which include sulfate, molybdenum, and uranium, were transiently elevated following flooding of the Little Wind River in 2010 and 2016. These flood

  15. Patient and public understanding and knowledge of antimicrobial resistance and stewardship in a UK hospital: should public campaigns change focus?

    Science.gov (United States)

    Micallef, Christianne; Kildonaviciute, Kornelija; Castro-Sánchez, Enrique; Scibor-Stepien, Aleksandra; Santos, Reem; Aliyu, Sani H; Cooke, Fiona J; Pacey, Sarah; Holmes, Alison H; Enoch, David A

    2017-01-01

    The rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies. A panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room. One hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%). We describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. Does stewardship make a difference in the quality of care? Evidence from clinics and pharmacies in Kenya and Ghana.

    Science.gov (United States)

    Spreng, Connor P; Ojo, Ifelayo P; Burger, Nicholas E; Sood, Neeraj; Peabody, John W; Demaria, Lisa M

    2014-08-01

    To measure level and variation of healthcare quality provided by different types of healthcare facilities in Ghana and Kenya and which factors (including levels of government engagement with small private providers) are associated with improved quality. Provider knowledge was assessed through responses to clinical vignettes. Associations between performance on vignettes and facility characteristics, provider characteristics and self-reported interaction with government were examined using descriptive statistics and multivariate regressions. Survey of 300 healthcare facilities each in Ghana and Kenya including hospitals, clinics, nursing homes, pharmacies and chemical shops. Private facilities were oversampled. Person who generally saw the most patients at each facility. Percent of items answered correctly, measured against clinical practice guidelines and World Health Organization's protocol. Overall, average quality was low. Over 90% of facilities performed less than half of necessary items. Incorrect antibiotic use was frequent. Some evidence of positive association between government stewardship and quality among clinics, with the greatest effect (7% points increase, P = 0.03) for clinics reporting interactions with government across all six stewardship elements. No analogous association was found for pharmacies. No significant effect for any of the stewardship elements individually, nor according to type of engagement. Government stewardship appears to have some cumulative association with quality for clinics, suggesting that comprehensive engagement with providers may influence quality. However, our research indicates that continued medical education (CME) by itself is not associated with improved care. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  17. Development and Validation of an Instrument for Assessing Climate Change Knowledge and Perceptions: The Climate Stewardship Survey (CSS)

    OpenAIRE

    Scott L. WALKER; McNeal, Karen S

    2013-01-01

    The Climate Stewardship Survey (CSS) was developed to measure knowledge and perceptions of global climate change, while also considering information sources that respondents ‘trust.’ The CSS was drafted using a three-stage approach: development of salient scales, writing individual items, and field testing and analyses. Construct validity and alpha-level reliability was conducted on the 122-item test instrument to produce a refined 84-item CSS.  The field tested C...

  18. Contributing understanding of mitigation options for phosphorus and sediment to a review of the efficacy of contemporary agricultural stewardship measures

    OpenAIRE

    2010-01-01

    Experiences from the Mitigation Options for Phosphorus and Sediment (MOPS) projects, which aim to determine the effectiveness of measures to reduce pollutant loading from agricultural land to surface waters, have been used to contribute to the findings of a recent paper (Kay et al., 2009, Agricultural Systems, 99, 67-75), which reviewed the efficacy of contemporary agricultural stewardship measures for ameliorating the water pollution problems of key concern to the UK water industry. MOPS1 is...

  19. Resilience design: toward a synthesis of cognition, learning, and collaboration for adaptive problem solving in conservation and natural resource stewardship

    Directory of Open Access Journals (Sweden)

    Charles G. Curtin

    2014-06-01

    Full Text Available Through the resilience design approach, I propose to extend the resilience paradigm by re-examining the components of adaptive decision-making and governance processes. The approach can be divided into three core components: (1 equity design, i.e., the integration of collaborative approaches to conservation and adaptive governance that generates effective self-organization and emergence in conservation and natural resource stewardship; (2 process design, i.e., the generation of more effective knowledge through strategic development of information inputs; and (3 outcome design, i.e., the pragmatic synthesis of the previous two approaches, generating a framework for developing durable and dynamic conservation and stewardship. The design of processes that incorporate perception and learning is critical to generating durable solutions, especially in developing linkages between wicked social and ecological challenges. Starting from first principles based on human cognition, learning, and collaboration, coupled with nearly two decades of practical experience designing and implementing ecosystem-level conservation and restoration programs, I present how design-based approaches to conservation and stewardship can be achieved. This context is critical in helping practitioners and resources managers undertake more effective policy and practice.

  20. A Research Review on Managerial Stewardship Behavior%经理人管家主义行为研究回顾与展望

    Institute of Scientific and Technical Information of China (English)

    刘云; 张文勤

    2013-01-01

    公司治理研究主要从两个视角来研究委托人与经理人之间的关系,即代理主义视角和管家主义视角。代理主义视角把经理人视为代理人,从而形成代理主义理论;管家主义视角把经理人视为公司资产的管家,从而形成管家主义理论。文章介绍了经理人管家主义行为的理论基础、概念内涵、结构测量,并且探讨了经理人管家主义行为的影响因素、心理过程模型,最后指出未来研究应该集中在管家主义行为的影响因素和影响结果、管家主义文化或气氛、员工管家主义行为、集体管家主义行为等方面。%There are two different perspectives used to explore the relationship between principals and managers in corporate governance research field,one is agency perspective,the other is stewardship perspective. The agency perspective views man-agers as agents,thereby agency theory is developed. While the stewardship perspective views managers as stewards of organiza-tional assets, thereby stewardship theory is developed. Based on the review of past researches about stewardship, this article comprehensively introduced the theoretical foundation,definition,dimension and measurement of managerial stewardship be-havior, and also discussed the influencing factors and psychological process model of managerial stewardship behavior. At the end of this article,we pointed out that future research should focus on the antecedents and outcome variables of stewardship be-havior,stewardship culture or climate,employee stewardship behavior,collective stewardship behavior,and so on.

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

    Directory of Open Access Journals (Sweden)

    Simon R. Bush

    2015-02-01

    Full Text Available This paper explores the externally-led vertical differentiation of third-party certification standards using the case of the Marine Stewardship Council (MSC. We analyze this process in two dimensions. First, fisheries employ strategies to capture further market value from fishing practices that go beyond their initial conditions for certification and seek additional recognition for these activities through co-labelling with, amongst others, international NGOs. Second, fisheries not yet able to meet the requirements of MSC standards are being enrolled in NGO and private sector sponsored Fisheries Improvement Projects (FIPs, providing an alternative route to global markets. In both cases the credibility and authority of the MSC is challenged by new coalitions of market actors opening up new strategies for capturing market value and/or improving the conditions of international market access. Through the lens of global value chains, the results offer new insights on how such standards not only influence trade and markets, but are also starting to change their internal governance in response to threats to their credibility by actors and modes of coordination in global value chains.

  2. Strategic Program Planning Lessons Learned In Developing The Long-Term Stewardship Science and Technology Roadmap

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, B.W.; Hanson, D.J.; Matthern, G.E.

    2003-04-24

    Technology roadmapping is a strategic planning method used by companies to identify and plan the development of technologies necessary for new products. The U.S. Department of Energy's Office of Environmental Management has used this same method to refine requirements and identify knowledge and tools needed for completion of defined missions. This paper describes the process of applying roadmapping to clarify mission requirements and identify enhancing technologies for the Long-Term Stewardship (LTS) of polluted sites after site cleanup has been completed. The nature of some contamination problems is such that full cleanup is not achievable with current technologies and some residual hazards remain. LTS maintains engineered contaminant barriers and land use restriction controls, and monitors residual contaminants until they no longer pose a risk to the public or the environment. Roadmapping was used to clarify the breadth of the LTS mission, to identify capability enhancements needed to improve mission effectiveness and efficiency, and to chart out the research and development efforts to provide those enhancements. This paper is a case study of the application of roadmapping for program planning and technical risk management. Differences between the planned and actual application of the roadmapping process are presented along with lessons learned. Both the process used and lessons learned should be of interest for anyone contemplating a similar technology based planning effort.

  3. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    Science.gov (United States)

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  4. Using Private Rights to Manage Natural Resources: Is Stewardship Linked to Ownership?

    Directory of Open Access Journals (Sweden)

    Peter D. Dwyer

    2012-09-01

    Full Text Available There is increasing interest in privatizing natural resource systems to promote sustainability and conservation goals. Though economic theory suggests owners of private property rights have an incentive to act as resource stewards, few studies have tested this empirically. This paper asks whether private rights-owners were more conservative with respect to their management opinions than nonrights-owners in five Australian abalone (Haliotis spp. fisheries. Multiple regression analyses were used to link opinions to demographic, economic, and attitudinal variables. In contrast to standard economic assumptions, nonrights-owners suggested more conservative catch limits than did rights-owners, confirming qualitative observations of behavior in management workshops. Differing views about the condition of the resource and differing levels of experience contributed to these results. The first of its kind, this study directly demonstrates that private rights do not necessarily promote the greatest level of stewardship. This has substantial implications for how natural resources are governed globally, but also warns against applying simplistic behavioral assumptions to complex social-ecological systems.

  5. Product stewardship and science: safe manufacture and use of fiber glass.

    Science.gov (United States)

    Hesterberg, Thomas W; Anderson, Robert; Bernstein, David M; Bunn, William B; Chase, Gerald A; Jankousky, Angela Libby; Marsh, Gary M; McClellan, Roger O

    2012-03-01

    This paper describes a proactive product stewardship program for glass fibers. That effort included epidemiological studies of workers, establishment of stringent workplace exposure limits, liaison with customers on safe use of products and, most importantly, a research program to evaluate the safety of existing glass fiber products and guide development of new even safer products. Chronic inhalation exposure bioassays were conducted with rodents and hamsters. Amosite and crocidolite asbestos produced respiratory tract cancers as did exposure to "biopersistent" synthetic vitreous fibers. "less biopersistent" glass fibers did not cause respiratory tract cancers. Corollary studies demonstrated the role of slow fiber dissolution rates and biopersistence in cancer induction. These results guided development of safer glass fiber products and have been used in Europe to regulate fibers and by IARC and NTP in classifying fibers. IARC concluded special purpose fibers and refractory ceramic fibers are "possibly carcinogenic to humans" and insulation glass wool, continuous glass filament, rock wool and slag wool are "not classifiable as to their carcinogenicity to human." The NTP's 12th report on carcinogens lists "Certain Glass Wool Fibers (Inhalable)" as "reasonably anticipated to be a human carcinogen." "Certain" in the descriptor refers to "biopersistent" glass fibers and excludes "less biopersistent" glass fibers.

  6. New Developments in NOAA's Comprehensive Large Array-Data Stewardship System

    Science.gov (United States)

    Ritchey, N. A.; Morris, J. S.; Carter, D. J.

    2012-12-01

    The Comprehensive Large Array-data Stewardship System (CLASS) is part of the NOAA strategic goal of Climate Adaptation and Mitigation that gives focus to the building and sustaining of key observational assets and data archives critical to maintaining the global climate record. Since 2002, CLASS has been NOAA's enterprise solution for ingesting, storing and providing access to a host of near real-time remote sensing streams such as the Polar and Geostationary Operational Environmental Satellites (POES and GOES) and the Defense Meteorological Satellite Program (DMSP). Since October, 2011 CLASS has also been the dedicated Archive Data Segment (ADS) of the Suomi National Polar-orbiting Partnership (S-NPP). As the ADS, CLASS receives raw and processed S-NPP records for archival and distribution to the broad user community. Moving beyond just remote sensing and model data, NOAA has endorsed a plan to migrate all archive holdings from NOAA's National Data Centers into CLASS while retiring various disparate legacy data storage systems residing at the National Climatic Data Center (NCDC), National Geophysical Data Center (NGDC) and the National Oceanographic Data Center (NODC). In parallel to this data migration, CLASS is evolving to a service-oriented architecture utilizing cloud technologies for dissemination in addition to clearly defined interfaces that allow better collaboration with partners. This evolution will require implementation of standard access protocols and metadata which will lead to cost effective data and information preservation.

  7. Emergence of a global science-business initiative for ocean stewardship.

    Science.gov (United States)

    Österblom, Henrik; Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-08-22

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science-business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well.

  8. A Report to Congress on Long-Term Stewardship. Volume I - Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousands of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

  9. Use of computer decision support in an antimicrobial stewardship program (ASP).

    Science.gov (United States)

    Evans, R S; Olson, J A; Stenehjem, E; Buckel, W R; Thorell, E A; Howe, S; Wu, X; Jones, P S; Lloyd, J F

    2015-01-01

    Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use. A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control's National Healthcare Surveillance Network. Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children's Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities. To be effective, ASPs need an enormous amount of "timely" information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.

  10. Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies.

    Science.gov (United States)

    Liew, Y X; Lee, W; Cai, Y Y; Teo, J; Tang, S S-L; Ong, R W-Q; Lim, C L-L; Lingegowda, P B; Kwa, A L-H; Chlebicki, M P

    2012-11-01

    As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.

  11. On the value of environmental stewardship and sustainability in health administration education.

    Science.gov (United States)

    Verderber, Stephen; Fauerbach, Julia; Walter, Brandon

    2008-01-01

    Global warming, the depletion of the world'snatural resources, and excessive consumer consumption in developed countries are determinants reshaping the way we live our everyday lives. These factors are rapidly giving rise to new ecological paradigms of environmental stewardship and in healthcare environments that express sustainable theories and practices. This has given rise to a systematic system for promoting and assessing the energy performance and efficiency of healthcare facilities known as Leadership in Energy Efficient Environmental Design (LEED), and a parallel certification program, the Green Guide for Heath Care. These developments are examined in direct relation to the functions of managerial ethics. A series of ten sustainability-based ethical dilemmas are presented. Each is examined in relation to the need to inculcate in future healthcare administrators a critical understanding and appreciation of the need to reposition contemporary healthcare organizations at the center--as leading civic participants and role models in relation to the emerging movement towards carbon neutrality in the healthcare industry.

  12. A Report to Congress on Long-Term Stewardship. Volume II, Site Summaries

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousand of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

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

    Science.gov (United States)

    Bexell, Sarah M.

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

  14. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

    Science.gov (United States)

    Chalmers, Lauren; Cross, Jessica; Chu, Cindy S; Phyo, Aung Pyae; Trip, Margreet; Ling, Clare; Carrara, Verena; Watthanaworawit, Wanitda; Keereecharoen, Lily; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

    2015-10-01

    Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  15. Evolution of data stewardship over two decades at a NASA data center

    Science.gov (United States)

    Armstrong, E. M.; Moroni, D. F.; Hausman, J.; Tsontos, V. M.

    2013-12-01

    physical domain was still critical, especially relevant to assessments of data quality, additional skills in computer science, statistics and system engineering also became necessary. Furthermore, the level of effort to implement data curation has not expanded linearly either. Management of ongoing data operations demands increased productivity on a continual basis and larger volumes of data, with constraints on funding, must be managed with proportionately less human resources. The role of data curation has also changed within the perspective of satellite missions. In many early missions, data management and curation was an afterthought (since there were no explicit data management plans written into the proposals), while current NASA mission proposals must have explicit data management plans to identify resources and funds for archiving, distribution and implementing overall data stewardship. In conclusion, the role of the data scientist/engineer at the PO.DAAC has shifted from supporting singular missions and primarily representing a point of contact for the science community to complete end-to-end stewardship through the implementation of a robust set of dataset lifecycle policies from ingest, to archiving, including data quality assessment for a broad swath of parameter based datasets that can number in the hundreds.

  16. Field Work Proposal: PUBLIC OUTREACH EVENT FOR ACCELERATOR STEWARDSHIP TEST FACILITY PILOT PROGRAM

    Energy Technology Data Exchange (ETDEWEB)

    Hutton, Andrew [TJNAF; Areti, Hari [TJNAF

    2015-03-05

    Jefferson Lab’s outreach efforts towards the goals of Accelerator Stewardship Test Facility Pilot Program consist of the lab’s efforts in three venues. The first venue, at the end of March is to meet with the members of Virginia Tech Corporate Research Center (VTCRC) (http://www.vtcrc.com/tenant-directory/) in Blacksburg, Virginia. Of the nearly 160 members, we expect that many engineering companies (including mechanical, electrical, bio, software) will be present. To this group, we will describe the capabilities of Jefferson Lab’s accelerator infrastructure. The description will include not only the facilities but also the intellectual expertise. No funding is requested for this effort. The second venue is to reach the industrial exhibitors at the 6th International Particle Accelerator Conference (IPAC’15). Jefferson Lab will host a booth at the conference to reach out to the >75 industrial exhibitors (https://www.jlab.org/conferences/ipac2015/SponsorsExhibitors.php) who represent a wide range of technologies. A number of these industries could benefit if they can access Jefferson Lab’s accelerator infrastructure. In addition to the booth, where written material will be available, we plan to arrange a session A/V presentation to the industry exhibitors. The booth will be hosted by Jefferson Lab’s Public Relations staff, assisted on a rotating basis by the lab’s scientists and engineers. The budget with IPAC’15 designations represents the request for funds for this effort. The third venue is the gathering of Southeastern Universities Research Association (SURA) university presidents. Here we plan to reach the research departments of the universities who can benefit by availing themselves to the infrastructure (material sciences, engineering, medical schools, material sciences, to name a few). Funding is requested to allow for attendance at the SURA Board Meeting. We are coordinating with DOE regarding these costs to raise the projected conference

  17. Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010

    Directory of Open Access Journals (Sweden)

    Daniel J. Pallin

    2014-05-01

    Full Text Available Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA. The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs and analyze potential quality measures. Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation. Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4% were for skin infection, and 2.7% (2.6-2.9% were first visits for skin infection, with no increase over time (p=0.80. However, anti-CA-MRSA antibiotic use increased, from 61% (56-66% to 74% (71-78% of antibiotic regimens (p<0.001. Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06. Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse. Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse. Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for

  18. Forest Stewardship Council (FSC) pesticide policy and integrated pest management in certified tropical plantations.

    Science.gov (United States)

    Lemes, Pedro Guilherme; Zanuncio, José Cola; Serrão, José Eduardo; Lawson, Simon A

    2017-01-01

    The Forest Stewardship Council (FSC) was the first non-governmental organization composed of multi-stakeholders to ensure the social, environmental, and economic sustainability of forest resources. FSC prohibits certain chemicals and active ingredients in certified forest plantations. A company seeking certification must discontinue use of products so listed and many face problems to comply with these constraints. The aim of this study was to assess the impacts of certification on pest management from the perspective of Brazilian private forestry sector. Ninety-three percent of Brazilian FSC-certified forest companies rated leaf-cutting ants as "very important" pests. Chemical control was the most important management technique used and considered very important by 82 % of respondents. The main chemical used to control leaf-cutting ants, sulfluramid, is in the derogation process and was classified as very important by 96.5 % of the certified companies. Certified companies were generally satisfied in relation to FSC certification and the integrated management of forest pests, but 27.6 % agreed that the prohibitions of pesticides for leaf-cutting ant and termite control could be considered as a non-tariff barrier on high-productivity Brazilian forest plantations. FSC forest certification has encouraged the implementation of more sustainable techniques and decisions in pest management in forest plantations in Brazil. The prohibition on pesticides like sulfluramid and the use of alternatives without the same efficiency will result in pest mismanagement, production losses, and higher costs. This work has shown that the application of global rules for sustainable forest management needs to adapt to each local reality.

  19. Campus sustainability and natural area stewardship: student involvement in adaptive comanagement

    Directory of Open Access Journals (Sweden)

    Marianne E. Krasny

    2014-09-01

    Full Text Available University campus sustainability initiatives have proliferated over the last decade. We contend that such initiatives benefit from applying conceptual frameworks to help understand and guide their activities and from a focus on campus open space and natural areas management. Informed by an adaptive comanagement framework encompassing social learning, social capital, and shared action, we used semistructured interviews to examine student participation in the immediate response and longer-term policy formulation following a crisis that occurred in a campus natural area. Students exhibited social learning as demonstrated by reflection and the integration of new ideas through discussions with administrators and peers, as well as social capital through increased social trust, which led to a shift in perspective regarding norms of student-administrator interactions. Further, students participated in shared action, such as posting warning signs in dangerous areas, and importantly, through their contributions to longer-term campus natural area safety and recreational access policy. Three conditions explain student engagement in the adaptive comanagement process: the presence of a pre-existing student organization that had built bonding social capital and was committed to campus natural area stewardship, openness to multiple stakeholder viewpoints and commitment to action on the part of the university administration, and the presence of a crisis that spurred emotions and action. Based on these findings, we assert that student organizations can contribute to an adaptive comanagement process and that such a process is consistent with university and campus sustainability values related to the importance of student engagement, mental health, and learning.

  20. Marine Stewardship Council certification of fisheries in Russia: a current status and prospects

    Directory of Open Access Journals (Sweden)

    Dmitry Liudvigovich Lajus

    2015-11-01

    Full Text Available Russia supports the sixth largest fisheries worldwide, which grew 25% during the last decade and is forecasted to grow 40% more up to 2020. Such voluminous and fast growing fisheries cause challenges for their sustainability. Marine Stewardship Council (MSC voluntary certification is now the most recognized system aimed to achieve sustainability of fisheries through informed choice of consumers. The certified fisheries benefit through recognition of MSC logo by consumers. The certificate is awarded to fisheries with a good status of target species and limited impact to structure and function of ecosystems, and to protected species. The recent research showed that MSC certified fisheries in average refer to healthier stocks than non-certified ones. Russia entered the program in the second half of the 2000s, and the first certificate was awarded in 2009. Now the MSC process in Russia is very intensive and currently involves thirteen fisheries, seven of them already are certified. The certified fisheries can be subdivided into three groups: (i set net Pacific salmon fisheries of the Far East, (ii bottom trawl codfish fisheries in the Barents Sea, and (iii pelagic trawl Alaska pollock fisheries in the Sea of Okhotsk. The total catch of fisheries involved in the MSC program now is about one-third for Pacific salmon, most of codfish and about a half for Alaska pollock. Process of MSC certifications in Russia faces various problems, caused by differences between western and Russian traditions of fishery management, difficulties of access to scientific information, insufficient support from governmental institutions, illegal fishing, insufficient independent observance, influence of hatcheries on salmon wild stocks and others. We believe that to improve sustainability of Russian fisheries, it is needed to demonstrate economical benefits of certification for those fisheries which are not involved in the program, to involve new fisheries in the process

  1. Automatic day-2 intervention by a multidisciplinary Antimicrobial Stewardship-Team leads to multiple positive effects

    Directory of Open Access Journals (Sweden)

    Jan-Willem H Dik

    2015-06-01

    Full Text Available Background: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary Antimicrobial Stewardship-Team (A-Team was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS and antimicrobial use.Methods: Automatic e-mail alerts were sent after 48 hours of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient’s therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort. Results: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81 compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21 (p=0.012. Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24 to 5.93 DDD/patient (95% CI: 5.02-6.83 (p=0.008. For patients with severe underlying diseases (e.g. cancer these outcome measures remained unchanged.Conclusions: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.

  2. Practical implications of understanding the influence of motivations on commitment to voluntary urban conservation stewardship.

    Science.gov (United States)

    Asah, Stanley T; Blahna, Dale J

    2013-08-01

    -building motivations may help enhance volunteers' commitment to conservation stewardship and address the pressing challenge of retaining urban conservation volunteers.

  3. Field Work Proposal: PUBLIC OUTREACH EVENT FOR ACCELERATOR STEWARDSHIP TEST FACILITY PILOT PROGRAM

    Energy Technology Data Exchange (ETDEWEB)

    Hutton, Andrew [TJNAF; Areti, Hari [TJNAF

    2015-03-05

    Jefferson Lab’s outreach efforts towards the goals of Accelerator Stewardship Test Facility Pilot Program consist of the lab’s efforts in three venues. The first venue, at the end of March is to meet with the members of Virginia Tech Corporate Research Center (VTCRC) (http://www.vtcrc.com/tenant-directory/) in Blacksburg, Virginia. Of the nearly 160 members, we expect that many engineering companies (including mechanical, electrical, bio, software) will be present. To this group, we will describe the capabilities of Jefferson Lab’s accelerator infrastructure. The description will include not only the facilities but also the intellectual expertise. No funding is requested for this effort. The second venue is to reach the industrial exhibitors at the 6th International Particle Accelerator Conference (IPAC’15). Jefferson Lab will host a booth at the conference to reach out to the >75 industrial exhibitors (https://www.jlab.org/conferences/ipac2015/SponsorsExhibitors.php) who represent a wide range of technologies. A number of these industries could benefit if they can access Jefferson Lab’s accelerator infrastructure. In addition to the booth, where written material will be available, we plan to arrange a session A/V presentation to the industry exhibitors. The booth will be hosted by Jefferson Lab’s Public Relations staff, assisted on a rotating basis by the lab’s scientists and engineers. The budget with IPAC’15 designations represents the request for funds for this effort. The third venue is the gathering of Southeastern Universities Research Association (SURA) university presidents. Here we plan to reach the research departments of the universities who can benefit by availing themselves to the infrastructure (material sciences, engineering, medical schools, material sciences, to name a few). Funding is requested to allow for attendance at the SURA Board Meeting. We are coordinating with DOE regarding these costs to raise the projected conference

  4. Deep-sea genetic resources: New frontiers for science and stewardship in areas beyond national jurisdiction

    Science.gov (United States)

    Harden-Davies, Harriet

    2017-03-01

    The deep-sea is a large source of marine genetic resources (MGR), which have many potential uses and are a growing area of research. Much of the deep-sea lies in areas beyond national jurisdiction (ABNJ), including 65% of the global ocean. MGR in ABNJ occupy a significant gap in the international legal framework. Access and benefit sharing of MGR is a key issue in the development of a new international legally-binding instrument under the United Nations Convention on the Law of the Sea (UNCLOS) for the conservation and sustainable use of marine biological diversity in ABNJ. This paper examines how this is relevant to deep-sea scientific research and identifies emerging challenges and opportunities. There is no internationally agreed definition of MGR, however, deep-sea genetic resources could incorporate any biological material including genes, proteins and natural products. Deep-sea scientific research is the key actor accessing MGR in ABNJ and sharing benefits such as data, samples and knowledge. UNCLOS provides the international legal framework for marine scientific research, international science cooperation, capacity building and marine technology transfer. Enhanced implementation could support access and benefit sharing of MGR in ABNJ. Deep-sea scientific researchers could play an important role in informing practical new governance solutions for access and benefit sharing of MGR that promote scientific research in ABNJ and support deep-sea stewardship. Advancing knowledge of deep-sea biodiversity in ABNJ, enhancing open-access to data and samples, standardisation and international marine science cooperation are significant potential opportunity areas.

  5. The National Map hydrography data stewardship: what is it and why is it important?

    Science.gov (United States)

    Arnold, Dave

    2014-01-01

    The National Hydrography Dataset (NHD) and Watershed Boundary Dataset (WBD) were designed and populated by a large consortium of agencies involved in hydrography across the United States. The effort was led by the U.S. Geological Survey (USGS), the U.S. Environmental Protection Agency (EPA), and the Natural Resources Conservation Service (NRCS). The high-resolution NHD dataset, completed in 2007, is based on the USGS 7.5-minute series topographic maps at a scale of 1:24,000. There are now 26 million features in the NHD representing a 7.5 million mile stream network with over 6.5 million waterbodies. The six-level WBD, completed in 2010, is based on 1:24,000 scale data and contains over 23,000 watershed polygons. The NHD’s flow network, attribution, and linear referencing are used to conduct extensive scientific analyses. The NHD is ideal for cartographic applications such as the US Topo topographic map series, and also is available on the Geospatial Platform, which provides shared and trusted geospatial data, services, and applications for use by government agencies, their partners, and the public. The WBD watersheds are used by scientists and managers to identify discrete drainage areas. The ongoing maintenance of the NHD and WBD is essential for improving these datasets to meet the ever increasing demand for currency, additional detail, and more significant attribution. The best source of information about changes in local hydrography are users closest to the data, such as State and local governments, as well as Federal land management agencies, and other users of the data. The need for local knowledge has led to the creation of a collaborative data stewardship process to revise and maintain the NHD.

  6. General surgeon's antibiotic stewardship: Climbing the Rogers Diffusion of Innovation Curve-Prospective Cohort Study.

    Science.gov (United States)

    Rizan, Chantelle; Phee, Jaewon; Boardman, Charlotte; Khera, Goldie

    2017-04-01

    The primary aim of this study was to establish concordance of general surgeon's prescribing practice with local IV-oral antibiotic guidelines. The secondary aim was to evaluate the effect of introducing educational antibiotic measures. The Rogers Diffusion of Innovation Model was used to explore the adoption of antibiotic stewardship practices. In this prospective, cohort study, data was collected on 100 pre and 100 post awareness intervention programme patients. The educational intervention comprised raising awareness of a) the guidelines b) pre-intervention results c) introducing an IV-oral antibiotic prompt sheet. The concordance with local guidelines was compared between pre- and post-intervention groups using Fisher's Exact Test or Pearson's Chi Test (SPSS Statistics V22). The concordance of general surgical doctors with local IV-oral antibiotic guidelines was poor and did not improve significantly following the awareness intervention programme. There was no uptake of the antibiotic prompt sheet. There was a trend towards increase in the number of patients switched from IV to oral antibiotics at 48-72 h and significant increase (p review IV antibiotics. Antibiotic governance measures failed to inspire even an initial group of innovators to use the antibiotic prompt sheets. It appears educational measures are effective in improving prescribing behavior and intent amongst a group of early adopters, but this fails to reach a critical mass. In order to improve antibiotic governance and embark upon the Rogers Diffusion of Innovation Curve, more must be done to engage general surgical doctors in timely, judicious antibiotic prescribing. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Collaborative Establishment of a Long-Term Archive for Stewardship of Interdisciplinary Scientific Data

    Science.gov (United States)

    Downs, R. R.; Chen, R. S.; Cartolano, R. T.; Bose, R.

    2008-12-01

    Much of the scientific data that are being collected today cannot be recreated if they are not properly preserved and documented. Establishment of reliable long-term digital archives is essential to preserving these data and associated documentation beyond the working lifetimes of current scientists. Numerous challenges, both technical and institutional, need to be addressed before these data or their documentation become lost or inaccessible. Direct collaboration between university research libraries and active scientific data centers is one approach to addressing these challenges. We report here on the collaboration between the Columbia Libraries / Information Services and the Center for International Earth Science Information Network (CIESIN) to establish an interdisciplinary long-term archive for data from the NASA Socioeconomic Data and Applications Center (SEDAC). The SEDAC long-term archive serves as a trustworthy digital repository to support preparation, submission, appraisal, ingest, discovery, integration, and interoperability of scientific data that are expected to be of long-term interest to both natural and social scientists. Significant progress has been made in establishing the necessary policies and procedures, implementing needed standards and technologies, and assessing strengths and possible weaknesses in the long-term sustainability of the archive. Benefits have included sharing approaches and best practices for information technology solutions and scientific data stewardship. A key issue is the expected future integration of this specialized archive into the long-term digital repository currently being developed by the University. Planned activities include testing the migration of selected data from the SEDAC long-term archive to the forthcoming Libraries repository and the development of interfaces between the digital object management systems being implemented by SEDAC and the Libraries, which are both based on the Flexible Extensible

  8. Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome.

    Science.gov (United States)

    Bedini, Andrea; De Maria, Nicola; Del Buono, Mariagrazia; Bianchini, Marcello; Mancini, Mauro; Binda, Cecilia; Brasacchio, Andrea; Orlando, Gabriella; Franceschini, Erica; Meschiari, Marianna; Sartini, Alessandro; Zona, Stefano; Paioli, Serena; Villa, Erica; Gyssens, Inge C; Mussini, Cristina

    2016-10-01

    A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  9. The Changing Role of Data Stewardship in Creating Trustworthy, Interdisciplinary High Performance Data Platforms for the Future.

    Science.gov (United States)

    Richards, C. J.; Evans, B. J. K.; Wyborn, L. A.; Wang, J.; Trenham, C. E.; Druken, K. A.

    2016-12-01

    The Australian National Computational Infrastructure (NCI) has ingested over 10PB of national and international environmental, Earth systems science and geophysics reference data onto a single platform to advance high performance data (HPD) techniques that enable interdisciplinary Data-intensive Science. Improved Data Stewardship is critical to evolve both data and data services that support the increasing need for programmatic usability and that prioritises interoperability rather than just traditional data download or portal access. A data platform designed for programmatic access requires quality checked collections that better utilise interoperable data formats and standards. Achieving this involves strategies to meet both the technical and `social' challenges. Aggregating datasets used by different communities and organisations requires satisfying multiple use cases for the broader research community, whilst addressing existing BAU requirements. For NCI, this requires working with data stewards to manage the process of replicating data to the common platform, community representatives and developers to confirm their requirements, and with international peers to better enable globally integrated data communities. It is particularly important to engage with representatives from each community who can work collaboratively to a common goal, as well as capture their community needs, apply quality assurance, determine any barriers to change and to understand priorities. This is critical when managing the aggregation of data collections from multiple producers with different levels of stewardship maturity, technologies and standards, and where organisational barriers can impact the transformation to interoperable and performant data access. To facilitate the management, development and operation of the HPD platform, NCI coordinates technical and domain committees made up of user representatives, data stewards and informatics experts to provide a forum to discuss

  10. Integrated Weed Control for Land Stewardship at Legacy Management's Rocky Flats Site in Colorado - 13086

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Jody K. [Stoller LMS Team, Contractor to the U.S. Department of Energy Office of Legacy Management, 11025 Dover Street, Suite 1000, Westminster, Colorado 80021 (United States)

    2013-07-01

    Land stewardship is one of nine sustainability programs in the U.S. Department of Energy's Environmental Management System. Land stewardship includes maintaining and improving ecosystem health. At the Rocky Flats Site near Westminster, Colorado, land stewardship is an integral component of the Office of Legacy Management's post-closure monitoring and management at the site. Nearly 263 hectares (650 acres) were disturbed and re-vegetated during site cleanup and closure operations. Proactive management of revegetation areas is critical to the successful reestablishment of native grasslands, wetlands, and riparian communities. The undisturbed native plant communities that occur at the site also require active management to maintain the high-quality wetlands and other habitats that are home to numerous species of birds and other wildlife such as elk and deer, rare plant communities, and the federally listed threatened Preble's meadow jumping mouse. Over the past several decades, an increase of Noxious weeds has impacted much of Colorado's Front Range. As a result, weed control is a key component of the land stewardship program at Rocky Flats. Thirty-three species of state-listed Noxious weeds are known to occur in the Central and Peripheral Operable Units at Rocky Flats, along with another five species that are considered invasive at the site. Early detection and rapid response to control new invasive species is crucial to the program. An integrated weed control/vegetation management approach is key to maintaining healthy, sustainable plant communities that are able to resist Noxious weed invasions. Weed mapping, field surveys, and field-staff training sessions (to learn how to identify new potential problem species) are conducted to help detect and prevent new weed problems. The integrated approach at Rocky Flats includes administrative and cultural techniques (prevention), mechanical controls, biological controls, and chemical controls. Several

  11. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel.

    Science.gov (United States)

    Pardo, Joe; Klinker, Kenneth P; Borgert, Samuel J; Butler, Brittany M; Giglio, Patricia G; Rand, Kenneth H

    2016-02-01

    The purpose of this study was to evaluate the impact of the FilmArray Blood Culture Identification (BCID) Panel on the management of patients with blood cultures growing gram positive cocci and Candida. We retrospectively compared clinical and economic outcomes between patients during the BCID testing period and a matched historical control group before BCID testing was introduced. A total of 84 BCID patients were matched to 252 historical controls. BCID identification of coagulase negative staphylococci contaminants resulted in shorter post-culture length of stay (P historical controls (P = 0.047). The BCID, coupled with antimicrobial stewardship intervention, was a cost effective tool to improve patient care.

  12. Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter-Associated Asymptomatic Bacteriuria.

    Science.gov (United States)

    Trautner, Barbara W; Grigoryan, Larissa; Petersen, Nancy J; Hysong, Sylvia; Cadena, Jose; Patterson, Jan E; Naik, Aanand D

    2015-07-01

    .4 per 1000 bed-days; IRR, 0.24; 95% CI, 0.13-0.42) (P < .001 for both). Overtreatment of ASB at the comparison site was similar across all periods (odds ratio, 1.32; 95% CI, 0.69-2.52). When analyzed by type of ward, the decrease in ASB overtreatment was significant in long-term care. A multifaceted intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality improvement methods. These improvements persisted during a low-intensity maintenance period. The impact was more pronounced in long-term care, an emerging domain for antimicrobial stewardship.

  13. A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

    Directory of Open Access Journals (Sweden)

    Mary Richard Akpan

    2016-01-01

    Full Text Available The growing problem of antimicrobial resistance (AMR has led to calls for antimicrobial stewardship programs (ASP to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI. Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001 higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of

  14. Subdivision design and stewardship affect bird and mammal use of conservation developments.

    Science.gov (United States)

    Farr, Cooper M; Pejchar, Liba; Reed, Sarah E

    2017-06-01

    Developing effective tools for conservation on private lands is increasingly important for global biodiversity conservation; private lands are located in more productive and biologically diverse areas, and they face accelerated rates of land conversion. One strategy is conservation development (CD) subdivisions, which cluster houses in a small portion of a property and preserve the remaining land as protected open space. Despite widespread use, the characteristics that make CD more or less effective at achieving biodiversity conservation are not well understood. We investigated CD's ability to successfully protect animal populations by examining bird and mammal occurrences in 14 CD subdivisions and four undeveloped areas (range: 14-432 ha) in northern Colorado, USA. Using point count and camera trap data in an occupancy modeling framework, we evaluated the relative importance of nine subdivision design factors (e.g., housing density, proportion of CD protected) and 14 stewardship factors (e.g., presence of livestock, percent native vegetation cover) in influencing the overall community composition and the probability of use by 16 birds and six mammals. We found that habitat use by 75% of birds and 83% of mammals was associated with design characteristics that maximized the natural or undisturbed land area both within and near the development (e.g., proportion of CD protected, total area of protected open space, proportion of natural land cover in the surrounding landscape). These factors were also associated with an increasing dominance of human-sensitive bird species, larger-bodied mammals, and mammals with larger home ranges. Habitat use by birds was also influenced by local land use composition and quality, and use by several bird and mammal species decreased with increased localized disturbances. We found few differences in habitat use between sampling sites in undeveloped areas and in CD subdivisions. These similarities indicate that, if CDs are large enough

  15. Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle

    Science.gov (United States)

    Romolini, Michele; Morgan Grove, J.; Ventriss, Curtis L.; Koliba, Christopher J.; Krymkowski, Daniel H.

    2016-08-01

    Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

  16. Point-Counterpoint: Reflex Cultures Reduce Laboratory Workload and Improve Antimicrobial Stewardship in Patients Suspected of Having Urinary Tract Infections

    Science.gov (United States)

    2015-01-01

    Urinary tract infections (UTIs) are frequent and lead to a large number of clinical encounters. A common management strategy for patients suspected of having a urinary tract infection is to test for pyuria and bacteria by urine analysis (UA) of midstream urine, with initiation of antibiotic therapy and urine culture if one or both tests are positive. Although this practice was first used in an outpatient setting with midstream urine samples, some institutions allow its use in the management of catheterized patients. The ideas behind the reflex urine culture are to limit laboratory workload by not performing culture on negative specimens and to improve antimicrobial stewardship by not giving antimicrobials to patients with negative UA results. The questions are, first, whether reflex urine culture reduces workloads significantly and, second, whether it improves antimicrobial stewardship in the era of increasing numbers of urinary tract infections due to extensively drug-resistant Gram-negative bacilli. Romney Humphries from UCLA supports the idea that reflex urine cultures are of value and describes what reflex parameters are most useful, while Jennifer Dien Bard of Children's Hospital Los Angeles discusses their limitations. PMID:26659213

  17. Point-Counterpoint: Reflex Cultures Reduce Laboratory Workload and Improve Antimicrobial Stewardship in Patients Suspected of Having Urinary Tract Infections.

    Science.gov (United States)

    Humphries, Romney M; Dien Bard, Jennifer

    2016-02-01

    Urinary tract infections (UTIs) are frequent and lead to a large number of clinical encounters. A common management strategy for patients suspected of having a urinary tract infection is to test for pyuria and bacteria by urine analysis (UA) of midstream urine, with initiation of antibiotic therapy and urine culture if one or both tests are positive. Although this practice was first used in an outpatient setting with midstream urine samples, some institutions allow its use in the management of catheterized patients. The ideas behind the reflex urine culture are to limit laboratory workload by not performing culture on negative specimens and to improve antimicrobial stewardship by not giving antimicrobials to patients with negative UA results. The questions are, first, whether reflex urine culture reduces workloads significantly and, second, whether it improves antimicrobial stewardship in the era of increasing numbers of urinary tract infections due to extensively drug-resistant Gram-negative bacilli. Romney Humphries from UCLA supports the idea that reflex urine cultures are of value and describes what reflex parameters are most useful, while Jennifer Dien Bard of Children's Hospital Los Angeles discusses their limitations. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  18. Impact of rapid identification of Staphylococcus aureus bloodstream infection without antimicrobial stewardship intervention on antibiotic optimization and clinical outcomes.

    Science.gov (United States)

    Turner, R Brigg; Lalikian, Karineh; Fry, Madeline; Schwartz, Jacqueline; Chan, Dominic; Won, Regina

    2017-10-01

    Few studies have evaluated the clinical impact of polymerase chain reaction (PCR) for Staphylococcus aureus bloodstream infections in resource-limited settings that lack direct antimicrobial stewardship intervention. This retrospective cohort study compared patients with standard microbiological identification (n=343) to those with additional identification by (PCR) (n=130). Time to initiation of optimal therapy was similar between groups but substantially shorter in the PCR group for those infected with methicillin susceptible S. aureus (median 40.0h vs. 28.3h, P=0.001). After controlling for confounding factors including infectious diseases consultation, the PCR group had a shorter time to initiation of optimal therapy by 9.7h (95% CI 4.3-15.0h). Clinical outcomes were similar in the non-PCR and PCR groups. While time to initiation of optimal therapy was shorter in the PCR group, greater reductions may be realized through additional education, direct antimicrobial stewardship intervention, or additional clinician notification. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Policy options to reduce consumer waste to zero: comparing product stewardship and extended producer responsibility for refrigerator waste.

    Science.gov (United States)

    Nicol, Scott; Thompson, Shirley

    2007-06-01

    Today, over-consumption, pollution and resource depletion threaten sustainability. Waste management policies frequently fail to reduce consumption, prevent pollution, conserve resources and foster sustainable products. However, waste policies are changing to focus on lifecycle impacts of products from the cradle to the grave by extending the responsibilities of stakeholders to post-consumer management. Product stewardship and extended producer responsibility are two policies in use, with radically different results when compared for one consumer product, refrigerators. North America has enacted product stewardship policies that fail to require producers to take physical or financial responsibility for recycling or for environmentally sound disposal, so that releases of ozone depleting substances routinely occur, which contribute to the expanding the ozone hole. Conversely, Europe's Waste Electrical and Electronic Equipment (WEEE) Directive requires extended producer responsibility, whereby producers collect and manage their own post-consumer waste products. WEEE has resulted in high recycling rates of greater than 85%, reduced emissions of ozone-depleting substances and other toxins, greener production methods, such as replacing greenhouse gas refrigerants with environmentally friendly hydrocarbons and more reuse of refrigerators in the EU in comparison with North America.

  20. Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle.

    Science.gov (United States)

    Romolini, Michele; Morgan Grove, J; Ventriss, Curtis L; Koliba, Christopher J; Krymkowski, Daniel H

    2016-08-01

    Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

  1. Change in eating and body related behaviors during the first year of university.

    Science.gov (United States)

    Timko, C A; Mooney, K; Juarascio, A

    2010-01-01

    Significant changes in BMI, disordered eating, and body image dissatisfaction occur during the first year of university. However, previous research has not yet isolated the key factors that lead to these changes. This study sought to add to the body of research in this area by investigating students' eating attitudes, behaviors, body image, and weight at the beginning and the end of the first year of university. Participants were initially 64 male and female university students from two universities: one rural and one urban. Twenty-eight percent of the participants completed assessments at two time points. These included a series of questionnaires designed to measure disordered eating, body image dissatisfaction and weight. These changes were different for males and females. Substantial changes in eating behaviors, attitudes, body image and BMI occur during the first year of university. Concrete knowledge about these changes might help students adapt to university life.

  2. [8-year experience in 40 patients with an axillary-femoral graft].

    Science.gov (United States)

    Bialostozky, L; Rish, L; Legaspi, R; Gutiérrez Bosque, R; Archundia, A; Morales, F; Oropeza, G

    1977-01-01

    The 8 years (1967-1975) experience with axillary-femoral and femoro-femoral grafts in 40 patients is presented; 6 females and 34 males, between 50 and 90 years of age, with arteriosclerosis, all complicated by chronic illnesses. The results have been satisfactory, as the grafts are functioning from 2 months to 80 months (6 years, 8 months), most of them being more than 12 months old. Twenty eight of the 40 patients operated are alive. Four patients (10%) had infection of their grafts. In 6 (15%) the graft closed because of severe progresive distal obstruction. Three patients (7.5%) died in the first 32 post-operative days. In 9 (22.5%) the deaths were not related to surgery. The indications for placement of axillary-femoral and femoro-femoral grafts is established.

  3. A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing".

    Science.gov (United States)

    Mullin, Katherine M; Kovacs, Christopher S; Fatica, Cynthia; Einloth, Colette; Neuner, Elizabeth A; Guzman, Jorge A; Kaiser, Eric; Menon, Venu; Castillo, Leticia; Popovich, Marc J; Manno, Edward M; Gordon, Steven M; Fraser, Thomas G

    2017-02-01

    BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2017;38:186-188.

  4. Fifty years of wilderness science: An international perspective

    Science.gov (United States)

    Steve Carver; Steve McCool; Zdenka Krenova; Mark Fisher; Stephen. Woodley

    2014-01-01

    The 50th Anniversary of the U.S. Wilderness Act is a cause for celebration, not least of which is the scientific use recognized in Section 4(b) of the act. This year also marks the 20th anniversary of publication of the International Journal of Wilderness (IJW). IJW plays a unique role in wilderness stewardship, science, and advocacy, providing a forum for presentation...

  5. Twenty-eight Cases of Diabetic Foot Ulcer and Gangrene Treated with the Chinese Herbal Medicine Combined with Injection of Ahylsantinfarctase

    Institute of Scientific and Technical Information of China (English)

    王凡

    2002-01-01

    @@ Since 1995, the Chinese herbal medicine for supplementing qi and activating blood circulation combined with injection of ahylsantinfarctase into the femoral artery has been used in 28 cases of diabetes complicated with gangrene and ulcer of the foot, with quite good therapeutic effects as reported in the following.

  6. Dose–response assessment of nephrotoxicity from a twenty-eight-day combined-exposure to melamine and cyanuric acid in F344 rats

    Energy Technology Data Exchange (ETDEWEB)

    Gamboa da Costa, Gonçalo, E-mail: goncalo.gamboa@fda.hhs.gov [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Jacob, Cristina C.; Von Tungeln, Linda S. [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Hasbrouck, Nicholas R. [Center for Veterinary Medicine, Laurel, MD 20708 (United States); Olson, Greg R. [Toxicologic Pathology Associates, Jefferson, AR 72079 (United States); Hattan, David G. [Center for Food Safety and Applied Nutrition, College Park, MD 20740 (United States); Reimschuessel, Renate [Center for Veterinary Medicine, Laurel, MD 20708 (United States); Beland, Frederick A. [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States)

    2012-07-15

    The adulteration of pet food with melamine and derivatives, including cyanuric acid, has been implicated in the kidney failure and death of cats and dogs in the USA and other countries. In a previous 7-day dietary study in F344 rats, we established a no-observed-adverse-effect level (NOAEL) for a co-exposure to melamine and cyanuric acid of 8.6 mg/kg bw/day of each compound, and a benchmark dose lower confidence limit (BMDL) of 8.4–10.9 mg/kg bw/day of each compound. To ascertain the role played by the duration of exposure, we treated F344 rats for 28 days. Groups of male and female rats were fed diet containing 0 (control), 30, 60, 120, 180, 240, or 360 ppm of both melamine and cyanuric acid. The lowest dose that produced histopathological alterations in the kidney was 120 ppm, versus 229 ppm in the 7-day study. Wet-mount analysis of kidney sections demonstrated the formation of melamine cyanurate spherulites in one male and two female rats at the 60 ppm dose and in one female rat at the 30 ppm dose, establishing a NOAEL of 2.1 mg/kg bw/day for males and < 2.6 mg/kg bw/day for females, and BMDL values as low as 1.6 mg/kg bw/day for both sexes. These data demonstrate that the length of exposure is an important component in the threshold of toxicity from a co-exposure to these compounds and suggest that the current risk assessments based on exposures to melamine alone may not reflect sufficiently the risk of a co-exposure to melamine and cyanuric acid. -- Highlights: ► A 28-day dietary co-exposure to melamine and cyanuric acid was conducted in F344 rats. ► The NOAELs were 2.1 mg/kg bw/day for males and < 2.6 mg/kg bw/day for females. ► BMDL values as low as 1.6 mg/kg bw/day for both sexes were determined. ► The length of exposure plays an important role in the threshold of toxicity. ► Current assessments may underestimate the risk of melamine and cyanuric acid.

  7. Private informational governance in Post-Soviet waters: Implications of the Marine Stewardship Council certification in the Russian Barents Sea region

    NARCIS (Netherlands)

    Pristupa, A.O.; Lamers, M.A.J.; Amelung, B.

    2016-01-01

    The Russian Barents Sea represents a celebrated example of sustainable fisheries management owing to effective and stable bilateral cooperation between Norway and Russia. The success of the state regime has not ruled out the emergence of private certification of the Marine Stewardship Council (MSC).

  8. Antibiotic stewardship in a tertiary care hospital of a developing country: establishment of a system and its application in a unit-GASP Initiative.

    Science.gov (United States)

    Shafiq, N; Praveen Kumar, M; Gautam, V; Negi, H; Roat, R; Malhotra, S; Ray, P; Agarwal, R; Bhalla, A; Sharma, N; Singh, R; Sharma, G D; Bahadur, L; Yadanapudi, N; Gupta, R; Singh, G

    2016-10-01

    Despite the proven benefits of antimicrobial stewardship, models for executing the same in the developing countries are sparse. The present study highlights the approaches undertaken by our group in initiating one such program in a public sector tertiary level health care setting of a developing country. The study focussed on development of a system after evaluation of existing issues and case study of implementation of the program in a unit within the hospital. The system building exercise included (1) development of generic data capture form for prospective audit and feedback; (2) development of an electronic system for data capture; (3) identification of key intervention points for strategy decision for stewardship in a particular unit; (4) application of the stewardship method and (5) evaluation of outcomes. A digital system for prospective audit was constructed after a background study. In the study unit, there was a significant decline in double anaerobic coverage. There was a significant decline in the average number of antimicrobials used per patients and a decrease in Defined Daily Dose of designated antimicrobials was noted. Additionally, there was an increase in the use of optimized doses. A system for undertaking antimicrobial stewardship with a mechanism for prospective audit was put in place. The system may be adopted by other public sector hospitals of the developing country.

  9. Effects of various antimicrobial stewardship programs on antimicrobial usage and resistance among common gram-negative bacilli causing health care-associated infections: A multicenter comparison.

    Science.gov (United States)

    Lai, Chung-Chih; Shi, Zhi-Yuan; Chen, Yen-Hsu; Wang, Fu-Der

    2016-02-01

    The effects of various antimicrobial stewardship programs (ASPs) on both antibiotic consumption and resistance among different hospitals within the same insurance system have rarely been investigated. This 6-year retrospective study included three medical centers with similar facilities and infection control measures in Taiwan. These hospitals used different types of ASPs: one had a hospital-wide preauthorization requirement by infectious diseases physicians for all broad-spectrum antibiotics, covering all intensive care units; the second used the same program, but excluded all intensive care units; and the third used postprescription review only. The nonsusceptibility of unduplicated isolates of gram-negative bacilli causing health care-associated infections and consumption of broad-spectrum antibiotics were analyzed. Overall, the usage of broad-spectrum antibiotics of all classes escalated significantly over time in all three hospitals, but consumption was lowest under the hospital-wide preauthorization program. Under this ASP, despite a 2-fold increase in the total broad-spectrum antibiotic consumption during study period, some declining trends of resistance were found, including ciprofloxacin-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and carbapenem-resistant P. aeruginosa. By contrast, the other two hospitals with preauthorization program excluding all intensive care units and postprescription review had similar high broad-spectrum antibiotic consumption, comparable growing trends of resistant strains in general, and the correlations of antibiotic consumption and resistance were basically positive. Carbapenem-resistant A. baumannii increased significantly over time in all three hospitals. This interhospital comparison suggested that hospital-wide preauthorization program is the most effective to reduce key gram-negative bacilli resistance, with the exception of carbapenem-resistant A. baumannii. Copyright © 2015. Published by Elsevier B.V.

  10. Increasing Capacity for Stewardship of Oceans and Coasts: Findings of the National Research Council Report

    Science.gov (United States)

    Roberts, S. J.; Feeley, M. H.

    2008-05-01

    inappropriate evaluation procedures; and, lack of a coordinated and strategic approach among donors. A New Framework Improving ocean stewardship and ending the fragmentation of current capacity building programs will require a new, broadly adopted framework for capacity building that emphasizes cooperation, sustainability, and knowledge transfer within and among communities. The report identifies four specific features of capacity building that would increase the effectiveness and efficiency of future programs: 1. Regional action plans based on periodic program assessments to guide investments in capacity and set realistic milestones and performance measures. 2. Long-term support to establish self-sustaining programs. Sustained capacity building programs require a diversity of sources and coordinated investments from local, regional, and international donors. 3. Development of leadership and political will. One of the most commonly cited reasons for failure and lack of progress in ocean and coastal governance initiatives is lack of political will. One strategy for strengthening support is to identify, develop, mentor, and reward leaders. 4. Establishment of networks and mechanisms for regional collaboration. Networks bring together those working in the same or similar ecosystems with comparable management or governance challenges to share information, pool resources, and learn from one another. The report also recommends the establishment of regional centers to encourage and support collaboration among neighboring countries.

  11. Public stewardship of private for-profit healthcare providers in low- and middle-income countries

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-01-01

    Background Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. Objectives To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. Search methods For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant

  12. Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

    Science.gov (United States)

    Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

    2017-01-01

    Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.

  13. Thirty Years After Jack Eddy at the Big Horn Medicine Wheel

    Science.gov (United States)

    Merriot, Ivy

    2017-01-01

    In the thirty years since John (Jack) Eddy’s work on the Big Horn Medicine Wheel, attention to the astronomy of medicine wheels went from high to low, with the lowest moment occurring during the ”welcome” talk of the Oxford IX International Archaeoastronomy (ISAAC) conference in Lima, Peru in 2011 when the wall-size projected image of the Big Horn Wheel carried a thick black “X” across its face. The alignments proposed by Eddy in 1974 and by Robinson in the 1980s have been reviewed and analyzed at the Wheel on Medicine Mountain in situ under bitter cold, clear dark nights at 10,000 feet altitude. Research was conducted using naked eye skywatching, transit surveying, and a Meade Cassegraine 8” electronic telescope. Along with this “review” of 20th century research, new research was conducted Wheel causing the second decade of the 21st century to bring new physical evidence and historical information for consideration.New research at the Big Horn Medicine Wheel gives evidence that the Wheel “mirrors” the night and daytime sky by creating a sky “grid” by its design made of basement and surface stones. The Wheel’s stone design mirrors the precession of the equinoxes by showing positions of all major pole stars over the full precessional cycle. Its twenty-eight sections are useful in the same way the twenty-eight sectioned Stations of the Moon star charts were useful in ancient and historical times. This manner of dividing the sky for tracking celestial objects holds celestial markers in constant position over millennia. This occurs because the Wheel’s center represents the Sun’ ecliptic north pole. Star charts that use the ecliptic pole do not need constant mathematical computation to keep up with current declinations and right ascensions. The Wheel’s twenty-eight sectioned sky chart keeps the same Dec and RA for celestial positions for thousands of years and will more quickly alert the observer to changes due to proper motion than will

  14. Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting.

    Science.gov (United States)

    Hripcsak, George; Bloomrosen, Meryl; FlatelyBrennan, Patti; Chute, Christopher G; Cimino, Jim; Detmer, Don E; Edmunds, Margo; Embi, Peter J; Goldstein, Melissa M; Hammond, William Ed; Keenan, Gail M; Labkoff, Steve; Murphy, Shawn; Safran, Charlie; Speedie, Stuart; Strasberg, Howard; Temple, Freda; Wilcox, Adam B

    2014-01-01

    Large amounts of personal health data are being collected and made available through existing and emerging technological media and tools. While use of these data has significant potential to facilitate research, improve quality of care for individuals and populations, and reduce healthcare costs, many policy-related issues must be addressed before their full value can be realized. These include the need for widely agreed-on data stewardship principles and effective approaches to reduce or eliminate data silos and protect patient privacy. AMIA's 2012 Health Policy Meeting brought together healthcare academics, policy makers, and system stakeholders (including representatives of patient groups) to consider these topics and formulate recommendations. A review of a set of Proposed Principles of Health Data Use led to a set of findings and recommendations, including the assertions that the use of health data should be viewed as a public good and that achieving the broad benefits of this use will require understanding and support from patients.

  15. Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians.

    Science.gov (United States)

    Balint, John A; Shelton, Wayne N

    2002-12-01

    There has been growing concern about the effects on the patient-physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called "double agency." Various authors have proposed ways to restore patient centeredness to the patient-physician interaction. We have previously discussed the need to establish a patient-physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug "doctor"; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient-physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.

  16. A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital.

    Science.gov (United States)

    López-Medrano, F; San Juan, R; Lizasoain, M; Catalán, M; Ferrari, J M; Chaves, F; Lumbreras, C; Montejo, J C; Herreros de Tejada, A; Aguado, J M

    2013-01-01

    Antimicrobial stewardship programmes promote excellence in the use of antimicrobials by selecting the appropriate antimicrobial agent and the correct dose, route of administration and duration of treatment. However, there is limited experience with such programmes targeting antifungal treatments. We present the results of a non-compulsory programme for the control of antifungals. For 12 months, prescriptions of oral voriconazole or intravenous voriconazole, caspofungin and liposomal amphotericin B were reviewed, and non-compulsory recommendations were made. The incidence and outcome of fungal infections were examined. The results for the dispensed defined daily doses (DDDs) and expenditure on antifungals were compared with those for the previous 12 months. The number of antifungal treatments reviewed was 662. A recommendation to change treatment was made in 29% of the cases, including a change from intravenous to oral treatment (15%), cessation of antifungal treatment (8%), and a change to fluconazole (6%). The DDDs of intravenous voriconazole and caspofungin were reduced by 31.4% and 20.2%, respectively. The DDDs of oral voriconazole and dispensed vials of liposomal amphotericin B were increased by 8.2% and 13.9%, respectively. Expenditure on antifungals was reduced by US$370681.78 (11.8% reduction). The programme was not related to significant increases in the incidence of candidaemia, percentage of persistent/relapsing candidaemia cases, percentage of fluconazole-resistant Candida species, incidence of infections by filamentous fungi, or 12-month mortality in patients with filamentous fungal infections. In conclusion, a stewardship programme targeting antifungals achieved a reduction in antifungal expenditure without reducing the quality of care provided. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.

  17. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.

    Directory of Open Access Journals (Sweden)

    Michelle T Hecker

    Full Text Available OBJECTIVE: To evaluate adherence to uncomplicated urinary tract infections (UTI guidelines and UTI diagnostic accuracy in an emergency department (ED setting before and after implementation of an antimicrobial stewardship intervention. METHODS: The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1, and after audit and feedback (period 2. RESULTS: Adherence to UTI guidelines increased from 44% (baseline to 68% (period 1 to 82% (period 2 (P≤.015 for each successive period. Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline to 14% (period 1 to 13% (period 2 (P<.001 and P = .7 for each successive period. Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period. For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods. CONCLUSIONS: A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.

  18. Prevalence of acid fast bacilli in Ajmer: A retrospective analysis of eight years data

    Directory of Open Access Journals (Sweden)

    Rathore R

    2001-01-01

    Full Text Available To assess prevalence of acid fast bacilli (AFB in Ajmer, a retrospective analysis of 8 years was done in 1905 AFB cultures in various clinical specimens. All specimens were cultured on Lowenstein-Jensen slants after decontamination and concentration using modified Petroff′s method. Smears were stained by Ziehl-Neelsen technique with acid and alcohol to exclude rapid growers. Four hundred and twenty eight AFB positive cultures were reported using morphological, staining and microscopic characteristics. Over all, AFB positive culture rate was 22.46%. Maximum positive cultures were from urinary system (253 followed by respiratory system (151, female genital systems (9, reticuloendothelial system (6, CNS (6, GIT (2, and CVS (1.

  19. From Performance to Decision Processes in 33 Years: A History of Organizational Behavior and Human Decision Processes under James C. Naylor.

    Science.gov (United States)

    Weber

    1998-12-01

    For the past 33 years, Organizational Behavior and Human Decision Processes has thrived under a single editor. That editor, James C. Naylor, is retiring from his long stewardship. This article chronicles the course of the journal under Jim's direction and marks some of the accomplishments and changes over the past three decades that go to his credit. Copyright 1998 Academic Press.

  20. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates.

    Directory of Open Access Journals (Sweden)

    Tom H Boyles

    Full Text Available BACKGROUND: Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. METHODS: An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. RESULTS: During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy's antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. CONCLUSIONS: Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.

  1. The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care.

    Science.gov (United States)

    Brink, Adrian John; Van Wyk, Johan; Moodley, V M; Corcoran, Craig; Ekermans, Pieter; Nutt, Louise; Boyles, Tom; Perovic, Olga; Feldman, Charles; Richards, Guy; Mendelson, Marc

    2016-05-10

    Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.

  2. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS).

    Science.gov (United States)

    2012-04-01

    Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

  3. Cabeza Prieta National Wildlife Refuge: Comprehensive Conservation Plan, Wilderness Stewardship Plan, Environmental Impact Statement

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Comprehensive Conservation Plan (CCP) was written to guide management on Cabeza Prieta NWR for the next 15 years. This plan outlines the Refuge vision and...

  4. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital.

    Science.gov (United States)

    Teo, J; Kwa, A L H; Loh, J; Chlebicki, M P; Lee, W

    2012-06-01

    Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a "whole-system" approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients' cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A "whole-system" ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.

  5. A multidisciplinary antimicrobial stewardship programme safely decreases the duration of broad-spectrum antibiotic prescription in Singaporean adult renal patients.

    Science.gov (United States)

    Cai, Yiying; Shek, Pui Ying; Teo, Isabelle; Tang, Sarah S L; Lee, Winnie; Liew, Yi Xin; Chlebicki, Piotr; Kwa, Andrea L

    2016-01-01

    Patients with chronic kidney disease have increased risk of infections. Thus, physicians may favour prolonged broad-spectrum antibiotic use. Studies focused on antimicrobial stewardship programmes (ASPs) in renal patients are currently lacking. Here we describe the role of a multidisciplinary ASP and the impact of ASP interventions in renal patients. A multidisciplinary ASP was initiated at a tertiary hospital in Singapore. Patients prescribed broad-spectrum parenteral antibiotics were identified daily and were subjected to prospective review with immediate concurrent feedback. ASP data from January 2010 to December 2011 were analysed for all renal patients. Outcome measures included the duration and appropriateness of antibiotics, intervention acceptance rates, cost savings and safety outcomes. A total of 2084 antibiotic courses were reviewed, of which 24% were inappropriate, with meropenem most commonly prescribed inappropriately (31.0%). The commonest reasons for inappropriate use were wrong choice (51.0%) and wrong duration (21.4%). In total, 634 recommendations were made, with high acceptance rates (73.3%). Recommendations to discontinue antibiotics (33.4%) and to optimise doses (17.2%) comprised the bulk of ASP work. A mean reduction of -1.28 days of antibiotic use was observed among patients with interventions accepted versus those rejected (Pantibiotic use without compromising safety in renal patients. Continued effort is needed to produce a long-term impact on antibiotic prescription and resistance.

  6. Law for Country: the Structure of Warlpiri Ecological Knowledge and Its Application to Natural Resource Management and Ecosystem Stewardship

    Directory of Open Access Journals (Sweden)

    Miles C. C. Holmes

    2013-09-01

    Full Text Available Indigenous Ecological Knowledge (IEK is deeply encoded in social processes. Our research shows that from an Indigenous perspective, IEK is a way of living whose core aim is to sustain the healthy functioning of people and country through relationships of reciprocity. However, IEK is often portrayed more prosaically as a body of knowledge about the environment. We introduce a framework, called ngurra-kurlu, that enables appreciation of indigenous perspectives on IEK. The framework was identified from the collaborative work of the authors with Warlpiri aboriginal elders in the Tanami Desert region of central Australia. Ngurra-kurlu facilitates cross-cultural understanding by distilling, from a complex cultural system, the five distinct conceptual categories that comprise IEK: law, skin, ceremony, language, and country. The framework enables engagement with nuanced environmental knowledge because it synthesizes, for cross-cultural audiences, all the key areas of knowledge and practice in which IEK is located. In particular, the framework highlights how social systems mediate the transmission, deployment, and regulation of environmental knowledge in on-ground situations, including collaborative natural resource management. Although the framework was generated in relation to one indigenous group, the epistemological structure of Warlpiri IEK is relevant throughout Australia, and the framework can be applied internationally to the emerging interest in fostering ecosystem stewardship in which the cultural connections between people and place are an integral part of ecosystems management.

  7. Angling into the Future: Ten Commandments for Recreational Fisheries Science, Management, and Stewardship in a Good Anthropocene

    Science.gov (United States)

    Elmer, Laura K.; Kelly, Lisa A.; Rivest, Stephanie; Steell, S. Clay; Twardek, William M.; Danylchuk, Andy J.; Arlinghaus, Robert; Bennett, Joseph R.; Cooke, Steven J.

    2017-08-01

    A new geological epoch, the "Anthropocene", has been defined as the period in which humans have had substantial geological and ecological influence on the planet. A positive future for this epoch can be referred to as the "good Anthropocene" and would involve effective management strategies and changes in human behavior that promote the sustainability and restoration of ecosystems. Recreational fisheries hold significant social, cultural, and economic value and can generate many benefits when managed sustainably and thus be an integral part of a "good Anthropocene". Here, we list ten commandments to facilitate persistence and long-term sustainability of recreational fisheries in the "good Anthropocene". This list includes fostering aquatic stewardship, promoting education, using appropriate capture gear, adopting evidence-based management approaches, promoting the concept of resilience, obtaining and using effort data in management, embracing the ecosystem approach, engaging in multilevel collaboration, enhancing accessibility, and embracing optimism. When used singly, or simultaneously, these ten commandments will contribute to the harmonization of sustainable fish populations and angling practices, to create recreational fisheries' "bright spots".

  8. A restricted test of single word intelligibility in 3-year-old children with and without cleft palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Poulsen, Mads

    2012-01-01

    Abstract Objective: In a previous study, children with cleft palate with hard palate closure at 12 months of age showed more typical phonological development than children with an unrepaired hard palate at 36 months of age. This finding was based on narrow transcription of word initial target...... consonants obtained from a simple naming test. To evaluate the relevance of this finding, we investigated how well the children's target words were understood by 84 naïve listeners. Design: A cross-sectional study. Participants: Data obtained from twenty-eight children with UCLP, 3 years of age, who received...... hard palate closure at either12 months (HPR (hard palate repaired)) or 36 months (HPU (hard palate unrepaired)), were compared to data obtained from 14 age-matched, typically developing, control children. Methods: Video recordings of the children naming target words were shown to 84 naïve listeners...

  9. Storyline and design: how civic stewardship shapes urban design in New York City

    Science.gov (United States)

    Erika S. Svendsen

    2013-01-01

    Our interest in reshaping the natural world to enhance human life can be traced back thousands of years to the earliest urban civilizations. From irrigation projects of the Indus Valley to the Roman aqueducts to designing integrated systems of landscaped parks and stream valleys, humans have sought to harness the capacity of nature to advance public well-being,...

  10. PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: UBIETY, UBIQUITY, SIGNIFICANCE, SOLUTIONS, AND STEWARDSHIP

    Science.gov (United States)

    The OSU Water- Resources Seminar Series bm a 3 0-year history, serves as a meeting place for " graduate students and faculty with a common interest in water resource issues but diverse major fields - from sociology to civil engineering to public health to fisheries and wildlife."...

  11. Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications.

    Science.gov (United States)

    Cunha, B A; Cunha, C B; Lam, B; Giuga, J; Chin, J; Zafonte, V F; Gerson, S

    2017-02-02

    Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl urinary tract infections. Urinary isolated susceptibility testing was done by micro broth dilution (MBD). Treatment duration was 5-7 days. Cure was defined as eradication of the uropathogen and failure was defined as minimal/no decrease in urine colony counts. Of 26 evaluable patients with renal insufficiency (CrCl < 60 ml/min), nitrofurantoin eradicated the uropathogen in 18/26 (69%) of patients, and failed in 8/26 (31%). Of the eight failures, five were due to intrinsically resistant uropathogens, e.g., Proteus sp., and one failure was related to an alkaline urine. Of the treatment failures, only two were due to renal insufficiency, i.e., CrCl < 30 ml/min. Since there are few oral antibiotics available to treat AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).

  12. Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship.

    Directory of Open Access Journals (Sweden)

    Young Kyung Yoon

    Full Text Available OBJECTIVE: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. METHODS: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18; Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36; and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54. RESULTS: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD: 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028 and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001. The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB (P = 0.031. CONCLUSIONS: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

  13. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy.

    Science.gov (United States)

    Daughton, Christian G

    2003-05-01

    Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. Although PPCPs typically have been identified in surface and ground waters, some are also undoubtedly associated with solid phases such as suspended particulates, sediments, and sewage sludges, despite their relatively high affinity for water. Often amenable to degradation, their continual introduction to waste-receiving waters results from their widespread, continuous, combined use by individuals and domestic animals, giving PPCPs a "pseudo-persistence" in the environment. Little is known about the environmental or human health hazards that might be posed by chronic, subtherapeutic levels of these bioactive substances or their transformation products. The continually growing, worldwide importance of freshwater resources, however, underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite the paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented to reduce or minimize the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment; additional, collateral benefits could automatically accrue, including reducing consumers' medication expenses and improving patient health and consumer safety. In this article, the first of a two-part mini-monograph describing the "green pharmacy," I focus initially on the background behind the imperative for an ecologically oriented stewardship program for PPCPs

  14. Improving antimicrobial stewardship: AmWeb, a tool for helping microbiologists in England to 'Start Smart' when advising on antibiotic treatment.

    Science.gov (United States)

    Johnson, Alan P

    2013-10-01

    As part of an antimicrobial stewardship programme, healthcare organizations should have local antibiotic treatment guidelines in place that take account of local antibiotic resistance patterns. The current issue of JAC reports the development of an interactive web tool, called AmWeb, for the local surveillance of resistance by hospital laboratories in England. The application of AmWeb should help to both optimize the management of patients with infection and contribute to efforts to prolong the active life of antibiotics currently available for use.

  15. Landscaping Locally: Fostering Stewardship with Real Science in High School Curricula

    Directory of Open Access Journals (Sweden)

    Sajit Zachariah

    2008-01-01

    Full Text Available The Igniting Streams of Learning in Science (ISLS academy engages 11th and 12th grade students and their teachers in a year-long learning community (LC experience. ISLS transforms attitudes about science in school curricula, local communities, college classrooms, and government agencies. The goals of ISLS are ambitious: 1 to increase student interest in teaching high school science, 2 to increase the number of students pursing Science, Technology, Engineering, and Math (STEM majors in college, and 3 to connect students to their local environments using methods of scientific investigation. The ISLS Academy uses a four-part model that can be replicated. The model is centered on a twelve day summer institute: 1 pre-institute formation of seven member learning communities, 2 immersion of LC members in the summer institute where they are introduced to bio-monitoring protocols while being mentored by college professors, graduate students, and professional scientists from government agencies and private industry, 3 post-institute adaptation of protocols in the development of learning objects (LOs (elements of a curriculum to address local environmental issues, and 4 follow-up activities with LC members using their LOs in teaching peers and others. This paper is a mid-project report on a three-year program. It concerns fourteen school districts from urban, suburban and rural areas where students and teachers demonstrate the applicability of real science curricula across districts. By using "real science", i.e. the bio-monitoring protocols of the Ohio Environmental Protection Agency, students recognize that they themselves can use science to assess and improve the health of their local environments. The success and applicability of the ISLS program to other regions is dependent upon fostering ownership in the use of scientific protocols and methods of learning that invite all students to become citizen scientists. Results thus far indicate a high level

  16. Stewardship of NASA's Earth Science Data and Ensuring Long-Term Active Archives

    Science.gov (United States)

    Ramapriyan, Hampapuram K.; Behnke, Jeanne

    2016-01-01

    Program, NASA has followed an open data policy, with non-discriminatory access to data with no period of exclusive access. NASA has well-established processes for assigning and or accepting datasets into one of 12 Distributed Active Archive Centers (DAACs) that are parts of EOSDIS. EOSDIS has been evolving through several information technology cycles, adapting to hardware and software changes in the commercial sector. NASA is responsible for maintaining Earth science data as long as users are interested in using them for research and applications, which is well beyond the life of the data gathering missions. For science data to remain useful over long periods of time, steps must be taken to preserve: (1) Data bits with no corruption, (2) Discoverability and access, (3) Readability, (4) Understandability, (5) Usability' and (6). Reproducibility of results. NASAs Earth Science data and Information System (ESDIS) Project, along with the 12 EOSDIS Distributed Active Archive Centers (DAACs), has made significant progress in each of these areas over the last decade, and continues to evolve its active archive capabilities. Particular attention is being paid in recent years to ensure that the datasets are published in an easily accessible and citable manner through a unified metadata model, a common metadata repository (CMR), a coherent view through the earthdata.gov website, and assignment of Digital Object Identifiers (DOI) with well-designed landing product information pages.

  17. Stewardship of NASA's Earth Science Data and Ensuring Long-Term Active Archives

    Science.gov (United States)

    Ramapriyan, H.; Behnke, J.

    2016-12-01

    NASA's Earth Observing System Data and Information System (EOSDIS) has been in operation since 1994. EOSDIS manages data from pre-EOS missions dating back to 1960s, EOS missions that started in 1997, and missions from the post-EOS era. Its data holdings come from many different sources - satellite and airborne instruments, in situ measures, field experiments, science investigations, etc. Since the beginning of the EOS Program, NASA has followed an open data policy, with non-discriminatory access to data with no period of exclusive access. NASA has well-established processes for assigning and/or accepting datasets into one of 12 Distributed Active Archive Centers (DAACs) that are parts of EOSDIS. EOSDIS has been evolving through several information technology cycles, adapting to hardware and software changes in the commercial sector. NASA is responsible for maintaining Earth science data as long as users are interested in using them for research and applications, which is well beyond the life of the data gathering missions. For science data to remain useful over long periods of time, steps must be taken to preserve: 1. Data bits with no corruption, 2. Discoverability and access, 3. Readability, 4. Understandability, 5. Usability and 6. Reproducibility of results. NASA's Earth Science data and Information System (ESDIS) Project, along with the 12 EOSDIS Distributed Active Archive Centers (DAACs), has made significant progress in each of these areas over the last decade, and continues to evolve its active archive capabilities. Particular attention is being paid in recent years to ensure that the datasets are "published" in an easily accessible and citable manner through a unified metadata model, a common metadata repository (CMR), a coherent view through the earthdata.gov website, and assignment of Digital Object Identifiers (DOI) with well-designed landing/product information pages.

  18. Periapical endodontic surgery: a 3-year follow-up study.

    Science.gov (United States)

    Maddalone, M; Gagliani, M

    2003-03-01

    To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.

  19. Advances and Challenges In Uncertainty Quantification with Application to Climate Prediction, ICF design and Science Stockpile Stewardship

    Science.gov (United States)

    Klein, R.; Woodward, C. S.; Johannesson, G.; Domyancic, D.; Covey, C. C.; Lucas, D. D.

    2012-12-01

    Uncertainty Quantification (UQ) is a critical field within 21st century simulation science that resides at the very center of the web of emerging predictive capabilities. The science of UQ holds the promise of giving much greater meaning to the results of complex large-scale simulations, allowing for quantifying and bounding uncertainties. This powerful capability will yield new insights into scientific predictions (e.g. Climate) of great impact on both national and international arenas, allow informed decisions on the design of critical experiments (e.g. ICF capsule design, MFE, NE) in many scientific fields, and assign confidence bounds to scientifically predictable outcomes (e.g. nuclear weapons design). In this talk I will discuss a major new strategic initiative (SI) we have developed at Lawrence Livermore National Laboratory to advance the science of Uncertainty Quantification at LLNL focusing in particular on (a) the research and development of new algorithms and methodologies of UQ as applied to multi-physics multi-scale codes, (b) incorporation of these advancements into a global UQ Pipeline (i.e. a computational superstructure) that will simplify user access to sophisticated tools for UQ studies as well as act as a self-guided, self-adapting UQ engine for UQ studies on extreme computing platforms and (c) use laboratory applications as a test bed for new algorithms and methodologies. The initial SI focus has been on applications for the quantification of uncertainty associated with Climate prediction, but the validated UQ methodologies we have developed are now being fed back into Science Based Stockpile Stewardship (SSS) and ICF UQ efforts. To make advancements in several of these UQ grand challenges, I will focus in talk on the following three research areas in our Strategic Initiative: Error Estimation in multi-physics and multi-scale codes ; Tackling the "Curse of High Dimensionality"; and development of an advanced UQ Computational Pipeline to enable

  20. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department.

    Science.gov (United States)

    Borde, Johannes P; Kern, Winfried V; Hug, Martin; Steib-Bauert, Michaela; de With, Katja; Busch, Hans-Jörg; Kaier, Klaus

    2015-07-01

    Early initiation of antimicrobial treatment for acute infection is an important task in the emergency department (ED) with a likely impact on the hospital-wide antibiotic use pattern. We implemented an antibiotic stewardship (ABS) programme focused on non-trauma emergency patients at a large university hospital centre targeting broad-spectrum cephalosporin and fluoroquinolone use. Guidelines and focused discussion groups emphasised reduced prescription of third-generation cephalosporins and fluoroquinolones and encouraged penicillins. Antibiotic consumption expressed as monthly drug density in WHO-Anatomical Therapeutic Chemical defined and locally recommended daily doses (DDD and RDD) per 100 patient days was analysed before (January 2008 to October 2011) and after starting the intervention (January 2012 to October 2013). We performed a before-and-after uncontrolled interventional study using interrupted time-series (ITS) analysis in one ED to investigate ABS intervention-related effects in a quasiexperimental research setting. The mean monthly total antibiotic use density declined from 111 RDD (138 DDD) per 100 patient days before the intervention to 86 RDD (128 DDD) per 100 patient days after starting the intervention. Among the different antibacterial drug classes, the consumption of third-generation cephalosporins showed the largest reduction and dropped significantly by -68% between preintervention and postintervention periods. Using the RDD dataset, ITS confirmed a highly significant postintervention change in level of third-generation cephalosporins (-15.2, 95% CI (-24.08 to -6.311)) and a corresponding increase in the use of aminopenicillin/betalactamase inhibitor formulations (+6.6, 95% CI (4.169 to 9.069)). The drug use densities for fluoroquinolones and for overall antibiotics declined, however, the postinterventional level changes missed statistical significance--overall (95% CI (-39.99 to 0.466), fluoroquinolones 95% CI (-11.72 to 4.333)). An

  1. Venous coronary artery bypass surgery: a more than 20-year follow-up study.

    Science.gov (United States)

    van Brussel, B L; Voors, A A; Ernst, J M P G; Knaepen, P J; Plokker, H W M

    2003-05-01

    Atherosclerosis in venous coronary artery bypass grafts begins early and accelerates from the fifth post-operative year. We studied the influence of 18 variables existing at the time of operation, and of 'classical' risk factors present at 1 and 5 years after operation on the long-term outcome of this type of surgery. Four hundred twenty-eight consecutive patients who underwent isolated venous coronary bypass surgery between April 1, 1976 and April 1, 1977 were followed prospectively. Follow-up was 99.3% complete with a mean duration of 22.8 years for the survivors. Multivariate analysis was performed using the Cox regression model. Actuarial survival after 5, 10, 15 and 20 years is 95, 83, 63 and 47%, respectively. The cumulative probability of event-free survival for cardiac death, acute myocardial infarction and re-intervention at 5, 10, 15 and 20 years, respectively, are 98, 90, 74, 60%; 99, 91, 83, 77%; and 97, 86, 67, 57%. Age and left ventricular functions are continuous incremental risk factors for mortality. Left ventricular function and completeness of revascularization, and age and vessel disease are independent predictors of cardiac death and re-intervention, respectively. Hypertension, diabetes mellitus, hypertriglyceridemia, obesity and smoking, present after operation have an independent influence on the occurrence of cardiac events. Risk factors (still) existing 1 and 5 years after operation have a negative influence on the long-term results. This emphasizes the need of treatment of these 'classical' risk factors still present after operation.

  2. Fiscal Year 2015 Site Sustainability Plan

    Energy Technology Data Exchange (ETDEWEB)

    Witt, Monica Rene [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-03-16

    Los Alamos National Laboratory is taking action to operate as a living laboratory for sustainable solutions in buildings, climate, energy, purchasing, transportation, waste, and water. LANL prepared the fiscal year (FY) 2015 Site Sustainability Plan (SSP) to describe progress towards the goals established in the SSPP. In addition, per the requirements of DOE Order 436.1, Departmental Sustainability, Los Alamos National Laboratory (LANL) uses its International Organization for Standardization (ISO) 14001:2004 certified Environmental Management System (EMS) to establish objectives to improve compliance, reduce environmental impacts, increase operational capacity, and meet long-term sustainability goals. The goals of the 2015 SSP are fully integrated into LANL’s institutional environmental objectives under the EMS and its Long-Term Strategy for Environmental Stewardship & Sustainability (LTSESS).

  3. Driving product stewardship

    DEFF Research Database (Denmark)

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

    , and conventional green competencies related to product development and manufacturing technologies, are related to each other and configure a corporate proactive approach towards the environment. The data used in this study were collected as part of a research project conducted in Bogotá, Colombia, and obtained....... There is also a suggestion that current stakeholder management in the supply chain limits the inclusion of critical stakeholders that are relevant for the integration of the voice of the environment into product design and development, customers in particular....

  4. Science Based Stockpile Stewardship

    Science.gov (United States)

    1994-11-01

    available on NOVA. Further, the NIF is designed with 192 bea&Adpts (48 indepen- 37 The National Ignition Facility - 192 Beam Amplifier columns Main amplifier...science (- 5-500 MeV) and directed to the neutron target. The epithermal neutrons are still tightly bunched in time (some tens of u sec), so that the...is useful as a test-bed to address: "* beam intercept and other orbit dynamics issues for an APT "* more precise measurements of neutron yield and

  5. Five- to 8-year results of the uncemented Duracon total knee arthroplasty system.

    Science.gov (United States)

    Chana, Rishi; Shenava, Yatish; Nicholl, Alison P; Lusted, Felicity J; Skinner, Paul W; Gibb, Paul A

    2008-08-01

    We report prospective clinical and radiographic outcomes of a series of 219 hydroxyapatite-coated Duracon (Stryker Howmedica Osteonics Corporation, Kalamazoo, Mich) total knee arthroplasties with a follow-up of 5 to 8 years. Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and SF-12 Health Status Questionnaire were used. Analysis of fluoroscopic radiographs was performed with the American Knee Society Score. All living patients (186 knees) were followed up. Twenty-eight patients (30 knees) had died. The preoperative Knee Society Score of 43.8 increased to 77.1 and the preoperative Function score of 20.3 increased to 63.4. WOMAC scores showed marked improvement (pain, 250 preoperatively to 157; stiffness, 115 preoperatively to 56; and function, 910 preoperatively to 588). There was no radiographic evidence of loosening or migration. Gaps visible at the bone-implant interface healed over the first year. Three prostheses were revised, 2 for deep infection and 1 for tibial tray subsidence. A survivorship of 98.6% has been achieved at 8 years. This intermediate-term study with 100% follow-up at 8 years demonstrates excellent clinical and radiographic outcomes. It is our opinion that these are comparable to the gold standard cemented total knee arthroplasties and may have advantages over other uncoated cementless designs.

  6. Clinical Evaluation of Small Diameter Straumann Implants in Partially Edentulous Patients: A 5-Year Retrospective Study

    Directory of Open Access Journals (Sweden)

    S. OZER

    2011-06-01

    Full Text Available Objective: The aim of the present study was to retrospectively evaluate small-diameter (3.3 mm Straumann® dental implants placed in the maxilla or the mandible over a period of 5 years in function.Materials and Methods: Twenty- eight partially edentulous patients received a total of 48 implants over a 5-year period. After the standard healing period (3 to 6 months, the implants were restored with single-tooth prostheses or fixed partial dentures. All patients were followed according to a strict maintenance program with regular recalls. The cumulative survival rates of implants were analyzed and prosthetic complications were assessed.Results: After 5 years of function, one single 10-mm-long implant in the maxillary premolar region was lost because of recurrent peri-implant infection in a female patient. Two single 10-mm-long maxillary implants placed in the posterior region were lost due to body fracture. The cumulative 5-year survival rate of the implants was 93.75 %. The most common prosthetic complication was loosening of the occlusal screw.Conclusion: Within the limited observation period and the number of patients included in this study, it may be concluded that the use of small-diameter implants appears to be predictable if clinical guidelines are followed and appropriate prosthetic restorations are provided. However, it should be noted that fatigue fracture may occur.

  7. ECHO Ontario Chronic Pain & Opioid Stewardship: Providing Access and Building Capacity for Primary Care Providers in Underserviced, Rural, and Remote Communities.

    Science.gov (United States)

    Dubin, Ruth E; Flannery, John; Taenzer, Paul; Smith, Andrew; Smith, Karen; Fabico, Ralph; Zhao, Jane; Cameron, Lindsay; Chmelnitsky, Dana; Williams, Rob; Carlin, Leslie; Sidrak, Hannah; Arora, Sanjeev; Furlan, Andrea D

    2015-01-01

    Chronic pain is a prevalent and serious problem in the province of Ontario. Frontline primary care providers (PCPs) manage the majority of chronic pain patients, yet receive minimal training in chronic pain. ECHO (Extension for Community Healthcare Outcomes) Ontario Chronic Pain & Opioid Stewardship aims to address the problem of chronic pain management in Ontario. This paper describes the development, operation, and evaluation of the ECHO Ontario Chronic Pain project. We discuss how ECHO increases PCP access and capacity to manage chronic pain, the development of a community of practice, as well as the limitations of our approach. The ECHO model is a promising approach for healthcare system improvement. ECHO's strength lies in its simplicity, adaptability, and use of existing telemedicine infrastructure to increase both access and capacity of PCPs in underserviced, rural, and remote communities.

  8. Parameters of effective competition activity and selection of young gymnasts in age 9-10 years

    Directory of Open Access Journals (Sweden)

    Bolyak A.A.

    2014-03-01

    Full Text Available Purpose: to determine the effective factors of competitive activities and criteria for selection of young gymnasts at the stage of preliminary basic training based on the tests of motor skills and physiological parameters using methods of statistical analysis. Material : results of psychophysical testing, anthropometry, data on the development of motor abilities of young gymnasts of 9-10 years and assessment of their technical training. The study group consisted of 29 young gymnasts aged 9-10 years. All of them had a sports category corresponding their ages. Results: among the sixteen benchmarks psychophysiological data figures stepwise regression equation determined the four most important factors that influence the effectiveness of the competitive activities of the young athletes. The stepwise regression equation allowed lowing the most influential factor affecting the competitive activity among anthropometric and motor performance from twenty- eight to twelve most significant factors. Conclusions: The application of regression analysis and stepwise regression method allowed developing the mathematical models of the efficiency of competitive activities of the gymnasts of 9-10 years that can be used in the practice of selection children for the pre basic training.

  9. Composite resin fillings and inlays. An 11-year evaluation

    DEFF Research Database (Denmark)

    Pallesen, Ulla; Qvist, Vibeke

    2003-01-01

    The purpose of this randomized, clinical study was to evaluate the clinical performance of composite resin materials used for fillings and indirect inlays. Twenty-eight sets of five class II restorations (two fillings, three inlays) were placed in 88 premolars and 52 molars in 28 adults. Brillian...

  10. The FAA's postmortem forensic toxicology self-evaluated proficiency test program: the second seven years.

    Science.gov (United States)

    Chaturvedi, Arvind K; Craft, Kristi J; Cardona, Patrick S; Rogers, Paul B; Canfield, Dennis V

    2009-05-01

    During toxicological evaluations of samples from fatally injured pilots involved in civil aviation accidents, a high degree of quality control/quality assurance (QC/QA) is maintained. Under this philosophy, the Federal Aviation Administration (FAA) started a forensic toxicology proficiency-testing (PT) program in July 1991. In continuation of the first seven years of the PT findings reported earlier, PT findings of the next seven years are summarized herein. Twenty-eight survey samples (12 urine, 9 blood, and 7 tissue homogenate) with/without alcohols/volatiles, drugs, and/or putrefactive amine(s) were submitted to an average of 31 laboratories, of which an average of 25 participants returned their results. Analytes in survey samples were correctly identified and quantitated by a large number of participants, but some false positives of concern were reported. It is anticipated that the FAA's PT program will continue to serve the forensic toxicology community through this important part of the QC/QA for laboratory accreditations.

  11. Subjects with Impaired Fasting Glucose: Evolution in a Period of 6 Years

    Directory of Open Access Journals (Sweden)

    E. Leiva

    2014-01-01

    Full Text Available Aim. To study the evolution of impaired fasting glucose (IFG, considering glucose and HbA1c levels and risk factors associated, in a period of 6 years. Methods. We studied 94 subjects with impaired fasting glucose (IFG that were diagnosed in 2005 and followed up to 2012. Glucose and HbA1c levels were determined. A descriptive analysis of contingence charts was performed in order to study the evolution in the development of type-2 diabetes mellitus (T2DM. Results. Twenty-eight of ninety-four subjects became T2DM; 51/94 remained with IFG; and 20/94 presented normal fasting glucose. From the 28 diabetic subjects, 9 had already developed diabetes and were under treatment with oral hypoglycemic agents; 5 were diagnosed with plasma glucose < 126 mg/dL, but with HbA1c over 6.5%. In those who developed diabetes, 15/28 had a family history of T2DM in first relative degree. Also, diabetic subjects had a BMI significantly higher than nodiabetics (t test: P < 0.01. The individuals that in 2005 had the highest BMI are those who currently have diabetes. Conclusion. The IFG constitutes a condition of high risk of developing T2DM in a few years, especially over 110 mg/dL and in obesity patients.

  12. Subjects with Impaired Fasting Glucose: Evolution in a Period of 6 Years

    Science.gov (United States)

    Leiva, E.; Mujica, V.; Orrego, R.; Wehinger, S.; Soto, A.; Icaza, G.; Vásquez, M.; Díaz, L.; Andrews, M.; Arredondo, M.

    2014-01-01

    Aim. To study the evolution of impaired fasting glucose (IFG), considering glucose and HbA1c levels and risk factors associated, in a period of 6 years. Methods. We studied 94 subjects with impaired fasting glucose (IFG) that were diagnosed in 2005 and followed up to 2012. Glucose and HbA1c levels were determined. A descriptive analysis of contingence charts was performed in order to study the evolution in the development of type-2 diabetes mellitus (T2DM). Results. Twenty-eight of ninety-four subjects became T2DM; 51/94 remained with IFG; and 20/94 presented normal fasting glucose. From the 28 diabetic subjects, 9 had already developed diabetes and were under treatment with oral hypoglycemic agents; 5 were diagnosed with plasma glucose < 126 mg/dL, but with HbA1c over 6.5%. In those who developed diabetes, 15/28 had a family history of T2DM in first relative degree. Also, diabetic subjects had a BMI significantly higher than nodiabetics (t test: P < 0.01). The individuals that in 2005 had the highest BMI are those who currently have diabetes. Conclusion. The IFG constitutes a condition of high risk of developing T2DM in a few years, especially over 110 mg/dL and in obesity patients. PMID:25215305

  13. A three-point time series study of antibiotic usage on an intensive care unit, following an antibiotic stewardship programme, after an outbreak of multi-resistant Acinetobacter baumannii.

    Science.gov (United States)

    Singh, S; Zhang, Y Z; Chalkley, S; Ananthan, K; Demertzi, E; Beach, M; Cohen, M; Grover, V; Chung, C; Tatlock, J; Soni, N; Azadian, B

    2015-09-01

    Antibiotic use in intensive care units (ICUs) can promote antimicrobial resistance. Outbreaks of multi-resistant bacteria significantly affect patient outcomes and delivery of care. Antibiotic stewardship programmes (ASPs), combining root-cause analyses and multi-faceted prevention strategies, are necessary, often at significant cost and time. Which elements of such strategies have the largest impact on antibiotic usage following an outbreak is unclear. The aim of this study was to investigate how antibiotic usage in a university hospital ICU changed with a non-protocolised ASP following a disruptive outbreak of multi-resistant Acinetobacter baumannii (MRAB). This was a three time-period observational cohort study. The primary endpoint was the change in overall antibiotic usage (daily defined dose, DDD, antibiotic-days, antibiotic-courses) for consecutive ICU patients staying >48 h, over three 6-month study time periods pre-MRAB (2008, n = 84) and post-MRAB (2010, n = 88; 2012, n = 122). Secondary endpoints were changes in antibiotic usage and patient demographics, in predefined admission categories (Medical Emergency, ME; Surgical Elective, SEL; and Surgical Emergency, SE). The mean age (54.6 ± 17.7, 58.1 ± 17.9, 62.8 ± 19.1 years*) and severity of illness (APACHE 14.8 ± 8.0, 16.7 ± 6.8, 18.3 ± 6.1*) increased, particularly medical admissions. There was a sustained reduction in DDD antibiotic usage [1895.1 (2008), 1224.2 (2010), 1236.6 (2012) per 1000 patient-days] but no overall change in antibiotic-days or antibiotic-courses. Antibiotic usage (antibiotic-days) fell significantly in surgical emergency admissions [20.2 ± 32.1, 4.6 ± 7.4*, 5.9 ± 7.3]. There was a sustained drop in beta-lactam, quinolone, glycopeptide and macrolide usage. Following an MRAB outbreak, and subsequent operational changes including enhanced ASPs (non-protocolised), there was a sustained overall fall in antibiotic usage in spite of

  14. Twenty-eight Patients with Restless Leg's Syndrome Treated by Modified Bugan Decoction%加味补肝汤治疗不宁腿综合征28例

    Institute of Scientific and Technical Information of China (English)

    衡向阳

    2005-01-01

    不宁腿综合征(restless leg’s syndrome)是指在静息状态下,特别是在夜间睡眠时出现的小腿部难以形容的不适感,必须活动才能缓解的一种病症。因病因及发病机理未明确,且医患双方对本病都不太重视,故临床报道较少。笔者自1996年以来,应用加味补肝汤治疗本病28例,收到满意疗效,现报道如下。

  15. Ideal ratios of isoleucine, methionine, methionine plus cystine, threonine, tryptophan, and valine relative to lysine for white leghorn-type laying hens of twenty-eight to thirty-four weeks of age

    Science.gov (United States)

    Seven separate experiments were conducted with Hy-Line W-36 hens to determine the ideal ratio of Arg, Ile, Met, Met+Cys, Thr, Trp, and Val relative to Lys for maximal egg mass. The experiments were conducted simultaneously and were each designed as a randomized complete block design with 60 experime...

  16. Clinical analysis of twenty-eight elderly patients with convulsive status epilepticus%老年惊厥性癫痫持续状态28例临床分析

    Institute of Scientific and Technical Information of China (English)

    王勤鹰; 余敏; 顾勤; 邓冰; 姜嘟嘟; 詹青

    2014-01-01

    目的:观察老年惊厥性癫痫持续状态( CSE)的临床特点。方法收集神经重症监护室( NICU)年龄≥60岁的CSE患者28例,回顾性分析其临床特点。结果脑血管病为28例老年CSE的首位病因。接受抗癫痫药物治疗后,CSE症状控制的中位时间为0.9 h,其中16例患者在1 h内症状控制,12例为难治性癫痫持续状态(RSE)。28例患者中,存活16例、死亡12例。死亡者与存活者相比,合并中枢神经系统新发疾病(P=0.027)和RSE的比例显著不同(P=0.027)。结论老年CSE患者基础情况差,病因多样,合并有中枢神经系统新发疾病或有RSE者的死亡率高。%Objective To observe the clinical characteristics of elderly patients with convulsive status epilepticus (CSE). Methods Retrospectively analyzed the clinical characteristics of 28 aged patients (age above 60) with CSE admitted to our neurological intensive care unit ( NICU) . Results The most common etiology of CSE in elder patients was cerebrovascular disease .Median time from antiepileptic drugs ( AEDs ) treatment to CSE successful terminated was 0.9 hour.Among these patients, CSE was terminated successfully in 16 patients within 1 hour, while other 12 patients were in status of refractory status epilepticus (RSE).As a result, 16 patients survived and 12 died. Compared died patients with those survived , the rates of new-onset central nervous system lesions ( P=0.027 ) and RSE ( P=0.027 ) were significantly different . Conclusion The elderly patients with CSE have poor health basis and various etiologies of CSE .Presenting of new-onset of central nervous system lesions and RSE are associated with the increased rate of death .

  17. Oregon Islands, Three Arch Rocks, and Cape Meares National Wildlife Refuges: Comprehensive Conservation Plan and Wilderness Stewardship Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Comprehensive Conservation Plan (CCP) was written to guide management on Oregon Islands, Three Arch Rocks, and Cape Meares NWRs for the next 15 years. This plan...

  18. Lung mass in a 28-year-old male: a case report of a rare tumor.

    Science.gov (United States)

    Mroz, Robert M; Korniluk, M; Swidzinska, E; Dzieciol, J; Czaban, J; Panek, B; Chyczewska, E

    2010-11-01

    A twenty eight-year-old male presented with a two week history of dyspnea, cough, hemoptysis, chest pain, and fever 38-39°C. He also complained of loss of appetite, general weakness and left leg pain for two months preceding admission. He was referred with suspicion of lung tumor to our institution. Chest X-ray showed almost total atelectasis of the right lung with compensatory overinflation of the contralateral lung. Using computed tomography (CT), a lesion of diameter of 19.3 x 14.1 x 19.1 cm in the right lung, pleuritis, Th3 osteolysis, and compensatory overinflation of the left lung was seen. Bronchoscopy revealed a total obstruction of the right main bronchus due to submucosal infiltration and compression of the right main bronchus with negative histology of bronchial biopsy specimens. Transthoracic fine needle aspiration revealed celullae suspectae probabiliter neoplasmaticae suggesting tumor fusocellularis. USG of the abdomen revealed liver with numerous heterogeneous, solid areas hypo- and hyperechogenic, some of them with features of liquid or the disintegration up to diameter of 74 mm. Subsequent fine needle aspirations of the thorax and liver revealed fibrolamellar hepatocarcinoma and carcinoma adenoides of the lung. Patient underwent chemotherapy with 5-FU/DDP/VCR with no response. This report presents a case of a rare lung metastasis from FL-HCC.

  19. Indications, Results and Mortality of Pulmonary Artery Banding Procedure: a Brief Review and Five- year Experiences

    Directory of Open Access Journals (Sweden)

    Hamid Hoseinikhah

    2016-05-01

    Full Text Available Background Pulmonary artery banding (PAB is a technique of palliative surgical therapy used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects. Materials and Methods We report 5- year experiences from January 2011 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital in Mashhad city, North East of Iran that consist of 50 patients with congenital heart disease with left to right shunt that pulmonary artery banding procedure was performed for them were studied. Results Age of patients (n=50 was 1to 9 months (mean=4.6 + 1.3. In this study, the most common disease that need to PAB procedure was Ventricular septal defect (VSD with twenty-eight patients (56%. Mean of extubation time (hour was 10.4 + 0.8 and mean of hospital stay (day was 13.3 + 2.4 respectively. Conclusion Although the number of pulmonary artery banding palliation surgery was decreased, but in selected group of congenital heart disease, this palliation to reduce over circulation of Pulmonary system, can use successfully with acceptable results and low mortality. We suggest pulmonary artery banding palliative surgery in these selected patients.

  20. Botulinum toxin type A and cervical dystonia: a seven-year follow-up

    Directory of Open Access Journals (Sweden)

    Carlos Henrique F. Camargo

    2011-10-01

    Full Text Available Most cases of cervical dystonia (CD are idiopathic, and focal injections of botulinum toxin A (BoNT/A are the treatment of choice. The objective of our study was to document the effects of long-term BoNT/A treatment in idiopathic CD patients. Fifty-eight patients with idiopathic CD were recruited from March 2001 to May 2002. Twenty-eight of the subjects were available for reassessment after seven years. During this period, all had received regular treatment with BoNT/A injections. Clinical information about patients and the severity of CD (TWSTRS and VAPS at baseline assessment (2001-2002 and follow-up (2008-2009 was compared. Significant motor improvement was detected based on TWSTRS scale scores, which were used to analyze clinical severity (19.6±6.6 and 17.7±4.8; p<0.05. There was no improvement in the severity of cervical pain (p=0.43. In conclusion, BoNT/A was a safe and effective long-term therapy for CD.

  1. Information literacy: are final-year medical radiation science students on the pathway to success?

    Science.gov (United States)

    Thompson, Nadine; Lewis, Sarah; Brennan, Patrick; Robinson, John

    2010-01-01

    It is necessary for Medical Radiation Science (MRS) students to become information literate in order to interact with and thrive in the professional health care arena. All health care professionals require information literacy (IL) skills to be independent learners and critical thinkers. To achieve this, effective search and evaluation methods must be cultivated in students. Twenty-eight final year MRS students participated in a 30-minute digitally recorded interview regarding their knowledge of information sources, where they locate information, and how they evaluate these sources. Constant comparative analysis via grounded theory was used to thematise the data. A conceptual framework was developed demonstrating the link between the key concepts of convenience, confidence and competence. The impact of the internet on the IL skills of students has been profound, due mainly to convenience. Most students had little confidence in their IL skills, however there were still some students who were confident with their skills and were competent who still preferred to access information sources that were convenient because there was nothing preventing them from doing so. By identifying problem areas, educators can redesign curricula around the strengths and weaknesses of students' IL skills, thus promoting lifelong learning and using electronic based learning to its full potential.

  2. Effect of educational outreach on general practice prescribing of antibiotics and antidepressants: A two-year randomised controlled trial

    Science.gov (United States)

    Enriquez-puga, Andres; Baker, Richard; Paul, Sanjoy; Villoro-Valdes, Renata

    2009-01-01

    Objective Prescribing of broad spectrum antibiotics and antidepressants in general practice often does not accord with guidelines. The aim was to determine the effectiveness of educational outreach in improving the prescribing of selected antibiotics and antidepressants, and whether the effect is sustained for two years. Design Single blind randomized trial. Setting Twenty-eight general practices in Leicestershire, England. Intervention Educational outreach visits were undertaken, tailored to barriers to change, 14 practices receiving visits for reducing selected antibiotics and 14 for improving antidepressant prescribing. Main outcome measures Number of items prescribed per 1000 registered patients for amoxicillin with clavulanic acid (co-amoxiclav) and quinolone antibiotics, and average daily quantities per 1000 patients for lofepramine and fluoxetine antidepressants, measured at the practice level for six-month periods over two years. Results There was no effect on the prescribing of co-amoxiclav, quinolones, or fluoxetine, but prescribing of lofepramine increased in accordance with the guidelines. The increase persisted throughout two years of follow-up. Conclusion A simple, group-level educational outreach intervention, designed to take account of identified barriers to change, can have a modest but sustained effect on prescribing levels. However, outreach is not always effective. The context in which change in prescribing practice is being sought, the views of prescribers concerning the value of the drug, or other unrecognised barriers to change may influence the effectiveness of outreach. PMID:19958063

  3. Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up.

    Science.gov (United States)

    Faldini, Cesare; Miscione, Maria Teresa; Chehrassan, Mohammadreza; Acri, Francesco; Pungetti, Camilla; d'Amato, Michele; Luciani, Deianira; Giannini, Sandro

    2011-12-01

    Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe's classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10-14 years). Average Harris Hip Score was 56 ± 9 (range 45-69) preoperatively, 90 ± 9 (range 81-100) 12 months after surgery, and 91 ± 8 (range 83-100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results.

  4. Age-related changes in the temporal dynamics of executive control: A study in 5- and 6-year-old children

    Directory of Open Access Journals (Sweden)

    Joanna eLucenet

    2014-07-01

    Full Text Available Based on the Dual Mechanisms of Control theory (Braver, Gray & Burgess, 2007, this study conducted in 5- and 6-year-olds, tested for a possible shift between two modes of control, proactive vs. reactive, which differ in the way goal information is retrieved and maintained in working memory. To this end, we developed a children-adapted version of the AX-Continuous-Performance Task (AX-CPT. Twenty-nine 5-year-olds and twenty-eight 6-year-olds performed the task in both low and high working-memory load conditions (corresponding respectively to a short and a long cue-probe delay. Analyses suggested that a qualitative change in the mode of control occurs within the 5-year-old group. However, quantitative, more graded changes were also observed both within the 5-year-olds, and between 5 and 6 years of age. These graded changes demonstrated an increasing efficiency in proactive control with age. The increase in working memory load did not impact the type of dynamics of control, but had a detrimental effect on sensitivity to cue information. These findings highlight that the development of the temporal dynamics of control can be characterized by a shift from reactive to proactive control together with a more protracted and gradual improvement in the efficiency of proactive control. Moreover, the question of whether the observed shift in the mode of control is task dependant is debated.

  5. A History of the Atomic Energy Commission

    Science.gov (United States)

    Buck, Alice L.

    1983-07-01

    This pamphlet traces the history of the US Atomic Energy Commission's twenty-eight year stewardship of the Nation's nuclear energy program, from the signing of the Atomic Energy Act on August 1, 1946 to the signing of the Energy Reorganization Act on October 11, 1974. The Commission's early concentration on the military atom produced sophisticated nuclear weapons for the Nation's defense and made possible the creation of a fleet of nuclear submarines and surface ships. Extensive research in the nuclear sciences resulted in the widespread application of nuclear technology for scientific, medical and industrial purposes, while the passage of the Atomic Energy Act of 1954 made possible the development of a nuclear industry, and enabled the United States to share the new technology with other nations.

  6. Neighborhood change and the role of environmental stewardship: a case study of green infrastructure for stormwater in the City of Portland, Oregon, USA

    Directory of Open Access Journals (Sweden)

    Vivek Shandas

    2015-09-01

    Full Text Available Throughout the history of cities, the ecological landscape has often been buried, removed, or taken for granted. A recent recognition that humans are part of the global ecosystem, and that human actions both cause and are affected by ecological change, brings with it an awareness of the value of nature in cities and of natural systems on which cities depend. The feedbacks between humans and their environment within an urban context can have profound implications for the growth of and change in cities, yet there is a limited understanding of the interactions between biophysical changes in cities and the implications of these changes on the quality of life for residents. The application of a coupled human and natural systems (CHANS framework provides a timely and fruitful opportunity to enrich the theory, methods, and understanding of these feedbacks and interconnections. Here, I integrated biophysical and social dimensions relevant to managing urban stormwater by examining a case study of Portland, Oregon, USA. I used empirical data from a pre-post survey (2-yr span of residents in eight urban neighborhoods to describe feedbacks and interactions between a localized biophysical change in the form of a large-scale decentralized stormwater program and the resulting changes in resident's perceptions in neighborhoods undergoing rapid change. My findings corroborate earlier findings suggesting that people with higher income and education levels are more likely to participate in stewardship actions. The results also suggest an overall and initial negative perception of neighborhoods facilities and services immediately following the construction of decentralized stormwater facilities, but conversely, high levels of anticipation for their construction. By describing these findings through a CHANS framework, I make explicit the importance of integrating scientific understanding, governance efforts, and human behaviors to address acute urban environmental

  7. The North Wind and the Sun: Pediatric Antimicrobial Stewardship Program Combining Restrictive and Persuasive Approaches in Hematology-Oncology Ward and Hematopoietic Stem Cell Transplant Unit.

    Science.gov (United States)

    Horikoshi, Yuho; Kaneko, Tetsuji; Morikawa, Yoshihiko; Isogai, Mihoko; Suwa, Junichi; Higuchi, Hiroshi; Yuza, Yuki; Shoji, Takayo; Ito, Kenta

    2017-08-17

    The Japanese government's goal for the reduction of antimicrobial consumption is two-thirds of the 2013 rate by 2020. While the antimicrobial stewardship programs (ASP) are essential in health care facilities, ASP data on pediatric hematology-oncology and hematopoietic stem cell transplant (HSCT) patients are limited. Our aim was to evaluate the impact of restrictive and persuasive ASP on immunocompromised children. The ASP for hematology-oncology and HSCT patients at Tokyo Metropolitan Children's Medical Center was assessed. Phase 1 was a post-prescriptive review of carbapenem conducted between April, 2010 and September, 2011. Phase 2 consisted of the preauthorization of carbapenem, prospective audit with feedback, a weekly luncheon meeting among physicians, consensus on febrile neutropenia management, and implementation of viral molecular diagnostics between October, 2011 and September, 2015. Both phases were compared for day-of-therapy (DOT) per 1,000 patient-days, cost of intravenous antimicrobial agents, average hospitalization duration, all-cause mortality, infection-related mortality at 30 days, and appropriateness of empirical treatment of bacteremia. The ASP did not differ from phase 1 to phase 2 in terms of average hospitalization length, mortality rate, or appropriateness of empirical treatment for bacteremia. DOTs of cefepime, piperacillin/tazobactam, meropenem, vancomycin, liposomal amphotericin B, and fosfluconazole decreased by 20%, 45%, 57%, 38%, 85% and 44%, respectively (p<0.05). The total cost of antibiotic and antifungal agents decreased by 27%, for a savings of $59,905 USD annually. Restrictive and persuasive ASP in the hematology-oncology ward and the HSCT unit safely decreased the use of antibacterial and antifungal agents.

  8. Rapid testing using the Verigene Gram-negative blood culture nucleic acid test in combination with antimicrobial stewardship intervention against Gram-negative bacteremia.

    Science.gov (United States)

    Bork, Jacqueline T; Leekha, Surbhi; Heil, Emily L; Zhao, LiCheng; Badamas, Rilwan; Johnson, J Kristie

    2015-03-01

    Rapid identification of microorganisms and antimicrobial resistance is paramount for targeted treatment in serious bloodstream infections (BSI). The Verigene Gram-negative blood culture nucleic acid test (BC-GN) is a multiplex, automated molecular diagnostic test for identification of eight Gram-negative (GN) organisms and resistance markers from blood culture with a turnaround time of approximately 2 h. Clinical isolates from adult patients at the University Maryland Medical Center with GN bacteremia from 1 January 2012 to 30 June 2012 were included in this study. Blood culture bottles were spiked with clinical isolates, allowed to incubate, and processed by BC-GN. A diagnostic evaluation was performed. In addition, a theoretical evaluation of time to effective and optimal antibiotic was performed, comparing actual antibiotic administration times from chart review ("control") to theoretical administration times based on BC-GN reporting and antimicrobial stewardship team (AST) review ("intervention"). For organisms detected by the assay, BC-GN correctly identified 95.6% (131/137), with a sensitivity of 97.1% (95% confidence interval [CI], 90.7 to 98.4%) and a specificity of 99.5% (95% CI, 98.8 to 99.8%). CTX-M and OXA resistance determinants were both detected. Allowing 12 h from Gram stain for antibiotic implementation, the intervention group had a significantly shorter duration to both effective (3.3 versus 7.0 h; P < 0.01) and optimal (23.5 versus 41.8 h; P < 0.01) antibiotic therapy. BC-GN with AST intervention can potentially decrease time to both effective and optimal antibiotic therapy in GN BSI.

  9. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center.

    Science.gov (United States)

    Borde, Johannes P; Kaier, Klaus; Steib-Bauert, Michaela; Vach, Werner; Geibel-Zehender, Annette; Busch, Hansjörg; Bertz, Hartmut; Hug, Martin; de With, Katja; Kern, Winfried V

    2014-04-15

    Restricted use of third-generation cephalosporins and fluoroquinolones has been linked to a reduced incidence of hospital-acquired infections with multidrug-resistant bacteria. We implemented an intensified antibiotic stewardship (ABS) programme in the medical service of a university hospital center aiming at a reduction by at least 30% in the use of these two drug classes. The ABS programme was focused on the 300-bed medical service. Prescription of third-generation cephalosporins was discouraged, whereas the use of penicillins was encouraged. Monthly drug use density was measured in WHO-ATC defined and locally recommended daily doses (DDD and RDD) per 100 patient days, to evaluate trends before (01/2008 to 10/2011) and after starting the intervention (1/2012 to 3/2013). The effect was analysed using interrupted time-series analysis with six non-intervention departments as controls. Following initiation of the ABS intervention, overall antibiotic use in the medical service declined (p fluoroquinolones (p fluoroquinolones from 17.7 to 10.1 (-43%), respectively. During the same period, the use of penicillins increased (15.4 to 18.2; 18%). The changes in expenditures for antibiotics in the medical service compared to control services minus programme costs indicated initial net cost savings likely to be associated with the programme. An intensified ABS programme targeting cephalosporin und fluoroquinolone use in the setting of a large academic hospital is feasible and effective. The intervention may serve as a model for other services and hospitals with a similar structure and baseline situation.

  10. Community Essay: Product stewardship in the United States: the changing policy landscape and the role of business

    Directory of Open Access Journals (Sweden)

    Vesela Veleva

    2009-02-01

    Full Text Available Since I came to the United States almost twelve years ago, I have been astonished by the rate of consumption and the enormous amount of waste generated by people and organizations. Could Americans wake up one day without electricity, gasoline, or bread, as happened to many Eastern European countries in the early 1990s? It was a tough lesson that many people of my generation will never forget. It is clear to me that the current rate of consumption and environmental pollution is unsustainable. Every few years, people change cars, computers, televisions, other appliances, and even their homes! It is often said that if every person on this planet consumed like Americans, we would need several planets Earth. But why should people in other countries not have the right to own a car, travel to exotic destinations, and purchase prepackaged food, modern appliances, and toys for their children? As an engineer and scientist trained in cleaner production, I have always believed in the unlimited potential of humankind to find solutions to seemingly unsolvable problems. But we need to have the right incentives. This does not mean people and organizations should not change their consumption patterns, but rather that we can build the economy from a systems perspective, considering the entire lifecycle of products and services and the social, economic, and environmental impacts of our actions today and in the decades to come. The current global recession makes it even clearer that a systems approach is critical going forward to ensure stable and sustainable development in an increasingly interconnected world. Business, government, and civil society organizations all need to work together to design the rules of the new economic system where products last longer, have no toxic chemicals, and are reused and recycled; society as a whole consumes less; and people spend more time with family and friends and less time working to maintain their “standard of living.”

  11. El régimen administrativo y contable del hospital de caridad de La Coruña en el siglo XVIII. (Stewardship and accountancy in the charity hospital of La Coruña during the XVIII century).

    OpenAIRE

    Salvador Montiel, Mª Dolores; Ruiz Lamas, Fernando Carlos

    2011-01-01

    El objetivo de este trabajo ha sido el análisis de la organización administrativa y del método contable empleado por el Hospital de Caridad de La Coruña en el siglo XVIII, lo cual se ha llevado a cabo a través del estudio de las Constituciones aplicables, del libro principal de cuentas y de otros documentos relacionados con la administración del Hospital. (The aim of this paper was to analyze the stewardship and accounting methods used in the Charity Hospital of La Coruña (Spain) during the X...

  12. Knowledge of adverse drug reaction reporting in first year postgraduate doctors in a medical college

    Directory of Open Access Journals (Sweden)

    Upadhyaya P

    2012-06-01

    Full Text Available Prerna Upadhyaya,1 Vikas Seth,2 Vijay V Moghe,1 Monika Sharma,1 Mushtaq Ahmed11Department of Pharmacology, Mahatma Gandhi Medical College, Sitapura, Jaipur, Rajasthan, 2Department of Pharmacology, Hind Institute of Medical Sciences, Safedabad, Barabanki, Lucknow, Uttar Pradesh, IndiaIntroduction: Poor reporting of adverse drug reactions (ADRs by doctors is a major hindrance to successful pharmacovigilance. The present study was designed to assess first-year residents’ knowledge of ADR reporting.Methods: First-year postgraduate doctors at a private medical college completed a structured questionnaire. The responses were analyzed by nonparametric methods.Results: All doctors were aware of the term “adverse drug reactions.” Fifty percent of the doctors reported being taught about ADR reporting during their undergraduate teaching, and 50% had witnessed ADRs in their internship training. Ten percent of patients suffering an ADR observed and reported by doctors required prolonged hospitalization for treatment as a result. Only 40% of interns reported the ADRs that they observed, while 60% did not report them. Twenty-eight percent reported ADRs to the head of the department, 8% to an ADR monitoring committee, and 4% to the pharmacovigilance center. Eighty-six percent of the doctors surveyed felt that a good knowledge of undergraduate clinical pharmacology therapeutics would have improved the level of ADR reporting.Conclusion: The knowledge of first-year doctors regarding ADR reporting is quite poor. There is a dire need to incorporate ADR reporting into undergraduate teaching, and to reinforce this during internships and periodically thereafter.Keywords: ADR reporting, pharmacovigilance, first-year postgraduate doctors

  13. Coupling landscape water storage and supplemental irrigation to increase productivity and improve environmental stewardship in the U.S. Midwest

    Science.gov (United States)

    Baker, John M.; Griffis, Timothy J.; Ochsner, Tyson E.

    2012-05-01

    Agriculture must increase production for a growing population while simultaneously reducing its environmental impacts. These goals need not be in tension with one another. Here we outline a vision for improving both the productivity and environmental performance of agriculture in the U.S. Midwest, also known as the Corn Belt. Mean annual precipitation has increased throughout the region over the past 50 years, consistent with climate models that attribute the increase to a warming troposphere. Stream gauge data indicate that higher precipitation has been matched or exceeded by higher stream flows, contributing to flooding, soil loss, and excessive nutrient flux to the Gulf of Mexico. We propose increasing landscape hydrologic storage through construction of ponds and restoration of wetlands to retain water for supplemental irrigation while also reducing flood risks. Primary productivity is proportional to transpiration, and analysis shows that in the U.S. Midwest both can be sustainably increased with supplemental irrigation. The proposed strategy should reduce interannual yield variability by limiting losses due to transient drought, while facilitating adoption of cropping systems that "perennialize" the landscape to take advantage of the full potential growing season. When implemented in concert, these practices should reduce the riverine nitrogen export that is a primary cause of hypoxia in the Gulf of Mexico. Erosive sediment losses should also be reduced through the combination of enhanced hydrologic storage and increased vegetative cover. Successful implementation would require watershed-scale coordination among producers and landowners. An obvious mechanism to encourage this is governmental farm policy.

  14. Mean 5-Year Clinical and Radiographic Outcomes of Cementless Total Hip Arthroplasty in Patients under the Age of 30

    Directory of Open Access Journals (Sweden)

    Jeremy M. Gililland

    2013-01-01

    Full Text Available We performed a retrospective review of 40 consecutive modern cementless THAs with 65-month mean followup in 34 patients under the age of 30 primarily for diagnoses other than inflammatory arthritis. We found acceptable functional improvement and radiographic outcomes at mean 5-year followup. We found a high transfusion rate, dislocation rate (10%, and midterm overall aseptic revision rate (17%. Twenty-eight (67.5% of hips in this series were metal on metal, with a large percentage of aseptic revisions related to metallosis (57%. When revisions due to metallosis were excluded, the aseptic revision rate was 7.5%. The high prevalence of prior pediatric hip surgery in these patients (50% may predispose to increased technical difficulty resulting in increased complications and higher revision rates. Although our revision rate was high in these young patients, it is favorable compared to older techniques and consistent with the limited data available with modern cementless techniques in patients of similar age. Cementless THA with modern designs remains a viable option for the treatment of arthritis in the young patient.

  15. MALDI-TOF alone versus MALDI-TOF combined with real-time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with positive blood cultures.

    Science.gov (United States)

    Beganovic, Maya; Costello, Michael; Wieczorkiewicz, Sarah M

    2017-02-22

    Introduction: Matrix-assisted laser desorption ionization time of flight (MALDI-TOF) decreases time to organism identification and improves clinical and financial outcomes. The purpose of this study was to evaluate the impact of MALDI-TOF alone vs MALDI-TOF combined with real-time, pharmacist-driven, antimicrobial stewardship (AMS) intervention on patient outcomes.Methods: This single-center, pre-post quasi-experimental study evaluated hospitalized patients with positive blood cultures identified via MALDI-TOF combined with prospective AMS intervention, compared to a control cohort with MALDI-TOF identification without AMS intervention. AMS intervention included: real-time MALDI-TOF pharmacist notification, and prospective AMS provider feedback. The primary outcome was time to optimal antimicrobial therapy (TTOT).Results: A total of 252 blood cultures were included for final analysis: 126 in each group. MALDI-TOF + AMS intervention significantly reduced overall TTOT (75.17 vs 43.06 h, p <0.001), Gram + contaminant TTOT (48.21 vs 11.75 h, p <0.001), Gram - infection (GNI) TTOT (71.83 vs 35.98 h, p <0.001), and reduced overall hospital LOS (15.03 vs 9.02 days, p 0.021). TTOT for Gram + infection (GPI) was improved (64.04 vs 41.61 h, p 0.082). For GPI: reduced hospital LOS (14.64 vs 10.31 days, p 0.002) and length of antimicrobial therapy 24.30 vs 18.97 days, p 0.018). For GNI: reduced time to microbiologic clearance (51.13 vs 34.51 h, p <0.001), hospital LOS (15.40 vs 7.90 days, p 0.027), and ICU LOS (5.55 vs 1.19 days, p 0.035).Conclusion: In order to achieve optimal outcomes, rapid identification with MALDI-TOF combined with real-time AMS interventions is more impactful than MALDI-TOF alone.

  16. Impact of Antimicrobial Stewardship Program (ASP) on Outcomes in Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) in an Acute-Tertiary Care Hospital.

    Science.gov (United States)

    Loo, Li Wen; Liew, Yi Xin; Lee, Winnie; Chlebicki, Piotr; Kwa, Andrea Lay-Hoon

    2015-09-01

    Acute bacterial skin and skin structure infections (ABSSSIs) are among the most common infections treated in hospitals, but to date, there has been little information with regards to the implementation of Antimicrobial Stewardship Programs (ASPs) for patients with ABSSSIs. Hence, we aim to evaluate the impact of ASPs on the following outcomes in patients with ABSSSIs: duration of therapy and hospital stay, 14-day reinfection, infection-related readmissions and mortality. A retrospective review of the ASP database was conducted, focusing on selected outcomes (as above) among all patients in whom the institution's ASP recommended a change in antibiotic regimen-de-escalation of the antibiotic based on culture results; discontinuation of the antibiotic; narrowing of the empirical coverage; and intravenous-to-oral (i.v.-to-p.o.) switch between September 2009 and December 2012. Data were expressed as mean ± standard deviation for continuous variables, and unpaired Student's t test was performed to determine intergroup differences between mean values. For categorical variables, data were presented as number and percentage and analyzed using the χ (2) test or Fisher's exact test, as appropriate. ASP recommended 407 interventions with an overall acceptance rate of 66.8%. ASP interventions significantly reduced median duration of therapy by 2 [from a median (interquartile range, IQR) of 8 (6-12) days to 6 (4-9) days] and median length of stay by 5 days [from median (IQR) of 12 (5-32) days to 7 (3-18) days]. This led to an estimated total cost avoidance of USD 0.7 million. There were no significant differences in the 14-day reinfection, infection-related readmission and mortality rates between patients whose physicians accepted and those who rejected ASP interventions. Interventions recommended by the ASP in Singapore General Hospital were safe and associated with a significant reduction in duration of therapy and hospital stay. The results of our study have affirmed

  17. Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study.

    Directory of Open Access Journals (Sweden)

    Giulio DiDiodato

    Full Text Available The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi. The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI.Single-site, 339 bed community-hospital in Barrie, Ontario, Canada. Primary outcome is HA-CDI incidence rate. Daily prospective and audit ASi is the exposure variable. ASi implemented across 6 wards in a non-randomized, stepped wedge design. Criteria for ASi; any intravenous antibiotic use for ≥ 48 hrs, any oral fluoroquinolone or oral second generation cephalosporin use for ≥ 48 hrs, or any antimicrobial use for ≥ 5 days. HA-CDI cases and model covariates were aggregated by ward, year and month starting September 2008 and ending February 2016. Multi-level mixed effect negative binomial regression analysis was used to model the primary outcome, with intercept and slope coefficients for ward-level random effects estimated. Other covariates tested for inclusion in the final model were derived from previously published risk factors. Deviance residuals were used to assess the model's goodness-of-fit.The dataset included 486 observation periods, of which 350 were control periods and 136 were intervention periods. After accounting for all other model covariates, the estimated overall ASi incidence rate ratio (IRR was 0.48 (95% 0.30, 0.79. The ASi effect was independent of antimicrobial utilization. The ASi did not seem to reduce the risk of Clostridium difficile infection on the surgery wards (IRR 0.87, 95% CI 0.45, 1.69 compared to the medicine wards (IRR 0.42, 95% CI 0.28, 0.63. The ward-level burden of

  18. Differences in the speech of 10- to 13-year-old boys from divorced and nondivorced families against the background of emotional attachment.

    Science.gov (United States)

    Böhm, Birgit

    2004-01-01

    In Germany, an increasing number of children live with one parent alone and have to cope with the separation or divorce of their parents. Emotional drawbacks have frequently been hypothesized for these children. Thus, we studied if such experiences are reflected in speech behavior. Twenty-eight 10- to 13-year-old boys from separated parents (physical separation of the parents was 2 years before the investigation) were compared with 26 boys from parents living together in an interview focusing on attachment-related themes and everyday situations. The interviews were analyzed with regard to coherence of speech, coping with emotional problems, reflectivity, child representation of both parents, and verbal and nonverbal expression of feelings. Boys from separated parents had incoherent speech, difficulties in coping with emotional problems, a poorer reflectivity (thinking about their own mental states and those of others), they represented neither parent supportively and did not show their feelings openly. These results can be traced back to an insecure attachment representation of the boys with separated parents.

  19. Antimicrobial stewardship in wound care

    DEFF Research Database (Denmark)

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

    2016-01-01

    of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document...... be as narrowly focused, and administered for the shortest duration, as possible. AMS teams should be interdisciplinary, especially including specialists in infection and pharmacy, with input from administrative personnel, the treating clinicians and their patients. CONCLUSIONS: Available evidence is limited...

  20. The Stewardship of Campus Heritage

    Science.gov (United States)

    Audrain, Calvert W.

    2011-01-01

    Even as technology and globalization are changing the way one lives and views the world, colleges and universities have become increasingly interested in preserving historic campus buildings and sites. Heritage has become more important to students, faculty, and staff, as well as to alumni, who have often been its prime supporters. This article…

  1. 我国农业/农村生态景观管护对策探讨%Countermeasures of landscape and ecological stewardship in agricultural/rural area of China

    Institute of Scientific and Technical Information of China (English)

    宇振荣; 张茜; 肖禾; 刘文平

    2012-01-01

    农业/农村生态环境综合整治已成为我国目前农业/农村可持续发展的重要任务.农业/农村生态景观建设和管护是生态环境管护的重要内容,也是休闲农业发展、乡村经济发展和文化复兴的基础.本文通过对比分析国内外农业/农村生态环境管护内容、制度以及研究实践,在农业/农村生态环境管护内容下,从生态景观角度,重点讨论了我国农业/农村生态景观管护在认识、工程技术和制度上存在的主要问题:对未来农业/农村的多功能性认识和研究有待提高、生态景观化工程技术有待开发、工程技术精细化和集成化有待提高、农业/农业生态景观管护制度有待完善.在此基础上,文章还提出了我国生态景观管护对策,包括:(1)拓宽和提升我国农业/农村的多功能性,如恢复农业景观生态服务功能、保护农业景观生物多样性、加强灾害适宜性管理及提高水土安全、加强乡村生态景观建设和促进休闲农业和乡村旅游发展等;(2)加强以农户或村集体为主体的管护制度建设;(3)加强部门协同机制和技术集成研究和示范.目前亟需提高公众和管理者对农业/农村生态景观管护的认识,培育良好的管护能力,开展农业/农村生态环境和景观管护工程技术研发、技术集成示范以及适合我国国情的管护制度研究探索.%Integrated measurement of agricultural and rural eco-environments management is critical for sustainable rural development. Ecological and landscape restorations are also key elements of rural environmental stewardship for agro-tourism, rural economic and cultural revival activities. Based on comparative reviews of European and American rural environmental stewardship policies and measures, this paper discussed problems of ecological and landscape restorations and enhancement in China's agricultural and rural environmental stewardships. The identified problems in

  2. Year in review 2011

    DEFF Research Database (Denmark)

    Afshari, Arash; Pagani, Leonardo; Harbarth, Stephan

    2012-01-01

    ABSTRACT: There is an ever-growing importance for critical assessment of benefits and harms of various strategies with regards to antibiotic stewardship, infection control, molecular detection of pathogens and adequate treatment of multidrug-resistant organisms in ICUs. Ongoing financial...... constraints globally, changing demographics with an increasing and aging population and the slow introduction of new antibiotics make the utilisation of the best available evidence and goal-directed strategies essential in the ICU setting. This review will summarise findings from some of the recent major...... publications in the area of infectious diseases with emphasis on the role of behaviour change strategies for infection control purposes, the role of biomarkers such as C-reactive protein and procalcitonin, and the impact of molecular diagnostics in clinical decision-making. Furthermore, we will update readers...

  3. Idaho National Laboratory Mission Accomplishments, Fiscal Year 2015

    Energy Technology Data Exchange (ETDEWEB)

    Allen, Todd Randall [Idaho National Lab. (INL), Idaho Falls, ID (United States); Wright, Virginia Latta [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-09-01

    A summary of mission accomplishments for the research organizations at the Idaho National Laboratory for FY 2015. Areas include Nuclear Energy, National and Homeland Security, Science and Technology Addressing Broad DOE Missions; Collaborations; and Stewardship and Operation of Research Facilities.

  4. Impact of rapid identification of Acinetobacter Baumannii via matrix-assisted laser desorption ionization time-of-flight mass spectrometry combined with antimicrobial stewardship in patients with pneumonia and/or bacteremia.

    Science.gov (United States)

    Wenzler, Eric; Goff, Debra A; Mangino, Julie E; Reed, Erica E; Wehr, Allison; Bauer, Karri A

    2016-01-01

    We evaluated the clinical and economic outcomes of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) with stewardship intervention in patients with Acinetobacter baumannii (AB) pneumonia and/or bacteremia. 66 patients were included in the pre-intervention group and 53 in the intervention group. The combination of AB identification via MALDI-TOF MS and ID PharmD intervention significantly reduced the median time to effective therapy compared to conventional identification without intervention [77.7 (95% CI: 73.1-84.8) to 36.6 (95% CI: 25.9-50.9) hours (P timely, effective antimicrobial therapy and is associated with increased clinical cure.

  5. Willamette Valley Vineyards becomes the first winery in the world to use sustainable cork stoppers certified by the Forest Stewardship Council%全球首家FSC葡萄酒厂得到认证

    Institute of Scientific and Technical Information of China (English)

    丁燕

    2007-01-01

    最近,美国俄勒冈州的威拉梅特谷葡萄园(Willamette Valley Vineyard)通过了森林管理委员会(Forest Stewardship Council,FSC)的认证,从而成为了世界上第一个FSC认证的葡萄酒厂,这意味着该酒厂以后所使用的软木塞将全部来自FSC认证的、可持续发展的、规范化管理的林地。此外,酒厂还获得了雨林联盟(Rainforest Alliance,RA)的产销监管链认证(Chain—of-Custody,COC),

  6. Correlates of 1-year incidence of urinary incontinence in older Latino adults enrolled in a community-based physical activity trial.

    Science.gov (United States)

    Morrisroe, Shelby N; Rodriguez, Larissa V; Wang, Pin-Chieh; Smith, Ariana L; Trejo, Laura; Sarkisian, Catherine A

    2014-04-01

    The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1-year incidence of UI in older community-dwelling Latino adults participating in a senior center-based physical activity trial in Los Angeles, California. Three hundred twenty-eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in-person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: "How often do you leak urine?" Potential correlates of 1-year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health-related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50-0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40-0.89) and mental (OR = 0.62, 95% CI = 0.43-0.91) HRQoL were independently associated with lower rates of 1-year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02-19.68) was independently associated with a higher rate of incident UI. One-year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.

  7. Trends in Antibiotic Use by Birth Season and Birth Year.

    Science.gov (United States)

    Kinlaw, Alan C; Stürmer, Til; Lund, Jennifer L; Pedersen, Lars; Kappelman, Michael D; Daniels, Julie L; Frøslev, Trine; Mack, Christina D; Sørensen, Henrik Toft

    2017-09-01

    We examined 2 birth cohort effects on antibiotic prescribing during the first year of life (henceforth, infancy) in Denmark: (1) the birth season effect on timing and overall occurrence of antibiotic prescribing, and (2) the birth year effect amid emerging nationwide pneumococcal vaccination programs and changing prescribing guidelines. We linked data for all live births in Denmark from 2004 to 2012 (N = 561 729) across the National Health Service Prescription Database, Medical Birth Registry, and Civil Registration System. Across birth season and birth year cohorts, we estimated 1-year risk, rate, and burden of redeemed antibiotic prescriptions during infancy. We used interrupted time series methods to assess prescribing trends across birth year cohorts. Graphical displays of all birth cohort effect data are included. The 1-year risk of having at least 1 redeemed antibiotic prescription during infancy was 39.5% (99% confidence interval [CI]: 39.3% to 39.6%). The hazard of a first prescription increased with age throughout infancy and varied by season; subsequently, Kaplan-Meier-derived risk functions varied by birth season cohort. After rollout of a first vaccination program and new antibiotic prescribing guidelines, 1-year risk decreased by 4.4% over 14 months (99% CI: 3.4% to 5.5%); it decreased again after rollout of a second vaccination program by 6.9% over 3 years (99% CI: 4.4% to 9.3%). In Denmark, birth season and birth year cohort effects influenced timing and risk of antibiotic prescribing during infancy. Future studies of antibiotic stewardship, effectiveness, and safety in children should consider these cohort effects, which may render some children inherently more susceptible than others to downstream antibiotic effects. Copyright © 2017 by the American Academy of Pediatrics.

  8. An EMG screening method (dysphagia limit) for evaluation of neurogenic dysphagia in childhood above 5 years old.

    Science.gov (United States)

    Ozdemirkiran, T; Secil, Y; Tarlaci, S; Ertekin, C

    2007-03-01

    Oropharyngeal dysphagia is not rare in older children before the adult age, especially the patients with cerebral palsy. Non-invasive simple tests are needed for the evaluation of children with neurogenic dysphagia including the patients with cerebral palsy. So we aimed to evaluate non-invasive ways to screen for dysphagia in children and the usefulness of this almost new electrophysiologic method for the detection of dysphagia in children with cerebral palsy. Twenty-eight healthy children and 12 patients with cerebral palsy were investigated for the applicability of this method. The movement of the larynx was monitored using a simple piezoelectric wafer sensor and submental surface EMG activity was recorded by bipolar silver-chloride electrodes taped under the chin over the submental muscle complex. The onset and duration of pharyngeal swallowing was recorded from submental-suprahyoid muscles such as the mylohyoid-genitohyoid-anterior digastric complex. By this method, the maximal water volume capacity was measured in single swallows with progressively increasing water volumes, this was called 'dysphagia limit'. The healthy control children revealed to swallow the bolus at once maximally 11.2+/-0.4 and 2.5 ml in average. Dysphagia limit varied from 7 to above 20 ml water volume from age 5-16 years old. Patients with cerebral palsy had the dysphagia limit of 7.7+/-1.8 and 6.4 ml in average. The dysphagia limit was significantly reduced in patients with cerebral palsy (pDysphagia limit seemed to be less sensitive in demonstrating the oropharyngeal swallowing disorders in childhood period (90% in the adult dysphagic patients). But the majority of patients with cerebral palsy (58%) showed abnormality. This electrophysiologic method is completely non-invasive, devoid from any hazard and applicable to children above 5 years. It may be candidate as a screening test before selection of dysphagic children.

  9. Medical Student Perceptions of the Learning Environment at the End of the First Year: A 28-Medical School Collaborative.

    Science.gov (United States)

    Skochelak, Susan E; Stansfield, R Brent; Dunham, Lisette; Dekhtyar, Michael; Gruppen, Larry D; Christianson, Charles; Filstead, William; Quirk, Mark

    2016-09-01

    Accreditation and professional organizations have recognized the importance of measuring medical students' perceptions of the learning environment, which influences well-being and professional competency development, to optimize professional development. This study was conducted to explore interactions between students' perceptions of the medical school learning environment, student demographic variables, and students' professional attributes of empathy, coping, tolerance of ambiguity, and patient-centeredness to provide ideas for improving the learning environment. Twenty-eight medical schools at 38 campuses recruited 4,664 entering medical students to participate in the two-cohort longitudinal study (2010-2014 or 2011-2015). The authors employed chi-square tests and analysis of variance to examine the relationship between Medical School Learning Environment Survey (MSLES) scores and student characteristics. The authors used mixed-effects models with random school and campus effects to test the overall variances accounted for in MSLES scores at the end of the first year of medical school. Student attributes and demographic characteristics differed significantly across schools but accounted for only 2.2% of the total variance in MSLES scores. Medical school campus explained 15.6% of the variance in MSLES scores. At year's end, students' perceptions toward the learning environment, as reported on the MSLES, differed significantly according to the medical school campus where they trained. Further studies are needed to identify specific factors, such as grading policies, administrative support, and existence of learning communities, which may influence perceptions of the learning environment at various schools. Identifying such variables would assist schools in developing a positive learning environment.

  10. The FTO genotype as a useful predictor of body weight maintenance: initial data from a 5-year follow-up study.

    Science.gov (United States)

    Matsuo, Tomoaki; Nakata, Yoshio; Hotta, Kikuko; Tanaka, Kiyoji

    2014-07-01

    We examined associations between the fat-mass and obesity-associated (FTO) gene (rs9939609) and any weight change over a 5-year period following a 14-week lifestyle intervention among middle-aged Japanese women. One hundred twenty-eight Japanese women (BMI >25 kg/m²) participated in a 14-week weight loss intervention between 2004 and 2006. Of the participants, 62 consented to the 5-year follow-up measurement session. Of these women, 47 women who achieved a weight loss of at least 10% from their baseline values during the 14-week intervention were included in the analysis. Body weight, body fat, abdominal fat assessed by CT scans, and metabolic risk factors (i.e., blood pressure, lipids, and glucose) were measured at baseline, post-intervention, and at the 5-year follow-up. During the 5-year non-intervention period, increases in body weight, fat mass, total abdominal fat, and subcutaneous abdominal fat were significantly greater in subjects with the homozygous minor allele (AA genotype, n=4; 8.5%) than in those with the homozygous major allele (TT genotype, n=31; 66.0%) or heterozygous allele (TA genotype, n=12; 25.5%). In multiple regression analyses, the variation in rs9939609 was a significant and independent predictor (Pweight during the 5-year follow-up. Our data suggest that Japanese women with the risk allele (AA) of rs9939609 may have more difficulty preventing fat gain from reoccurring after weight loss intervention than women with the other genotypes. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Microbiological surveillance and antimicrobial stewardship minimise the need for ultrabroad-spectrum combination therapy for treatment of nosocomial infections in a trauma intensive care unit: an audit of an evidence-based empiric antimicrobial policy.

    Science.gov (United States)

    Ramsamy, Yogandree; Muckart, David James Jackson; Han, Khine Swe Swe

    2013-03-15

    Nosocomial infections are a major cause of morbidity in the critically injured, and the incidence of resistant strains of bacteria is increasing. Management requires a strategy that achieves accurate empiric cover without antibiotic overuse - a goal that may be achieved by surveillance and antibiotic stewardship. With the aim of minimising the use of empirical ultrabroad-spectrum combination antimicrobial prescriptions and reducing bacterial resistance, the level I Trauma Intensive Care Unit (TICU) at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban employs stewardship and an antimicrobial policy based on surveillance. This study was undertaken with three aims: (i) to describe the spectrum and sensitivities of nosocomial pathogens in a level I TICU; (ii) to ascertain, based on surveillance data, how frequently initial empiric choice of antimicrobials was correct; and (iii) to determine how frequently ultrabroad-spectrum antimicrobials were prescribed and were actually necessary. Over a 12-month period, all critically injured patients who underwent mechanical ventilation in the TICU were identified from a prospectively gathered database. Information regarding every specimen submitted to the National Health Laboratory Services (NHLS) situated at IALCH was extracted from the laboratory computer database. For each patient, bacterial isolates and antimicrobial susceptibility were identified using standard laboratory techniques. Empiric prescriptions for presumed nosocomial sepsis were identified from the hospital's computerised patient record system and compared with culture results. Acinetobacter species were regarded as colonisers and treatment not offered unless this was the sole isolate in the presence of signs of severe sepsis. Results. Of 227 patients, 106 (46.6%) had 136 culture-positive isolates with a total of 323 pathogens (201 Gram-negative, 119 Gram-positive, 3 Candida albicans). There were 19 species of Gram-negative pathogens, of which 56

  12. Past Years

    Science.gov (United States)

    Lodge, Oliver

    2012-07-01

    Preface; 1. Ancestry and early days; 2. Schooldays; 3. Relation with other boys at school; 4. Education; 5. Influence of the Royal Institution; 6. Later education in London; 7. Reminiscences of Bedford College; 8. Scientific work and friends in London; 9. Personal retrospect; 10. Romance; 11. Influence of the British Association; 12. Reminiscences of Coopers Hill and assistants and popular lectures; 13. Liverpool; 14. Scientific work at Liverpool; 15. Scientific work at Liverpool (cont.); 16. Scientific work at Liverpool (cont.); 17. Electric waves and the beginnings of wireless; 18. Other friends; 19. Family life; 20. Holidays; 21. Side issues; 22. Early experiences in psychical research; 23. Psychical research; 24. Further psychic adventures, and psycho-physical phenomena; 25. Reminiscences of my years at the university of Birmingham; 26. Birmingham friendships and recollections; 27. Scientific retrospect; 28. Apologia pro vita mea; Index.

  13. CLINICAL PROFILE OF RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN CHILDREN UNDER 15 YEARS AGE GROUP AND ITS CORRELATION WITH ECHOCARDIOGRAPHY

    Directory of Open Access Journals (Sweden)

    Ramu

    2015-02-01

    Full Text Available Context ( Back ground Acute Rheumatic fever and Rheumatic heart disease are the most common acquired childhood heart disease in India. It is well established that 2 D Echo cardiography is more sensitive in picking up minor degrees of valvular regurgitation than clinical examination . AIMS & OBJECTIVES: To study the clinical profile of “Rheumatic Fever and Rheumatic heart disease“ & correlate it with Echocardiographic fin dings in Children under 15 years age group presenting to a tertiary care hospital. MATERIALS AND METHODS OF STUDY: Thirty six cases of Acute Rheumatic fever, which includes eight cases of first attack and twenty eight cases of reactivation of Rheumatic fev er were studied over a period of two years in paediatric medical wards, King George Hospital, Visakhapatnam. The revised (1992 modified Jones criteria with the 1988 WHO modification was taken as a criterion to diagnose Acute Rheumatic fever . RESULTS : Peak age of Acute Rheumatic fever and Chronic Rheumatic heart disease is between 5 - 10 years (55.8%. No sex variation has been observed. Fever and joint involvement are the most common clinical manifestations (87.5%each in first attack cases. Active cardi tis (75% the second most common manifestation , followed by arthralgia (25% and sore throat (25% , chorea , chest pain , abdominal pain were infrequent manifestations found to be 12.5% each. None of the cases had Erythema marginatum. CONCLUSION : In the pres ent study the clinical findings were correlated with that of previous studies and Echocardiographic findings were correlated well as far as moderate to severe lesions. Further Echocardiography was proved to be more sensitive in detecting even trivial or mi ld aortic regurgitation and mitral or aortic stenosis.

  14. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years' experience at a district general hospital.

    Science.gov (United States)

    Williams, T J; Bowie, P E

    1999-05-01

    Patients may find bronchoscopy without sedation unpleasant. There is some evidence that patient satisfaction correlates with amnesia for the procedure. For several years we have used doses of midazolam sufficient to put patients lightly asleep hoping to produce complete amnesia. We looked at practical aspects of this technique over a 2-year period. We studied 337 consecutive patients. They were 219 men and 118 women of mean age 63 +/- 12.4 (SD). Sixty-seven patients were aged 75 years or over and the eldest was 86. Sixty-three patients were already hospital inpatients but the remainder were seen as day cases. Midazolam was given by slow i.v. injection over several minutes until the patient was judged to be lightly asleep. Patients were given supplemental oxygen (3 l min-1) and monitored by ECG and pulse oximetry. A note was made of the time at which they awakened, defined as when nursing staff felt the patients were awake enough to have a cup of tea and toast. Patients were asked if they had any memory of the procedure both on awakening and when seen a few days later to discuss the results. The procedures were carried out in a well-staffed Day Case Unit with a recovery area. The mean dose of midazolam used was 10.8 mg (mean +/- SD = 0.16 +/- 0.095 mg kg-1). The midazolam was given over a median of 4 min (range 1-15 min). Patients took 59 +/- 45 min (mean +/- SD) to wake up. Twenty-eight patients were given flumazanil to reverse the sedation (11 for concern over bleeding following biopsies, three for desaturation during and three after procedure, four as they were frail, two as they were restless, two as they were hypotensive after procedure and three for miscellaneous reasons). Only nine patients could remember any part of the procedure. Incremental doses of midazolam given slowly until patients are lightly asleep almost invariably produce complete amnesia for bronchoscopy. This is a safe technique but patients need careful monitoring and may require reversal of

  15. Tuberculous Lymphadenitis in South-Eastern Nigeria; A 15 Years Histopathologic Review (2000-2014)

    Science.gov (United States)

    Ukekwe, FI; Olusina, DB; Banjo, AAF; Akinde, OR; Nzegwu, MA; Okafor, OC; Ocheni, S

    2016-01-01

    Background: The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent. Aim: To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria. Materials and Methods: This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria. Results: One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively. Conclusions: There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical

  16. 1-year In Vitro Evaluation of Tooth Discoloration Induced by 2 Calcium Silicate-based Cements.

    Science.gov (United States)

    Ramos, João Carlos; Palma, Paulo J; Nascimento, Rita; Caramelo, Francisco; Messias, Ana; Vinagre, Alexandra; Santos, João Miguel

    2016-09-01

    The purpose of this study was to compare tooth discoloration that occurs in teeth filled with ProRoot MTA (DENTSPLY Tulsa Dental Specialties, Tulsa, OK) or Biodentine (Septodont, Saint Maur des Fossés, France) over the course of 1 year. Twenty-eight intact premolars were resected 2 mm apical to the cementoenamel junction and the pulp tissues extirpated via the cervical cut. After the preparation of occlusal access to the pulp chamber, specimens were assigned into 4 groups according to a stratified randomization sampling process: group 1, negative control (dry sterile cotton pellet); group 2, positive control (blood-moistened cotton pellet); group 3, ProRoot WMTA (DENTSPLY Tulsa Dental Specialties); and group 4, Biodentine. The experimental materials were condensed into the crowns and the access sealed with glass ionomer restorative cement. Color was assessed at baseline (before placement of the materials), immediately after material filling, after 6 weeks of storage, and after 1 year using the Commission International de I'Eclairage L*a*b* system. Change in color, ΔE, was compared among groups and over time using analysis of variance. The 4 groups showed a significant decrease in L* values over time. Differences between Biodentine and WMTA were detected after 1 year, with the greater variation associated with WMTA (P = .001). The 4 groups presented a significant increase in ΔE from baseline to 1 year. All groups revealed perceptible color changes (ΔE > 2.3) between immediately after material filling and after 6 weeks and after 6 weeks and 1 year. After 1 year, no differences could be detected between Biodentine and WMTA. Delayed tooth discoloration was detected for the 2 materials at the 1-year evaluation, but it was more evident for ProRoot MTA than Biodentine. Luminance was the most affected parameter, with a higher decrease for ProRoot MTA. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. Four-millimeter implants supporting fixed partial dental prostheses in the severely resorbed posterior mandible: two-year results.

    Science.gov (United States)

    Slotte, Christer; Grønningsaeter, Arne; Halmøy, Anne-Marie; Öhrnell, Lars-Olof; Stroh, Göran; Isaksson, Sten; Johansson, Lars-Åke; Mordenfeld, Arne; Eklund, Jan; Embring, Jan

    2012-05-01

    Reduced alveolar bone volume complicates implant dentistry. In this prospective multicenter study, a new, 4-mm long Straumann SLActive implant (Ø 4.1 mm) supporting a fixed dental prosthesis (FDP) in the severely resorbed posterior mandible was evaluated for two years. Thirty-two patients (11 men, 21 women; mean age 64.1 years) participated. Ten to 12 weeks after single-stage surgery, a screw-retained FDP was attached to three or four 4-mm implants. One hundred implants were inserted. Three failed at surgery and four were lost before loading. Twenty-eight patients received FDPs (93 implants). Two patients were discontinued because of secondary exclusion criteria; therefore, 26 patients were followed up from baseline (BL). After 1 year, one patient insisted on removal of all implants and one patient died because of nonstudy-related complications. Twenty-four patients (87 implants) were eligible for examination 2 years post-loading. All implants were found to be stable [survival rate 95.7% (confidence interval, CI 88.8-98.3) after 1 year and 92.3% (CI 84.5-96.2) after 2 years]. The mean change from BL to 12 months was - 0.43 mm (CI 0.31-0.59; p < .001) and from 12 to 24 months - 0.11 mm (CI -0.01-0.23; p = .056). The survival rate is only slightly lower than in similar studies on 6 to 8.5 mm implants. This may be related to high initial stability and effective use of the residual bone volume with high primary bone-to-implant contact in dense bone structures. The surgical handling of the tested implant was found to be similar to that of implants of common length. However, the preparation procedure must be done with great care to avoid overdrilling. Careful planning and design of the prosthetic construction is mandatory to prevent unfavorable occlusion and avoid harmful shear forces. This study showed that 4 mm implants can support an FDP in severely resorbed posterior mandibles for at least 2 years and with healthy peri-implant conditions. © 2011 Wiley Periodicals

  18. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan

    2011-01-01

    ABSTRACT: Infections remain among the most important concerns in critically ill patients. Early and reliable diagnosis of infection still poses difficulties in this setting but also represents a crucial step toward appropriate antimicrobial therapy. Increasing antimicrobial resistance challenges...... established approaches to the optimal management of infections in the intensive care unit. Rapid infection diagnosis, antibiotic dosing and optimization through pharmacologic indices, progress in the implementation of effective antimicrobial stewardship and infection control programs, and management of fungal...

  19. Language, motor and cognitive development of extremely preterm children: modeling individual growth trajectories over the first three years of life.

    Science.gov (United States)

    Sansavini, Alessandra; Pentimonti, Jill; Justice, Laura; Guarini, Annalisa; Savini, Silvia; Alessandroni, Rosina; Faldella, Giacomo

    2014-01-01

    Survival rate of extremely low gestational age (ELGA) newborns has increased over 80% in the last 15 years, but its consequences on the short- and longer-term developmental competencies may be severe. The aim of this study was to describe growth trajectories of linguistic, motor and cognitive skills among ELGA children, compared to full-term (FT) peers, from the first to the third year of life, a crucial period for development. Growth curve analysis was used to examine individual and group differences in terms of initial status at 12 months and rate of growth through the second and the third year of life with five points of assessment. Twenty-eight monolingual Italian children, of whom 17 were ELGA (mean GA 25.7 weeks) and 11 were FT children, were assessed through the BSID-III at 12, 18, 24, 30 and 36 months for language skills and at 12, 24 and 30 months for motor and cognitive skills. ELGA children presented significantly lower scores than FT peers in language, motor and cognitive skills and they did not overcome their disadvantage by 3 years, even if their corrected age was taken into account. Concerning growth curves, in motor development a significant increasing divergence was found showing a Matthew effect with the preterm sample falling further behind the FT sample. In linguistic and cognitive development, instead, a stable gap between the two samples was found. In addition, great inter-individual differences in rate of change were observed for language development in both samples. Our findings highlight the theoretical and clinical relevance of analyzing, through growth curve analyses, the developmental trajectories of ELGA children in language skills taking into account their inter-individual variability also across motor and cognitive domains. After reading this article, the reader will interpret: (a) characteristics and growth trajectories of ELGA children from the first to the third year of life with respect to FT children in language, motor and

  20. The Belgian policy of funding antimicrobial stewardship in hospitals and trends of selected quality indicators for antimicrobial use, 1999-2010: a longitudinal study.

    Science.gov (United States)

    Lambert, Marie-Laurence; Bruyndonckx, Robin; Goossens, Herman; Hens, Niel; Aerts, Marc; Catry, Boudewijn; Neely, Fiona; Vogelaers, Dirk; Hammami, Naima

    2015-02-13

    In order to improve antimicrobial (AM) use, a policy of providing technical and financial support to AM management teams (AMTs) was rolled out in all Belgian hospitals between 2002 and 2008. We aimed to analyse the association of this policy with AM use for the two indications accounting for the largest number of patients receiving AM: prophylaxis for major lower limb orthopaedic surgery and pneumonia. We used patient-level data routinely collected in all Belgian acute care hospitals between 1999 and 2010. We modelled trends for selected quality indicators (QIs) using the year of AMT implementation in each hospital as the main 'change point', with fine-tuned case-mix adjustment. Of all admissions for lower limb orthopaedic surgery, and pneumonia between 1999 and 2010, 90% (325 094) and 95% (327 635), respectively, were found eligible for analyses. The surgery QI was defined as: cefazolin, dose in the expected range, and no use of other AM. For pneumonia, QIs were: ratio of oral/parenteral defined daily doses (DDD, O/P QI), and mean number of DDD minus penicillin, per 100 days of hospitalisation (DDD QI). Between 1999 and 2010, the surgery QI improved from 59% to 71%, the O/P QI from 0.72 to 0.97, and the DDD QI from 96 to 64. Heterogeneity between hospitals was high. Overall, no association was found with the year of implementation of the AMT. Improvements have been observed but could not be related at the national level to the policy under study. However, these results cannot be extrapolated to other QIs for AM use in hospitals. Our findings do not question the need for AMT, nor the need for continuation of AMT funding. Several recommendations can be made in order to make the best of Belgium's unique political and financial commitments in that field. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Creating a Digital Preservation Network with Shared Stewardship and Cost:The Experience of Partnerships in the National Digital Information Infrastructure and Preservation Program

    Institute of Scientific and Technical Information of China (English)

    MOLLY JOHNSON

    2008-01-01

    The National Digital Information Infrastructure and Preservation Program(NDIIPP)was initiated in December 2000 when the U.S.Congress authorized the Library of Congress to work with a broad range of institutions to develop a national strategy for the preservation of important at-risk born digital content.Guided by a strategy of broad collaborations and iterative learning,the Library of Congress began catalyzing a national network of partners dedicated to collecting and preserving important born-digital information.Over the last six years,the Library and its partners have been engaged in learning through action.Our investments in preservation partnerships,public policy deliberations related to intellectual property challenges,basic technical research,and network architecture models have increased our understanding of the sustaining roles and functions for a national network of diverse stakeholders.The emerging network of networks is complex and inclusive of a variety of stakeholders:content producers,content stewards and service providers from the public and private sectors.

  2. A feasibility study for an International Year of Landcare

    Science.gov (United States)

    Mutota, E.; Arnalds, A.

    2009-04-01

    for building a global land ethic and stewardship as foundational elements for a sustainable future. Such a year is ideal to promote the importance of improving the literacy of societies on their relationship with the land. However, establishing an International Year is not a seamless process. It needs to articulate clear goals and strategic objectives. A champion international lead agency is needed to facilitate the process in order to gain support among stakeholders at all levels. Maintaining a diverse body of committed stakeholders will secure the establishment of the year by the United Nations. With those points in place, launching a Year of Landcare will be feasible and ethically, culturally and environmentally desirable.

  3. Leadership and Stewardship of the Laboratory (Objective 4.1) Notable Outcome - Phase II Alternative Analysis and PNNL Site Plan Recommendation

    Energy Technology Data Exchange (ETDEWEB)

    Pittman, Jeffery P.; Cassidy, Stephen R.; Mosey, Whitney LC; Leitz, Erlan M.; Oukrop, Lanson J.

    2013-07-31

    Pacific Northwest National Laboratory (PNNL) and the Pacific Northwest Site Office (PNSO) have recently completed an effort to identify the current state of the campus and gaps that exist with regards to space needs, facilities and infrastructure. This effort has been used to establish a campus strategy to ensure PNNL is ready to further the United States (U.S.) Department of Energy (DOE) mission. Ten-year business projections and the impacts on space needs were assessed and incorporated into the long-term facility plans. In identifying/quantifying the space needs for PNNL, the following categories were addressed: Multi-purpose Programmatic (wet chemistry and imaging laboratory space), Strategic (Systems Engineering and Computation Analytics, and Collaboration space), Remediation (space to offset the loss of the Research Technology Laboratory [RTL] Complex due to decontamination and demolition), and Optimization (the exit of older and less cost-effective facilities). The findings of the space assessment indicate a need for wet chemistry space, imaging space, and strategic space needs associated with systems engineering and collaboration space. Based on the analysis, a 10-year campus strategy evolved that balanced four strategic objectives, as directed by the DOE Office of Science (DOE-SC): • Mission Alignment - maintain customer satisfaction • Reasonable & Achievable - do what makes sense from a practical and cost perspective • Campus Continuity - increase the federal control of assets and follow the Campus Master Plan • Guiding Principles - modern, collaborative, flexible, and sustainable. This strategy considered the following possible approaches to meet the identified space needs: • Institutional General Plant Project (IGPP) funded projects • Third party leased facilities • Science Laboratory Infrastructure (SLI) line item funded projects. Pairing the four strategic objectives with additional key metrics as criteria for selection, an initial

  4. The Hawai'i Undersea Research Laboratory: Applying Innovative Deep-sea Technologies Toward Research, Service, and Stewardship in Marine Protected Areas of the Pacific Region

    Science.gov (United States)

    Smith, J. R.

    2012-12-01

    The Hawai'i Undersea Research Laboratory (HURL) is the only U.S. deep submergence facility in the Pacific Rim tasked with supporting undersea research necessary to fulfill the mission, goals, and objectives of the National Oceanic and Atmospheric Administration (NOAA), along with other national interests of importance. Over 30 years of submersible operations have resulted in nearly 1900 dives representing 9300 hours underwater, and a benthic ecology database derived from in-house video record logging of over 125,000 entries based on 1100 unique deep-sea animal identifications in the Hawaiian Archipelago. As a Regional Center within the Office of Ocean Exploration and Research (OER), HURL conducts undersea research in offshore and nearshore waters of the main and Northwestern Hawaiian Islands and waters of the central, southern, and western Pacific. HURL facilities primarily support marine research projects that require data acquisition at depths greater than wet diving methods. These consist of the research vessel Ka'imikai-o-Kanaloa (KOK), human occupied submersibles Pisces IV and Pisces V (2000 m), a new remotely operated vehicle (6000 m), and a multibeam bathymetric sonar system (11,000 m). In addition, HURL has also supported AAUS compliant wet diving since 2003, including technical mixed gas/rebreather work. While ecosystem studies of island, atoll, and seamount flanks are the largest component of the HURL science program, many other thematic research areas have been targeted including extreme and unique environments, new resources from the sea, episodic events to long term changes, and the development of innovative technologies. Several examples of HURL's contributions to marine protected areas (MPAs) include: (a) A long term presence in the pristine ecosystems of the Papahānaumokuākea Marine National Monument in the Northwestern Hawaiian Islands. Researchers from National Marine Fisheries have used HURL assets to study endangered Hawaiian Monk Seal habitat

  5. Block-step asymmetry 5 years after large-head metal-on-metal total hip arthroplasty is related to lower muscle mass and leg power on the implant side.

    Science.gov (United States)

    Hjorth, M H; Stilling, M; Lorenzen, N D; Jakobsen, S S; Soballe, K; Mechlenburg, I

    2014-06-01

    Metal-on-metal articulations mimic the human hip anatomy, presumably lower dislocation rates and increase the range-of-motion. This study aims to measure the muscle mass and power of both legs in patients with unilateral metal-on-metal total hip arthroplasty, and to investigate their effect on block-step test, spatio-temporal gait parameters and self-reported function. Twenty-eight patients (7 women), mean age 50 (28-68) years, participated in a 5-7 year follow-up. Patients had received one type unilateral large-head metal-on-metal total hip articulation, all of which were well-functioning at follow-up. Mean muscle mass was measured by the total-body Dual energy X-ray Absorption scans, and muscle power was measured in a leg extensor power rig. Block-step test and spatio-temporal gait parameters were measured with an inertial measurement unit. Self-reported function was assessed by the Hip Disability and Osteoarthritis Outcome Score. We found a significant difference between the mean muscle mass of the implant-side leg and the non-implant-side leg in hip, thigh and calf areas (Pmuscle power (P=0.025). Correlations between mean muscle mass and mean muscle power were significant for both the implant-side leg (r=0.45, P=0.018) and the non-implant-side leg (r=0.51, P=0.007). The difference in mean muscle power between legs correlated with block-step test asymmetry during ascending (r=0.40, P=0.047) and descending (r=0.53, P=0.006). Correlations between self-reported function and power of the implant-side leg were not significant. Young patients have not fully regained muscle mass, muscle power and function 5-7 years after metal-on-metal total hip arthroplasty. Copyright © 2014. Published by Elsevier Ltd.

  6. Prognostic Impact of External Beam Radiation Therapy in Patients Treated With and Without Extended Surgery and Intraoperative Electrons for Locally Recurrent Rectal Cancer: 16-Year Experience in a Single Institution

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Sole, Claudio V., E-mail: cvsole@uc.cl [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Alvarez de Sierra, Pedro [Service of General Surgery, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Gómez-Espí, Marina [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Blanco, Jose [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Institute of Research Investigation, Hospital General Universitario Gregorio Marañón, Madrid (Spain); and others

    2013-08-01

    Purpose: To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). Methods and Materials: From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. Conclusions: EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

  7. USGS Information Technology Strategic Plan: Fiscal Years 2007-2011

    Science.gov (United States)

    ,

    2006-01-01

    Introduction: The acquisition, management, communication, and long-term stewardship of natural science data, information, and knowledge are fundamental mission responsibilities of the U.S. Geological Survey (USGS). USGS scientists collect, maintain, and exchange raw scientific data and interpret and analyze it to produce a wide variety of science-based products. Managers throughout the Bureau access, summarize, and analyze administrative or business-related information to budget, plan, evaluate, and report on programs and projects. Information professionals manage the extensive and growing stores of irreplaceable scientific information and knowledge in numerous databases, archives, libraries, and other digital and nondigital holdings. Information is the primary currency of the USGS, and it flows to scientists, managers, partners, and a wide base of customers, including local, State, and Federal agencies, private sector organizations, and individual citizens. Supporting these information flows is an infrastructure of computer systems, telecommunications equipment, software applications, digital and nondigital data stores and archives, technical expertise, and information policies and procedures. This infrastructure has evolved over many years and consists of tools and technologies acquired or built to address the specific requirements of particular projects or programs. Developed independently, the elements of this infrastructure were typically not designed to facilitate the exchange of data and information across programs or disciplines, to allow for sharing of information resources or expertise, or to be combined into a Bureauwide and broader information infrastructure. The challenge to the Bureau is to wisely and effectively use its information resources to create a more Integrated Information Environment that can reduce costs, enhance the discovery and delivery of scientific products, and improve support for science. This Information Technology Strategic Plan

  8. Technology Partnership Program fiscal year 1998 program plan

    Energy Technology Data Exchange (ETDEWEB)

    Ford, R.

    1997-09-15

    The Oak Ridge Y-12 Plant will use the Technology Partnership Program to support the DOE nuclear weapons complex (NWC), particularly at the Oak Ridge Y-12 Plant. This support will be achieved through partnerships with industry that enhance the science and technology base and the core capabilities necessary to meet current and future weapons program mission needs. This program will enhance the Weapons Complex technology base and core capabilities by participating, in diversified portfolios of collaborative projects with industrial. The Y-12 Technology Partnership Program (TPP) closely aligns its program with the goals, objectives, and strategies of the DP Stockpile Stewardship and Management plans and DOE technology transfer policy. The Y-12 Defense Programs Office is the primary customer of the Y-12 TPP, and provides input to program planning and execution. Industry involvement is also an essential component. Programs and projects within the Y-12 TPP are responsive to identified weapons complex mission needs. In FY98 the Y-12 TPP will execute the plan devised during FY97 which emphasized the program`s increasing focus on providing benefits to DP. This plan called for the soft-landing of four terminated projects early in FY97 and the normal conclusion of four others at various times throughout the year. Successful conclusion of these projects enabled a call for new TPP projects in FY98 with clearer Defense Program benefits. The Defense Programs benefits were assured by the participation of Y-12`s Weapon Advisory Council, which met to determine proposal guidelines and criteria. The Weapons Advisory Council later met to rank each proposal against the established guidelines assuring those proposals with the best DP benefits would be chosen. The goal for the Y-12 TPP program will be to successfully implement the winning proposals in the first quarter of FY98 and maintain administrative and fiscal control over these and continuing projects.

  9. Technology Partnership Program fiscal year 1998 program plan

    Energy Technology Data Exchange (ETDEWEB)

    Ford, R.

    1997-09-15

    The Oak Ridge Y-12 Plant will use the Technology Partnership Program to support the DOE nuclear weapons complex (NWC), particularly at the Oak Ridge Y-12 Plant. This support will be achieved through partnerships with industry that enhance the science and technology base and the core capabilities necessary to meet current and future weapons program mission needs. This program will enhance the Weapons Complex technology base and core capabilities by participating, in diversified portfolios of collaborative projects with industrial. The Y-12 Technology Partnership Program (TPP) closely aligns its program with the goals, objectives, and strategies of the DP Stockpile Stewardship and Management plans and DOE technology transfer policy. The Y-12 Defense Programs Office is the primary customer of the Y-12 TPP, and provides input to program planning and execution. Industry involvement is also an essential component. Programs and projects within the Y-12 TPP are responsive to identified weapons complex mission needs. In FY98 the Y-12 TPP will execute the plan devised during FY97 which emphasized the program`s increasing focus on providing benefits to DP. This plan called for the soft-landing of four terminated projects early in FY97 and the normal conclusion of four others at various times throughout the year. Successful conclusion of these projects enabled a call for new TPP projects in FY98 with clearer Defense Program benefits. The Defense Programs benefits were assured by the participation of Y-12`s Weapon Advisory Council, which met to determine proposal guidelines and criteria. The Weapons Advisory Council later met to rank each proposal against the established guidelines assuring those proposals with the best DP benefits would be chosen. The goal for the Y-12 TPP program will be to successfully implement the winning proposals in the first quarter of FY98 and maintain administrative and fiscal control over these and continuing projects.

  10. 注射疗法加中药热敷治疗钙化性冈上肌腱炎28例%Injection Therapy Combined with Hot Compress of Chinese Medicine for Treating Twenty-Eight Cases with Calcified Supraspinatus Tendonitis

    Institute of Scientific and Technical Information of China (English)

    王鹏; 侯鹍; 朱超

    2015-01-01

    目的:观察注射疗法配合中药热敷治疗钙化性冈上肌腱炎的临床疗效.方法:将56例钙化性冈上肌腱炎患者随机分为治疗组和对照组各28例.对照组给予热敷散热敷,治疗组在对照组的基础上给予局部注射治疗,用1%利多卡因20 mL,加得宝松1 mL配制成混悬液注射,每周1次,3次为1个疗程.结果:治疗组有效率为92.85%,对照组有效率为78.57%,两组有效率比较,差异具有统计学意义(P<0.05).治疗组患者肩部疼痛,关节活动度及X线平片的改善均优于对照组,差异具有统计学意义(P<0.05).结论:注射疗法配合中药热敷治疗钙化性冈上肌腱炎疗效显著且明显优于单纯中药热敷治疗.

  11. ENVIRONMENTAL STEWARDSHIP OF PHARMACEUTICALS - THE GREEN PHARMACY

    Science.gov (United States)

    The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of conceited attention beginning in the 1980s. PPCPs typically occur as trace environme...

  12. Personnel Management: Stewardship of Human Resources

    Science.gov (United States)

    MacLean, Douglas G.

    1976-01-01

    The personnel function of top management is examined by first studying the environment in which top management functions. The basic skills required to perform the function are discussed. Against this background, six elements of personnel management in colleges and universities are considered: goals and objectives, organization for personnel…

  13. Microbiological surveillance and antimicrobial stewardship minimise ...

    African Journals Online (AJOL)

    2011-06-06

    Jun 6, 2011 ... care units (ICUs),[3] driven by the fear that selecting the wrong ... Nosocomial infections are a major cause of morbidity in the critically injured, and the incidence of resistant strains of ..... Bad bugs, no drugs: no ESKAPE!

  14. 75 FR 31609 - Conservation Stewardship Program

    Science.gov (United States)

    2010-06-03

    ... method to determine in an open and participatory process, potential participants' current and future... the ranking factors were defined and implemented. Finally, program design and adaptive program... provide recommendations to the Chief. NRCS designed the program to recognize excellent stewards and...

  15. General Practitioner Antimicrobial Stewardship Programme Study (GAPS)

    DEFF Research Database (Denmark)

    Avent, Minyon L; Hansen, Malene Plejdrup; Gilks, Charles;

    2016-01-01

    BACKGROUND: There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess...... have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient...... testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing...

  16. Guiding phosphorus stewardship for multiple ecosystem services

    Science.gov (United States)

    Phosphorus is vital to agricultural production and water quality regulation. While the role of phosphorus in agriculture and water quality has been studied for decades, the benefits of sustainable phosphorus use and management for society due to its downstream impacts on multiple ecosystem services...

  17. Stewardship to tackle global phosphorus inefficiency

    NARCIS (Netherlands)

    Withers, P.J.A.; Dijk, van K.C.; Neset, T.S.S.; Nesme, Thomas; Oenema, Oene; Rubæk, G.H.; Schoumans, O.F.; Smit, Bert; Pellerin, Sylvain

    2015-01-01

    The inefficient use of phosphorus (P) in the food chain is a threat to the global aquatic environment and the health and well-being of citizens, and it is depleting an essential finite natural resource critical for future food security and ecosystem function. We outline a strategic framework of 5

  18. ENVIRONMENTAL STEWARDSHIP OF PHARMACEUTICALS - THE GREEN PHARMACY

    Science.gov (United States)

    The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of conceited attention beginning in the 1980s. PPCPs typically occur as trace environme...

  19. Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment

    Directory of Open Access Journals (Sweden)

    Marta de Lana

    2009-12-01

    Full Text Available Twenty-eight Chagas disease patients (CD, 22 with the indeterminate clinical form (IND and six with the cardiac or digestive form (CARD/DIG, were treated with benznidazole and underwent clinical and laboratorial analysis before (IND and CARD/DIG and nine years after [patients after treatment (CDt, patients with the indeterminate clinical form at treatment onset (INDt and with the cardiac or digestive form at treatment onset (CARD/DIGt] treatment. The data demonstrate that 82.1% of CDt patients (23/28 remained clinically stable and 95.4% of the INDt (21/22 and 33.3% of the CARD/DIGt (2/6 patients showed unaltered physical and laboratorial examinations. The clinical evolution rate was 2%/year and was especially low in INDt patients (0.5%/year relative to CARD/DIGt patients (7.4%/year. Positive haemoculture in treated patients was observed in 7.1% of the cases. None of the INDt (0/21 and 33.3% of the CARD/DIGt (2/6 patients displayed positive cultures. The PCR presented a positive rate significantly higher (85.2%, 23/27 than haemoculture and two samples from the same patient revealed the same result 57.7% of the patients. Conventional serology-ELISA on 16 paired samples remained positive in all individuals. Semi-quantitative ELISA highlighted significant decreases in reactivity, particularly in INDt relative to IND. Non-conventional serology-FC-ALTA-IgG, after treatment, showed positive results in all sera and 22 paired samples examined at seven and nine years after treatment, demonstrated significantly lower reactivity, particularly in INDt patients. This study was retrospective in nature, had a low number of samples and lacked an intrinsic control group, but the data corroborate other results found in the literature. The data also demonstrate that, even though a cure has not been detected in the none-treated patients, the benefits for clinical evolution were selectively observed in the group of INDt patients and did not occur for CARD

  20. The ICSU World Data System: a Global System of Data Systems, Year 4

    Science.gov (United States)

    Minster, J. H.; Mokrane, M.

    2012-12-01

    The primary goals of the ICSU World Data System (ICSU-WDS, created in October 2008), are to ensure the long-term stewardship of quality-assessed data for research and education, and the provision of such data and related data services to the international science community and other stakeholders. New technological options opened by today's management, curation and on-line distribution of multi-disciplinary digital data sets make these goals achievable. The WDS is built as an international federated system of long-term data archives and data related services covering a wide spectrum of sciences. Since our last report, an International Program Office (IPO) was inaugurated, and is hosted by NICT in Tokyo, Japan. In the past two years, 160 organizations have formally requested membership, and 44 of these applications have been fully completed among which 38 are from Regular and Network member organizations dealing directly with data curation and data analysis services. Others include Partner and Associate members. ICSU-WDS fosters and enables interdisciplinary data activities, but recognizes that many disciplines (e.g. seismology, oceanography, astronomy, space sciences, biodiversity, health and social sciences) have already developed domain-specific efficient answers to their data challenges. WDS is evolving into a system of data systems wherein integration of interdisciplinary data depends on implementation of interoperability arrangements. Although the focus of WDS is on the long-term stewardship of scientific data—so that the value of data holdings might actually increase with time—WDS members must share some overarching principles to achieve this goal. This is realized through promotion of close collaboration between members but more importantly through a formal accreditation process based on well-defined certification criteria. These include, for example, the development and adoption of standards and quality control practices, analysis and metadata services

  1. UPWARD MOVEMENT OF PLUTONIUM TO SURFACE SEDIMENTS DURING AN 11-YEAR FIELD STUDY

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan, D.; Beals, D.; Cadieux, J.; Halverson, J.

    2010-01-25

    An 11-y lysimeter study was established to monitor the movement of Pu through vadose zone sediments. Sediment Pu concentrations as a function of depth indicated that some Pu moved upward from the buried source material. Subsequent numerical modeling suggested that the upward movement was largely the result of invading grasses taking up the Pu and translocating it upward. The objective of this study was to determine if the Pu of surface sediments originated from atmosphere fallout or from the buried lysimeter source material (weapons-grade Pu), providing additional evidence that plants were involved in the upward migration of Pu. The {sup 240}Pu/{sup 239}Pu and {sup 242}Pu/{sup 239}Pu atomic fraction ratios of the lysimeter surface sediments, as determined by Thermal Ionization Mass Spectroscopy (TIMS), were 0.063 and 0.00045, respectively; consistent with the signatures of the weapons-grade Pu. Our numerical simulations indicate that because plants create a large water flux, small concentrations over multiple years may result in a measurable accumulation of Pu on the ground surface. These results may have implications on the conceptual model for calculating risk associated with long-term stewardship and monitored natural attenuation management of Pu contaminated subsurface and surface sediments.

  2. UPWARD MOVEMENT OF PLUTONIUM TO SURFACE SEDIMENTS DURING AN 11-YEAR FIELD STUDY

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan, D.; Beals, D.; Cadieux, J.; Halverson, J.

    2010-01-25

    An 11-y lysimeter study was established to monitor the movement of Pu through vadose zone sediments. Sediment Pu concentrations as a function of depth indicated that some Pu moved upward from the buried source material. Subsequent numerical modeling suggested that the upward movement was largely the result of invading grasses taking up the Pu and translocating it upward. The objective of this study was to determine if the Pu of surface sediments originated from atmosphere fallout or from the buried lysimeter source material (weapons-grade Pu), providing additional evidence that plants were involved in the upward migration of Pu. The {sup 240}Pu/{sup 239}Pu and {sup 242}Pu/{sup 239}Pu atomic fraction ratios of the lysimeter surface sediments, as determined by Thermal Ionization Mass Spectroscopy (TIMS), were 0.063 and 0.00045, respectively; consistent with the signatures of the weapons-grade Pu. Our numerical simulations indicate that because plants create a large water flux, small concentrations over multiple years may result in a measurable accumulation of Pu on the ground surface. These results may have implications on the conceptual model for calculating risk associated with long-term stewardship and monitored natural attenuation management of Pu contaminated subsurface and surface sediments.

  3. KAMIR评分与GRACE评分预测急性心肌梗死患者一年死亡率的临床研究%Clinical assessment of KAMIR and GRACE scores system on predicting one-year mortality of acute myocardial infarction patients

    Institute of Scientific and Technical Information of China (English)

    高戎; 钱骏; 徐建如

    2013-01-01

    目的 比较KAMIR评分与GRACE评分预测急性心肌梗死(AMI)患者一年死亡率的价值.方法 对收治128例AMI患者进行回顾性分析,计算KAMIR、GRACE评分,采用受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC);KAMIR和GRACE的评分AUC比较采用Z检验.结果 KAMIR及GRACE评分预测AMI患者一年死亡率的AUC分别为0.880和0.792,两者比较差异有统计学意义(Z=2.524,P=0.0116).结论 KAMIR评分对预测AMI患者一年死亡率有较好的预测价值.%Objective To evaluate the predictive value of KAMIR and GRACE scores system score on predicting one - year mortality of acute myocardial infarction (AMI) patients. Methods One hundred and twenty - eight patients with AMI were retrospectively analyzed. The KAMIR and GRACE scores were calculated. The area under the receiver operating characteristic ( ROC ) curve ( AUC ) was evaluated using ROC curve. KAMIR, GRACE scores and AUC were analyzed by Z test. Results The AUCs of KAMIR and GRACE score for predicting one - year mortality of AMI patients were 0. 880 and 0. 792,respectively, which were significantly different between the two scores system(Z =2. 524,P = 0.0116). Conclusion KAMIR score is a better predictive factor of one - year mortality for AMI patients.

  4. 2008: transition year and crucial year!

    CERN Multimedia

    Association du personnel

    2008-01-01

    The year 2008 will be an important, even crucial year for the Organization and its staff. Indeed, the start-up of the LHC will mark the beginning of a fascinating period for the physics community and, more generally, for basic science in Europe and the world. All eyes of this community will be focused on the CERN site in Geneva. It is essential that we are able, all together, to successfully pass this milestone to enter the LHC era, thus crowning over a decade of hard work of all staff concerned.

  5. Happy New Year

    Institute of Scientific and Technical Information of China (English)

    姚婷

    2008-01-01

    As part of the the Chinese New Year celebration, people buy presents, decorations, special foods and new clothing. Railroad stations throughout China are filled with travelers who take their vacation days around New Year to return home for a family

  6. Five Extraordinary Years

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    THE Hong Kong Special Administrative Regionis now five years old. These have been fiveextraordinary and innovative years, duringwhich the concept of "one country, two sys-tems" advocated by Deng Xiaoping has become a

  7. Western New Year

    Institute of Scientific and Technical Information of China (English)

    康俊民

    2006-01-01

    @@ There is one-day holiday in most countries on New Year's Day. The real celebrations for New Year happen on the night before-on New Year's Eve. There are several interesting customs in the West, and there are many differences from country to country.

  8. Yangliuqing New Year Pictures

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    HANGING up New Yearpictures during khe SpringFestival to symbolize goodluck in the coming year has longbeen a tradition in China,The pic-tures are both colorful and jubilantin theme and composition so as toattract everything good in the com-ing year and drive away evil.Four main“schools” of folk artdealing with New Year pictures ex-ist.Among the best known is thewoodblocK print from Yangliuqing,

  9. Is Three Years Enough?

    Science.gov (United States)

    Waits, Bert K.; Demana, Franklin

    1988-01-01

    Argues that the college preparatory curriculum should include more than three years of mathematics. Presents data indicating that 86 percent of students with less than three years of college preparatory mathematics take remedial mathematics and relatively few students are ready to take calculus when they enter the university. (PK)

  10. Final Year Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Hubsch, Tristan [Howard University

    2013-06-20

    In the last years of this eighteen-year grant project, the research efforts have focused mostly on the study of off-shell representations of supersymmetry, both on the worldline and on the world- sheet, i.e., both in supersymmetric quantum mechanics and in supersymmetric field theory in 1+1-dimensional spacetime.

  11. One Year Later

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    It has now been one year since the catastrophic 8.0-magnitude earthquake slammed Sichuan Province on May 12, 2008. At 2:28 p.m. on that terrible day, the most destructive calamity to hit China in 60 years struck

  12. 20 Years and Counting

    Science.gov (United States)

    Kuzyk, Raya

    2008-01-01

    In commemoration of the Librarian of the Year Award's 20th anniversary, this article presents brief vignettes on all 19 of the title holders. When "Library Journal" named them Librarians of the Year, these inimitable 19 (for the 20th, Norma Blake, see EJ788676) had singled themselves out as risk takers, visionaries, bulldogs, pragmatists,…

  13. THE BLOOD PRESSURE AMONG HIGH RISK PILGRIMS OF KLOTER 30 BEKASI, YEAR 2003 BEFORE DEPARTURE IN INDONESIA AND AFTER UMRAH IN MECCA

    Directory of Open Access Journals (Sweden)

    Betty Roosihermiatie

    2012-11-01

    Full Text Available The main cause of mortality among Indonesian pilgrims was circulatory diseases. The death was common among old pilgrims, especially due to heart failure. It is known that hypertension is one of the causes of heart failure The study aimed to determine blood pressures among high risk pilgrims after umrah in Mecca, Saudi Arabia and blood pressure in Indonesia with influencing factors: sex, body mass index, accommodation room density, and number of condition/diseases.It was an observational study. Twenty eight high risk pilgrims of kelompok terbang (kloter or flight group 30 JKS year 2003 were voluntarily participated in the study. The blood pressure of the respondents was measured at sitting position. Mean differences of systolic and diastolic blood pressure in Indonesia and after umrah was compared by paired t-test. Systolic blood pressure in Indonesia after umrah, by controlling confounding variables was analyzed by linear regression model. The systolic blood pressure of respondents after umrah tended to decrease to 0.43 mm Hg in comparison to 1 mmHg increase on examination in Indonesia, at number of conditions/diseases to be constant. It is likely that the psychological sincerity (ikhlas has influenced the decrease of sympathetic intervations system in brainstem for blood pressure to lower of systolic blood pressure. Meanwhile, the systolic blood pressure after umrah tended to increase to 11.94 mmHg for a number of conditions/diseases to be constant. The pilgrimage activities is hard, especially in surrounding higher climate at the average of 39• C. So pilgrims with the condition as old people or having diseases influenced the systolic blood pressure. The peripheral vasoconstriction possibly caused increase systolic blood pressure. Pilgrimage is a hard physical activity, more over for high risk pilgrims. Hence, monitoring pilgrim health conditions, especially the high risk pilgnms, should be conducted by kloter health workers, like to control

  14. Mathematics year 5 answers

    CERN Document Server

    Alexander, Serena; Poggo, Tammy

    2014-01-01

    Features the complete set of answers to the exercises in Mathematics Year 5, to save you time marking work and enable you to identify areas requiring further attention. The book includes diagrams and workings where necessary, to ensure pupils understand how to present their answers. Also available from Galore Park www.galorepark.co.uk :. - Mathematics Year 5. - Mathematics Year 6. - 11+ Maths Practice Exercises. - 11+ Maths Revision Guide. - 10-Minute Maths Tests Workbook Age 8-10. - 10-Minute Maths Tests Workbook Age 9-11. - Mental Arithmetic Workbook Age 8-10. - Mental Arithmetic Workbook Ag

  15. Antimicrobial resistance in Pseudomonas sp. causing infections in trauma patients: A 6 year experience from a south asian country

    Directory of Open Access Journals (Sweden)

    Nonika Rajkumari

    2014-01-01

    Full Text Available Drug resistance to Pseudomonas sp. has spread to such a level irrespective of the type of patients, that its pattern of distribution and antibiotic resistance needs to be studied in detail, especially in trauma patients and hence the study. A 6 year study was carried out among trauma patients to see the trend and type of resistance prevalent in the apex hospital for trauma care in India among nonduplicate isolates where multidrug-resistance (MDR, cross-resistance and pan-drug resistance in Pseudomonas sp. were analyzed. Of the total 2,269 isolates obtained, the species, which was maximally isolated was Pseudomonas aeruginosa (2,224, 98%. The highest level of resistance was seen in tetracycline (2,166, 95.5%, P < 0.001 and chloramphenicol (2,160, 95.2%, P < 0.001 and least in meropenem (1,739, 76.7%, P < 0.003. Of the total, 1,692 (74.6% isolates were MDR in which P. aeruginosa (75% were maximum. MDR Pseudomonas is slowing increasing since the beginning of the study period. Of 1,797 imipenem-resistant P. aeruginosa isolated during the study period, 1,763 (98% showed resistance to ciprofloxacin or levofloxacin, suggesting that cross-resistance may have developed for imipenem due to prior use of fluoroquinolones. Antibiotic resistance in Pseudomonas sp. is fast becoming a problem in trauma patients, especially in those who requires prolong hospital stay, which calls for proper antimicrobial stewardship.

  16. Year 2000 awareness

    Energy Technology Data Exchange (ETDEWEB)

    Holmes, C.

    1997-11-01

    This report contains viewgraphs on the challenges business face with the year 2000 software problem. Estimates, roadmaps, virtual factory software, current awareness, and world wide web references are given.

  17. 60 Years Unforgettable

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    <正>CPAFFC President Li Xiaolin,Former President Chen Haosu and two young staff cutting the cake in celebration of the 60th anniversary of the CPAFFC at a CCTV special program 60 Years Unforgettable on May 16

  18. Happy (Chinese) New Year!

    Science.gov (United States)

    Johnson, Georgia G.

    1979-01-01

    Suggestions are made for a classroom celebration of Chinese New Year, including discussion of the Chinese calendar and customs, a short list of appropriate children's stories, and food ideas, including a recipe for fortune cookies. (SJL)

  19. Year book Australia 1986

    Energy Technology Data Exchange (ETDEWEB)

    Castles, I. (comp.)

    1986-01-01

    The Year Book is the principal reference work produced by the Central Office of the Australian Bureau of Statistics (ABS). It provides a comprehensive and detailed statistical review of all asepcts of the economy and social conditions of Australia. In addition, it contains descriptive matter dealing with Australia's history, geography, physiography, climate and meteorology, government, defence, international relations, culture and environment. The first Official Year Book was published early in 1908. This is the seventieth Year Book issued under the authority of the Commonwealth Government and follows a similar pattern to previous editions. However chapters have been revised and new material has been added. Most of the statistics contained in this volume relate to the years ended June or December 1984 to 1985. More detailed, and in most cases more recent, statistics are available in other ABS publications.

  20. Hve Years and Counting

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    A war may drag on for months and years. So does the war on terror. Five years have passed since the 9/11 events changed the skyline in New York and the security and political landscape of the world. Since the war on terror was declared, achievements have been made. Afghanistan's Taliban regime was toppled. Saddam Hussein was captured and put on trial. A terrorist plot was foiled in London. But in spite of these triumphs, one cannot help wondering: Has the

  1. 100 years of superconductivity

    CERN Document Server

    Rogalla, Horst

    2011-01-01

    Even a hundred years after its discovery, superconductivity continues to bring us new surprises, from superconducting magnets used in MRI to quantum detectors in electronics. 100 Years of Superconductivity presents a comprehensive collection of topics on nearly all the subdisciplines of superconductivity. Tracing the historical developments in superconductivity, the book includes contributions from many pioneers who are responsible for important steps forward in the field.The text first discusses interesting stories of the discovery and gradual progress of theory and experimentation. Emphasizi

  2. Chinese New Year

    Institute of Scientific and Technical Information of China (English)

    王芳

    2005-01-01

    The Chinese New Year is now known as the Spnng Festival because it starts trom the beginning otspring. Though there are some sayings about its origin (起源), all agree that the word Nian, which inmodern Chinese means “year”, was originally the name of a beast (野兽) that started to eat people thenight before the beginning of a new year.

  3. Years Follow-Up

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2013-05-01

    Full Text Available   Inroduction: Heart failure (HF is an important cause of morbidity and mortality in the cases of Beta-thalassemia major. The purpose of this study was to estimate HF prevalence in these patients and to assess the survivability of those who were treated with intensive chelating therapy.   Design and methods: This cross sectional study included 72 beta-thalassemia major cases, the mean age at the time of referral was 15.7±6.2 years (range 6-35 years and were followed in a prospective 2 year study. A self-reporting symptom questionnaire was administered, a 12-lead ECG was taken and an echocardiography was obtained from all participants. Echocardiography was performed at 6 month intervals or when a new symptom developed. Results: Risk factors (except for iron overload in the study population were hypothyroidism and diabetes mellitus. The male to female ratio was0.75.Twelve patients had left ventricular (LV systolic dysfunction and 57,79% had LV diastolic dysfunction whereas 11,15% had RV failure. Fifty-nine (81% patients had cardiac disease of which diastolic dysfunction was the most common manifestation .Those with systolic dysfunction were older at presentation (22 ± 6 years versus 31 ± 4 years; P

  4. Celebrating nine years together

    Directory of Open Access Journals (Sweden)

    Martinico Giuseppe

    2017-08-01

    Full Text Available Perspectives on Federalism starts off its ninth year with this issue which gathers, as usual, a series of multi-disciplinary pieces. Almost two years have passed since we started our collaboration with De Gruyter, and our journal has since then enjoyed continued growth and has been acquiring international visibility. 2017 is going to be rich in surprises for our readers, with a wealth of interesting projects and special issues which will increase the already high standard of the journal. 2016 was also a very challenging year for scholars interested in federalism; the start of the Trump Presidency and the results of the referendum on Brexit held on 23 June 2016 are just two examples.

  5. Emergent technologies: 25 years

    Science.gov (United States)

    Rising, Hawley K.

    2013-03-01

    This paper will talk about the technologies that have been emerging over the 25 years since the Human Vision and Electronic Imaging conference began that the conference has been a part of, and that have been a part of the conference, and will look at those technologies that are emerging today, such as social networks, haptic technologies, and still emerging imaging technologies, and what we might look at for the future.Twenty-five years is a long time, and it is not without difficulty that we remember what was emerging in the late 1980s. Yet to be developed: The first commercial digital still camera was not yet on the market, although there were hand held electronic cameras. Personal computers were not displaying standardized images, and image quality was not something that could be talked about in a standardized fashion, if only because image compression algorithms were not standardized yet for several years hence. Even further away were any standards for movie compression standards, there was no personal computer even on the horizon which could display them. What became an emergent technology and filled many sessions later, image comparison and search, was not possible, nor the current emerging technology of social networks- the world wide web was still several years away. Printer technology was still devising dithers and image size manipulations which would consume many years, as would scanning technology, and image quality for both was a major issue for dithers and Fourier noise.From these humble beginnings to the current moves that are changing computing and the meaning of both electronic devices and human interaction with them, we will see a course through the changing technology that holds some features constant for many years, while others come and go.

  6. Sixty Years of Friendship

    Institute of Scientific and Technical Information of China (English)

    Liu; Gengyin

    2014-01-01

    <正>On December 2,1977,the CPAFFC held a grand reception in the Great Hall of the People to celebrate the 80th birthday of Rewi Alley,an old friend from New Zealand.Comrade Deng Xiaoping attended the reception and declared:"Tens of thousands of foreign friends have devoted themselves to the cause of Chinese revolution.Even so,rare are those like Comrade Rewi Alley,who for 50 years on end has done tremendous work for the Chinese people,in our years of difficulty and

  7. New year, old hat

    Science.gov (United States)

    American Geological Institute; American Institute of Physics; American Associationthe Advancement of Science; Carlowicz, Michael

    It is only August, but October 1 looms large on the calendar. That is the day when the 1997 fiscal year (FY ‧97) begins for the U.S. federal government, and like last year, that day might come without a budget.In a flurry of summer activity, the U.S. Congress has passed several landmark bills on welfare reform, expansion of health coverage for workers between jobs, a raise in the minimum wage, and a Safe Drinking Water Act. The House of Representatives even passed all 13 of its annual appropriations bills before Congress took its August recess.

  8. 60 Years of Impression

    Institute of Scientific and Technical Information of China (English)

    DENG Qiwei

    2009-01-01

    @@ It has been 60 years since foundation of the People's Republic of China.These 60 years,China has experienced a huge transformation,from short supply of textile and apparel to nowadays big country of it.Facing the tough time of economic crisis,China's textile and apparel industry has been carrying out adjustment and renovation in time.How to enhance independent and creative capacity,upgrade technology,and improve brands' influence,to explore a new industrialized road and achieve the goal of being a strong country of textile by 2020 as well,it still has a long way to go.

  9. ENLIGHT 10 year Anniversary

    CERN Multimedia

    Alvarez, Paul

    2012-01-01

    Ten years ago, in February 2002, the European Network for Light Ion Hadron Therapy (ENLIGHT) had its inaugural meeting at CERN. As a pioneering multidisciplinary network celebrates its 10th anniversary, some of the founders recall how it all started. Picture 1 : Participants at the 10th anniversary meeting of ENLIGHT at CNAO, Pavia, in September 2012.

  10. Eleventh Year Mathematics.

    Science.gov (United States)

    Buchman, Aaron; Zimmerman, Robert

    This outline for Eleventh Year Mathematics in New York adheres closely to the recommendations of The Commission of Mathematics of the College Entrance Examination Board and thus presents a unified development of certain aspects of algebra, trigonometry, and analytic geometry. Its aim is both as a terminal course in mathematics and as a solid…

  11. Fifty years in neonatology.

    Science.gov (United States)

    Manley, Brett J; Doyle, Lex W; Davies, Mark W; Davis, Peter G

    2015-01-01

    Neonatology, the care and study of newborn infants, is a 'young' specialty. Over the last 50 years, there have been many advances in the way that neonatologists care for newborn infants, particularly those born preterm, leading to dramatic improvements in mortality. To illustrate these advances, we describe four eras in neonatology from the point of view of the junior hospital doctor.

  12. IREDA: ten years on

    Energy Technology Data Exchange (ETDEWEB)

    Sahai, I.M.

    1998-04-01

    The Indian Renewable Energy Development Agency has a ten-year history of promoting small hydro energy sources for many communities beyond the reach of the national grid. Sources of funding for hydro installations in India are mentioned. It is suggested that the expansion of the hydro schemes would benefit from greater co-ordination between central and state governments. (UK)

  13. Affordances: Ten Years On

    Science.gov (United States)

    Brown, Jill P.; Stillman, Gloria

    2014-01-01

    Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

  14. Western New Year

    Institute of Scientific and Technical Information of China (English)

    康俊民

    2006-01-01

    There is One-day holiday in most countries on New Year's Day.The real celebrations for New Year happen on the night before-on New Year's Eve,There are several interesting customs in the West ,and there are many differences form country to country.

  15. ESO: The CERN Years

    CERN Multimedia

    Schaeffer, A

    2012-01-01

    In 1970, CERN and ESO signed a collaboration agreement for the construction of the Observatory’s first telescope. That same year, ESO’s Telescope Division and Sky Atlas laboratory settled on the CERN site in Meyrin. Let’s turn back to the beginnings of this lasting and fruitful alliance.

  16. Ten Years of CERI.

    Science.gov (United States)

    Hameyer, Uwe

    1980-01-01

    Reports on the activities of the Centre for Educational Research and Innovation (CERI) within the last 10 years and in the future. Topics include mathematics instruction, lifelong learning, environmental education at the university level, inservice and preservice education and education for the handicapped adolescent. (SA)

  17. Creativity: The Early Years

    Science.gov (United States)

    Shade, Rick; Shade, Patti Garrett

    2016-01-01

    There is a myth that some people are creative and others are not. However, all children are born creative. They love to explore, ask questions, and are incredibly imaginative. Parents are key in nurturing their child's creativity in the early years. This article offers resources and strategies parents can use at different ages and stages (newborn,…

  18. A Tumultuous Year

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    2011 sees international order in transition amid chaos While the global financial crisis continued to take a toll on societies and politics globally 2011 has been a year of relentless turmoil and chaos. What underlies these waves of turmoil is the labor pains of the birth of a new international order.

  19. 'THE FIVE ACCURSED YEARS'

    DEFF Research Database (Denmark)

    Bryld, Claus

    2007-01-01

    The subject for this paper is the question of how the Second World War has been perceived and used since that war - in Denmark, and especially in recent years, but also with a comparative view to Norway and Sweden. In addition to an outline of the development of public history regarding the war...

  20. 150 years of science

    Directory of Open Access Journals (Sweden)

    Francesca Messina

    2011-08-01

    Full Text Available This preview of the Festival della Scienza 2011 focuses on a major initiative celebrating 150 years of Italian scientific research. Run jointly by the Italian Research Council (CNR and the Associazione Festival della Scienza, the project presents outstanding achievements in various fields including neuroscience, web technologies, genetics, chemistry and much more.

  1. 7 CFR 932.19 - Crop year and fiscal year.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Crop year and fiscal year. 932.19 Section 932.19... Regulating Handling Definitions § 932.19 Crop year and fiscal year. (a) Crop year means the 12-month period... be recommended by the committee and approved by the Secretary. (b) Fiscal year means the...

  2. 60 Years of Impression

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    It has been 60 years since foundation of the People’s Republic of China. These 60 years, China has experienced a huge transformation, from short supply of textile and apparel to nowadays big country of it. Facing the tough time of economic crisis, China’s textile and apparel industry has been carrying out adjustment and renovation in time. How to enhance independent and creative capacity, upgrade technology, and improve brands’ influence, to explore a new industrialized road and achieve the goal of being a strong country of textile by 2020 as well, it still has a long way to go.But once we look back the history, we find pride and inspiration of China’s textile industry.

  3. 25 years of service

    CERN Multimedia

    2004-01-01

    On Thursday 2 December, the Director-General received the 14 staff members who began to work in 1979, CERN's 25th anniversary, and are now themselves celebrating 25 years of service at CERN. Beugnet Claude / AB Bourgeois Georges / AB Goossens Michel / IT Herzog Patrick / IT Jeanneret Jean-Bernard / AB Lacarrère Daniel / TS Mollay Robert / TS Mornacchi Giuseppe / PH Ployer Annie / DSU Remondino Vittorio / AT Stellfeld Donat / AB Taureg Hans / PH Terrier Jean-Pierre / AB Wehrle Urs / AB

  4. Fiscal Year 1982

    Science.gov (United States)

    1983-01-01

    staff continued to serve as referees for various professional journals. Papers were refereed last year for the following: 0 Management Science 0 Journal...1 DRCSM 1 DRCSM-E 1 DRCSM-W 1 DRCSM-I 1 DRC SM-P 1 DRCSM-PM 1 DRCRE 1 DRCCP 1 DRCIS 1 DRCDM 1 DRCDP 1 DRCMS 1 DRCQA Dep Chf of Staff for Logistics

  5. Ten Years of Chandra

    Science.gov (United States)

    Weisskopf, Martin C.

    2009-01-01

    We celebrated the 10-th anniversary of the Launch of the Chandra X-ray Observatory on July 13, 2009. During these 10 years data from this Great Observatory have had a profound impact on 21st century astrophysics. With its unrivaled capability to produce sub-arcsecond images, the Observatory has enabled astronomers to make new discoveries in topics as diverse as comets and cosmology. We shall review some of the highlights, discuss the current status, and future plans.

  6. JCE: 80 Years New

    Science.gov (United States)

    Moore, John W.

    2003-01-01

    Participating in the National Science, Technology, Engineering, and Mathematics Education Digital Library project is an exciting prospect for JCE. We expect to be able to make major contributions to the project and derive major benefits from participating in it. Your help in this important undertaking would be most welcome and greatly appreciated. Help us demonstrate that an 80-year-old can dance to a new tune!

  7. Twenty-Year Reunion

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    A massive earthquake measuring 7.8 on the Richter Scale struck the city of Tangshan at 3:42 a.m. on July 28, 1976. The city, which had history of well over 100 years and a population of over one million people, was left in ruins. The violent earthquake killed 242,469 people, with 164,851 people sustaining injuries, 2,652 children under 16 years of age left as orphans and 885 elderly people as widowers. Some 96 percent of the city’s buildings and houses collapsed, with a direct economic loss of 10 billion yuan. Earthquake tremors spread over a two million square kilometer area, with hundreds of millions people placed in peril by the natural disaster.The Tangshan earthquake set a record as the world’s strongest earthquake of the century. The people of Tangshan have set a new record for the rate of reconstruction accomplished over the past 20 years. The support of the People’s Liberation Army and people across the nation combined with the unyielding efforts of survivors led to the establishment of a new Ta

  8. 2011: What a year!

    CERN Multimedia

    Staff Association

    2012-01-01

    “What a year it’s been, and what a way to end it. The star of the show has been the LHC, along with its experiments, which have again turned in an Oscar-winning performance. But there has been a strong supporting cast of actors ranging from antimatter to the CLOUD experiment.” This is what the Director-General wrote to us on 20 December in his message with his wishes for the festive season. And, do not forget, the famous hyperfast neutrinos toward Gran Sasso that put CERN on the front of the world stage. These achievements which are the pride and strength of the Organization were made possible “thanks to the hard work of all CERN’s staff,” as noted by the Director-General in his New Year speech of Wednesday, January 11. He reviewed the year 2011 and set out the challenges ahead in 2012 and beyond. The scientific and technological achievements of 2011 are a great satisfaction to the Director-General, his team and all CERN staff. Moreover, despite a...

  9. 40 Years of Discovery

    Energy Technology Data Exchange (ETDEWEB)

    Weinstein, B; Heller, A

    2003-07-08

    History is most interesting when seen through the eyes of those who lived it. In this 40th anniversary retrospective of bioscience research at Lawrence Livermore National Laboratory, we've asked 19 scientists to share their personal recollections about a major accomplishment in the program's history. We have not tried to create a comprehensive or seamless story. Rather, we've attempted to capture the perspectives of key individuals, each of whom worked on a research program that met significant milestones. We have focused particularly on programs and accomplishments that have shaped the current Biology and Biotechnology Research Program (BBRP). In addition, we have included a timeline of biosciences at LLNL, a history of the directorate that appeared in the Laboratory's magazine, ''Science & Technology Review'', in 2002, and a list of bioscience-related articles that have appeared over the years in ''Science & Technology Review and its predecessor, Energy & Technology Review''. The landscape of biological science today is stunningly different from 40 years ago. When LLNL bioscience began in 1963, we knew about the structure of DNA and that it was the carrier of genetic information. However, it would be another year before scientists would understand how DNA codes for the production of proteins and more than a decade before the earliest DNA sequence would be known. It is sometimes difficult to remember that it was only 15 years ago that the polymerase chain reaction, a synthetic method to amplify pieces of DNA was developed, and that only within the last half-dozen years has sequence data for entire organisms begun to be available. In this publication, we have tried to capture some of the landmark and seminal research history: radiation effects studies, which were a major reason for founding the biological research program, and flow sorting and chromosome painting, which dramatically changed our ability to

  10. Antimicrobial use over a four-year period using days of therapy measurement at a Canadian pediatric acute care hospital

    Science.gov (United States)

    Dalton, Bruce R; MacTavish, Sandra J; Bresee, Lauren C; Rajapakse, Nipunie; Vanderkooi, Otto; Vayalumkal, Joseph; Conly, John

    2015-01-01

    BACKGROUND: Antimicrobial resistance is a concern that is challenging the ability to treat common infections. Surveillance of antimicrobial use in pediatric acute care institutions is complicated because the common metric unit, the defined daily dose, is problematic for this population. OBJECTIVE: During a four-year period in which no specific antimicrobial stewardship initiatives were conducted, pediatric antimicrobial use was quantified using days of therapy (DOT) per 100 patient days (PD) (DOT/100 PD) at the Alberta Children’s Hospital (Calgary, Alberta) for benchmarking purposes. METHODS: Drug use data for systemic antimicrobials administered on wards at the Alberta Children’s Hospital were collected from electronic medication administration records. DOT were calculated and rates were determined using 100 PD as the denominator. Changes over the surveillance period and subgroup proportions were represented graphically and assessed using linear regression. RESULTS: Total antimicrobial use decreased from 93.6 DOT/100 PD to 75.7 DOT/100 PD (19.1%) over the 2010/2011 through to the 2013/2014 fiscal years. During this period, a 20.0% increase in PD and an essentially stable absolute count of DOT (2.9% decrease) were observed. Overall, antimicrobial use was highest in the pediatric intensive care and oncology units. DISCUSSION: The exact changes in prescribing patterns that led to the observed reduction in DOT/100 PD with associated increased PD are unclear, but may be a topic for future investigations. CONCLUSION: Antimicrobial use data from a Canadian acute care pediatric hospital reported in DOT/100 PD were compiled for a four-year time period. These data may be useful for benchmarking purposes. PMID:26600813

  11. The University Treasurer's Report Can Make Sense Without Abandoning Fund Accounting or Stewardship. NACUBO, The College and University Business Officer, Studies in Management, Vol. 2, No. 9, June, 1973.

    Science.gov (United States)

    Wilkinson, William M.

    This article suggests that all too often college and university financial reports are meaningless. They indicate the current funds "surplus" or "deficit" that has been the typical university response when asked how the university did that year. In place of this, the university financial support should look at the total picture of the university,…

  12. 500 years after Columbus.

    Science.gov (United States)

    Imbach, A

    1992-01-01

    The astonishing range of plants and animals of Central America's 7 countries (Guatemala, Belize, Honduras, El Salvador, Nicaragua, Costa Rica and Panama) is disappearing, as 60% of its forests have been cut for lumber and firewood as well as for cotton, cattle, or subsistence crops. Up to 5 million Mayans lived sustainably for thousands of years in an area now being destroyed by a few hundred thousand inhabitants. The Spanish colonization that started 500 years ago was concentrated in Panama, Nicaragua, and Guatemala. The majority of the English-speaking country of Belize are descended from the black slave population whose culture spread down the coast to Central America. Panama's service economy is based on the Panama Canal and trade and finance. Costa Rica benefits from a tourist industry based on its natural beauty, however, it also has the highest rate of deforestation and its fast population growth could jeopardize earlier social and economic progress. In El Salvador and Guatemala long periods of civil conflict have taken their toll on the economy and the environment. El Salvador has a mountainous territory and limited natural resources and industrialization, while the best land is in the hands of a few families. Honduras and Nicaragua retain the highest proportion of forest cover of the countries in the region, despite Nicaragua's years of tyranny, then revolution and the Contra war, and Honduras's own turmoils. Belize has achieved some stability, and is now strengthening its Central American links. Its coral reefs and coastal areas offer potential for sustainable development through fishing and tourism. Central American countries face the challenges of their fragile environments and major social problems.

  13. aged over 55 years

    Directory of Open Access Journals (Sweden)

    Anna Knyszyńska

    2016-06-01

    Full Text Available Background . Aging is a physiological process during which a number of adverse and irreversible organ involution changes, leading to a reduction in functional capacity of the body, both in physical and mental terms. The risk of chronic disease and depression increases with age. Objectives . Analysis of body composition and depression in people over 55 years of age with metabolic syndrome. Material and methods . The study group is 157 persons aged 55–69 years (112 women and 45 men. The authors analyzed body composition by electrical bioimpedance analyzer (Jawon IOI 353. In addition to the assessment of depression a questionnaire involving 30-point Geriatric Depression Scale was used. Results . In the study group women scored significantly lower than men on the average values of lean body mass, and an average of 7% higher than the value determining the percentage of body fat. The vast majority (70.7%; n = 111 patients showed no signs of depression. It has been shown that women with major depression had significantly higher mean values of body fat compared to women characterized by the absence or a mild depression. Conclusions . Diagnosis of depression in the elderly may be difficult due to the presence of the “masked depression”. There is a trend indicating the relationship between the prevalence of depressive symptoms and weight and body composition of people over 55 years of age, but in order to verify it the authors need to continue the study on increased number of research groups, perhaps taking into account different environmental factors.

  14. Years of Change

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    It’s well-known to people who are familiar with China that the grand boom of the country has been achieved through the revolutionary state policy of reform and opening up.This effort has helped the nation break its eco- nomic shackles and escape the grip of poverty. Against all expectations,this initiative was triggered by a group of starv- ing farmers from a small village in Fengyang County,east China’s Anhui Province.In the deep of winter 30 years ago,18 households of the village

  15. Ceremony marking Einstein Year

    CERN Multimedia

    2005-01-01

    Sunday 13th November at 10:00amat Geneva's St. Peter's Cathedral To mark Einstein Year and the importance of the intercultural dialogue of which it forms a part, a religious service will take place on Sunday 13 November at 10 a.m. in St. Peter's Cathedral, to which CERN members and colleagues are warmly welcomed. Pastor Henry Babel, senior minister at the Cathedral, will speak on the theme: 'God in Einstein's Universe'. Diether Blechschmidt will convey a message on behalf of the scientific community.

  16. PAs: Fifty years young.

    Science.gov (United States)

    Mandel, Ellen D; North, Shannon

    2017-10-01

    The PA profession is 50 years young. Practicing PAs and current students hail from several generational categories ranging from Builders to Generation Z. This article reviews how different generations may have experienced PA program expansion, professional identity, state licensing, and prescription delegation. The authors sampled a cohort of PA program applicants about their views on what evokes optimism and concern for the PA profession. These themes mirror the recently paved professional road, while posing the all-important question: What construction lies on the horizon?

  17. NEW YEAR, NEW JOURNAL

    Institute of Scientific and Technical Information of China (English)

    Zunqi; Lin

    2013-01-01

    <正>We are excited to release the first issue of High Power Laser Science and Engineering(abbreviated HPLaser)at the beginning of 2013,Year of the Snake in the Chinese calendar.First of all,I would like to give our sincere thanks to those who have contributed to the publishing of the new journal.Since the invention of laser in 1960,the requirements of scientific research have driven the development of high power laser technology.Laser output power continues to increase dramatically through the development of laser technology,and many new research topics are being discovered and created.

  18. Ceremony marking Einstein Year

    CERN Multimedia

    2005-01-01

    Sunday 13th November at 10:00amat Geneva's St. Peter's Cathedral To mark Einstein Year and the importance of the intercultural dialogue of which it forms a part, a religious service will take place on Sunday 13 November at 10 a.m. in St. Peter's Cathedral, to which CERN members and colleagues are warmly welcomed. Pastor Henry Babel, senior minister at the Cathedral, will speak on the theme: 'God in Einstein's Universe'. Diether Blechschmidt will convey a message on behalf of the scientific community.

  19. [Osteology--100 years].

    Science.gov (United States)

    Götte, S

    2001-10-01

    As is the case for many other subspecialties of medical science, osteology has developed in tandem with technological progress over the last 100 years. The discover of X-rays made visualization of the skeletal system possible. Progress in surgery and hygiene permitted examination and treatment of bones in vivo. Optical techniques made it possible to gain insight into the microarchitecture of the bone. Chemistry and biochemistry opened the door for pathophysiology and microcellular assessment of the bone so that modern osteology deals with interventions in cellular mechanisms, in particular for the treatment of bone diseases. The realization that the bone represents a dynamic tissue, characterized by processes of generation and degeneration, was decisive. These events have a profound influence on the treatment of osteoporosis. Questions pertaining to osteology have been subject to heightened interdisciplinary debate in the past few years, which is reflected in interdisciplinary associations and co-operative groups, and ultimately the umbrella Society of Osteology. Contemplation of the subject from an interdisciplinary viewpoint shows what a significant and natural role orthopedics plays in research on bone metabolism, but also in the treatment of bone diseases. Interdisciplinary cooperation aids quality control and is also reflected in the formulation of common guidelines for the clinical picture of osteoporosis, which constitutes a major epidemiological disease.

  20. 2010: a decisive year

    CERN Multimedia

    Association du personnel

    2010-01-01

    Salaries, Health Insurance, Pensions The year 2010 will see the LHC reach an energy likely to open a new window on the microscopic world. Furthermore, in 2010, the Organization, in its role as a State, will have to consolidate the social security system of its present, past, and future employees. This means our Pension Fund, which is showing a deficit of two thousand million Swiss francs, and our Health Insurance Scheme, which is also in deficit. The next five-yearly review of our salaries will also end in 2010. During this time of good wishes, let us hope that the level of our salaries and of our health insurance remain attractive in order to attract, retain and motivate the staff of the highest competence needed by CERN to carry out its current and future projects. Adhere to the principles as well On Thursday 17 December, the Staff Association called on you to participate in a gathering in the main building and to sign a petition (see photos). More than 800 of you attended that day, for which we thank...