WorldWideScience

Sample records for unit main outcome

  1. Global Units modulo Circular Units : descent without Iwasawa's Main Conjecture

    CERN Document Server

    Belliard, Jean-Robert

    2009-01-01

    Iwasawa's classical asymptotical formula relates the orders of the $p$-parts $X_n$ of the ideal class groups along a $\\ZM_p$-extension $F_\\infty/F$ of a number field $F$, to Iwasawa structural invariants $\\la$ and $\\mu$ attached to the inverse limit $X_\\infty=\\limpro X_n$. It relies on "good" descent properties satisfied by $X_n$. If $F$ is abelian and $F_\\infty$ is cyclotomic it is known that the $p$-parts of the orders of the global units modulo circular units $U_n/C_n$ are asymptotically equivalent to the $p$-parts of the ideal class numbers. This suggests that these quotients $U_n/C_n$, so to speak unit class groups, satisfy also good descent properties. We show this directly, i.e. without using Iwasawa's Main Conjecture.

  2. A mobile Magnetic Sensor Unit for the KATRIN Main Spectrometer

    CERN Document Server

    Osipowicz, A; Letnev, J; Marte, P; Müller, A; Spengler, A; Unru, A; 10.1088/1748-0221/7/06/T06002

    2012-01-01

    The KArlsruhe TRItium Neutrino experiment (KATRIN) aims to measure the electron neutrino mass with an unprecedented sensitivity of 0.2 eV/c2, using b decay electrons from tritium decay. For the control of magnetic field in the main spectrometer area of the KATRIN experiment a mobile magnetic sensor unit is constructed and tested at the KATRIN main spectrometer site. The unit moves on inner rails of the support structures of the low field shaping coils which are arranged along the the main spectrometer. The unit propagates on a caterpillar drive and contains an electro motor, battery pack, board electronics, 2 triaxial flux gate sensors and 2 inclination senors. During operation all relevant data are stored on board and transmitted to the master station after the docking station is reached.

  3. Properties and outcomes of spinal rehabilitation units in four countries

    DEFF Research Database (Denmark)

    Fromovich-Amit, Y; Biering-Sørensen, F; Baskov, V

    2009-01-01

    for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). RESULTS: Differences were found between the units in rehabilitation objectives, facilities and special equipment......OBJECTIVE: Compare rehabilitation after spinal cord lesions (SCL) in different countries. DESIGN: Multicenter comparative study. SETTING: Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. SUBJECTS: 199 SCL patients. INTERVENTIONS: Information was collected about unit...... properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. chi (2)-test, t-test, ANOVA and ANCOVA were used for statistical analysis. MAIN OUTCOME MEASURES: Time from lesion onset to admission...

  4. Improving Pupil Referral Unit Outcomes: Pupil Perspectives

    Science.gov (United States)

    Michael, Siobhan; Frederickson, Norah

    2013-01-01

    Concern has been expressed about the quality of alternative provision for young people with social, emotional and behavioural difficulties, and the poor academic and social outcomes many experience. Little research has sought the views of the young people themselves regarding the enablers and barriers to positive outcomes they have encountered. A…

  5. Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care

    Directory of Open Access Journals (Sweden)

    Camila Amthauer

    Full Text Available ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender, main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%, aged between 29 days and two years (44.5%. There was a prevalence of the urgent risk category (43.6%. The main flowchart used in the care was worried parents (22.4% and the most prevalent discriminator was recent event (15.3%. The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital.

  6. Identifying meaningful outcome measures for the intensive care unit.

    Science.gov (United States)

    Martinez, Elizabeth A; Donelan, Karen; Henneman, Justin P; Berenholtz, Sean M; Miralles, Paola D; Krug, Allison E; Iezzoni, Lisa I; Charnin, Jonathan E; Pronovost, Peter J

    2014-01-01

    Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time. To a large extent, ICU outcome measures deemed valid, important, and preventable by clinicians are unavailable, and abstracting clinical data from the medical record is excessively burdensome. Even if a set of outcomes garnered consensus, ensuring adequate risk adjustment to facilitate fair comparisons across institutions presents another challenge. This study reports on a consensus process to build 5 outcome measures for broad use to evaluate the quality of ICU care and inform quality improvement efforts.

  7. Prognosis of unprotected left main coronary artery stenting and the factors affecting the outcomes in Chinese

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background The long term prognosis of unprotected left main coronary artery (LMCA) stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes. Methods From May 1997 to March 2003,224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis .Results Stents were implanted into LMCA successfully in 223 cases (99.6 %). One death (0.5%) and one case of non-Q wave nonfatal myocardial infarction (MI) occurred in hospital. The mean follow-up time was (15.6±12.3) months. Cardiac death developed in 10 cases (4.5%), noncardiac death in 2 cases (0.9%), nonfatal MI in 4 cases (1.8%), target lesion revascularization (TLR) of LMCA in 26 cases (11.7%) and TLR of nonLMCA in 37 cases (16.5%). Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction (LVEF < 40%), female gender and LMCA combined with multivessel disease; that major adverse cardiac events (MACE) correlated with LVEF < 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF < 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The restenosis rate was 31.4%. Conclusions Long-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF ≥ 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.

  8. Long Term Outcome of Unprotected Left Main Stem Percutaneous Coronary Intervention, a Single Centre Experience

    Directory of Open Access Journals (Sweden)

    Egred M

    2014-11-01

    Full Text Available Percutaneous coronary intervention (PCI is increasingly used for unprotected left main coronary artery disease (UPLMS revascularization. Data regarding long-term mortality in this subset of patients remain sparse. We aim to present our outcome data on all comers who had UPLMS PCI. Methods: Retrospective dataset analysis of prospectively collected data evaluating all UPLMS PCI performed in a large tertiary cardiac centre, between September 2003 and December 2012. Long-term mortality data were available over a median duration of 21 months (IQR 10 months to 43 months. Results: In total there were 483 procedures performed. The cohort consisted of 58% with non ST elevation myocardial infarction (NSTEMI, 17% with STEMI and 25% with stable angina (SA. The overall in-hospital and long-term mortality were 7% and 22% respectively. The in-hospital mortality was 23%, 6%, and 1.6% in STEMI, NSTEMI, and SA respectively. Long-term mortality was 31% in STEMI patients, 26% in NSTEMI and 10% in SA. The use of drug eluting stents (DES [adjusted RR 0.40 (95% CI, 0.23-0.69] and Intravascular ultrasound (IVUS [adjusted RR 0.17 (95% CI 0.04-0.72] were independently associated with improved long-term survival. Conclusion: UPLMS PCI is associated with favourable long-term survival. The use of DES and IVUS guided PCI appear to be associated with improved long-term outcome and should be considered in the routine management of this cohort of patients.

  9. Different school placements following language unit attendance: which factors affect language outcome?

    Science.gov (United States)

    Conti-Ramsden, Gina; Botting, Nicola; Knox, Emma; Simkin, Zoë

    2002-01-01

    The study compared the outcomes of two groups of children who were attending language unit provision at 7 years of age. Of 242 children in the original study, 62 (28%) transferred to mainstream school placements at age 8 years. These children were then closely matched to children still attending language unit provision at this age using measures of non-verbal IQ, expression and comprehension. These two groups of children were compared on outcome at 11 years in the areas of language skill, non-verbal IQ and social behaviour. Teacher/speech-language therapist opinions of placement were also examined as factors affecting outcome. Results show that children who moved to mainstream provision at 8 years were more likely to be attending mainstream at 11 years, although the majority received extra support. No further differences were evident in outcome according to placement type. However, there was a main effect of teacher/therapist opinion on outcome--children whose teachers were not entirely happy with the 8-year placement performed more poorly at 11 years on language measures. There were no differences on any other measures. The findings suggest that follow-on placements for children attending language units need to be more closely in line with teacher's opinions and that more flexibility needs to be evident in school placement policy in order that appropriate educational settings can be arranged.

  10. 牛津英语8A Unit3 Main task教案设计

    Institute of Scientific and Technical Information of China (English)

    胡雪莲

    2011-01-01

    Content:Main task Objectives Knowledge objectives:To revise and consolidate words and grammar in this unit;To master some places of interest in China. Ability objectives:To select and organize information:To identity and sort out information in order to plan a day out:To write a letter to invite your friends to go sighting. Moral objectives:To encourage students to love our motherland Difficult points:To write a letter to invite your friends to go sighting Aids:A Multi-media computer Time:45 minutes Teaching procedures: Step one:Brainstorm (ask students to brainstorm information about some places of interest.)

  11. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Directory of Open Access Journals (Sweden)

    Jensen Gunnar

    2011-01-01

    Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

  12. The main factors influencing canine demodicosis treatment outcome and determination of optimal therapy.

    Science.gov (United States)

    Arsenović, Milica; Pezo, Lato; Vasić, Nebojša; Ćirić, Rodoljub; Stefanović, Milan

    2015-07-01

    The main idea of this research was to evaluate the efficacy of canine demodicosis conventional treatments using mathematical analyses. All available papers published between 1980 and 2014 were used in this study. One hundred six clinical trials enrolling 3414 cases of generalized demodicosis in dogs are studied. Dogs entered in the analysis were only the ones in which the disease occurred naturally, excluding the studies in which transplantation of Demodex canis mites was done from other animals. In conventional acaricide treatments, sorted according to active substances (moxidectin, amitraz, doramectin, ivermectin, and milbemycin oxime), the way of application (spot-on, dips, orally, or subcutaneous), concentration, and interval of application were used as input parameters in mathematical modeling. Data of interest were the treatment outcome, the number of dogs that went into remission, the number of animals not responding to treatment microscopically, the average duration of therapy, the follow-up period, the number of patients with disease recurrence, the number of adverse effects, and the number of animals with side effects. Dogs lost to follow-up or when the treatment was discontinued, due to various reasons not in connection with the therapy protocol, were not considered. Statistical and mathematical analyses were applied for prediction of the drugs' effectiveness. Developed mathematical models showed satisfactorily r (2), higher than 0.87. Good evidence for recommending the use of milbemycin oxime PO (0.5 mg/kg, daily) and moxidectin spot-on (Advocate®, Bayer) weekly is found. A bit less effective therapies were based on ivermectin PO (0.5 mg/kg, daily), moxidectin PO (0.35 mg/kg, daily), and amitraz dips (0.05 % solution, weekly), respectively. It is important to keep in mind that Advocate® is recommended by the manufacturer for use in milder cases.

  13. Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care.

    Science.gov (United States)

    Amthauer, Camila; Cunha, Maria Luzia Chollopetz da

    2016-08-29

    to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency. cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital. caracterizar os atendimentos realizados por meio da classificação de risco pelo Sistema de Triagem de Manchester, identificando dados demográficos (idade, sexo), principais fluxogramas, discriminadores e desfechos na emergência pediátrica. estudo quantitativo transversal. Os dados referentes à classificação de risco foram obtidos por meio de uma pesquisa ao registro informatizado de dados dos prontuários dos pacientes atendidos na emergência pediátrica no período de um ano. Para análise foi utilizada estatística descritiva com frequências absolutas e relativas. foram realizados 10.921 atendimentos na emergência pediátrica, em sua maioria do sexo masculino (54,4%), com idade entre 29 dias e dois anos (44

  14. Main Power Distribution Unit for the Jupiter Icy Moons Orbiter (JIMO)

    Science.gov (United States)

    Papa, Melissa R.

    2004-01-01

    Around the year 2011, the Jupiter Icy Moons Orbiter (JIMO) will be launched and on its way to orbit three of Jupiter s planet-sized moons. The mission goals for the JIMO project revolve heavily around gathering scientific data concerning ingredients we, as humans, consider essential: water, energy and necessary chemical elements. The JIM0 is an ambitious mission which will implore propulsion from an ION thruster powered by a nuclear fission reactor. Glenn Research Center is responsible for the development of the dynamic power conversion, power management and distribution, heat rejection and ION thrusters. The first test phase for the JIM0 program concerns the High Power AC Power Management and Distribution (PMAD) Test Bed. The goal of this testing is to support electrical performance verification of the power systems. The test bed will incorporate a 2kW Brayton Rotating Unit (BRU) to simulate the nuclear reactor as well as two ION thrusters. The first module of the PMAD Test Bed to be designed is the Main Power Distribution Unit (MPDU) which relays the power input to the various propulsion systems and scientific instruments. The MPDU involves circuitry design as well as mechanical design to determine the placement of the components. The MPDU consists of fourteen relays of four different variations used to convert the input power into the appropriate power output. The three phase system uses 400 Vo1ts(sub L-L) rms at 1000 Hertz. The power is relayed through the circuit and distributed to the scientific instruments, the ION thrusters and other controlled systems. The mechanical design requires the components to be positioned for easy electrical wiring as well as allowing adequate room for the main buss bars, individual circuit boards connected to each component and power supplies. To accomplish creating a suitable design, AutoCAD was used as a drafting tool. By showing a visual layout of the components, it is easy to see where there is extra room or where the

  15. Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: Fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS)

    NARCIS (Netherlands)

    M-C. Morice (Marie-Claude); T.E. Feldman (Ted); M. Mack (Michael); E. Stahle (Elisabeth); D.R. Holmes (David); A. Colombo (Antonio); M-A.M. Morel (Marie-Angèle); M.J.B.M. van den Brand (Marcel); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); D. Carrié (Didier); G. Fournial (Gerard); S.K. James (Stefan); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractAims: The SYNTAX-LE MANS substudy prospectively evaluated 15-month angiographic and clinical outcomes in patients with treated left main (LM) disease. Methods and results: In the SYNTAX trial, 1,800 patients with three-vessel and/or LM disease were randomised to either CABG or PCI; of th

  16. Adult Hospice Social Work Intervention Outcomes in the United States.

    Science.gov (United States)

    Alcide, Amary; Potocky, Miriam

    2015-01-01

    A descriptive and critical analysis of the available empirical literature on social work psychosocial intervention outcomes for adult hospice patients and caregivers was conducted. The electronic bibliographic databases CINHAL (EBSCO), MEDLINE, ProQuest, EMBASE, Campbell Collaboration, and The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched. Search criteria were (a) social work interventions, (b) intervention was tested, (c) adult hospice patients and/or caregivers, (d) studies within the United States, (e) and studies between 2004 and 2014. Of the 21 studies that met the initial search criteria, 5 publications met all review criteria. Based on assessment of study results, intervention effect, and quality of evidence, the ADAPT Problem-Solving Intervention (PSI) and the Hospice Caregiver Support Project have some indications of practical effect on caregiver quality of life, anxiety, stress, and problem-solving skills. The Caregiver Life Line (CaLL) intervention had little to no effect on caregiver role stress or coping skills. The few available studies provide foundational insight into the need for the expansion of research efforts to evaluate hospice social work interventions and document the contributions of social work to the field.

  17. Heterogeneous arsenic enrichment in meta-sedimentary rocks in central Maine, United States

    Energy Technology Data Exchange (ETDEWEB)

    O' Shea, Beth, E-mail: bethoshea@sandiego.edu [Department of Marine Science and Environmental Studies, University of San Diego, 5998 Alcala Park, San Diego, CA 92110 (United States); Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964 (United States); Stransky, Megan; Leitheiser, Sara [Department of Marine Science and Environmental Studies, University of San Diego, 5998 Alcala Park, San Diego, CA 92110 (United States); Brock, Patrick [School of Earth and Environmental Sciences, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367 (United States); Marvinney, Robert G. [Maine Geological Survey, 93 State House Station, Augusta, ME 04333 (United States); Zheng, Yan [School of Earth and Environmental Sciences, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367 (United States); Lamont-Doherty Earth Observatory of Columbia University, 61 Route 9W, Palisades, NY 10964 (United States)

    2015-02-01

    Arsenic is enriched up to 28 times the average crustal abundance of 4.8 mg kg{sup −1} for meta-sedimentary rocks of two adjacent formations in central Maine, USA where groundwater in the bedrock aquifer frequently contains elevated As levels. The Waterville Formation contains higher arsenic concentrations (mean As 32.9 mg kg{sup −1}, median 12.1 mg kg{sup −1}, n = 38) than the neighboring Vassalboro Group (mean As 19.1 mg kg{sup −1}, median 6.0 mg kg{sup −1}, n = 38). The Waterville Formation is a pelitic meta-sedimentary unit with abundant pyrite either visible or observed by scanning electron microprobe. Concentrations of As and S are strongly correlated (r = 0.88, p < 0.05) in the low grade phyllite rocks, and arsenic is detected up to 1944 mg kg{sup −1} in pyrite measured by electron microprobe. In contrast, statistically significant (p < 0.05) correlations between concentrations of As and S are absent in the calcareous meta-sediments of the Vassalboro Group, consistent with the absence of arsenic-rich pyrite in the protolith. Metamorphism converts the arsenic-rich pyrite to arsenic-poor pyrrhotite (mean As 1 mg kg{sup −1}, n = 15) during de-sulfidation reactions: the resulting metamorphic rocks contain arsenic but little or no sulfur indicating that the arsenic is now in new mineral hosts. Secondary weathering products such as iron oxides may host As, yet the geochemical methods employed (oxidative and reductive leaching) do not conclusively indicate that arsenic is associated only with these. Instead, silicate minerals such as biotite and garnet are present in metamorphic zones where arsenic is enriched (up to 130.8 mg kg{sup −1} As) where S is 0%. Redistribution of already variable As in the protolith during metamorphism and contemporary water–rock interaction in the aquifers, all combine to contribute to a spatially heterogeneous groundwater arsenic distribution in bedrock aquifers. - Highlights: • Arsenic is enriched up to 138 mg kg

  18. Heterogeneous arsenic enrichment in meta-sedimentary rocks in central Maine, United States

    Science.gov (United States)

    O’Shea, Beth; Stransky, Megan; Leitheiser, Sara; Brock, Patrick; Marvinney, Robert G.; Zheng, Yan

    2014-01-01

    Arsenic is enriched up to 28 times the average crustal abundance of 4.8 mg kg−1 for meta-sedimentary rocks of two adjacent formations in central Maine, USA where groundwater in the bedrock aquifer frequently contains elevated As levels. The Waterville Formation contains higher arsenic concentrations (mean As 32.9 mg kg−1, median 12.1 mg kg−1, n=36) than the neighboring Vassalboro Group (mean As 19.1 mg kg−1, median 6.0 mg kg−1, n=36). The Waterville Formation is a pelitic meta-sedimentary unit with abundant pyrite either visible or observed by scanning electron microprobe. Concentrations of As and S are strongly correlated (r=0.88, p<0.05) in the low grade phyllite rocks, and arsenic is detected up to 1,944 mg kg−1 in pyrite measured by electron microprobe. In contrast, statistically significant (p<0.05) correlations between concentrations of As and S are absent in the calcareous meta-sediments of the Vassalboro Group, consistent with the absence of arsenic-rich pyrite in the protolith. Metamorphism converts the arsenic-rich pyrite to arsenic-poor pyrrhotite (mean As 1 mg kg−1, n=15) during de-sulfidation reactions: the resulting metamorphic rocks contain arsenic but little or no sulfur indicating that the arsenic is now in new mineral hosts. Secondary weathering products such as iron oxides may host As, yet the geochemical methods employed (oxidative and reductive leaching) do not conclusively indicate that arsenic is associated only with these. Instead, silicate minerals such as biotite and garnet are present in metamorphic zones where arsenic is enriched (up to 130.8 mg kg−1 As) where S is 0%. Redistribution of already variable As in the protolith during metamorphism and contemporary water-rock interaction in the aquifers, all combine to contribute to a spatially heterogeneous groundwater arsenic distribution in bedrock aquifers. PMID:24861530

  19. Short- and long-term outcomes of AL amyloidosis patients admitted into intensive care units.

    Science.gov (United States)

    Guinault, Damien; Canet, Emmanuel; Huart, Antoine; Jaccard, Arnaud; Ribes, David; Lavayssiere, Laurence; Venot, Marion; Cointault, Olivier; Roussel, Murielle; Nogier, Marie-Béatrice; Pichereau, Claire; Lemiale, Virginie; Arnulf, Bertrand; Attal, Michel; Chauveau, Dominique; Azoulay, Elie; Faguer, Stanislas

    2016-09-01

    Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo-Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on-going chemotherapy at ICU admission significantly predicted death at 6 months. Short-term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on-going chemotherapy for active amyloidosis impacted on long-term outcomes.

  20. APPLE PRICE AND PRODUCTION FORECASTS FOR MAINE AND THE UNITED STATES

    OpenAIRE

    Hayward, Russel A.; Criner, George K.; Skinner, Steven P.

    1984-01-01

    An econometric model of U.S. and Maine apple production and prices was estimated with ordinary least squares multiple regression. A Gauss-Seidel solution technique was used to examine the equation system goodness of fit and to forecast endogenous variable values. Results indicate that supply expansion in the U.S. and Maine will continue, but Maine's slower rate of increase will erode its market share. Apple prices for the U.S. and Maine are predicted to decline in real terms by the year 2000 ...

  1. Effects of nursing care and staff skill mix on patient outcomes within acute care nursing units.

    Science.gov (United States)

    Hart, Patricia; Davis, Nancy

    2011-01-01

    This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.

  2. The COST 731 Action and the MAP D-PHASE Initiative - Overview on Main Outcomes

    Science.gov (United States)

    Rossa, A. M.

    2010-09-01

    The COST 731 Action, launched in 2005, addresses the problem of forecasting (heavy) precipitation events and the corresponding hydrological processes in connection with the uncertainty inherent in this task. The actual threat to society that potentially occurs from intense (and thus rare) events only becomes effective after the involvement of the hydrosphere. The main focus of the Action is the quantification of forecast uncertainty and its propagation through a meteo-hydrological forecast chain. COST 731 is structured in three working groups, which deal with uncertainty cascading from observation (predominantly from radar) into numerical weather prediction (NWP) models, from observation and NWP into hydrological models, and the use of uncertainty as support in decision making. The groups of scientists involved in the action therefore represent radar meteorology, NWP, hydrological modeling, as well as social scientists who deal with risk communication. MAP D-PHASE (Mesoscale Alpine Programme, Demonstration of Probabilistic Hydrological and Atmospheric Simulation of Flooding Events in the Alps) is the second WMO/WWRP Forecast Demonstration Project and constitutes an important element of COST 731. Its Operations Period (June - November 2007) was centred in the Alpine region and experienced a number of interesting weather cases. Real-time forecast information of 7 limited area ensemble prediction systems, 23 high-resolution limited area numerical weather prediction models, as well as 7 hydrological models coupled to NWP QPF and/or radar QPE input were collected, and synthetically displayed on a visualization platform. In this presentation an overview of the COST 731 main achievements of the action as well as open issues and future opportunities are given. They are put into context with the results and perspectives of D-PHASE, first verification results, end user feedback, lessons learnt. A notable number of operational groups in hydrological modeling are in the

  3. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...... with a stronger SOC experienced significantly less pain (P nurse anesthetists...

  4. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle;

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...

  5. Achieving excellence in private intensive care units: The effect of transformational leadership and organisational culture on organisational change outcomes

    Directory of Open Access Journals (Sweden)

    Portia J. Jordan

    2015-03-01

    Full Text Available Orientation: Organisational change outcomes in private intensive care units are linked to higher patient satisfaction, improved quality of patient care, family support, cost-effective care practices and an increased level of excellence. Transformational leadership and fostering a positive organisational culture can contribute to these change outcomes.Research purpose: The study determined whether transformational leadership and a supportive organisational culture were evident in six private intensive care units in the Eastern Cape, South Africa. A conceptual framework to investigate the relationship between transformational leadership, organisational culture, and organisational change outcomes, was proposed and tested.Motivation for the study: The prevalence of transformational leadership, a positive organisational culture and their effect on organisational change outcomes in private healthcare industries require further research in order to generate appropriate recommendations.Research design, approach and method: A positivistic, quantitative design was used. A survey was conducted using a questionnaire which, in previous studies, produced scores with Cronbach’s alpha coefficients greater than 0.80, to collect data from a sample of 130 professional nurses in private intensive care units.Main findings: Transformational leadership and a positive organisational culture were evident in the private intensive care units sampled. A strong, positive correlation exists between transformational leadership, organisational culture, and organisational change outcomes. This correlation provides sufficient evidence to accept the postulated research hypotheses. Innovation and intellectual stimulation were identified as the factors in need of improvement.Practical or managerial implications: The findings of the study may be used by managers in intensive care units to promote organisational change outcomes, linked to transformational leadership and a positive

  6. Justification of the choice of units for mains-noah soil cultivation of sweet sorghum and their effectiveness

    Science.gov (United States)

    Kashapov, N. F.; Nafikov, M. M.; Gazetdinov, M. X.; Nafikova, M. M.; Nigmatzyanov, A. R.

    2016-06-01

    The article is devoted to problems of improving the efficiency of tillage crops. Presents an approach that focuses on the application of resource-saving technologies. To investigate the relationship between the financial welfare of the management and selection of units for primary processing of the soil. Conducted economic evaluation and identified the energy efficiency of main processing of the soil under sweet sorghum.

  7. Management of Interface between Main Contractor and Subcontractors for Successful Project Outcomes

    Directory of Open Access Journals (Sweden)

    Harry White

    2014-01-01

    Full Text Available There has been increased dependence on subcontracting within the construction industry, the operational relationship between the Main Contractor (MC and Subcontractor (SC plays a significant role in successful delivery of projects. Through the literature review this paper argues that despite SCs bring added value to construction projects, the increased reliance on SCs has strained relationships between the MC and SC. Also MCs are more concerned with risk and price reduction which undermine the relationship heavily. Current practices in the construction industry in managing SCs were evaluated through a case study and semi-structured interviews. A questionnaire survey was used to investigate the ways of facilitating the interface between the MC and SC in general. The study highlighted that prevailing adverse relationships and culture in the industry are influencing the success of construction projects. The lack of trust is a key factor affecting the relationships between MC and SCs. However, the proactive involvement of the MC with SCs in maintaining continuity of the team from procurement to construction stage and transparency in the processes were key success factors for successful completion of the project.

  8. Treatments and outcomes of peritoneal surface tumors through a centralized national service (United kingdom).

    Science.gov (United States)

    Rout, S; Renehan, A G; Parkinson, M F; Saunders, M P; Fulford, P E; Wilson, M S; O'Dwyer, S T

    2009-10-01

    Treatment of peritoneal surface malignancies with combined cytoreductive surgery and heated intraperitoneal chemotherapy may improve oncologic outcome. To better define treatment pathways, five-year results in patients referred to one of two centralized national treatment centers in the United Kingdom were analyzed. A prospective database of patients referred to the Manchester Peritoneal Tumor Service, established in 2002, was analyzed. Outcomes were evaluated using Kaplan-Meier life tables and Cox models. Two hundred seventy-eight patients (median age, 56.9 (range, 16-86) years) were considered by a dedicated multidisciplinary team and tracked on seven clinical pathways. Among the 118 surgically treated, the most common diagnosis was pseudomyxoma peritonei (101 patients, 86%). Major complications occurred in 11 patients (9%); there was no 30-day mortality. Where complete cytoreduction was achieved, three-year and five-year tumor-related survival rates were 94% and 86%, respectively. In the Cox model, incompleteness of cytoreduction (P = 0.001) and high-grade tumor (P < 0.0001) were independent prognosticators of poor outcome. The establishment of a national treatment center has allowed refinement of techniques to achieve internationally recognized results. Having achieved low levels of morbidity and mortality in the treatment of mainly pseudomyxoma peritonei of appendiceal origin, the technique of cytoreductive surgery and heated intraperitoneal chemotherapy may be considered for peritoneal carcinomatosis of colorectal origin.

  9. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

    Science.gov (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L

    2006-07-01

    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  10. Variation Character of Grain Yield per Unit Area in Main Grain-producing Area of Northeast China

    Institute of Scientific and Technical Information of China (English)

    CHENG Yeqing; ZHANG Pingyu; ZHANG Huimin

    2007-01-01

    Based on the surveys and the statistic data during 1980-2003, the variation character of grain yield per unit area in Northeast China and its main factors have been discussed by the methods of statistics and grey correlation analysis. The results show that: 1) the grain yield per unit area has been taking on an increasing trend in the recent 20 years. It increased from 2519.80kg/ha in 1980 to 4216.11 kg/ha in 2003, with an increasing rate of 67.32%; 2) the variation of grain yield per unit area is considerably prominent and its range is also very great, with the maximal increase rate of 42.59% and maximal decrease rate of 21.13%, respectively, which are far above the whole Chinese average level; 3) the variation of main crops' yield per unit area is remarkable, which takes on the character that the yield of corn is much higher than that of soybean and rice; and 4) the grey correlation analysis shows that the most important factors impacting the variation of grain yield per unit area are the total power of agricultural machinery, the consumption of chemical fertilizer and effective irrigated area. However, the influence of natural disaster and income level should not be ignored. Effective ways to improve grain yield per unit area are to construct farmland improvement groundwork, reclaim the middle- and low-yield farmland, etc.

  11. A Historical Analysis of Three Main Issues Affecting United States Foreign Policy in the Middle East

    Science.gov (United States)

    1979-06-01

    18:94; 87:335). Is peace a futile goal of the Arab-Israeli con- flict? Perceptively, Noam Chomsky described the conflict: International affairs can...statistical model in this thesis. The various communication media suggest conflict- ing views on the role of United States foreign policy in world politics...reap propaganda benefits in all countries that had sufficient Jewish populations. Fourth, it was 5! designed to beat the Germans in gaining Jewish

  12. Preparation and Chemical Properties of π-Conjugated Polymers Containing Indigo Unit in the Main Chain

    Directory of Open Access Journals (Sweden)

    Hiroki Fukumoto

    2014-03-01

    Full Text Available π-Conjugated polymers based on indigo unit were prepared. Dehalogenative polycondensation of N-hexyl-6,6'-dibromoindigo with a zerovalent nickel complex gave a homopolymer, P(HexI, in 77% yield. Copolymer of N-hexyl-indigo and pyridine, P(HexI-Py, was also prepared in 50% yield. P(HexI showed good solubility in organic solvents, whereas P(HexI-Py was only soluble in acids such as HCOOH. The weight-average molecular weights (Mw of P(HexI and P(HexI-Py were determined to be 10,000 and 40,000, respectively, by a light scattering method. Pd-catalyzed polycondensation between 6,6'-dibromoindigo with N-BOC (BOC = t-butoxycarbonyl substituents and a diboronic compound of 9,9-dioctylfluorene afforded the corresponding alternating copolymer, P(BOCI-Flu, as a deep red solid in 98% yield. P(BOCI-Flu was soluble in N-methyl-2-pyrroridone and showed an Mw of 29,000 in GPC analysis. Treatment of P(BOCI-Flu with CF3COOH smoothly led to a BOC-deprotection reaction to give an insoluble deep green polymer, P(I-Flu, in a quantitative yield. Diffuse reflectance spectra of powdery P(BOCI-Flu and P(I-Flu showed peaks at about 580 nm and 630 nm, respectively, which are thought to originate from the indigo unit.

  13. Evaluation of severe accident risks, Peach Bottom, Unit 2: Main report

    Energy Technology Data Exchange (ETDEWEB)

    Payne, A.C.; Breeding, R.J.; Jow, H.N.; Shiver, A.W. (Sandia National Labs., Albuquerque, NM (USA)); Helton, J.C. (Arizona State Univ., Tempe, AZ (USA)); Smith, L.N. (Science Applications International Corp., Albuquerque, NM (USA))

    1990-12-01

    In support of the Nuclear Regulatory Commission's (NRC's) assessment of the risk from severe accidents at commercial nuclear power plants in the US reported NUREG-1150, the Severe Accident Risk Reduction Program (SARRP) has completed a revised calculation of the risk to the general public from severe accidents at the Peach Bottom Atomic Power Station, Unit 2. This power plant, located in southeastern Pennsylvania, is operated by the Philadelphia Electric Company. The emphasis in this risk analysis was not on determining a so-called'' point estimate of risk. Rather, it was to determine the distribution of risk, and to discover the uncertainties that account for the breadth of this distribution. Off-site risk initiated by events both internal and external to the power station were assessed. 39 refs., 174 figs., 133 tabs.

  14. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  15. Dedicated pediatric cardiac intensive care unit in a developing country: Does it improve the outcome?

    Directory of Open Access Journals (Sweden)

    Rakhi Balachandran

    2011-01-01

    Conclusions : Establishment of a dedicated pediatric cardiac intensive care unit has shown better outcomes in terms of earlier extubation, de-intensification, and discharge from the ICU. Blood stream infections were also reduced.

  16. Medical complications and outcomes at an onsite rehabilitation unit for older people.

    LENUS (Irish Health Repository)

    Mulroy, M

    2013-09-01

    The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

  17. Trace metals in soils of the main geomorphological units in the southwestern part of Western Siberia

    Science.gov (United States)

    Konstantinova, E. Yu

    2016-09-01

    Total concentrations of Ti, Cr, Mn, Ni, Cu, Zn, Rb, Sr, and Pb as well as soil granulometric texture were studied for three plot sites representing different geomorphologic units of the southwestern part of Western Siberia: periphery of the upland Tobolsky Mainland, Ishim plain, Turinskaya plain. Interregional difference in the relationship by and among the content of trace elements and particle size distribution of soil horizons is established. Thus, for the soils of Turinskaya plain such interrelations are not observed. For the soils of Ishim Plain moderate negative correlation between Pb concentrations and medium silt, as well as average positive correlations between Zn and fine sand, coarse sand and Pb are found. For the soils of the high terraces of the Irtish and periphery of Tobolsky Mainland interface zone moderate positive correlations between contents of Ti, Zn, Sr and fine sand, weak positive ones between Rb and medium sand, moderate negative ones between Zn and clay, Ti, Ni, Cu, Zn, Rb, Sr, and fine dust, Ti, Cu, Zn, Rb, Sr and medium silt are observed. Consequently, properties and genesis of local parent rocks are significant factors for distribution and accumulation of trace elements in the soils of the southern taiga; at the same time, the processes of bioaccumulation in thick humus horizons of dark gray soils and chernozems apparently play an important part in accumulation and migration of trace elements in forest-steppe soils of Ishim and Turinskaya plains.

  18. Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes.

    Science.gov (United States)

    Fu, Shiwan; Turner, Angus; Tan, Irene; Muir, Josephine

    2017-08-14

    To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. Systematic literature review. Worldwide. Peer-reviewed journal articles that included the use of a mobile eye health unit. Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application. © 2017 National Rural Health Alliance Inc.

  19. Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

    NARCIS (Netherlands)

    Waele, J. De; Lipman, J.; Sakr, Y.; Marshall, J.C.; Vanhems, P.; Barrera Groba, C.; Leone, M.; Vincent, J.L.; Pickkers, P.

    2014-01-01

    BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point preva

  20. Homeschooled adolescents in the United States: developmental outcomes.

    Science.gov (United States)

    Green-Hennessy, Sharon

    2014-06-01

    The mission of schools has broadened beyond academics to address risk behaviors such as substance use, delinquency, and socialization problems. With an estimated 3.4% of all U.S. youth being homeschooled, this study examines how U.S. homeschoolers fare on these outcomes given their lack of access to these school services. Adolescents (ages 12-17) from the 2002 through 2011 National Surveys of Drug Use and Health (NSDUH) were divided based on school status (home vs. traditional schooling) and religious affiliation (stronger vs. weaker). Controlling for demographic differences, homeschoolers with weaker religious ties were three times more likely to report being behind their expected grade level and two and a half times more likely to report no extracurricular activities in the prior year than their traditionally schooled counterparts. This group was also more likely to report lax parental attitudes toward substance use. Findings suggest homeschoolers with weaker religious ties represent an at-risk group.

  1. Dehydrocoupling and Silazane Cleavage Routes to Organic-Inorganic Hybrid Polymers with NBN Units in the Main Chain.

    Science.gov (United States)

    Lorenz, Thomas; Lik, Artur; Plamper, Felix A; Helten, Holger

    2016-06-13

    Despite the great potential of both π-conjugated organoboron polymers and BN-doped polycyclic aromatic hydrocarbons in organic optoelectronics, our knowledge of conjugated polymers with B-N bonds in their main chain is currently scarce. Herein, the first examples of a new class of organic-inorganic hybrid polymers are presented, which consist of alternating NBN and para-phenylene units. Polycondensation with B-N bond formation provides facile access to soluble materials under mild conditions. The photophysical data for the polymer and molecular model systems of different chain lengths reveal a low extent of π-conjugation across the NBN units, which is supported by DFT calculations. The applicability of the new polymers as macromolecular polyligands is demonstrated by a cross-linking reaction with Zr(IV) .

  2. Hospital markup and operation outcomes in the United States.

    Science.gov (United States)

    Gani, Faiz; Ejaz, Aslam; Makary, Martin A; Pawlik, Timothy M

    2016-07-01

    Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. All hospitals in which a patient underwent a cardiothoracic or gastrointestinal procedure were identified using the Nationwide Inpatient Sample for 2012. Markup ratios (ratio of charges to costs) for the total cost of hospitalization were compared across hospitals. Risk-adjusted morbidity, failure-to-rescue, and mortality were calculated using multivariable, hierarchical logistic regression. Among the 3,498 hospitals identified, markup ratios ranged from 0.5-12.2, with a median markup ratio of 2.8 (interquartile range 2.7-3.9). For the 888 hospitals with extreme markup (greatest markup ratio quartile: markup ratio >3.9), the median markup ratio was 4.9 (interquartile range 4.3-6.0), with 10% of these hospitals billing more than 7 times the Medicare-allowable costs (markup ratio ≥7.25). Extreme markup hospitals were more often large (46.3% vs 33.8%, P markup ratio compared with 19.3% (n = 452) and 6.8% (n = 35) of nonprofit and government hospitals, respectively. Perioperative morbidity (32.7% vs 26.4%, P markup hospitals. There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

    Directory of Open Access Journals (Sweden)

    HUGO KARLING MORESCHI

    2015-02-01

    Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

  4. Thermal evolution of a main detachment zone during late orogenic collapse: the pilat unit case (Variscan chain).

    Science.gov (United States)

    Gardien, V.; Allemand, P.

    2003-04-01

    The high temperature uplift of deep seated nappes in different tectonic settings is a major question in orogenic domains. Detailed petrological and structural study were performed in the Pilat Unit (Eastern french Massif Central: Variscan chain) in order to discuss the thermal evolution of a main shear zone during late orogenic extension. The Pilat Unit is a 20 km long x 5 km large metamorphic unit and as a strain gradient within it perpandicular to the long axe of the unit. The mylonitic fabrics, in the strained zone are notherly directed. Geometrical and geochronological data indicate that these fabrics are associated with extesional regime that was a post-thickening event. Thermobarometrical determination supported by microstructural analyses indicate the develpoment of contrasting P-T-time evolution in the Pilat Unit. In the strongly mylonitized southern domain in which foliation and streching lineation show a top to the north normal slip, the calculated P-T conditions indicate an increase in temperature during decompression illustrated by the following mineral assemblages:1) Grt + Stau + Kya + Rut, 2) Bio + Sill + Cord, 3) And + Musco + K-feld and dated at 322 Ma. In the northern and less deformed domain, the calculated P-T conditions correspond to a cooling event during decompression illustrated by the following assemblages: 1) Grt + Stau + Kya + Rut, 2) Bio + Musco + Ilm, 3) And + Chlo + Pyro + Tour, dated at 313 Ma. The difference in T° between the southern and the northern domain is 200-250°C and Δ t is 10Ma. Based on these data, we have elaborated 1D numerical model simulating the thermal evolution of the continental crust during thinning associated or not with magma underplating.

  5. Revised Definitions for Statistical Units – Methodology, Application and User Needs. The Main Conceptual Issues of the “Units Discussion” of the Years 2009–2014

    Directory of Open Access Journals (Sweden)

    Roland Sturm

    2015-09-01

    Full Text Available In the years 2009 to 2014 in the European Statistical System (ESS modified definitions for basic statistical units have been proposed and discussed. The author took part in this discussion as regular participant in the ESS “Working Group Business Registers and Statistical Units”, as participant in the ESSnet “Profiling of large and complex multinational enterprise groups” (2009–2013 and as member of the Eurostat task force “Statistical Units” which worked from 2013 to 2015 on the main issues...

  6. Analysis of the Main Indicators of Socio-Economic Development of the Kharkiv Region and its Administrative-Territorial Units

    Directory of Open Access Journals (Sweden)

    Yaroshenko Igor V.

    2016-01-01

    Full Text Available The publication conducts an analysis of the socio-economic development of the Kharkiv region and its administrative-territorial units. The Kharkiv region has a fairly strong economic potential and demonstrates a high level of socioeconomic development. Along with this, asymmetries in the development of administrative-territorial units of the Kharkov region do not decrease, the constant reallocation of resources from the more economically self-sufficient territories in the region towards the less self-sufficient leads to internal regional tensions and deprives the administrative-territorial units of incentives to economic growth. Establishment of an effective system of organization and management of socio-economic development at the local level in Ukraine remains one of the priority tasks for implementing structural reforms. One of the main directions in addressing the interregional differentiation and overcoming problems of regional development in Ukraine is modernization of both administrative-territorial organization and local self-government bodies, through the implementation of the decentralization reform

  7. Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; QIAN Jun; Kwan Tak W; XU Bo; Gary Mintz; YE Fei; ZHANG Jun-jie; KAN Jing; SUN Xue-wen; ZHANG Ai-ping; CHEN Jin-guo

    2010-01-01

    Background Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (Ml), and target vessel revascularization (TVR).Results UPLMS ISR rate was 14.8% (n=73, 15.7% after BMS, 14.5% for DES) after average of (3.89±2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58±5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9±23.3) months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

  8. Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

    2013-04-01

    To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

  9. The impact of financial and nonfinancial incentives on business-unit outcomes over time.

    Science.gov (United States)

    Peterson, Suzanne J; Luthans, Fred

    2006-01-01

    Unlike previous behavior management research, this study used a quasi-experimental, control group design to examine the impact of financial and nonfinancial incentives on business-unit (21 stores in a fast-food franchise corporation) outcomes (profit, customer service, and employee turnover) over time. The results showed that both types of incentives had a significant impact on all measured outcomes. The financial incentive initially had a greater effect on all 3 outcomes, but over time, the financial and nonfinancial incentives had an equally significant impact except in terms of employee turnover.

  10. Investigation of Main Radiation Source above Shield Plug of Unit 3 at Fukushima Daiichi Nuclear Power Station

    Science.gov (United States)

    Hiratama, Hideo; Kondo, Kenjiro; Suzuki, Seishiro; Tanimura, Yoshihiko; Iwanaga, Kohei; Nagata, Hiroshi

    2017-09-01

    Pulse height distributions were measured using a CdZnTe detector inside a lead collimator to investigate main source producing high dose rates above the shield plugs of Unit 3 at Fukushima Daiichi Nuclear Power Station. It was confirmed that low energy photons are dominant. Concentrations of Cs-137 under 60 cm concrete of the shield plug were estimated to be between 8.1E+9 and 5.7E+10 Bq/cm2 from the measured peak count rate of 0.662 MeV photons. If Cs-137 was distributed on the surfaces of the gaps with radius 6m and with the averaged concentration of 5 points, 2.6E+10 Bq/cm2, total amount of Cs-137 is estimated to be 30 PBq.

  11. Investigation of Main Radiation Source above Shield Plug of Unit 3 at Fukushima Daiichi Nuclear Power Station

    Directory of Open Access Journals (Sweden)

    Hiratama Hideo

    2017-01-01

    Full Text Available Pulse height distributions were measured using a CdZnTe detector inside a lead collimator to investigate main source producing high dose rates above the shield plugs of Unit 3 at Fukushima Daiichi Nuclear Power Station. It was confirmed that low energy photons are dominant. Concentrations of Cs-137 under 60 cm concrete of the shield plug were estimated to be between 8.1E+9 and 5.7E+10 Bq/cm2 from the measured peak count rate of 0.662 MeV photons. If Cs-137 was distributed on the surfaces of the gaps with radius 6m and with the averaged concentration of 5 points, 2.6E+10 Bq/cm2, total amount of Cs-137 is estimated to be 30 PBq.

  12. Characterizing the natural radiation levels throughout the main geological units of Sabkhat al Jabboul area, northern Syria.

    Science.gov (United States)

    Al-Hilal, Mohamed; Aissa, Mosa

    2015-02-01

    The concentrations of equivalent eU, eTh, and K% were determined together with soil gas radon values and carborne gamma-ray survey in order to define the natural radioactivity levels throughout main geological units of Sabkhat al Jabboul region. Forty five soil and rock samples were collected from various lithofacies in each geological unit, and analyzed by γ-ray spectrometric technique for determining the concentration values of major radioelements. Such radiometric data could be used to differentiate between various lithologies of the investigated rocks. Although no distinct radioactive anomalies were found in the area, the radiometric profiles showed some minor variations with slightly higher values than the normal level. Despite the low radioactivity and the lack of rocks diversity in the surveyed area, it was possible to classify some certain rock types based on their radiometric response. The relationships between eU, eTh and their ratios were discussed for the Quaternary, Neogene and Paleogene formations, in order to evaluate the degree of uranium distribution and remobilization. The overall results of this radiometric survey were generally low, and lying within the range of the normal background levels in Syrian.

  13. Variation in outcomes in Veterans Affairs intensive care units with a computerized severity measure.

    Science.gov (United States)

    Render, Marta L; Kim, H Myra; Deddens, James; Sivaganesin, Siva; Welsh, Deborah E; Bickel, Karen; Freyberg, Ron; Timmons, Stephen; Johnston, Joseph; Connors, Alfred F; Wagner, Douglas; Hofer, Timothy P

    2005-05-01

    unit profiling and analysis of natural experiments to understand process and outcome links and quality efforts.

  14. A Brief Cognitive-Behavioral Psycho-Education (B-CBE Program for Managing Stress and Anxiety of Main Family Caregivers of Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vico Chung Lim Chiang

    2016-09-01

    Full Text Available Having a loved one in the intensive care unit (ICU is a stressful event, which may cause a high level of anxiety to the family members. This could threaten their wellbeing and ability to support the patients in, or after discharge from, the ICU. To investigate the outcomes of a brief cognitive-behavioral psycho-education program (B-CBE to manage stress and anxiety of the main family caregivers (MFCs, a pragmatic quasi-experimental study involving 45 participants (treatment group: 24; control group: 21 was conducted in an ICU. The Depression and Anxiety Stress Scale and the Critical Care Family Need Inventory were used to evaluate the primary outcomes on stress and anxiety, and satisfaction with family needs. The treatment group reported significantly better improvement in the information satisfaction score compared to the control group (p < 0.05; η2 = 0.09. Overall main effects were observed on the stress (p < 0.01; η2 = 0.20, anxiety (p < 0.01; η2 = 0.18, depression (p < 0.05; η2 = 0.13, support satisfaction (p < 0.05; η2 = 0.13, and comfort satisfaction (p < 0.05; η2 = 0.11 scores. The experience of this study suggest that MFCs are in great need of additional support like B-CBE to manage their stress and anxiety. Given the brevity of B-CBE, it is practical for critical care nurses to deliver and MFCs to take within the industrious context of an ICU. More studies are needed to investigate these types of brief psychological interventions.

  15. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury.

    Science.gov (United States)

    El-Abdellati, Esmael; Eyselbergs, Michiel; Sirimsi, Halil; Hoof, Viviane Van; Wouters, Kristien; Verbrugghe, Walter; Jorens, Philippe G

    2013-03-14

    Because neither the incidence and risk factors for rhabdomyolysis in the ICU nor the dynamics of its main complication, i.e., rhabdomyolysis-induced acute kidney injury (AKI) are well known, we retrospectively studied a large population of adult ICU patients (n = 1,769). CK and sMb (serum myoglobin) and uMb (urinary myoglobin) were studied as markers of rhabdomyolysis and AKI (RIFLE criteria). Hemodialysis and mortality were used as outcome variables. Prolonged surgery, trauma, and vascular occlusions are associated with increasing CK values. CK correlates with sMb (p sMb or uMb.The logistic regression showed a positive correlation between CK and the development of AKI, with an OR of 2.21. Univariate logistic regression suggests that elevations of sMb and uMb are associated with the development of AKI, with odds ratios of 7.87 and 1.61 respectively. The ROC curve showed that for all three markers a significant correlation with AKI, for sMb with the greatest area under the curve. The best cutoff values for prediction of AKI were CK > 773 U/l; sMb > 368 μg/l and uMb > 38 μg/l respectively. Because it also has extrarenal elimination kinetics, our data suggest that measuring myoglobin in patients at risk for rhabdomyolysis in the ICU may be useful.

  16. Bayesian framework to identify the main effects of long term climatic constraints on soil moisture decline in conterminous United States

    Science.gov (United States)

    Guevara, M.; Vargas, R.

    2016-12-01

    We used a Bayesian regression framework based on Hamiltonian Monte Carlo simulations to identify the main effects of mean annual soil moisture, temperature, evapotranspiration, and precipitation, on long-term soil moisture decline across conterminous United States based on 36 years of remotely sensed available data. We found that mean soil moisture was a positive control of soil moisture decline in areas with long-term high precipitation but low evapotranspiration. Furthermore, mean soil moisture is a negative control on soil moisture decline in areas with long-term low precipitation and low evapotranspiration. In contrast, mean soil moisture had no effect on soil moisture decline in areas with long-term low precipitation and high evapotranspiration. These results highlight the importance of having accurate spatial soil moisture information to better inform earth system models to predict regional to global water balance and climate trends. These results support the current understanding of the basic physical mechanisms governing the coupling of soil moisture with temperature, precipitation, and evapotranspiration, but bring attention to high spatial heterogeneity in the constraints of soil moisture at the continental scale. The response of soil moisture to climate variability is considered to be one of the largest uncertainties for global land surface models, and resolving high spatial resolution of soil moisture is an ongoing challenge. Independent estimates of high spatial resolution of soil moisture could improve parameterizations of land surface models and cross-validate the current functions that mainly relay on precipitation, aerodynamic representation of the latent and sensible heat fluxes, and land surface cover type.

  17. Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units.

    Science.gov (United States)

    Rochefort, Christian M; Clarke, Sean P

    2010-10-01

    This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.

  18. Typhoid perforation: Post-operative Intensive Care Unit care and outcome

    Directory of Open Access Journals (Sweden)

    Mukaila Oyegbade Akinwale

    2016-01-01

    Full Text Available Background: Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU on account of sepsis or septic shock and to improve survival. Patients and Methods: This is a prospective observational study in which 67 consecutive patients who had exploratory laparotomy for typhoid perforation between August 2009 and October 2012 in the main operating theatre of the University College Hospital, Ibadan, were studied. The attending anaesthetists had the freedom of choosing the appropriate anaesthetic drugs depending on the patients' clinical condition. The reason for admission into the ICU, the types of organ support required and outcomes were recorded. Results: Twenty-five patients (37.3% out of 67 required critical care. Reasons for admission among others included poor respiratory effort, hypotension, septic shock and delayed recovery from anaesthesia. Twenty-one patients (84% required mechanical ventilation with a mean duration of 2.14 days (range 1–5 days. Fourteen patients required ionotropic support and the length of ICU stay ranged from 1 to 15 days (mean 4.32 days. Nineteen patients (76% were successfully managed and discharged to the ward while 24% (6 patients mortality rate was recorded. Conclusion: This study showed high rate of post-operative ICU admission in patients with typhoid perforation with a high demand for critical care involving mechanical ventilation and ionotropic support. In centres that manage patients presenting with typhoid ileitis and perforation, post-operative critical care should be available.

  19. Typhoid perforation: Post-operative Intensive Care Unit care and outcome.

    Science.gov (United States)

    Akinwale, Mukaila Oyegbade; Sanusi, Arinola A; Adebayo, Oluwaseun K

    2016-01-01

    Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU) on account of sepsis or septic shock and to improve survival. This is a prospective observational study in which 67 consecutive patients who had exploratory laparotomy for typhoid perforation between August 2009 and October 2012 in the main operating theatre of the University College Hospital, Ibadan, were studied. The attending anaesthetists had the freedom of choosing the appropriate anaesthetic drugs depending on the patients' clinical condition. The reason for admission into the ICU, the types of organ support required and outcomes were recorded. Twenty-five patients (37.3%) out of 67 required critical care. Reasons for admission among others included poor respiratory effort, hypotension, septic shock and delayed recovery from anaesthesia. Twenty-one patients (84%) required mechanical ventilation with a mean duration of 2.14 days (range 1-5 days). Fourteen patients required ionotropic support and the length of ICU stay ranged from 1 to 15 days (mean 4.32 days). Nineteen patients (76%) were successfully managed and discharged to the ward while 24% (6 patients) mortality rate was recorded. This study showed high rate of post-operative ICU admission in patients with typhoid perforation with a high demand for critical care involving mechanical ventilation and ionotropic support. In centres that manage patients presenting with typhoid ileitis and perforation, post-operative critical care should be available.

  20. RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

    Science.gov (United States)

    Zapatero-Gaviria, Antonio; Javier Elola-Somoza, Francisco; Casariego-Vales, Emilio; Fernandez-Perez, Cristina; Gomez-Huelgas, Ricardo; Bernal, José Luis; Barba-Martín, Raquel

    2017-08-01

    To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

  1. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    Science.gov (United States)

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  2. Health outcomes among women trafficked for sex in the United States: a closer look.

    Science.gov (United States)

    Muftic, Lisa R; Finn, Mary A

    2013-06-01

    Human trafficking is recognized as a major public health problem and a tragic transnational crime. Little is known about the health outcomes of victims of human trafficking. This study identifies the relationship of risk factors to physical, sexual, and mental health outcomes in three groups of women (N = 38) exploited for sex in the United States: international trafficking victims, domestic trafficking victims, and nontrafficked sex workers. To date this is the first study to examine the impact of risk factors on health outcomes using a sample of women trafficked for sex in the United States that includes both domestic and international victims. Overall, findings suggest that the experiences in sex work of domestic trafficking victims were dissimilar to those of international trafficking victims. Moreover, domestic trafficking victims displayed poorer health outcomes compared to international trafficking victims. In terms of risk factors, a higher percentage of women involved in street prostitution reported sexual health problems, co-occurring health issues, and addiction. Childhood physical/sexual victimization was related to poor physical health.

  3. Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit

    Directory of Open Access Journals (Sweden)

    Karen Ruby Lionel

    2014-01-01

    Full Text Available Background and Aim: Although large studies have demonstrated the association between hyperglycemia and adverse intensive care unit (ICU outcomes, it is yet unclear which subset of patients benefit from tight sugar control in ICU. Recent evidence suggests that stress induced hyperglycemia (SIH and co-incidentally detected diabetes mellitus are different phenomena with different prognoses. Differentiating SIH from diabetic hyperglycemia is challenging in ICU settings. We followed a cohort of trauma patients admitted to a surgical intensive care unit (SICU to evaluate if initial glycated hemoglobin A (HbA 1 c level predicts the outcome of admission. Materials and Methods: A cohort of 120 consecutive admissions to SICU following trauma were recruited and admission blood sugar and HbA 1 c were measured. Outcomes were prospectively measured by blinded ICU doctors. A logistic regression model was developed to assess if HbA 1 c predicts poor outcomes in these settings. Results: Nearly 24% of the participants had HbA 1 c ≥ 6. Those with HbA 1 c ≥ 6 had 3.14 times greater risk of poor outcome at the end of hospital stay when compared to those with HbA 1 c < 6 and this risk increased to an odds ratio of 4.57 on adjusting for other significant predictors: Acute Physiology and Chronic Health Evaluation II, injury severity score, admission blood sugar and age at admission. Conclusions: Substantial proportion of trauma admissions has underlying diabetes. HbA 1 c, a measure of pre admission glycaemic status is an important predictor of ICU outcome in trauma patients.

  4. Patients' characterization, hospital course and clinical outcomes in five Italian respiratory intensive care units.

    Science.gov (United States)

    Polverino, Eva; Nava, Stefano; Ferrer, Miquel; Ceriana, Piero; Clini, Enrico; Spada, Elisa; Zanotti, Ercole; Trianni, Ludovico; Barbano, Luca; Fracchia, Claudio; Balbi, Bruno; Vitacca, Michele

    2010-01-01

    Respiratory intensive care units (RICU) dedicated to weaning could be suitable facilities for clinical management of "post-ICU" patients. We retrospectively analyzed the time course of patients' characteristics, clinical outcomes and medical staff utilization in five Italian RICUs by comparing three periods of 5 consecutive years (from 1991 to 2005). A total of 3,106 patients (age 76 +/- 4 years; 72% males) were analyzed. The number of co-morbidities per patient (from 1.8 to 3.0, p = 0.05) and the previous intensive care unit (ICU) stay (from 25 to 32 days, p = 0.002) increased over time. The doctor-to-patient ratio significantly decreased over time (from 1:3 to 1:5, p rehabilitative units (from 70 to 75%). The mortality rate increased over time (from 9 to 15%). Significant correlations between the doctor-to-patient ratio and the rates of weaning success (r = 0.679, p = 0.005), home discharge (r = 0.722, p = 0.002) and the RICU length of stay (LOS) (r = -0.683, p = 0.005) were observed. The clinical outcomes of our units worsened over 15 years, likely as consequence of admitting more severely ill patients. The potential further negative influence of reduced medical staff availability on weaning success, home discharge and LOS warrants future prospective investigations.

  5. The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting : effects on patient outcomes

    NARCIS (Netherlands)

    Vrijhoef, HJM; Diederiks, JPM; Spreeuwenberg, C; Wolffenbuttel, BHR; van Wilderen, LJGP

    2002-01-01

    A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for pati

  6. Population-level differences in revascularization treatment and outcomes among various United States subpopulations

    Institute of Scientific and Technical Information of China (English)

    Garth Graham; Yang-Yu Karen Xiao; Dan Rappoport; Saima Siddiqi

    2016-01-01

    Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction(MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to

  7. Trans-border (east Serbia/west Bulgaria correlation of the Jurassic sediments: Main Jurassic paleogeographic units

    Directory of Open Access Journals (Sweden)

    Tchoumatchenco Platon

    2006-01-01

    Full Text Available In the region across the Serbian/Bulgarian state border, there are individualized 5 Jurassic paleogeographic units (from West to East: (1 the Thracian Massif Unit without Jurassic sediments; (2 the Lužnica-Koniavo Unit - partially with Liassic in Grsten facies and with deep water Middle Callovian-Kimmeridgian (p. p sediments of the type "ammonitico rosso", and Upper Kimmeridgian-Tithonian siliciclastics flysch; (3 The Getic Unit subdivided into two subunits - the Western Getic Sub-Uni - without Lower Jurassic sediments and the Eastern Getic Sub-Unit with Lower Jurassic continental and marine sediments, which are followed in both sub-units by carbonate platform limestones (type Stramberk; (4 the Infra (Sub-Getic Unit - with relatively deep water Liassic and Dogger sediments (the Dogger of type "black shales with Bossitra alpine" and Middle Callovian-Tithonian of type "ammonitico rosso"; (5 the Danubian Unit - with shallow water Liassic, Dogger and Malm (Miroč-Vrška Čuka Zone, deep water Dogger and Malm (Donjomilanovačko-Novokoritska Zone.

  8. An Investigation for Arranging the Video Display Unit Information in a Main Control Room of Advanced Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, Chong Cheng; Yang, Chih Wei [Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan (China)

    2014-08-15

    Current digital instrumentation and control and main control room (MCR) technology has extended the capability of integrating information from numerous plant systems and transmitting needed information to operations personnel in a timely manner that could not be envisioned when previous generation plants were designed and built. A MCR operator can complete all necessary operating actions on the video display unit (VDU). It is extremely flexible and convenient for operators to select and to control the system display on the screen. However, a high degree of digitalization has some risks. For example, in nuclear power plants, failures in the instrumentation and control devices could stop the operation of the plant. Human factors engineering (HFE) approaches would be a manner to solve this problem. Under HFE considerations, there exists 'population stereotype' for operation. That is, the operator is used to operating a specific display on the specific VDU for operation. Under emergency conditions, there is possibility that the operator will response with this habit population stereotype, and not be aware that the current situation has already changed. Accordingly, the advanced nuclear power plant should establish the MCR VDU configuration plan to meet the consistent teamwork goal under normal operation, transient and accident conditions. On the other hand, the advanced nuclear power plant should establish the human factors verification and validation plan of the MCR VDU configuration to verify and validate the configuration of the MCR VDUs, and to ensure that the MCR VDU configuration allows the operator shift to meet the HFE consideration and the consistent teamwork goal under normal operation, transient and accident conditions. This paper is one of the HF V V plans of the MCR VDU configuration of the advanced nuclear power plant. The purpose of this study is to confirm whether the VDU configuration meets the human factors principles and the consistent

  9. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury.

    Science.gov (United States)

    Treggiari, Miriam M; Martin, Diane P; Yanez, N David; Caldwell, Ellen; Hudson, Leonard D; Rubenfeld, Gordon D

    2007-10-01

    Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). Cohort study of patients with acute lung injury (ALI). ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a population-based cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P = 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P = 0.62). These findings were robust for varying assumptions about the study population definition. Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.

  10. Outcomes for women admitted to a mother and baby unit: a systematic review.

    Science.gov (United States)

    Gillham, Rebecca; Wittkowski, Anja

    2015-01-01

    Mother and baby units (MBUs) provide inpatient psychiatric care for mothers and their infants up to a year after childbirth. They are commissioned to support the mother-infant relationship as well as stabilize maternal mental health. As their efficacy at meeting these aims had not previously been systematically assessed, this paper reviewed the international literature relating to psychological outcomes following MBU admission. A systematic search of five databases identified 23 papers eligible for inclusion, reporting on a range of outcomes indicating positive effects on maternal mental health and the mother-infant relationship and an absence of adverse effects on child development. The review also highlighted specific groups responding less favorably to MBU admission, eg, mothers with a diagnosis of schizophrenia. Although the included studies were of variable methodological quality, the research findings consistently indicated positive effects. Implications for research and clinical practice are outlined in the discussion.

  11. Building capacity for Health Impact Assessment: Training outcomes from the United States

    Energy Technology Data Exchange (ETDEWEB)

    Schuchter, Joseph [Berkeley, CA (United States); Rutt, Candace, E-mail: awr8@cdc.gov [Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity, 4770 Buford Highway MS/F-77, Atlanta, GA 30341 (United States); Satariano, William A. [University of California Berkeley, School of Public Health, Division of Community Health and Human Development, Berkeley, CA (United States); Seto, Edmund [University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, WA (United States)

    2015-01-15

    Background: Despite the continued growth of Health Impact Assessment (HIA) in the US, there is little research on HIA capacity-building. A comprehensive study of longer-term training outcomes may reveal opportunities for improving capacity building activities and HIA practice. Methods: We conducted in-depth interviews with HIA trainees in the United States to assess their outcomes and needs. Using a training evaluation framework, we measured outcomes across a spectrum of reaction, learning, behavior and results. Results: From 2006 to 2012, four organizations trained over 2200 people in at least 75 in-person HIA trainings in 29 states. We interviewed 48 trainees, selected both randomly and purposefully. The mean duration between training and interview was 3.4 years. Trainees reported that their training objectives were met, especially when relevant case-studies were used. They established new collaborations at the trainings and maintained them. Training appeared to catalyze more holistic thinking and practice, including a range of HIA-related activities. Many trainees disseminated what they learned and engaged in components of HIA, even without dedicated funding. Going forward, trainees need assistance with quantitative methods, project management, community engagement, framing recommendations, and evaluation. Conclusions: The research revealed opportunities for a range of HIA stakeholders to refine and coordinate training resources, apply a competency framework and leverage complimentary workforce development efforts, and sensitize and build the capacity of communities. - Highlights: • We interviewed HIA trainees in the United States to assess longer-term outcomes. • Training appeared to catalyze a range of beneficial partnerships and activities. • Trainees reported outstanding needs for specific skills and competencies. • There are various opportunities to improve training and capacity-building.

  12. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. Fewer than 1 in

  13. Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

    Science.gov (United States)

    Jain, Shruti; Guleria, Kiran; Vaid, Neelam B; Suneja, Amita; Ahuja, Sharmila

    2016-01-01

    This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

  14. Area racism and birth outcomes among Blacks in the United States.

    Science.gov (United States)

    Chae, David H; Clouston, Sean; Martz, Connor D; Hatzenbuehler, Mark L; Cooper, Hannah L F; Turpin, Rodman; Stephens-Davidowitz, Seth; Kramer, Michael R

    2017-04-13

    There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the "n-word." This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as racism was associated with relative increases of 5% in the prevalence of preterm birth and 5% in the prevalence of low birthweight among Blacks. Our study provides evidence for the utility of an Internet query-based measure as a proxy for racism at the area-level in epidemiologic studies, and is also suggestive of the role of racism in contributing to poor birth outcomes among Blacks. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Improved Outcome of Severe Acute Pancreatitis in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Polychronis Pavlidis

    2013-01-01

    Full Text Available Background. Severe acute pancreatitis (SAP is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU. Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010. Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8. The most common aetiologies were alcohol (40% and gallstones (30%. On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI was 4. Forty patients (80% tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, . ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy. Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity.

  16. The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

    Science.gov (United States)

    Sarton, Cheryl; Lichter, Erika

    2016-01-01

    The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes. PMID:27747104

  17. Cholera in Pregnancy: Outcomes from a Specialized Cholera Treatment Unit for Pregnant Women in Léogâne, Haiti

    Science.gov (United States)

    Ciglenecki, Iza; Bichet, Mathieu; Tena, Javier; Mondesir, Erneau; Bastard, Mathieu; Tran, Nguyen-Toan; Antierens, Annick; Staderini, Nelly

    2013-01-01

    Background The association between cholera in pregnancy and negative fetal outcome has been described since the 19th century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011. Methods Pregnant women with cholera were hospitalized in a specialized unit within the MSF hospital compound in Léogâne and treated using standard cholera treatment guidelines but with earlier, more intense fluid replacement. All women had intravenous access established at admission regardless of their hydration status, and all received antibiotic treatment. Data were collected on patient demographics, pregnancy and cholera status, and pregnancy outcome. In this analysis we calculated risk ratios for fetal death and performed logistic regression analysis to control for confounding factors. Results 263 pregnant women with cholera were hospitalized between December 2010 and July 2011. None died during hospitalization, 226 (86%) were discharged with a preserved pregnancy and 16 (6%) had live fullterm singleton births, of whom 2 died within the first 5 days postpartum. The remaining 21 pregnancies (8%) resulted in intrauterine fetal death. The risk of fetal death was associated with factors reflecting severity of the cholera episode: after adjusting for confounding factors, the strongest risk factor for fetal death was severe maternal dehydration (adjusted risk ratio for severe vs. mild dehydration was 9.4, 95% CI 2.5–35.3, p = 0.005), followed by severe vomiting (adjusted risk ratio 5.1, 95% 1.1–23.8, p = 0.041). Conclusion This is the largest cohort of pregnant women with cholera described to date. The main risk factor identified for fetal death was severity of dehydration. Our experience suggests that establishing specialized multidisciplinary units which facilitate close follow-up of both pregnancy and dehydration

  18. KC-46A Formal Training Unit (FTU) and First Main Operating Base (MOB 1) Beddown EIS. Volume 1

    Science.gov (United States)

    2014-03-01

    support a1rcraft operations and pHot and personnel training • ht UMI O~f’t EIS, the USAF ldet~titJ.s AltUS AF8 as the PTI~ fened A#etnAtfv• for liH! FTV...Frequency, commonly perceived as pitch, is the number of times per second the sound causes air molecules to oscillate . Frequency is measured in units of

  19. 76 FR 75508 - United States Navy Restricted Area, SUPSHIP Bath Maine Detachment Mobile at AUSTAL, USA, Mobile...

    Science.gov (United States)

    2011-12-02

    ... Maine Detachment Mobile at AUSTAL, USA, Mobile, AL; Restricted Area AGENCY: U.S. Army Corps of Engineers... parties for the restricted area around the AUSTAL, USA shipbuilding facility located in Mobile, Alabama... Gulf Coast) assumed the duties of administering new construction contracts at AUSTAL USA in...

  20. Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units.

    Science.gov (United States)

    Staggs, Vincent S

    2015-12-31

    The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes. © The Author(s) 2015.

  1. Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

    Science.gov (United States)

    Koornneef, Erik; Robben, Paul; Blair, Iain

    2017-09-20

    The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. From the existing research literature it is not possible to conclude whether UAE health system reforms are

  2. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study.

    Science.gov (United States)

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina

    2015-07-01

    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  3. Studing the Influence of Six Main Industrial Losses on Overall Equipment Effectiveness in Cold Rolling Unit of Mobarakeh Steel Complex

    Directory of Open Access Journals (Sweden)

    seyed Akbar Nilipour Tabatabaei

    2011-03-01

    Full Text Available Overall Equipment Effectiveness (OEE is a key indicator and a basis for evaluating the effectiveness of equipments as well as assessing the effectiveness of the Total Productive Maintenance (TPM system. This indicator together with overall equipment performance can be used in production lines such as steel production. The aim of this article is to study the influence of six main industrial losses on the OEE indicator . For this purpose, the OEE has been calculated in the cold rolling production lines of Mobarakeh Steel Complex the gap between production lines and the global industrial standards has been studied the causes of production system inefficiency has been investigated and the effectiveness of TPM system, equipments' bottlenecks and the influence of the main industry losses on OEE have been studied. The findings imply that the influence of the variation of availability and performance rates on OEE is high, while the influence of the variation of quality rate on OEE is not considerable.

  4. Disease profile and Outcome of Newborn admitted to Neonatology unit of BPKIHS

    Directory of Open Access Journals (Sweden)

    Piush Kanodia

    2015-12-01

    Full Text Available Background & Objectives: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. Every year, millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU for various indications. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit.Materials & Methods: A retrospective study was conducted at neonatology unit of BPKIHS, from January 2014 to December 2014. A total of 1009 neonates (both inborn and out-born were admitted to neonatology division during the study period. Data was collected from the hospital record section. Ethical clearance was taken from the institutional ethical committee before the initiation of the study. Data was entered and descriptive analysis was done by using SPSS 20.0.Results: Total of 1009 neonates were admitted in neonatology unit. Among them, 349(34.5% cases were admitted due neonatal sepsis, 236 (23.3% due to prematurity and 233 (23.1% with birth asphyxia. Among birth asphyxia, 102(43.7% were in HIE III, 34.3% and 21.8% in HIE II and HIE I, respectively. The overall mortality was 47 (4.7% during hospital stay.Conclusion: Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortalityJCMS Nepal. 2015;11(3:20-24.

  5. Impact of SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention for unprotected left main coronary artery.

    Science.gov (United States)

    Nozue, Tsuyoshi; Kamijima, Ryo; Iwaki, Taku; Michishita, Ichiro

    2012-01-01

    SYNTAX score is an angiographic scoring system that was developed to quantify the number, complexity, and location of lesions in patients undergoing coronary revascularization. Up to now, the impact of SYNTAX score on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) lesions has not been fully examined. Therefore, we evaluate the usefulness of the SYNTAX score and identify the cutoff value of this score to predict 1-year clinical outcomes in patients undergoing PCI for unprotected LMCA lesions. This was a single-center retrospective study that included 49 consecutive patients undergoing elective PCI for unprotected LMCA lesions. We calculated the SYNTAX score and examined the correlations between this score and 1-year clinical outcomes. Major adverse cardiac events (MACE) occurred in 12 patients (24%): target lesion revascularization in 9 patients (18%), myocardial infarction in 2 (4%), and cardiac death in 1 (2%). The frequency of MACE was significantly higher in the intermediate (47%) or high score group (50%) than in the low score group (4%). Furthermore, the SYNTAX score was significantly higher in the MACE group than in the non-MACE group (31 vs. 22, p = 0.008). Receiver-operating characteristic curve showed that the SYNTAX score exhibited 83% sensitivity and 76% specificity for predicting the development of MACE at a cutoff value 26. These results demonstrate that the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI for unprotected LMCA lesions.

  6. The effects of maternity leave on children's birth and infant health outcomes in the United States.

    Science.gov (United States)

    Rossin, Maya

    2011-03-01

    This paper evaluates the impacts of unpaid maternity leave provisions of the 1993 Family and Medical Leave Act (FMLA) on children's birth and infant health outcomes in the United States. My identification strategy uses variation in pre-FMLA maternity leave policies across states and variation in which firms are covered by FMLA provisions. Using Vital Statistics data and difference-in-difference-in-difference methodology, I find that maternity leave led to small increases in birth weight, decreases in the likelihood of a premature birth, and substantial decreases in infant mortality for children of college-educated and married mothers, who were most able to take advantage of unpaid leave. My results are robust to the inclusion of numerous controls for maternal, child, and county characteristics, state, year, and month fixed effects, and state-year interactions, as well as across several different specifications. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  8. A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit.

    Science.gov (United States)

    Amira, Christiana Oluwatoyin; Bello, Babawale Taslim; Braimoh, Rotimi Williams

    2016-05-01

    Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days). Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5%) catheters were removed, 14 (20.3%) due to catheter malfunction, eight (11.6%) due to infection, five (7.2%) elective removal, and three (4.3%) due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

  9. Outcome of mechanically ventilated patients initially denied admission to an intensive care unit and subsequently admitted.

    Science.gov (United States)

    Naser, Wasim; Schwartz, Naama; Finkelstein, Richard; Bisharat, Naiel

    2016-11-01

    The outcome of mechanically ventilated patients initially denied admission to an intensive care unit (ICU) and subsequently admitted is unclear. We compared outcomes of patients denied ICU admission and subsequently admitted, to those of patients admitted to the ICU and to patients refused ICU admission. The medical records of all the patients who were subjected to mechanical ventilation for at least 24h over a 4year period (2010-2014) were reviewed. Of 707 patients (757 admissions), 124 (18%) were initially denied ICU admission and subsequently admitted. Multivariate stepwise logistic regression analysis showed significant association with death of: age, length of stay, nursing home residency, duration of mechanical ventilation, previous admission with mechanical ventilation, cause for mechanical ventilation, rate of failed extubations, associated morbidity (previous cerebrovascular accident, dementia, chronic renal failure), and occurrence of nosocomial bacteremia. The odds for death among patients denied ICU admission and subsequently transferred to the ICU compared to patients admitted directly to the ICU was 3.6 (95% CI: 1.9-6.7) (Padmission compared to those who were initially denied and subsequently admitted were not statistically significant (OR=1.7, 95% CI: 0.8-3.8). In conclusion, patients denied ICU admission and subsequently admitted face a considerable risk of morbidity and mortality. Their odds of death are nearly three times those admitted directly to the ICU. Late admission to the ICU does not appear to provide benefit compared to patients who remain in general medicine wards.

  10. Outcomes in achalasia from a surgical unit where pneumatic dilatation is first-line therapy.

    Science.gov (United States)

    Howard, J M; Mongan, A-M; Manning, B J; Byrne, P; Lawler, P; Ravi, N; Reynolds, J V

    2010-08-01

    The management of achalasia remains controversial, with little consensus on the optimal patient treatment pathway. In our own esophageal unit, we offer pneumatic dilatation as the initial therapy in most patients as first-line therapy. In this study, we aimed to examine the safety and efficacy of our own approach to the management of patients with a diagnosis of achalasia, examining symptomatic outcomes, patient satisfaction, and need for further intervention, as well as examining patient factors associated with treatment failure. Sixty-seven consecutive patients underwent pneumatic dilatation as first-line therapy (53% male, mean age 46 years). All attended regular outpatient follow-up (mean 37, range 3-132 months). Twenty-five percent of patients required a second intervention because of symptom recurrence, at a median period of 4.5 months. Symptomatic outcomes were excellent or good in 80%. Significant predictors of treatment failure and poor symptom score included a younger age at the time of diagnosis and increased esophageal diameter on barium swallow. This study suggests that pneumatic dilatation is a safe and effective approach as first-line therapy in patients with newly diagnosed achalasia.

  11. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    LENUS (Irish Health Repository)

    Dover, Mary

    2013-09-17

    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  12. Long-term outcomes of minor troponin elevations in the intensive care unit.

    Science.gov (United States)

    Velasquez, A; Ghassemi, M; Szolovits, P; Park, S; Osorio, J; Dejam, A; Celi, L

    2014-05-01

    The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. A total of 4224 patients (2547 controls and 1677 positives) were analysed. The primary outcome was mortality at one year. Secondary outcomes were 30-day mortality and hospital and ICU lengths of stay. After adjusting for age, sex, Simplified Acute Physiology Score, Sequential Organ Failure Assessment and combined Elixhauser score, we found that minor troponin elevations (peak troponin elevation between 0.01 and 0.09 ng/ml) were associated with a higher one-year mortality (Hazard Ratio 1.22, P troponin presence; Hazard Ratio 1.03, P troponin increment). This relationship held for the subgroup of seven-day post-discharge survivors (Hazard Ratio 1.26, P troponin also significantly increased the net reclassification index over traditional risk markers for mortality prediction (net reclassification score 0.12, P troponin elevation was also associated with 30-day mortality (odds ratio 1.33, P=0.003). Importantly, troponin testing did not increase the adjusted mortality odds (P=0.9). Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.

  13. Outcomes of Emergency Medical Patients Admitted to an Intermediate Care Unit With Detailed Admission Guidelines.

    Science.gov (United States)

    Simpson, Catherine E; Sahetya, Sarina K; Bradsher, Robert W; Scholten, Eric L; Bain, William; Siddique, Shazia M; Hager, David N

    2017-01-01

    An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department. To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines. Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012. A total of 317 unique patients were admitted (mean age, 54 [SD, 16] years). Most patients were admitted with respiratory (26.5%) or cardiac (17.0%) syndromes. The mean (SD) Acute Physiology and Chronic Health Evaluation score version II, Simplified Acute Physiology Score version II, and Charlson Comorbidity Index were 15.6 (6.5), 20.7 (11.8), and 2.7 (2.3), respectively. Severity of illness and length of stay were significantly different for patients who required intensive care within 24 hours of admission (n = 16) or later (n = 25), patients who continued with inter mediate care for more than 24 hours (n = 247), and patients who were downgraded or discharged in less than 24 hours (n = 29). Overall hospital mortality was 4.4% (14 deaths). Emergency medical patients with moderate severity of illness and comorbidity can be admitted to an intermediate level of care with relatively infrequent transfer to intensive care and relatively low mortality. ©2016 American Association of Critical-Care Nurses.

  14. Remedial investigation/feasibility study of the Clinch River/Poplar Creek operable unit. Volume 1: Main text

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-01

    This report presents the findings of an investigation into contamination of the Clinch River and Poplar Creek near the US Department of Energy`s (DOE`s) Oak Ridge Reservation (ORR) in eastern Tennessee. For more than 50 years, various hazardous and radioactive substances have been released to the environment as a result of operations and waste management activities at the ORR. In 1989, the ORR was placed on the National Priorities List (NPL), established and maintained under the federal Comprehensive environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Under CERCLA, NPL sites must be investigated to determine the nature and extent of contamination at the site, assess the risk to human health and the environment posed by the site, and, if necessary, identify feasible remedial alternatives that could be used to clean the site and reduce risk. To facilitate the overall environmental restoration effort at the ORR, CERCLA activities are being implemented individually as distinct operable units (OUs). This document is the combined Remedial Investigation and Feasibility Study Report for the Clinch River/Poplar Creek OU.

  15. Piloting yoga and assessing outcomes in a residential behavioural health unit.

    Science.gov (United States)

    McIlvain, S J; Miller, B; Lawhead, B A; Barbosa-Leiker, C; Anderson, A

    2015-04-01

    This study examined if adolescents on a residential behavioural health unit would participate in a yoga intervention. Yoga has been used as a mind-body practice for more than 2000 years; however, studies are limited regarding its effects on adolescents with mental illness on an inpatient unit. Yoga was added, twice weekly, to the program schedule. Trait Emotional Intelligence Questionnaire-Adolescent Short Form (TEIQue-ASF) scores were measured over 8 weeks. Additional measures included daily numbers of quiet times, time outs, and point card scores. Twenty-two adolescents completed the study. The TEIQue-ASF assessment was able to detect changes in total scores over 8 weeks. Increased yoga participation was related to higher values of the TEIQue-ASF subdomain of sociability, increase in weekly point card totals, a decrease in behavioural time outs, and a decrease in combined behavioural interventions at various time points throughout the programme. This study was relevant because it was conducted on an adolescent inpatient unit. It provides support that yoga, as part of a residential programme, is a feasible intervention for adolescents with mental illness. Changes in the various measures cannot be directly linked to yoga because of lack of a comparison group. Additional studies with a larger sample, and randomization, are needed to evaluate the potential benefits of yoga and to determine if changes to the TEIQue-ASF can be attributed to yoga or other behavioural-based interventions. Little is known about how yoga will impact behavioural health outcomes for adolescents with mental illness in an inpatient setting. This study examined if adolescents on a residential behavioural health unit would participate in a yoga intervention to address emotional regulation. A single cohort study design was used. Yoga was added to the programme schedule twice weekly. Trait Emotional Intelligence Questionnaire-Adolescent Short Form (TEIQue-ASF) scores and additional behavioural

  16. Pregnancy outcomes in women growing up with perinatally acquired HIV in the United Kingdom and Ireland

    Directory of Open Access Journals (Sweden)

    Laura Byrne

    2014-11-01

    Full Text Available Introduction: In the United Kingdom and Ireland more than 40% of individuals living with perinatally acquired HIV are now aged >16. Globally, increasing numbers of women with perinatally acquired HIV are becoming pregnant, but data on fertility and pregnancy outcomes is scarce. We present pregnancy outcome data for this emerging cohort. Methods: Pregnancies in diagnosed HIV-infected women in the United Kingdom and Ireland, and children diagnosed with HIV, are reported to the National Study of HIV in Pregnancy and Childhood. We analyzed data on pregnancies in women diagnosed aged ≤13 with perinatally acquired HIV, reported by June 2014. Results: A total of 759 females born before 2001, diagnosed with perinatally acquired HIV aged ≤13 years, and in care in the UK and Ireland have been reported. Forty-four of these (6% have had at least one pregnancy reported, with nineteen 2nd and four 3rd/4th pregnancies. Women's year of birth ranged from 1985 to 1996; 60% of women were UK/Irish-born and 39% African-born. Twenty one percent were diagnosed at 500 cells/µL in 36% of first pregnancies, 350–499 in 15% and 1000 in 5%. Forty four percent of live births were delivered by elective caesarean section (CS, 27% by emergency CS, 27% by planned vaginal delivery and with one unplanned vaginal delivery. Of 29 live births with viral load <50, 31% were delivered by elective CS, 17% by emergency CS and 52% by vaginal delivery. Fifteen percent of infants were delivered at 32–36 weeks gestation, and 2% at 30 weeks; 16% weighed 1.5–2.5 kg and 16% weighed <1.5 kg. Among 38 of the 51 infants where infection status is already reported, one is perinatally infected. Conclusions: Currently at least 6% of perinatally infected women in care in the UK and Ireland have experienced one or more pregnancies. Linking paediatric, pregnancy and second generation data will enable further monitoring of pregnancy outcomes in this newly emerging population.

  17. Remedial investigation/feasibility study of the Clinch River/Poplar Creek operable unit. Volume 1, main text

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    This document is the combined Remedial Investigation/Feasibility Study (RI/FS) Report for the Clinch River/Poplar Creek Operable Unit (CR/PC OU), an off-site OU associated with environmental restoration activities at the U.S. Department of Energy (DOE) Oak Ridge Reservation (ORR). As a result of past, present, and potential future releases of hazardous substances into the environment, the ORR was placed on the National Priorities List in December 1989 (54 FR 48184). Sites on this list must be investigated for possible remedial action, as required by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA, 42 U.S.C. 9601, et seq.). This report documents the findings of the remedial investigation of this OU and the feasibility of potential remedial action alternatives. These studies are authorized by Sect. 117 of CERCLA and were conducted in accordance with the requirements of the National Contingency Plan (40 CFR Part 300). DOE, the U.S. Environmental Protection Agency (EPA), and the Tennessee Department of Environment and Conservation (TDEC) have entered into a Federal Facility Agreement (FFA), as authorized by Sect. 120 of CERCLA and Sects. 3008(h) and 6001 of the Resource Conservation and Recovery Act (RCRA) (42 U.S.C. 6901, et seq.). The purpose of this agreement is to ensure a coordinated and effective response for all environmental restoration activities occurring at the ORR. In addition to other responsibilities, the FFA parties mutually define the OU boundaries, set remediation priorities, establish remedial investigation priorities and strategies, and identify and select remedial actions. A copy of this FFA is available from the DOE Information Resource Center in Oak Ridge, Tennessee.

  18. Remedial investigation/feasibility study for the Clinch River/Poplar Creek operable unit. Volume 1. Main text

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-01

    This is the combined Remedial Investigation/Feasibility Study Report for the Clinch River/Poplar Crack (CR/PC) Operable Unit (OU). The CR/PC OU is located in Anderson and Roane Counties, Tennessee and consists of the Clinch River and several of its embayments in Melton Hill and Watts Bar Reservoirs. These waters have received hazardous substances released over a period of 50 years from the US Department of Energy`s Oak Ridge Reservation (ORR), a National Priority List site established under the Comprehensive Environmental Response, Compensation, and Liability Act. A remedial investigation has been conducted to determine the current nature and extent of any contamination and to assess the resulting risk to human health and the environment. The feasibility study evaluates remedial action alternatives to identify any that are feasible for implementation and that would effectively reduce risk. Historical studies had indicated that current problems would likely include {sup 137}Cs in sediment of the Clinch River, mercury in sediment and fish of Poplar Creek and PCBs and pesticides in fish from throughout the OU. Peak releases of mercury and {sup 137}Cs occurred over 35 years ago, and current releases are low. Past releases of PCBs from the ORR are poorly quantified, and current releases are difficult to quantify because levels are so low. The site characterization focused on contaminants in surface water, sediment, and biota. Contaminants in surface water were all found to be below Ambient Water Quality Criteria. Other findings included the following: elevated metals including cesium 137 and mercury in McCoy Branch sediments; PCBs and chlordane elevated in several fish species, presenting the only major human health risk, significant ecological risks in Poplar Creek but not in the Clinch River.

  19. Sustainability in a global context: How does local factor affect the outcomes of CSR activities in international business units?

    DEFF Research Database (Denmark)

    Thomsen, Christa; Lauring, Jakob

    In recent years CSR has become increasingly important for the activities and branding of MNCs. While some studies have investigated CSR management and branding in domestic situations, fewer studies exist in the case of international business units (subsidiaries, joint ventures, and franchises...... as CSR branding outcomes). Our findings show that local values were positively associated with external CSR engagement and that employee relations were positively related to both internal and external CSR engagement. None of the local factors were significantly associated with CSR branding outcomes......). In this study, we use a sample consisting of 119 Danish business units that are located in China. We set out to investigate the relationship between local factors (the local business unit’s Chinese values and internal employee relations in the unit) and CSR outcomes (internal and external CSR engagement as well...

  20. Joint Peru/United States report on Peru/United States cooperative energy assessment. Volume 1. Executive summary, main report and appendices

    Energy Technology Data Exchange (ETDEWEB)

    1979-08-01

    In 1978, the US and Peru conducted a comprehensive assessment of Peru's energy resources, needs, and uses and developed several alternative energy strategies that utilize the available resources to meet their energy requirements. This Volume I reports the findings of the assessment and contains the executive summary, the main report, and five appendices of information that support the integrated energy supply and demand analysis. The following chapters are included: The Energy Situation in Peru (economic context and background, energy resources and production, energy consumption patterns); Reference Supply and Demand Projection (approach, procedures, and assumptions; economic projections; energy demand and supply projections; supply/demand integration; uncertainties); and The Development of Strategies and Options (the analysis of options; strategies; increased use of renewables, hydropower, coal; increased energy efficiency; and financial analysis of strategies).

  1. An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit.

    Science.gov (United States)

    Lillibridge, Nichole; Botti, Mari; Wood, Beverley; Redley, Bernice

    2017-05-19

    To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. Naturalistic, exploratory descriptive design using observation. Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. Patient outcomes sensitive to the quality of interprofessional handover on patient

  2. Strategies for Monitoring Outcomes in HIV-Exposed Uninfected Children in the United Kingdom.

    Science.gov (United States)

    Thorne, Claire; Tookey, Pat

    2016-01-01

    Surveillance of pregnancies in women living with HIV is carried out on a national basis in the United Kingdom (UK) through the National Study of HIV in Pregnancy and Childhood. There are currently around 1100-1200 HIV-exposed uninfected (HEU) infants born every year in the UK, where vertical transmission of HIV now occurs in fewer than 5 in every 1000 pregnancies. By the end of 2014, there was a cumulative total of more than 15,000 HEU children with any combination antiretroviral therapy (cART) exposure and more than 5000 with cART exposure from conception in the UK. HEU infants are increasingly being exposed to newer antiretroviral drugs for which less is known regarding both short- and long-term safety. In this commentary, we describe the approaches that have been taken to explore health outcomes in HEU children born in the UK. This includes the Children exposed to AntiRetroviral Therapy (CHART) Study, which was a consented follow-up study carried out in 2002-2005 of HEU children born in 1996-2004. The CHART Study showed that 4% of HEU children enrolled had a major health or development problem in early childhood; this was within expected UK norms, but the study was limited by small numbers and short-term follow-up. However, the problems with recruitment and retention that were encountered within the CHART Study demonstrated that comprehensive, clinic-based follow-up was not a feasible approach for long-term assessment of HEU children in the UK. We describe an alternative approach developed to monitor some aspects of their long-term health, involving the "flagging" of HEU infants for death and cancer registration with the UK Office for National Statistics. Some of the ethical concerns regarding investigation of long-term outcomes of in utero and perinatal exposure to antiretrovirals, including those relating to consent and confidentiality, are also discussed.

  3. Strategies for monitoring outcomes in HIV-exposed uninfected children in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Claire eThorne

    2016-05-01

    Full Text Available Surveillance of pregnancies in women living with HIV is carried out on a national basis in the United Kingdom (UK through the National Study of HIV in Pregnancy and Childhood (NSHPC. There are currently around 1100-1200 HIV-exposed uninfected (HEU infants born every year in the UK, where vertical transmission of HIV now occurs in fewer than five in every 1000 pregnancies. By the end of 2014, there was a cumulative total of more than 15,000 HEU children with any combination antiretroviral therapy (cART exposure and more than 5,000 with cART exposure from conception in the UK. HEU infants are increasingly being exposed to newer antiretroviral drugs for which less is known regarding both short and longer-term safety. In this commentary, we describe the approaches that have been taken to explore health outcomes in HEU children born in the UK. This includes the Children exposed to AntiRetroviral Therapy (CHART Study, which was a consented follow-up study carried out in 2002-2005 of HEU children born in 1996-2004. The CHART Study showed that 4% of HEU children enrolled had a major health or development problem in early childhood; this was within expected UK norms but the study was limited by small numbers and short-term follow-up. However, the problems with recruitment and retention that were encountered within the CHART Study demonstrated that comprehensive, clinic-based follow-up was not a feasible approach for long-term assessment of HEU children in the UK. We describe an alternative approach developed to monitor some aspects of their long-term health, involving the flagging of HEU infants for death and cancer registration with the UK Office for National Statistics. Some of the ethical concerns regarding investigation of long-term outcomes of in utero and perinatal exposure to antiretrovirals including those relating to consent and confidentiality are also discussed.

  4. A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit

    Directory of Open Access Journals (Sweden)

    Christiana Oluwatoyin Amira

    2016-01-01

    Full Text Available Hemodialysis (HD catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days. Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5% catheters were removed, 14 (20.3% due to catheter malfunction, eight (11.6% due to infection, five (7.2% elective removal, and three (4.3% due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

  5. Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit

    Directory of Open Access Journals (Sweden)

    Jose Chacko

    2012-01-01

    Full Text Available Background and Aims: Although smoke inhalation is well known to cause acute lung injury, there are few reports in literature that study the evolution, clinical course and outcomes of isolated inhalational lung injury in a modern intensive care setting. A major fire disaster provided us the opportunity to study victims of isolated inhalational injury admitted to our Multidisciplinary Intensive Care Unit (MICU. Materials and Methods: We studied the clinical course, ICU and hospital outcomes of 13 victims of a fire disaster who required mechanical ventilation for isolated inhalational lung injury. All patients were followed up at regular intervals, and their functional status was assessed at 8 months after hospital discharge. Results: The Lung Injury Scores (LIS worsened to reach a nadir on Day 3 of injury. There was a significant correlation between the LIS on Day 3 and duration of mechanical ventilation (r = 0.8; P = 0.003, ICU (r = 0.8; P = 0.002 and hospital (r = 0.6; P = 0.02 days. Late-onset airway complications were encountered in four patients. Three of them required long-term artificial airways - two with a tracheostomy while the third patient required surgical insertion of a "T" tube. Persistent problems with phonation occurred in two patients. At 8 months postdischarge, all patients were independent with activities of daily living; all were back to work, except for two who continued to need artificial airways. Conclusions: Inhalational lung injury progresses over the first few days and is worst after 72 h. Late-onset airway complications may manifest after several weeks and require repeated intervention.

  6. Ileus and Small Bowel Obstruction in an Emergency Department Observation Unit: Are there Outcome Predictors?

    Directory of Open Access Journals (Sweden)

    Charles L. Emerman

    2011-05-01

    Full Text Available Introduction: The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED observation unit (OU and to identify predictors of successful management for such patients. Methods: We performed a retrospective chart review of 129 patients admitted to a university-affiliated, urban, tertiary hospital ED OU from January 1999 through November 2004. Inclusion criteria were all adult patients admitted to the OU with an ED diagnosis of ileus, partial small bowel obstruction, or small bowel obstruction, and electronic medical records available for review. The following variables were examined: ED diagnosis, history of similar admission, number of prior abdominal surgeries, surgery in the month before, administration of opioid analgesia at any time after presentation, radiographs demonstrating air–fluid levels or dilated loops of small bowel, hypokalemia, use of nasogastric decompression, and surgical consultation. Results: Treatment failure, defined as hospital admission from the OU, occurred in 65 (50.4% of 129 patients. Only the use of a nasogastric tube was associated with OU failure (21% discharged versus 79% requiring admission, P ¼ 0.0004; odds ratio, 5.294; confidence interval, 1.982–14.14. Conclusion: Half of the patients admitted to our ED OU with ileus or varying degrees of small bowel obstruction required hospital admission. The requirement of a nasogastric tube in such patients was associated with a greater rate of observation unit failure. [West J Emerg Med. 2011;12(4:404–407.

  7. Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.

    Science.gov (United States)

    Fitzner, Karen; Fox, Kathe; Schmidt, Joseph; Roberts, Mark; Rindress, Donna; Hay, Joel

    2005-08-01

    Despite widespread adoption of disease management (DM) programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to 292 appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey. Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction. More respondents were highly satisfied with clinical results than with utilization or cost outcomes of their programs (46%, 17%, and 13%, respectively). Detailed results were analyzed for 57 DM programs with over 230,000 enrollees. Most responding plans offered DM programs for diabetes and asthma, with return on investment (ROI) ranging from 0.16:1 to 4:1. Weighted by number of enrollees per DM program, average ROI was 2.56:1 for asthma (n = 1,136 enrollees) and 1.98:1 for diabetes (n = 25,364). Most (but not all) respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes. Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement.

  8. Family history and disease outcomes in patients with Crohn's disease: A comparison between China and the United States.

    Science.gov (United States)

    Wang, Pei-Qi; Hu, Jun; Al Kazzi, Elie S; Akhuemonkhan, Eboselume; Zhi, Min; Gao, Xiang; de Paula Pessoa, Raquel Holand; Ghazaleh, Sami; Cornelius, Tuhina; Sabunwala, Suhel Abbas; Ghadermarzi, Shadi; Tripathi, Kartikeya; Lazarev, Mark; Hu, Pin-Jin; Hutfless, Susan

    2016-11-06

    To investigate the differences in family history of inflammatory bowel disease (IBD) and clinical outcomes among individuals with Crohn's disease (CD) residing in China and the United States. We performed a survey-based cross-sectional study of participants with CD recruited from China and the United States. We compared the prevalence of IBD family history and history of ileal involvement, CD-related surgeries and IBD medications in China and the United States, adjusting for potential confounders. We recruited 49 participants from China and 145 from the United States. The prevalence of family history of IBD was significantly lower in China compared with the United States (China: 4.1%, United States: 39.3%). The three most commonly affected types of relatives were cousin, sibling, and parent in the United States compared with child and sibling in China. Ileal involvement (China: 63.3%, United States: 63.5%) and surgery for CD (China: 51.0%, United States: 49.7%) were nearly equivalent in the two countries. The lower prevalence of familial clustering of IBD in China may suggest that the etiology of CD is less attributed to genetic background or a family-shared environment compared with the United States. Despite the potential difference in etiology, surgery and ileal involvement were similar in the two countries. Examining the changes in family history during the continuing rise in IBD may provide further insight into the etiology of CD.

  9. Outcomes after emergency percutaneous coronary intervention in patients with unprotected left main stem occlusion: the BCIS national audit of percutaneous coronary intervention 6-year experience.

    Science.gov (United States)

    Patel, Niket; De Maria, Giovanni Luigi; Kassimis, George; Rahimi, Kazem; Bennett, Derrick; Ludman, Peter; Banning, Adrian P

    2014-09-01

    This study sought to evaluate in-hospital outcomes and 3-year mortality of patients presenting with unprotected left main stem occlusion (ULMSO) treated with primary percutaneous coronary intervention (PPCI). Limited data exists about management and outcome following presentation with ULMSO. From January 1, 2007 to December 21, 2012, 446,257 PCI cases were recorded in the British Cardiovascular Intervention Society database of all PCI cases in England and Wales. Of those, 568 were patients having emergency PCI for ST-segment elevation infarction (0.6% of all PPCI) who presented with ULMSO (TIMI [Thrombolysis In Myocardial Infarction] flow grade 0/1 and stenosis >75%), and they were compared with 1,045 emergency patients treated with nonocclusive LMS disease. Follow-up was obtained through linkage with the Office of National Statistics. Presentation with ULMSO, compared with nonocclusive LMS disease, was associated with a doubling in the likelihood of periprocedural shock (57.9% vs. 27.9%; p < 0.001) and/or intra-aortic balloon pump support (52.5% vs. 27.2%; p < 0.001). In-hospital (43.3% vs. 20.6%; p < 0.001), 1-year (52.8% vs. 32.4%; p < 0.001), and 3-year mortality (73.9% vs 52.3%, p < 0.001) rates were higher in patients with ULMSO, compared with patients presenting with a patent LMS, and were significantly influenced by the presence of cardiogenic shock. ULMSO and cardiogenic shock were independent predictors of 30-day (hazard ratio [HR]: 1.61 [95% confidence interval (CI): 1.07 to 2.41], p = 0.02, and HR: 5.43 [95% CI: 3.23 to 9.12], p<0.001, respectively) and 3-year all-cause mortality (HR: 1.52 [95% CI: 1.06 to 2.17], p = 0.02, and HR: 2.98 [95% CI: 1.99 to 4.49], p < 0.001, respectively). In patients undergoing PPCI for ULMSO, acute outcomes are poor and additional therapies are required to improve outcome. However, long-term outcomes for survivors of ULMSO are encouraging. Copyright © 2014 American College of Cardiology Foundation. Published by

  10. Patterns and Outcomes Associated with Patient Migration for Liver Transplantation in the United States.

    Directory of Open Access Journals (Sweden)

    Kristopher P Croome

    Full Text Available Traveling to seek specialized care such as liver transplantation (LT is a reality in the United States. Patient migration has been attributed to organ availability. The aims of this study were to delineate patterns of patient migration and outcomes after LT.All deceased donor LT between 2008-2013 were extracted from UNOS data. Migrated patients were defined as those patients who underwent LT at a center in a different UNOS region from the region in which they resided and traveled a distance > 100 miles.Migrated patients comprised 8.2% of 28,700 LT performed. Efflux and influx of patients were observed in all 11 UNOS regions. Regions 1, 5, 6, and 9 had a net efflux, while regions 2, 3, 4, 7, 10, and 11 had a net influx of patients. After multivariate adjustment for donor and recipient factors, graft (p = 0.68 and patient survival (p = 0.52 were similar between migrated and non-migrated patients.A significant number of patients migrated in patterns that could not be explained alone by regional variations in MELD score and wait time. Migration may be a complex interplay of factors including referral patterns, specialized services at centers of excellence and patient preference.

  11. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit.

    Science.gov (United States)

    Plikat, Katharina; Langgartner, Julia; Buettner, Roland; Bollheimer, L Cornelius; Woenckhaus, Ulrike; Schölmerich, Jürgen; Wrede, Christian E

    2007-02-01

    Acute and chronic critical conditions are associated with reduced serum levels of free triiodothyronine (FT(3)), free thyroxine FT(4), and thyrotropin, known as nonthyroidal illness syndrome (NTIS). It is still controversial whether these changes reflect a protective mechanism or a maladaptive process during prolonged illness. However, larger studies to determine the prevalence of the NTIS and its association with outcome in medical intensive care units (ICUs) are missing. Complete thyroid hormone levels from 247 of 743 patients admitted to our ICU between October 2002 and February 2004 were retrospectively evaluated. From these patients, Acute Physiology and Chronic Health II scores, ICU mortality, length of stay, mechanical ventilation, and concomitant medication were recorded. Ninety-seven patients (44.1%) had low FT(3) levels indicating an NTIS, either with normal (23.6%) or reduced (20.5%) serum thyrotropin levels. Of 97 patients with NTIS, 24 (23.3%) also showed reduced serum FT(4) levels. The NTIS was significantly associated with Acute Physiology and Chronic Health II scores, mortality, length of stay, and mechanical ventilation. In a multivariate Cox regression analysis, the combination of low FT(3) and low FT(4) was an independent risk factor for survival. Nonthyroidal illness syndrome is frequent at a medical ICU. A reduction of FT(4) together with FT(3) is associated with an increase in mortality and might reflect a maladaptive process, thereby worsening the disease.

  12. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.

    Science.gov (United States)

    McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken

    2010-11-02

    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. Interrupted time series. The emergency general surgery ward of a university hospital in the United Kingdom. Seven safety relevant care processes. A Lean intervention targeting five of the seven care processes relevant to patient safety. 969 patients were admitted during the four month study period before the introduction of the Lean intervention (May to August 2007), and 1114 were admitted during the four month period after completion of the intervention (May to August 2008). Compliance with the five process measures targeted for Lean intervention (but not the two that were not) improved significantly (relative improvement 28% to 149%; PLean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.

  13. Severe acidosis does not predict fatal outcomes in intensive care unit patients: a retrospective analysis.

    Science.gov (United States)

    Paz, Yoav; Zegerman, Alexander; Sorkine, Patrick; Matot, Idit

    2014-04-01

    Severe acidosis is a potentially life-threatening acid-base imbalance. The outcome of patients with severe acidosis has only been anecdotally described. We therefore assessed the discharge rate of such patients from the intensive care unit (ICU) and survival time after the event. A retrospective evaluation of medical records of patients admitted to the ICU of Tel Aviv Medical Center between 2005 and 2010, in whom arterial blood pH less than 6.8 was documented during their ICU stay, was performed. Twenty-eight patients were suitable for study entry. Septic shock was the most common underlying medical condition (33%). Nine (32.1%) patients were either discharged alive or survived for at least 30 days in the ICU after their arterial blood pH measurement was less than 6.8. More than a quarter of the patients with life-threatening acidosis (n = 8; 28.6%) were discharged home and returned to their prehospitalization daily activity. Mean follow-up period for these patients was 132 ± 111 weeks. Multivariate analysis identified hyperkalemia, Acute Physiology and Chronic Health Evaluation II score, and Glasgow Coma Scale as determinants for ICU death after severe acidosis. A significant number of patients can outlast severe acidosis and return to their prehospitalization status. Larger studies are needed to define the patient population most likely to benefit from aggressive resuscitation efforts during severe acidosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Limiting Severe Outcomes and Impact on Intensive Care Units of Moderate-Intermediate 2009 Pandemic Influenza: Role of Infectious Diseases Units

    OpenAIRE

    Sergio Carbonara; Giuseppe Bruno; Giuseppe Di Ciaula; Anna Donata Pantaleo; Gioacchino Angarano; Laura Monno

    2012-01-01

    PURPOSE: The rate of severe outcomes of patients with 2009 pandemic (A/H1N1) influenza (2009pI) hospitalized in non-intensive care units (ICUs) has not been defined thus far. This study aims to assess the efficacy of the management of patients with influenza-like illness (ILI) of moderate intermediate severity in an infectious diseases unit (IDU) during the first wave of 2009pI and its influence on the burden of ICUs. METHODS: All patients hospitalized from October 27, 2009, to February 5, 20...

  15. The vitamin D hypothesis revisited: race-based disparities in birth outcomes in the United States and ultraviolet light availability.

    Science.gov (United States)

    Thayer, Zaneta M

    2014-04-15

    Skin color has been proposed to contribute to race-based health disparities in the United States because of differences in ultraviolet (UV) light-induced vitamin D synthesis. The prediction of this hypothesis, herein named the UVD hypothesis, is that racial disparities in health outcomes are correlated with UV light availability. This paper investigates whether UV light availability is associated with disparities in the rates of low birth weight (LBW) and preterm birth (PTB) between whites and blacks, because these outcomes are thought to be influenced by vitamin D status and to shape disease risk in later life. Data on LBW and PTB from 2007 (n = 2,825,620 births) were compared with data on UV light exposure across the United States. Contrary to the predictions of the UVD hypothesis, LBW and PTB rate disparities were greatest in states with the highest UV light exposure. Notably, income inequality was positively and significantly related to LBW and PTB disparities, even after controlling for UV light availability. The results of this analysis demonstrate that there is a significant environmental gradient in racial disparities in birth outcomes in the United States, but other social or environmental factors associated with living in the southern United States are likely stronger contributors to disparities in birth outcomes than UV light-induced vitamin D status.

  16. Preliminary Findings on the Health of the Nation Outcome Scales for Children and Adolescents in an Inpatient Secure Adolescent Unit

    Science.gov (United States)

    Hunt, Jenny; Wheatley, Malcolm

    2009-01-01

    To date there is limited research examining the use of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) with adolescents in secure care. The aim of this article is to examine the inter-rater reliability, concurrent validity and clinical utility of HoNOSCA in an adolescent secure psychiatric unit. Twenty-four…

  17. Capability Deprivation and Income Poverty in the United States, 1994 and 2004: Measurement Outcomes and Demographic Profiles

    Science.gov (United States)

    Wagle, Udaya R.

    2009-01-01

    Shifting focus from income to capability signifies an important milestone toward accurately measuring poverty and deprivation. This paper operationalizes capability deprivation in the United States and compares measurement outcomes among various capability approaches and between capability and income spaces. Of the three capability approaches…

  18. Clinical outcomes of a specialised inpatient unit for adults with mild to severe intellectual disability and mental illness.

    Science.gov (United States)

    Lunsky, Y; White, S E; Palucka, A M; Weiss, J; Bockus, S; Gofine, T

    2010-01-01

    Limitations of general psychiatric services have led to the development of specialised psychiatric programmes for patients with intellectual disability (ID) and mental health needs. Few studies have examined treatment outcomes of specialised inpatient units, and no studies have explored how the effects of intervention may differ for individuals at varying levels of cognitive ability. The present study examined clinical outcomes of inpatients with mild ID in contrast to inpatients with moderate to severe ID within the same service. Thirty-three patients (17 with mild ID and 16 with moderate to severe ID) discharged between 2006 and 2008 from a specialised inpatient unit in Canada for adults with ID and mental illness were studied. In addition to examining change in scores on clinical measures, outcomes with regard to length of stay, diagnostic change, residential change and re-admission to hospital were explored. Both groups demonstrated clinical improvement from admission to discharge. However, only patients with mild ID demonstrated improvements on the Global Assessment of Functioning. This study is one of the first to consider outcomes of higher and lower functioning individuals with ID on a specialised inpatient unit. Results suggest that outcomes may be different for these groups, and some clinical measures may be more sensitive to changes in patients with more severe disabilities.

  19. [Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011].

    Science.gov (United States)

    Heudorf, U; Gasteyer, S; Samoiski, Y; Voigt, K

    2012-08-01

    Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health

  20. Development of energy efficient small power motors with integrated electronic unit for 230V mains connection; Entwicklung von energieeffizienten Kleinmotoren mit integrierter Betriebselektronik fuer direkte Netzeinspeisung

    Energy Technology Data Exchange (ETDEWEB)

    Lelkes, Andras [GEFEG-NECKAR Antriebssysteme GmbH, Gosheim (Germany)

    2011-07-01

    This paper describes the development and the optimization of a drives family with integrated electronic control unit. This integration makes elegant and compact drive solutions for numerous industrial applications possible. The wiring effort and the space required in the electronic cabinet are reduced considerably. All these drives are based virtually on the same control hardware and firmware. Therefore, all family members can be controlled by customers on the same way. Especially interesting are the new members of the drives family for direct 230V 50Hz mains connection. (orig.)

  1. Etiology and Outcome of Non-Traumatic Coma in Children Admitted to Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Fariba Khodapanahandeh

    2009-12-01

    Full Text Available Objective: Non-traumatic coma is a relatively common condition in children that may cause considerable mortality and morbidity. The purpose of this study was to determine clinical presentation, etiology and outcome of non-traumatic coma in children.Methods: In a retrospective cross sectional study over a period of 5 years, files of 150 children aged between 1 month and 14 years admitted with non-traumatic coma to pediatric intensive care unit of Rasool Akram hospital were reviewed. Historical, presenting symptoms, clinical and laboratory data were collected. Etiology of coma was determined on the basis of clinical history and relevant investigations. The outcome was recorded as died or neurological condition at discharge as normal, mild or sever disability. Chi-square test was used to test the differences in categorical variables.Findings: There were 63 (42% boys and 87 (58% girls. The mean±SD age of patients was 2.7±2.35 years. Systemic presentations including nausea, vomiting, fever, lethargy and poor feeding were more prominent in children under 2 years. Etiology of coma in 49 patients (32.7% was infectious (meningitis, encephalitis, respiratory and systemic. Other causes were status epilepticus 44 (29.4%, metabolic (diabetic ketoacidosis, inborn errors of metabolism 11 (7.3%, intoxications 10 (6.7%, accidental (drowning, electrical shock, suffocation 9 (6%, shunt dysfunction (secondary to congenital brain malformations 7 (4.6%, others (acute disseminated encephalomyelitis, vasculitis, hypertensive encephalopathy 11 (7.3%, unknown 9 (6%. Infection occurred significantly (P=0.002 in children under 2 years of age, whereas accidents and intoxications were more prominent (P=0.004 in those between 2 and 6 years. Overall 25 children (16.6% died. Of those survived 16 became severely disabled. Accidents and infections had higher mortality compared to other groups (P<0.001 and P=0.02 respectively.Conclusion: Our results showed that infection was the

  2. TREATMENT OUTCOMES IN PATIENTS TREATED UNDER RNTCP IN KARAD TUBERCULOSIS UNIT

    Directory of Open Access Journals (Sweden)

    Vandana

    2014-12-01

    Full Text Available BACKGROUND: The Revised National Tuberculosis Control Programme (RNTCP, India. OBJECTIVE: To study the treatment outcomes in patients treated under RNTCP &causes of defaulted, death, failure among them. MATERIAL & METHODS: This study was conducted in Karad Tuberculosis Unit (TU, Satara District, Maharashtra. Under Karad Tuberculosis Unit there were nine PHCs, Sub District Hospital and Krishna Hospital, six Designated Microscopy Centre’s (DMC, three Integrated Counseling and Testing Centre’s (ICTC – KH, SDH and Undale. All patients registered during January2008 to June 2009 i.e.806 were the study subjects. Before commencement of study permission of District Tuberculosis Officer (DTO was taken. STUDY TYPE: Longitudinal (Prospective Study. STUDY PLAN: Patients were interviewed using pre-tested semi structured questionnaires at their residence at the start of treatment, after completion of intensive phase and cohort was further followed up for approximately six months. RESULTS & OBSERVATIONS: Out of 233 new sputum smear positive (NSP patients, 214 had their sputum smear negative at the end of Intensive phase (IP; hence sputum conversion rate was 91.84% in present study. We found that233newsputum smear positive cases out of which 187 were cured. Thus the cure rate was 80.2%.Out of which 506 smear negative and extra pulmonary patients 462 completed treatment hence treatment completion rate was 91.30%. Out of 233 new smear sputum positive cases, 23 died thus death rate was 9.8%, 5 patients were treatment failure thus the failure rate was 2.1 %. 12 patients defaulted the treatment thus defaulted rate was5.15%.Due to tuberculosis 22 (2.7% patients died, 27 (3.3% due to HIV, 17 (2.1% defaulted due to migration, 5 (0.6% defaulted due to addiction of alcohol, 3 (0.4% defaulted due to not relief from symptoms, 1 (0.1% defaulted due to adverse reaction.16 (2% failed in due to initial heavy bacillary load. CONCLUSION: It is observed that our regimens

  3. National Initiatives to Improve Healthcare Outcomes: A Comparative Study of Health Delivery Systems in Slovakia and the United States.

    Science.gov (United States)

    Curtis, Robert; Caplanova, Anetta; Novak, Marcel

    2015-01-01

    While the United States and Slovakia offer different healthcare delivery systems, each country faces the same challenges of improving the health status of their populations. The authors explore the impact of their respective systems on the health of their populations and compare the health outcomes of both nations. They point out that socioeconomic factors play a far more important role in determining population health outcomes than do the structures of the systems surrounding the care delivery. The authors illustrate this finding through a comparison of the poverty and education levels of a selected minority group from each country in relation to the health outcomes for each population group. The comparison reveals that education is a more influential determinant in a population's health outcomes, than the improved access to care offered by a universal system.

  4. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants.

    Science.gov (United States)

    Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B

    2017-09-21

    To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.Journal of Perinatology advance online publication, 21 September 2017; doi:10.1038/jp.2017.146.

  5. Relationships between registered nurse staffing, processes of nursing care, and nurse-reported patient outcomes in chronic hemodialysis units.

    Science.gov (United States)

    Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P

    2008-01-01

    Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an increased likelihood of frequent occurrences of dialysis hypotension, skipped dialysis treatments, shortened dialysis treatments, and patient complaints in hemodialysis units. These findings indicate that federal, state, and dialysis organization policies must foster staffing structures and processes of care in dialysis units that effectively utilize the invaluable skills and services of professional, registered nurses.

  6. Sustainability in a global context: How does local factor affect the outcomes of CSR activities in international business units?

    DEFF Research Database (Denmark)

    Thomsen, Christa; Lauring, Jakob

    In recent years CSR has become increasingly important for the activities and branding of MNCs. While some studies have investigated CSR management and branding in domestic situations, fewer studies exist in the case of international business units (subsidiaries, joint ventures, and franchises...... as CSR branding outcomes). Our findings show that local values were positively associated with external CSR engagement and that employee relations were positively related to both internal and external CSR engagement. None of the local factors were significantly associated with CSR branding outcomes...

  7. Utilization of preventive care services and their effect on cardiovascular outcomes in the United States

    Directory of Open Access Journals (Sweden)

    Varun Vaidya

    2011-01-01

    Full Text Available Varun Vaidya, Gautam Partha, Jennifer HowePharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo College of Pharmacy, Toledo, OH, USAObjective: To describe and analyze utilization of preventive care services and their effect on cardiovascular outcomes in the United States.Methods: Data from the 2007 Medical Expenditure Panel Survey (MEPS were used to analyze utilization of preventive care services and their effect on cardiovascular outcomes. Recommendations by the Seventh Report of the Joint Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and the National Cholesterol Education Program were used to determine appropriate levels of preventive care utilization. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable, while age, gender, race, ethnicity, insurance status, and perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, while a multivariate logistic regression model was built to predict odds of utilizing appropriate levels of preventive services.Results: Total number of adult respondents for which data were available for blood pressure checkup and cholesterol checkup was 20,523 and 15,784, respectively. Overall, MEPS respondents were found to adhere to guideline recommendations for preventive care utilization. Multivariate logistic regression showed that odds of utilization of preventive care services were higher for elderly patients (age >65 years for blood pressure (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.92–2.97 and cholesterol (OR = 3.05, 95% CI: 2.18–4.27 preventive services compared with younger population (age 18–54 years. Males had much lower odds of

  8. Characteristics and outcome of stroke patients with cerebrovascular accident at the intensive care unit of a tertiary hospital in Nigeria.

    Science.gov (United States)

    Tobi, Ku; Okojie, Nq

    2013-01-01

    Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial. Aim & Objectives: To determine the characteristics and outcome of patients with cerebrovascular accident managed at the Intensive Care Unit of University of Benin Teaching Hospital. Demographic characteristics, clinical features and course, treatment options and outcome of all stroke patients admitted in ICU from January 2002 to January 2012 were retrieved from the hospital records and analyzed. A patient before and after each stroke patient were selected as controls for the study. Primary outcome variable was ICU mortality, type of stroke whether ischemic or haemorrhagic, duration of stay, whether patients were transferred from the medical/stroke ward or from the accident and emergency department of the hospital. A total of thirty six (36) stroke patients were admitted into the ICU within the study period accounting for 5.6% of the total ICU admissions. The male: female ratio is 2:1 and patients aged >60 years accounted for 55.6%. Stroke patients admitted into ICU had a mortality rate of 77.8%. Patients with severe stroke admitted into the ICU were 4 times more likely to die compared to non-stroke patients in the ICU (p=0.002, OR=4.472). However, severe stroke had no significant impact on duration of ICU stay (p=0.454, OR=1.464). Stroke patients have a high mortality in the intensive care unit that is independent on the type and route of admission. Provision of the support equipment and instruments required for high dependency service in the intensive care unit and early admission should improve the outcome.

  9. Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit.

    Science.gov (United States)

    Murki, Anuradha; Dhope, Sheetal; Kamineni, Vasundhara

    2017-03-01

    To evaluate and compare the feto-maternal outcomes of pregnant women with potentially life-threatening complications (PLTC) and near miss events admitted to the obstetric high dependency units (OHDU). Pregnant women with PLTC admitted to the OHDU were enrolled. Feto-maternal outcomes, need for NICU admission and neonatal mortality, were compared between women without near miss events (controls) and those with near miss events. Of the 1505 admissions to the obstetric department during the study period, 1127 delivered at our hospital. Among the deliveries 125 (11%) women were admitted to the OHDU and 19 (15%) of them were referred to the intensive care unit (ICU) of the hospital. The incidence of near miss morbidity (n = 46) was 37% among the mothers admitted to OHDU and 4.1% among the deliveries. The outcomes were similar in both groups for mean birth weight (among live births), neonatal death and still birth or intra-uterine deaths. The mean duration of ICU stay, proportion of ICU admission, and the mean duration of hospital stay were significantly higher for women with near miss events. In the presence of standardized OHDU and an ICU, the feto-maternal outcomes of women with PLTC and near miss event are similar to those without near miss events.

  10. Implementation of a multidisciplinary team that includes a registered dietitian in a neonatal intensive care unit improved nutrition outcomes.

    Science.gov (United States)

    Sneve, Jennifer; Kattelmann, Kendra; Ren, Cuirong; Stevens, Dennis C

    This study determined whether nutrition outcomes of neonates who were receiving neonatal intensive care were improved with the implementation of a fully functioning multidisciplinary team that included a registered dietitian. A medical record review was conducted of neonates with birth weights of 1500 g or less who were cared for in Sanford Children's Hospital neonatal intensive care unit from January 1 to December 31, 2001 (prior to functioning multidisciplinary team establishment) and January 1 to December 31, 2004 (subsequent to establishment of a multidisciplinary team). Data from charts in the 2 time periods were examined for differences in nutrition outcomes. Outcome variables included length of stay, birth weight, discharge weight, weight gained for specified time periods, weight at full feeds, weight gain per day, length, head circumference, and number of days to start enteral feeding. Analysis of covariance, controlling for the effect of birth weight, was used to determine differences and was considered significant at P multidisciplinary team (1099 g, 95% CI: 955-1165 vs 1164 g, 95% CI: 1067-1211, respectively). Weight at discharge, total weight gained, total daily weight gained, daily weight gain from birth to the initiation of enteral feeds, daily weight gain from birth to full feeds, and head circumference growth were significantly greater for neonates in the postgroup than in the pre-multidisciplinary team group. Implementation of a multidisciplinary team that included a registered dietitian improved the nutrition outcomes of low birth weight infants in a neonatal intensive care unit.

  11. Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

    2010-01-01

    is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... enrolled, one in a community hospital comprising 66 patients and one in a specialized unit comprising 111 patients. Data on treatment, rebleeding and mortality were collected from medical records according to the Baveno III/IV Criteria. RESULTS: Treatments in the specialized unit versus the community...... shunt therapy was initiated in 91 vs. 74% (P specialized vs. community). Six-week mortality was 17 vs. 24% (P = 0.25) with 5-day mortality of 6 vs. 3% (P = 0.34) and mortality day 6-42, 12 vs. 22% (P = 0.07) (specialized vs. community). Failure to control bleeding and failure to prevent...

  12. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Tonga Nfor

    2015-08-01

    Full Text Available Purpose: Previous studies comparing percutaneous coronary intervention (PCI with coronary artery bypass graft surgery (CABG in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83 vs. 13.6 ± 7.1% for CABG (n=187 (P=0.31. After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8. There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001. Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23. Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.

  13. Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit.

    Science.gov (United States)

    Ryu, Jeong Am; Yang, Jeong Hoon; Chung, Chi Ryang; Suh, Gee Young; Hong, Seung Chyul

    2017-06-01

    Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients. © 2017 The Korean Academy of Medical Sciences.

  14. Association of unit size, resource utilization and occupancy with outcomes of preterm infants.

    Science.gov (United States)

    Shah, P S; Mirea, L; Ng, E; Solimano, A; Lee, S K

    2015-07-01

    Assess association of NICU size, and occupancy rate and resource utilization at admission with neonatal outcome. Retrospective cohort study of 9978 infants born at 23-32 weeks gestation and admitted to 23 tertiary-level Canadian NICUs during 2010-2012. Adjusted odds ratios (AOR) were estimated for a composite outcome of mortality/any major morbidity with respect to NICU size, occupancy rate and intensity of resource utilization at admission. A total of 2889 (29%) infants developed the composite outcome, the odds of which were higher for 16-29, 30-36 and >36-bed NICUs compared with bed NICUs (AOR (95% CI): 1.47 (1.25-1.73); 1.49 (1.25-1.78); 1.55 (1.29-1.87), respectively) and for NICUs with higher resource utilization at admission (AOR: 1.30 (1.08-1.56), Q4 vs Q1) but not different according to NICU occupancy. Larger NICUs and more intense resource utilization at admission are associated with higher odds of a composite adverse outcome in very preterm infants.

  15. SYNTHESIS AND CHARACTERIZATION OF BIODEGRADABLE POLYESTERAMIDES CONSTRUCTED MAINLY BY ALTERNATING DIESTERDIAMIDE UNITS FROM N,N'-BIS(2-HYDROXYETHYL)-ADIPAMIDE AND DIACIDS

    Institute of Scientific and Technical Information of China (English)

    Hui-yun Sun; Tiao Yin; Jing-bo Zhao; Zhi-yuan Zhang; Wan-tai Yang

    2013-01-01

    Two kinds of aliphatic alternating polyesteramide prepolymers were prepared through melt polycondensation from N,N'-bis(2-hydroxyethyl)-adipamide and adipic acid or sebacic acid.Chain extension of them was conducted with 2,2'-(1,4-phenylene)-bis(2-oxazoline) and adipoyl biscaprolactamate as combined chain extenders.The chain extended polyesteramides (ExtPEAs) were characterized by IR,1H-NMR,differential scanning calorimetry,thermogravimetric analysis,wide angle X-ray scattering,tensile test and enzymatic degradation.The results showed that the ExtPEA(4,m)s were mainly constituted with the diester adipamide alternating units.ExtPEA(4,4) and ExtPEA(4,8) had Tm of 83.8℃ and 85.8℃ and initial decomposition temperature above 310.0℃.They crystallized similarly as Nylon-66 did and were flexible thermoplastic materials with tensile strength up to 25.64 MPa and strain at break up to 737%.

  16. [Behavioral and psychological symptoms of dementia in a pilot psychogeriatric unit: management and outcomes].

    Science.gov (United States)

    Koskas, P; Belqadi, S; Mazouzi, S; Daraux, J; Drunat, O

    2011-03-01

    Behavioral and psychological symptoms in dementia (BPSD) are a major concern. The French government gave a consensual definition of reinforced intermediate-term care units for BPSD within the project "Plan Alzheimer 2008/2012". Our aim was to report one of the first experiences of this unit in France. Fifty-two patients (38 females, 14 males) were included, mean age 82.07±7.84 (73-97). About 80% of patients were improved and there was a high discharge rate to home of about 30%. Night-time behaviors, aberrant motor behaviors and agitation were the most frequent symptoms. Our study confirms that demented elderly patients greatly benefit from a specific BPSD care unit in agreement with the objective of Plan Alzheimer 2008/2012. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  17. Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2016-01-01

    Full Text Available Introduction. Acute kidney injury (AKI is a common occurrence in the intensive care unit (ICU. Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU. Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients’ demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality. Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5, p=0.028, mechanical ventilation (OR 13.063; 95% CI 2.3–72, p=0.003, and need for vasopressors (OR 16.8; 95% CI 3.4–82.6, p=0.001 had statistically significant association with mortality. Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

  18. Intensive care unit admission in patients following rapid response team activation: call factors, patient characteristics and hospital outcomes.

    Science.gov (United States)

    Le Guen, M P; Tobin, A E; Reid, D

    2015-03-01

    Rapid Response Systems (RRSs) have been widely introduced throughout hospital health systems, yet there is limited research on the characteristics and outcomes of patients admitted to an intensive care unit (ICU) following RRS activation. Using database extraction, this study examined the factors associated with ICU admission and patient outcome in patients receiving RRS activation in a tertiary level hospital between 2009 and 2013. Of 3004 RRS activations, 392 resulted in ICU admissions. Call factors associated with ICU admission and increased hospital mortality included tachypnoea (P Medical Emergency Team call triggers breached simultaneously (P admission included young age (P admission and hospital mortality post RRS activation. This information may be useful for risk stratification of deteriorating patients and determination of appropriate escalation.

  19. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI

  20. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    Science.gov (United States)

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    Background Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. Methods and Findings This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of

  1. Limiting severe outcomes and impact on intensive care units of moderate-intermediate 2009 pandemic influenza: role of infectious diseases units.

    Directory of Open Access Journals (Sweden)

    Sergio Carbonara

    Full Text Available PURPOSE: The rate of severe outcomes of patients with 2009 pandemic (A/H1N1 influenza (2009pI hospitalized in non-intensive care units (ICUs has not been defined thus far. This study aims to assess the efficacy of the management of patients with influenza-like illness (ILI of moderate intermediate severity in an infectious diseases unit (IDU during the first wave of 2009pI and its influence on the burden of ICUs. METHODS: All patients hospitalized from October 27, 2009, to February 5, 2010, with ILI were included in this prospective observational study. The IDU was organized and the staff was trained to provide intermediate care; patients were transferred to the ICU only if they required invasive ventilation, extracorporeal membrane oxygenation, or advanced cardiovascular support. Demographic data, clinical presentation, coexisting medical conditions, and laboratory and radiological findings were recorded and analyzed, as well as treatment and outcome data. RESULTS: Overall, 108 patients (median age 36 years [IQR 27-54], 57.4% males including 66.7% with ≥ 1 risk factor for severe influenza, 47.2% with confirmed 2009pI by RT-PCR and 63.9% with pneumonia, were enrolled in the study. All subjects received intravenous fluids and 83.3% were administered oseltamivir, 96.3% antibacterials, 19.4% oxygen therapy without ventilatory support, and 10.2% non-invasive ventilation. A total of 106 (98.1% subjects were discharged after a 6-day median hospital stay [IQR 4-9]. Two patients (1.9% were transferred to the ICU. There were no deaths. CONCLUSIONS: These results suggest that the aggressive treatment of patients with moderate intermediate severity 2009 pandemic ILI in non-ICU wards may result in a low rate of severe outcomes and brief hospitalization. IDUs, if properly organized for intermediate care, may efficiently provide correct disease management, in addition to complying with infection control requirements, thus reducing the burden of the pandemic

  2. Host society acculturation and health practices and outcomes in the United States: public health policy and research implications worldwide.

    Science.gov (United States)

    Andreeva, Valentina A; Unger, Jennifer B

    2014-08-01

    The unprecedented ethnocultural diversity in the United States and other Western countries likely changes the social norms for various health practices in the host populations, thus impacting prevalence of such practices and leading to the need for modification of public health policies. However, application of host acculturation (HA) principles in the public health domain remains underdeveloped. We conducted a narrative review of theoretical and empirical information about the association between HA and health practices or outcomes, drawing on evidence from health-care services, complementary and alternative medicine, diet, smoking, alcohol use, and psychological well-being. Given the experience of different countries with large immigrant populations, future multidisciplinary studies are needed both to supply additional empirical evidence and to identify ubiquitous HA processes, and thus inform public health promotion initiatives in the United States and worldwide.

  3. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

    OpenAIRE

    2016-01-01

    Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age

  4. Accounting for health-care outcomes: implications for intensive care unit practice and performance.

    Science.gov (United States)

    Sorensen, Roslyn; Iedema, Rick

    2010-08-01

    The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.

  5. Meta-analysis on continuous outcomes in minimal important difference units

    DEFF Research Database (Denmark)

    Shrier, Ian; Christensen, Robin; Juhl, Carsten

    2016-01-01

    OBJECTIVE: To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. STUDY DESIGN AND SETTING: Meta-analyses of published data. We calculated the variance of MDMID as a random variable u...

  6. Unemployment and substance outcomes in the United States 2002-2010.

    Science.gov (United States)

    Compton, Wilson M; Gfroerer, Joe; Conway, Kevin P; Finger, Matthew S

    2014-09-01

    The economic shock of 2008-2009 provided an opportunity to study the robustness of observed statistical associations between unemployment and problematic substance use. Data from 405,000 non-institutionalized adult participants in the 2002 to 2010 U.S. National Survey on Drug Use and Health were used to compare substance outcomes among unemployed and employed persons. Association of unemployment with substance outcomes was examined for the years 2002-2004, 2005-2007, 2008, and 2009-2010, corresponding to periods prior to and after the economic downturn of 2008. Multivariate logistic regression models adjusted for age, sex, race/ethnicity, education, urban/rural residence, current DSM-IV Major Depression, and local county unemployment rates. Higher rates of past month tobacco and illicit drug use, heavy alcohol use, and past-year drug or alcohol abuse/dependence were found among the unemployed. Markedly increased unemployment in 2009-2010 did not moderate the association between substance outcomes and employment. This association was not confounded by sex, age group, or race/ethnicity for tobacco and illicit drugs, although it varied for alcohol outcomes among 18-25 year-olds. Results based on retrospective data regarding marijuana use in the period prior to unemployment suggest its use was associated with future job loss. Employment status was strongly and robustly associated with problematic use of substances. Prevention and treatment interventions are warranted for a group whose employment and resulting insurance status may impair access to much needed health care. Published by Elsevier Ireland Ltd.

  7. Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

    Directory of Open Access Journals (Sweden)

    Baddley John W

    2013-01-01

    Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

  8. Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996-2013, United States

    Science.gov (United States)

    Miller, Ted R.

    2015-01-01

    Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on 3 more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8%, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4,700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development, increase breast-feeding, and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand. PMID:26076883

  9. Labor market outcomes of immigrant women in the United States: 1970 to 1990.

    Science.gov (United States)

    Schoeni, R F

    1998-01-01

    42% of immigrant workers in the US are women. Data from the 1970, 1980, and 1990 US censuses are analyzed in the study of differences in labor market outcomes between US-born and immigrant women, and among immigrant women born in different countries or regions of the world. There was little difference between US-born and immigrant women as a whole in 1970. However, over the next 20 years, immigrants women's labor force participation rate and weekly earnings relative to natives became lower, and their unemployment rates became higher. By 1990, the wage gap was 14%. At the same time, the share of self-employed women and the amount of time worked among employed women were almost the same for immigrant women and the US-born throughout the period 1970-90. Immigrants born in the UK, Canada, Europe, Japan, Korea, China, the Philippines, and the Middle East have had steady or improved wages and unemployment relative to US-born women. Immigrants from Mexico and Central America have experienced relatively high unemployment and low earnings, with the wage gap reaching 35% in 1990. Disparities in the number of completed years of schooling explains a substantial share of the observed differences in labor market outcomes.

  10. Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States' settings.

    Science.gov (United States)

    Lai, Anita; Tenpenny, Elliott; Nestler, David; Hess, Erik; Stiell, Ian G

    2016-03-01

    Introduction The objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients. This was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses. In total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0). The U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

  11. Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey.

    Science.gov (United States)

    Tukenmez Tigen, Elif; Bilgin, Huseyin; Perk Gurun, Hande; Dogru, Arzu; Ozben, Beste; Cerikcioglu, Nilgun; Korten, Volkan

    2017-06-01

    Thirty-six patients with candidemia and 37 control patients were included consecutively to determine the characteristics of candidemia episodes. The patients with candidemia had higher mortality with higher Sequential Organ Failure Assessment scores and frequency of use of a central venous catheter, total parenteral nutrition, and broad-spectrum antibiotics; chronic renal failure with replacement therapy; and longer stay in an intensive care unit. Candida albicans was the predominant species followed by Candida glabrata, Candida tropicalis, and Candida parapsilosis. All isolates of C glabrata were itraconazole-resistant. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Clinical and visual outcomes of patients with uveitis in the mid-Atlantic United States

    Directory of Open Access Journals (Sweden)

    Bajwa A

    2015-09-01

    Full Text Available Asima Bajwa,1 Chang Sup Lee,1 Jim Patrie,2 Wenjun Xin,2 Ashvini K Reddy1 1Department of Ophthalmology, 2Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Purpose: To report the clinical outcomes of uveitis patients at the University of Virginia. Methods: Retrospective, observational study of uveitis patients seen at the University of Virginia from 1984 to 2014. Parametric and nonparametric methods were used to analyze the change in best-corrected visual acuity (BCVA in relation to demographics, diagnoses, management, and complications. Results: The study included 644 eyes of 491 patients. Patients with mild visual loss (logMAR <0.4 at presentation were younger than those with severe visual loss (SVL, logMAR >1.0 (P=0.002. Females were more likely to have mild visual loss as compared to males (P=0.025. Median overall BCVA was logMAR 0.18 at initial and final presentation (P=1.00. Vision loss at diagnosis was a predictor for moderate visual loss (MVL, logMAR 0.4 to <1.0 to SVL at last follow-up (P<0.001. Eyes with ocular hypertension were positively associated with MVL and SVL as compared to normotensive eyes (1.89 times at baseline, 2.62 times at last follow-up. Median BCVA was 0.18 logMAR for the anterior uveitis (AU and 0.48 logMAR for the non-AU patients (P<0.001. AU patients were less likely to have SVL than non-AU group (P<0.001. AU group received local corticosteroids more frequently and systemic corticosteroids less commonly than non-AU patients (P<0.001. AU patients with MVL to SVL were more likely to have ophthalmic surgery (cataract, glaucoma or pars plana vitrectomy [PPV] than those without MVL or SVL (P<0.001. Non-AU patients with MVL to SVL were more likely to have PPV than those without MVL or SVL (P=0.001. Conclusion: Mean overall BCVA remained stable. Favorable visual results were associated with younger age, female gender, and AU. Poor visual prognosis was concomitant with SVL at presentation

  13. Cross-Cultural Studies of Implicit Theories of Creativity: A Comparative Analysis between the United States and the Main Ethnic Groups in Singapore

    Science.gov (United States)

    Ramos, Suzanna J.; Puccio, Gerard J.

    2014-01-01

    This article explores the extent of influence of culture on implicit theories of creativity among laypeople from the United States and Singapore, as well as the ethnic groups in Singapore. Adaptive and innovative styles of creativity were examined, as well as their own conceptions of creativity. Laypersons from the United States and Singapore were…

  14. Cross-Cultural Studies of Implicit Theories of Creativity: A Comparative Analysis between the United States and the Main Ethnic Groups in Singapore

    Science.gov (United States)

    Ramos, Suzanna J.; Puccio, Gerard J.

    2014-01-01

    This article explores the extent of influence of culture on implicit theories of creativity among laypeople from the United States and Singapore, as well as the ethnic groups in Singapore. Adaptive and innovative styles of creativity were examined, as well as their own conceptions of creativity. Laypersons from the United States and Singapore were…

  15. Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

    Directory of Open Access Journals (Sweden)

    Omender Singh

    2011-01-01

    Full Text Available Background and Aim: There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU. We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital. Methods: We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained. Results: Seventy (50.7% patients were males and majority (47.8% of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%, followed by alcohol, 34/138 (24.63% and opioids, 10/138 (7.2%. Thirty-two (23% consumed two or more agents. Commonest mode of toxicity was suicidal (78.3% and the route of exposure was mainly oral (97.8%. The highest incidence of toxicity was due to drugs (46.3% followed by household agents (13%. Organ failure was present in 67 patients (48.5%. During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%. All deaths were due to aluminium phosphide poisoning. Conclusions: The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.

  16. Main Memory

    NARCIS (Netherlands)

    P.A. Boncz (Peter); L. Liu (Lei); M. Tamer Özsu

    2008-01-01

    htmlabstractPrimary storage, presently known as main memory, is the largest memory directly accessible to the CPU in the prevalent Von Neumann model and stores both data and instructions (program code). The CPU continuously reads instructions stored there and executes them. It is also called Random

  17. Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation.

    Science.gov (United States)

    Flatow, V H; Ibragimova, N; Divino, C M; Eshak, D S A; Twohig, B C; Bassily-Marcus, A M; Kohli-Seth, R

    2015-01-01

    The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

  18. A Randomized Controlled Trial to Compare 2 Scalable Interventions for Lower Urinary Tract Symptom Prevention: Main Outcomes of the TULIP Study.

    Science.gov (United States)

    Sampselle, Carolyn M; Newman, Diane K; Miller, Janis M; Kirk, Keri; DiCamillo, Mary Ann; Wagner, Todd H; Raghunathan, Trivellor E; Diokno, Ananias C

    2017-06-01

    We compared 2-year urinary incontinence and urgency scores of older women who attended a 2-hour bladder health class vs those who viewed a 20-minute abbreviated class video for the purpose of urinary incontinence prevention. A randomized, 2-arm, parallel design study was done to test the superiority of the 20-minute video over the 2-hour class. Outcomes at baseline, and 3, 12 and 24 months were the scores on questions 1 to 3 of ICIQ-SF (International Consultation on Incontinence Short Form) as the primary outcome and on IUSS (Indevus Urgency Severity Scale). Intent to treat analysis was done to compare the change from baseline in each intervention group across time and also with each other. Multiple imputation was used for missing data. A total of 647 women participated in the study. Mean age was 63 years and approximately 28% of the participants were African American, primarily from an urban setting. The 2 arms were balanced on body mass index at baseline, age, race/ethnicity, education, employment status, income and marital status. No differences in primary or secondary outcomes were demonstrated between the 2 groups from baseline to the 3, 12 or 24-month visits. The absence of significant differences in the outcome measures of ICIQ-SF and IUSS between the 2-hour class and the 20-minute video groups demonstrates that the 2 interventions were comparable. As urinary incontinence and urgency tend to rise annually in older women, instruction in bladder health self-care provided through either the 2-hour class or the 20-minute video format is a useful intervention to prevent urinary incontinence in older women. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Washing older blood units before transfusion reduces plasma iron and improves outcomes in experimental canine pneumonia.

    Science.gov (United States)

    Cortés-Puch, Irene; Wang, Dong; Sun, Junfeng; Solomon, Steven B; Remy, Kenneth E; Fernandez, Melinda; Feng, Jing; Kanias, Tamir; Bellavia, Landon; Sinchar, Derek; Perlegas, Andreas; Solomon, Michael A; Kelley, Walter E; Popovsky, Mark A; Gladwin, Mark T; Kim-Shapiro, Daniel B; Klein, Harvey G; Natanson, Charles

    2014-02-27

    In a randomized controlled blinded trial, 2-year-old purpose-bred beagles (n = 24), with Staphylococcus aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 mL/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ injury, plasma iron, and cell-free hemoglobin (CFH) levels depending on the age of stored blood (all, P blood improved survival rates, shock score, lung injury, cardiac performance and liver function, and reduced levels of non-transferrin bound iron and plasma labile iron. In contrast, washing fresh blood worsened all these same clinical parameters and increased CFH levels. Our data indicate that transfusion of fresh blood, which results in less hemolysis, CFH, and iron release, is less toxic than transfusion of older blood in critically ill infected subjects. However, washing older blood prevented elevations in plasma circulating iron and improved survival and multiple organ injury in animals with an established pulmonary infection. Our data suggest that fresh blood should not be washed routinely because, in a setting of established infection, washed RBC are prone to release CFH and result in worsened clinical outcomes.

  20. The Effectiveness of Healthy Community Approaches on Positive Health Outcomes in Canada and the United States

    Directory of Open Access Journals (Sweden)

    Hazel Williams-Roberts

    2015-12-01

    Full Text Available Healthy community approaches encompass a diverse group of population based strategies and interventions that create supportive environments, foster community behavior change and improve health. This systematic review examined the effectiveness of ten most common healthy community approaches (Healthy Cities/Communities, Smart Growth, Child Friendly Cities, Safe Routes to Schools, Safe Communities, Active Living Communities, Livable Communities, Social Cities, Age-Friendly Cities, and Dementia Friendly Cities on positive health outcomes. Empirical studies were identified through a search of the academic and grey literature for the period 2000–2014. Of the 231 articles retrieved, 26 met the inclusion criteria with four receiving moderate quality ratings and 22 poor ratings using the Effective Public Health Practice Project Quality Assessment Tool. The majority of studies evaluated Safe Routes to School Programs and reported positive associations with students’ active commute patterns. Fewer studies assessed benefits of Smart Growth, Safe Communities, Active Living Communities and Age-Friendly Cities. The remaining approaches were relatively unexplored in terms of their health benefits however focused on conceptual frameworks and collaborative processes. More robust studies with longer follow-up duration are needed. Priority should be given to evaluation of healthy community projects to show their effectiveness within the population health context.

  1. Downstream Procedures and Outcomes After Stress Testing For Suspected Coronary Artery Disease in the United States

    Science.gov (United States)

    Mudrick, Daniel W; Cowper, Patricia A; Shah, Bimal R; Patel, Manesh R; Jensen, Neil C; Drawz, Matthew J; Peterson, Eric D; Douglas, Pamela S

    2013-01-01

    Background Millions of Americans with suspected coronary artery disease undergo non-invasive cardiac stress testing annually. Downstream procedures and subsequent outcomes among symptomatic patients without known coronary disease referred for stress testing are not well characterized in contemporary community practice. Methods We examined administrative insurance billing data from a national insurance provider from November 2004 through June 2007. After excluding patients with prior cardiac disease or chest pain evaluation, we identified 80,676 people age 40–64 years with outpatient cardiac stress testing within 30 days after an office visit for chest pain. We evaluated rates of invasive coronary angiography, coronary revascularization, and cardiovascular events after stress testing. Results Within 60 days, only 8.8% of stress test patients underwent cardiac catheterization and only 2.7% underwent revascularization; within one year only 0.5% suffered death, myocardial infarction, or stroke. There were marked geographic variations in one-year rates of catheterization (3.8–14.8%) and revascularization (1.2–3.0%) across 20 hospital referral regions. Conclusions In this large national cohort of middle-aged patients without previously coded cardiac diagnosis who were referred for stress testing after outpatient chest pain evaluation, few proceeded to invasive angiography or revascularization, and subsequent cardiovascular events were infrequent. PMID:22424017

  2. Main Memory

    OpenAIRE

    Boncz, Peter; Liu, Lei; Özsu, Tamer, M.

    2008-01-01

    Primary storage, presently known as main memory, is the largest memory directly accessible to the CPU in the prevalent Von Neumann model and stores both data and instructions (program code). The CPU continuously reads instructions stored there and executes them. It is also called Random Access Memory (RAM), to indicate that load/store instructions can access data at any location at the same cost, is usually implemented using DRAM chips, which are connected to the CPU and other peripherals (di...

  3. Long-term outcomes in adults with leukemia treated with transplantation of two unrelated umbilical cord blood units

    Institute of Scientific and Technical Information of China (English)

    YIN Yue; LI Yuan; DONG Yu-jun; REN Han-yun; CEN Xin-an; QIU Zhi-xiang; OU Jin-ping; WANG Wen-sheng; WANG Mang-ju; XU Wei-lin; WANG Li-hong

    2011-01-01

    Background Wide application of umbilical cord blood transplantation (UCBT) in adult patients is limited by low cell-dose available in one umbilical cord blood (UCB) unit. The aim of this study was to investigate the safety and long-term outcomes of UCBT from unrelated donors in adult and adolescent patients with leukemia.Methods Thirteen patients with leukemia received double-unit UCBT with human leukocyte antigen (HLA) mismatched at 0-2 loci. We analyzed the engraftment, graft-versus-host disease (GVHD) and survival.Results Twelve evaluable patients (92.3%) had neutrophil and platelet engraftment at a median of 21 days (range,16-38 days) and 34 days (range, 25-51 days), respectively. At day 30, engraftment was derived from one donor in 8patients (66.7%, 95% CI40.0%-93.4%), and from both donors in 4 patients (33.3%, 95% CI 6.7%-60.0%) with 1 unit predominated. Unit with larger nucleated cell (NC) dose would predominate in engraftment (P=0.039), whereas CD34+ cell dose or HLA-match failed to demonstrate any relationship with unit predominance. Only one patient developed grade Ⅱ acute graft-versus-host disease (aGVHD). Chronic GVHD (cGVHD) was observed in 2 of 11 patients who survived more than 100 days, and both were limited. The median follow-up after transplantation for the 13 patients was 45 months (range 1.5-121.0 months) and 72 months (range 41.0-121.0 months) for the 8 alive and with full donor chimerism. The 5-year cumulative disease free survival (DFS) was (61.5±13.5)%. Of the 13 patients, 5 patients died in 1 year and 1-year transplantation related mortality (TRM) was 23.1% (95% CI 0.2%-46.0%).Conclusion Double-unit UCBT from unrelated donors with HLA-mismatched at 0-2 loci may overcome the cell-dose barrier and be feasible for adults and adolescents with leukemia.

  4. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Romi Nangalu

    2016-01-01

    Full Text Available Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU and on the pediatric risk of mortality (PRISM scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years, who were divided into cases with weight for age <3 rd centile and controls with ≥3 rd centile of WHO charts. Cases were subdivided into mild/moderate (61-80% of expected weight for age and severe malnutrition (<60%. Results: Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003. There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063 and hospital stay (P - 0.0332 compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027. Conclusion: Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected.

  5. Pulmonary embolism in intensive care unit: Predictive factors, clinical manifestations and outcome

    Directory of Open Access Journals (Sweden)

    Bahloul Mabrouk

    2010-01-01

    Full Text Available Objective : To determine predictive factors, clinical and demographics characteristics of patients with pulmonary embolism (PE in ICU, and to identify factors associated with poor outcome in the hospital and in the ICU. Methods : During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study periods, all patients admitted to our ICU were classified into four groups. The first group includes all patients with confirmed PE; the second group includes some patients without clinical manifestations of PE; the third group includes patients with suspected and not confirmed PE and the fourth group includes all patients with only deep vein thromboses (DVTs without suspicion of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q scan or by a spiral computed tomography (CT scan showing one or more filling defects in the pulmonary artery or in its branches. The diagnosis was also confirmed by echocardiography when a thrombus in the pulmonary artery was observed. Results : During the study periods, 4408 patients were admitted in our ICU. The diagnosis of PE was confirmed in 87 patients (1.9%. The mean delay of development of PE was 7.8 ± 9.5 days. On the day of PE diagnosis, clinical examination showed that 50 patients (57.5% were hypotensive, 63 (72.4% have SIRS, 15 (17.2% have clinical manifestations of DVT and 71 (81.6% have respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 81 cases (93.1% and low molecular weight heparins were used in 4 cases (4.6%. The mean ICU stay was 20.2 ± 25.3 days and the mean hospital stay was 25.5 ± 25 days. The mortality rate in ICU was 47.1% and the in-hospital mortality rate was 52.9%. Multivariate analysis showed that

  6. Patient-Reported Outcomes From the United States Clinical Trial for a Hybrid Cochlear Implant.

    Science.gov (United States)

    Kelsall, David C; Arnold, Renée J G; Lionnet, Leonard

    2017-10-01

    To assess patient-reported outcomes (PROs) in individuals with significant residual low-frequency hearing and severe-to-profound high-frequency sensorineural hearing loss (SNHL) who received the hybrid cochlear implant (CI). Prospective, multicenter, nonrandomized, single-arm repeated measures, single-subject design. Tertiary centers, ambulatory care. Fifty adults with severe-to-profound high-frequency SNHL and residual low-frequency hearing with aided word recognition scores between 10 and 60% in the ear to be implanted, and in the contralateral ear greater than or equal to implant ear less than or equal to 80%. Therapeutic; hybrid CI. Speech, spatial and qualities of hearing scale (SSQ), device use questionnaire (DUQ), University of Washington Clinical Assessment of Music Perception (UW-CAMP) assessed preoperatively and after 6 and 12 (SSQ and DUQ only) months of hybrid CI use. Significant improvements in mean SSQ ratings were demonstrated at 6 and 12 months postactivation overall and for domains related to speech hearing, spatial hearing, and sound quality. Significant improvement was also found for overall satisfaction on the DUQ and across a number of specific listening situations in addition to aspects related to social engagement. UW-CAMP pitch discrimination and melody and timbre recognition abilities were not compromised postoperatively, allowing hybrid subjects to maintain superior music perception abilities than typically observed with standard CIs. Patients who received the hybrid CI demonstrated significant PRO benefits on the SSQ and the DUQ after 6 and 12 months of CI use. In addition, given the opportunity to maintain useful low-frequency acoustic hearing, patients retained music listening abilities, as assessed by the UW-CAMP.

  7. Epidemiology and survival outcomes of sinonasal verrucous carcinoma in the United States.

    Science.gov (United States)

    Alonso, Jose E; Han, Albert Y; Kuan, Edward C; Suh, Jeffrey D; John, Maie A St

    2017-09-02

    Verrucous carcinoma (VC) is a rare, variant of squamous cell carcinoma with benign cytohistopathologic features and a generally favorable prognosis. Epidemiologic and clinical outcomes data are lacking as a result of limited cases of sinonasal VC. To describe the incidence and determinants of survival of patients with verrucous carcinoma of the sinonasal tract between the years of 1973 to 2014 using the Surveillance, Epidemiology, and End Results (SEER) database. The SEER registry was utilized to calculate survival trends for patients with verrucous carcinoma of the sinonasal tract between 1973 and 2014. Patient data then was analyzed with respect to age, sex, race, and treatment modalities (surgery and radiation therapy). Overall survival (OS) and disease-specific survival (DSS) were calculated. A total of 86 cases of VC of the sinonasal tract were identified. The cohort was comprised of 69.8% males. The mean age at diagnosis was 67.4 years. The nasal cavity was the most common primary site (51.2%), followed by the maxillary sinus (40.7%) and nasopharynx (5.8%). The median OS was 97.6 months. 89.5% of cases underwent surgery and 20.9% received both surgery and radiation therapy. Overall survival at 2, 5, and 10 years was 73%, 59%, and 36%, respectively. On multivariate analysis, advanced age (P Verrucous carcinoma of the sinonasal tract is associated with a generally favorable prognosis. Age, primary site, and surgical therapy are independent predictors of OS and DSS, respectively. We present the first population-based analysis of sinonasal VC, thus clarifying the prognosis and reinforcing the management of this malignancy. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Clinical outcomes from a foam wedge splinting program for axillary contracture prevention in the intensive care unit.

    Science.gov (United States)

    Godleski, Matthew; Holden, Mary Sullivan; Luby, Darcie; Weitzenkamp, David; Boimbo, Sandra; Lindberg, Gordon

    2014-01-01

    Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 ± 32.5 days. At discharge, the mean shoulder abduction was 132° ± 38° on the left and 118° ± 22° on the right. The mean shoulder flexion was 132° ± 31° on the left and 123° ± 29° on the right. As much as 90% of the subjects had greater than 90° of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research.

  9. Phragmites australis management in the United States: 40 years of methods and outcomes.

    Science.gov (United States)

    Hazelton, Eric L G; Mozdzer, Thomas J; Burdick, David M; Kettenring, Karin M; Whigham, Dennis F

    2014-01-01

    Studies on invasive plant management are often short in duration and limited in the methods tested, and lack an adequate description of plant communities that replace the invader following removal. Here we present a comprehensive review of management studies on a single species, in an effort to elucidate future directions for research in invasive plant management. We reviewed the literature on Phragmites management in North America in an effort to synthesize our understanding of management efforts, identify gaps in knowledge and improve the efficacy of management. Additionally, we assessed recent ecological findings concerning Phragmites mechanisms of invasion and integrated these findings into our recommendations for more effective management. Our overall goal is to examine whether or not current management approaches can be improved and whether they promote reestablishment of native plant communities. We found: (i) little information on community-level recovery of vegetation following removal of Phragmites; and (ii) most management approaches focus on the removal of Phragmites from individual stands or groups of stands over a relatively small area. With a few exceptions, recovery studies did not monitor vegetation for substantial durations, thus limiting adequate evaluation of the recovery trajectory. We also found that none of the recovery studies were conducted in a landscape context, even though it is now well documented that land-use patterns on adjacent habitats influence the structure and function of wetlands, including the expansion of Phragmites. We suggest that Phragmites management needs to shift to watershed-scale efforts in coastal regions, or larger management units inland. In addition, management efforts should focus on restoring native plant communities, rather than simply eradicating Phragmites stands. Wetlands and watersheds should be prioritized to identify ecosystems that would benefit most from Phragmites management and those where the

  10. Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom.

    Science.gov (United States)

    Thomas, Helen L; Banner, Nicholas R; Murphy, Cara L; Steenkamp, Retha; Birch, Rhiannon; Fogarty, Damian G; Bonser, And Robert S

    2012-06-15

    We investigated the incidence of chronic kidney disease (CKD) in the United Kingdom heart transplant population, identified risk factors for the development of CKD, and assessed the impact of CKD on subsequent survival. Data from the UK Cardiothoracic Transplant Audit and UK Renal Registry were linked for 1732 adult heart transplantations, 1996 to 2007. Factors influencing time to CKD, defined as National Kidney Foundation CKD stage 4 or 5 or preemptive kidney transplantation, were identified using a Cox proportional hazards model. The effects of distinct CKD stages on survival were evaluated using time-dependent covariates. A total of 3% of patients had CKD at transplantation, 11% at 1-year and more than 15% at 6 years posttransplantation and beyond. Earlier transplantations, shorter ischemia times, female, older, hepatitis C virus positive, and diabetic recipients were at increased risk of developing CKD, along with those with impaired renal function pretransplantation or early posttransplantation. Significant differences between transplantation centers were also observed. The risk of death was significantly higher for patients at CKD stage 4, stage 5 (excluding dialysis), or on dialysis, compared with equivalent patients surviving to the same time point with CKD stage 3 or lower (hazard ratios of 1.66, 8.54, and 4.07, respectively). CKD is a common complication of heart transplantation in the UK, and several risk factors identified in other studies are also relevant in this population. By linking national heart transplantation and renal data, we have determined the impact of CKD stage and dialysis treatment on subsequent survival in heart transplant recipients.

  11. The German CPU Registry: Dyspnea independently predicts negative short-term outcome in patients admitted to German Chest Pain Units.

    Science.gov (United States)

    Hellenkamp, Kristian; Darius, Harald; Giannitsis, Evangelos; Erbel, Raimund; Haude, Michael; Hamm, Christian; Hasenfuss, Gerd; Heusch, Gerd; Mudra, Harald; Münzel, Thomas; Schmitt, Claus; Schumacher, Burghard; Senges, Jochen; Voigtländer, Thomas; Maier, Lars S

    2015-02-15

    While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients. We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea. Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, pCPU patients. Our data show that dyspnea is associated with a fourfold higher 3month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  13. STUDY OF VENTILATOR ASSOCIATED PNEUMONIA IN NEONATAL INTESIVE CARE UNIT: CHARACTERISTICS, RISK FACTORS AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Dr. Shalini Tripathi

    2010-01-01

    Full Text Available Ventilator Associated Pneumonia (VAP, the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU, over a period of 1 year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Diagnosis of VAP was made by the guidelines given by National Nosocomial infection Surveillance System (NNIS, 1996. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The risk factors such as birth weight, prematurity (gestational age < 37 weeks, duration of mechanical ventilation, number of reintubations, length of hospital stay, primary diagnosis of neonate, postnatal age and small for gestational age (SGA were studied for the development of VAP. Risk factors found significant on bivariate analysis were subjected to multiple regression analysis to determine the most important predictors of VAP. The study group comprised of 98 neonates out of which, 30 neonates developed VAP (30.6%. VAP rates were 37.2 per 1000 days of mechanical ventilation. Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%, E.coli (23.2% and Acinetobacter (17.8% being the other two common organisms. Very low birth weight (< 1500 grams, prematurity (gestational age < 37 week, duration of mechanical ventilation, number of reintubations and length of NICU stay were significantly associated with VAP in bivariate analysis. Multiple regression analysis revealed that duration of mechanical ventilation (OR 1.10, 95% CI 1.02, 1.21; P = 0.021 and very low birth weight (OR 3.88, 95% CI 1.05, 14.34; P = 0.042 were

  14. Outcome of Very Lov Birth Weight Infants in Neonatal Care Unit of Dicle University Faculty of Medicine

    Directory of Open Access Journals (Sweden)

    Selahattin Katar

    2006-01-01

    Full Text Available Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal care unit of our hospital from April 2005 to February 2006.The number of VLBW admissions to the our neonatal care unit was 91, fourty one percent female and %49 were male. The mean birth weight was 1191±261 g and gestational age was 29±2.4 weeks. The mortality rate was 37.3 %. Antenatal steroids had been given to only 8% of mothers. The most important maternal risk factors were preeclampsia/eclampsia 30%, premature rupture of membranes 13%, hemorhage 8%. Respiratory distress syndrome was diagnosed 47%, surfactant was given to 40% of these infants. The major causes of death were sepsis, respiratuar distres syndrome, and extreme prematurity.Compared with reports from other developed NICU, VLBW infants at our center had higher mortality rates. We conclude that, the major cause of high mortality rate depends on low-social –cultural –education conditions associated with insufficient prenatal care, neonatal care and inaccurate neonatal transport in our region.

  15. Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Santos Paulo

    2012-08-01

    Full Text Available Abstract Background Patients have to travel long distances to undergo hemodialysis (HD in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD patients undergoing maintenance HD. Methods We studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec Coping Scale, respectively. The sample was stratified in three groups: I-patients residing in Sobral (where the dialysis unit is located; II-patients residing in towns up to 100 km from Sobral; and III-patients residing in towns distant greater than 100 km from Sobral. Analysis of variance was used to detect differences in quality of life and coping scores between the groups. Logistic regression was used to test distance as a predictor of depression. Results There were 47 (29.2% patients residing in Sobral, 46 (28.6% up to 100 km away and 68 (42.2% greater than 100 km from Sobral. There were no differences related to quality of life and coping scores between the groups. Distance was not a predictor of depression. Conclusions Social and cultural factors may explain the lack of differences. Studies from other regions are needed to clarify the distance effects on self-perceived outcomes among HD patients.

  16. Evaluating Depression Care Management in a Community Setting: Main Outcomes for a Medicaid HMO Population with Multiple Medical and Psychiatric Comorbidities

    Directory of Open Access Journals (Sweden)

    Jeanette A. Waxmonsky

    2012-01-01

    Full Text Available The authors describe the implementation of a depression care management (DCM program at Colorado Access, a public sector health plan, and describe the program’s clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed.

  17. MAIN CONTENTS

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    The Key to Agricultural Science and Technology Innovation should be placed on the FiveMajor Changes Based on analysis and forecasting on grain consumption influencing factors, production influencing factors and import influencing factors, the supply and demand of main sorts of grain in China is forecas- ted respectively, including paddy, wheat, corn and soybean. In 2020, grain consumption quantity, grain production quantity and grain import quantity of China is 693 million tons, 644 million tons and 49 million tons respectively. For grain security in future, new stratagem on food security should be im- plemented, grain import circumstance and global grain security. Father mechanism should be im- proved, and early warning and regulation on grain production capacity should be paid attention to sys- temically.

  18. Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

    Science.gov (United States)

    Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

    2014-08-01

    To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout

  19. The main factors affecting the long-term outcomes in patients after acute cerebrovascular disorder: results of the LIS-2 study

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2016-01-01

    Full Text Available Aim. To evaluate the long-term prognosis of life in patients after cerebral stroke (MI and to identify the main factors influencing it.Material and methods. All patients (n=960 who had MI or transient ischemic attack in the period from 01.01.2009 to 31.12.2011, admitted to Lyubertsy district hospital №2, were included into the register of LIS-2. The primary endpoint was total mortality of patients.Results. The average age of patients was 72±9 years, 2/3 were women. 207 patients (21.7% died in the hospital, 753 were discharged from the hospital. Median follow-up was 2.8 (2.1, 3.5 years. 31.5% of the patients died during this period. The main cause of death (36% was re-MI, and 22.4% of patients died from the heart failure. The relative risk (RR of death was significantly increased with the age of patients (RR=1.1. The probability of death increased in the presence of diabetes mellitus (RR=1.4, alcohol abuse (RR=2.3, any signs of consciousness disorders in the acute phase of MI (RR=1.6, heart failure (RR=1.6, atrial fibrillation (RR=1.4. Patients who were treated with calcium channel blockers before admission to the hospital, had a lower risk of death than those who did not receive these drugs (RR=0.4. Prescription of ACE inhibitors at discharge from the hospital reduced significantly the risk of death in the long-term period (RR=0.7.Conclusion. High rate of long-term mortality in the LIS-2 register can be largely explained by the poor quality of primary and secondary prevention of cardiovascular events.

  20. Renal Dysfunction Is an Independent Risk Factor for Mortality after Liver Resection and the Main Determinant of Outcome in Posthepatectomy Liver Failure

    Directory of Open Access Journals (Sweden)

    M. G. Wiggans

    2013-01-01

    Full Text Available Introduction. The aim of this study was to assess the interaction of liver and renal dysfunction as risk factors for mortality after liver resection. Materials and Methods. A retrospective analysis of 501 patients undergoing liver resection in a single unit was undertaken. Posthepatectomy liver failure (PHLF was defined according to the International Study Group of Liver Surgery (ISGLS definition (assessed on day 5 and renal dysfunction according to RIFLE criteria. 90-day mortality was recorded. Results. Twenty-three patients died within 90 days of surgery (4.6%. The lowest mortality occurred in patients without evidence of PHLF or renal dysfunction (2.7%. The mortality rate in patients with isolated PHLF or renal dysfunction was 20% compared to 45% in patients with both. Diabetes (, renal dysfunction (, and PHLF on day 5 ( were independent predictors of 90-day mortality. Discussion. PHLF and postoperative renal dysfunction are independent predictors of 90-day mortality following liver resection but the predictive value for mortality is significantly higher when failure of both organ systems occurs simultaneously.

  1. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Amina Godinjak

    2016-11-01

    Full Text Available Objective. The aim is to determine SAPS II and APACHE II scores in medical intensive care unit (MICU patients, to compare them for prediction of patient outcome, and to compare with actual hospital mortality rates for different subgroups of patients. Methods. One hundred and seventy-four patients were included in this analysis over a oneyear period in the MICU, Clinical Center, University of Sarajevo. The following patient data were obtained: demographics, admission diagnosis, SAPS II, APACHE II scores and final outcome. Results. Out of 174 patients, 70 patients (40.2% died. Mean SAPS II and APACHE II scores in all patients were 48.4±17.0 and 21.6±10.3 respectively, and they were significantly different between survivors and non-survivors. SAPS II >50.5 and APACHE II >27.5 can predict the risk of mortality in these patients. There was no statistically significant difference in the clinical values of SAPS II vs APACHE II (p=0.501. A statistically significant positive correlation was established between the values of SAPS II and APACHE II (r=0.708; p=0.001. Patients with an admission diagnosis of sepsis/septic shock had the highest values of both SAPS II and APACHE II scores, and also the highest hospital mortality rate of 55.1%. Conclusion. Both APACHE II and SAPS II had an excellent ability to discriminate between survivors and non-survivors. There was no significant difference in the clinical values of SAPS II and APACHE II. A positive correlation was established between them. Sepsis/septic shock patients had the highest predicted and observed hospital mortality rate.

  2. Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2016-01-01

    Full Text Available Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU patients infected with human immune deficiency virus (HIV. There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference to P<0.05. Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS (58.4%, multiorgan failure (20.8%, and sepsis (20.8%. The mean Acute Physiologic and Chronic Health Evaluation (APACHE II score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4, P=0.01, mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76, P=0.01, and ARDS (OR 4.5 (95% CI: 1.07–16.7, P=0.04 had a statistically significant association with mortality. Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.

  3. Association between heat shock protein 70 gene polymorphisms and clinical outcomes in intensive care unit patients with sepsis

    Directory of Open Access Journals (Sweden)

    Kartik Ramakrishna

    2014-01-01

    Full Text Available Objective: The objective of the following study is to evaluate the associations between single nucleotide polymorphisms (SNPs in the Heat Shock Protein 70 (HSP70 gene, gene expression of interleukin-6 (IL-6 and tumor necrosis factor-alpha (TNF- and medical intensive care unit (MICU stay and organ failure in sepsis. Materials and Methods: MICU patients with sepsis were genotyped for rs1061581, rs2227956, rs1008438 and rs1043618 polymorphisms in HSP70 gene using polymerase chain reaction (PCR-restriction fragment length polymorphism analysis or allele-specific PCR. Messenger ribonucleic acid (mRNA expression of IL-6 and TNF- were quantitated in peripheral blood lymphocytes. Outcomes were recorded. Results: 108 patients (48 male aged 40.7 ± 16.0 (mean ± standard deviation years included H1N1 infection (36, scrub typhus (29 and urosepsis (12. Seventy-one (65.7% had dysfunction of three or more organ systems, 66 patients (61.1% were treated by mechanical ventilation, 21 (19.4% needed dialysis. ICU stay was 9.3 ± 7.3 days. Mortality was 38.9%. One or more SNPs were noted in 101/108 (93.5% and organ failure was noted in only 1/7 patients without a single SNP. The A allelotypes of rs1061581 and rs1008438 were associated with hematological dysfunction (P = 0.03 and 0.07 and longer ICU stay (P = 0.05 and 0.04, whereas IL-6 and TNF- mRNA levels were associated with central nervous system dysfunction. Conclusions: HSP70 genotypes may determine some adverse outcomes in patients with sepsis.

  4. Study of Characteristics, risk factors and outcome for Ventilator Associated Pneumonia in Neonatal Intensive Care Unit patient

    Directory of Open Access Journals (Sweden)

    Mehdi Moradi

    2013-09-01

    Full Text Available Background: Ventilator Associated Pneumonia (VAP, developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.Methods: Neonates admitted to neonatal intensive care unit (NICU, over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.Results: Thirty eight patients were enrolled (58% were boys and 42% were girls. 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%. On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00. Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days, longer NICU length of stay (39 vs 21.5 median days and higher total median hospital costs (79.5 vs 52 million rials than those without VAP. The mortality rate was not different between two groups.Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

  5. Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

    Directory of Open Access Journals (Sweden)

    Saadat H

    2011-10-01

    Full Text Available Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs. This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27% were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation hospitalization duration was 3.04 (±0.71 days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602. The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205. Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699. Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization

  6. Early diagnosis and treatment of invasive aspergillosis as a main determinant of outcome – review of literature according to the presented case report

    Directory of Open Access Journals (Sweden)

    Michał Borys

    2017-03-01

    Although. [i]Aspergillus spp[/i] infection is not the major cause of morbidity in Intensive Care Units (ICUs, mortality among patients treated for it is tremendous. Moreover, invasive aspergillosis (IA is an independent risk factor of hospital costs and length of stay. The prevalence of this disease is inversely correlated with the immunocompetence of individuals; for instance, the incidence of IA among patients with leukemia is estimated as high as 12.7%. Although there is a significant improvement in the antifungal armamentarium, the appropriate treatment is still being given too late, mostly because of late diagnosis. As well as the diagnosis, the criteria for recognition of IA constitute a challenge. [b]Objective[/b]. The aim of this review, based on a case report, is to introduce the problem of poor diagnosis and treatment of IA, especially in the critical care settings. The presented scenario is an example which assists in showing the evidence-based medicine (EBM approach to the treatment of fungal infections. Furthermore, to demonstrate the appropriate approach to diagnosis and treatment of invasive aspergillosis, the guidelines of The European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG are presented. [b]Conclusions.[/b] According to presented literature, Galactomannan assay enables early diagnosis and remains a specific and sensitive tool to diagnose [i]Asppergillosis, [/i]both in serum and BAL fluid. The guidelines recommend voriconazole as a first line treatment in IA. Failure to detect and implement proper antifungal treatment may lead to fatal consequences, as in the presented case.

  7. Healthcare costs and outcomes of managing β-thalassemia major over 50 years in the United Kingdom.

    Science.gov (United States)

    Weidlich, Diana; Kefalas, Panos; Guest, Julian F

    2016-05-01

    The objective was to estimate the incidence-based costs of treating β-thalassemia major (BTM) to the United Kingdom's National Health Service (NHS) over the first 50 years of a patient's life in terms of healthcare resource use and corresponding costs and the associated health outcomes. This was a modeling study based on information obtained from a systematic review of published literature and clinicians involved in managing BTM in the United Kingdom. A state transition model was constructed depicting the management of BTM over a period of 50 years. The model was used to estimate the incidence-based health economic impact that BTM imposes on the NHS and patients' health status in terms of the number of quality-adjusted life-years (QALYs) over 50 years. The expected probability of survival at 50 years is 0.63. Of patients who survive, 33% are expected to be without any complication and the other 67% are expected to experience at least one complication. Patients' health status over this period was estimated to be a mean of 11.5 discounted QALYs per patient. Total healthcare expenditure attributable to managing BTM was estimated to be £483,454 ($720,201) at 2013/14 prices over 50 years. The cost of managing BTM could be potentially reduced by up to 37% if one in two patients had a bone marrow transplant, with an ensuing improvement in health-related quality of life. This analysis provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to this rare disease. © 2016 AABB.

  8. Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome

    Directory of Open Access Journals (Sweden)

    Lanini Simone

    2010-08-01

    Full Text Available Abstract Background HCV is a leading cause of liver chronic diseases all over the world. In developed countries the highest prevalence of infection is reported among intravenous drug users and haemodialysis (HD patients. The present report is to identify the pathway of HCV transmission during an outbreak of HCV infection in a privately run haemodialysis (HD unit in Italy in 2005. Methods Dynamics of the outbreak and infection clinical outcomes were defined through an ambi-directional cohort study. Molecular epidemiology techniques were used to define the relationships between the viral variants infecting the patients and confirm the outbreak. Risk analysis and auditing procedures were carried out to define the transmission pathway(s. Results Of the 50 patients treated in the HD unit 5 were already anti-HCV positive and 13 became positive during the study period (AR = 28.9%. Phylogenic analysis identified that, all the molecularly characterized incident cases (10 out of 13, were infected with the same viral variant of one of the prevalent cases. The multivariate analysis and the auditing procedure disclosed a single event of multi-dose vials heparin contamination as the cause of transmission of the infection in 11 out of the 13 incident cases; 2 additional incident cases occurred possibly as a result of inappropriate risk management. Discussion More than 30% of all HCV infections in developed countries results from poor application of standard precautions during percutaneous procedures. Comprehensive strategy which included: educational programmes, periodical auditing on standard precaution, use of single-dose vials whenever possible, prospective surveillance for blood-borne infections (including a system of prompt notification and risk assessment/management dedicated staff are the cornerstone to contain and prevent outbreaks in HD Conclusions The outbreak described should serve as a reminder to HD providers that patients undergoing dialysis are

  9. Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea.

    Science.gov (United States)

    Noh, Hyun Kyung; Lee, Eunjoo

    2015-01-01

    The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.

  10. Traditional open-bay versus single-family room neonatal intensive care unit: a comparison of selected nutrition outcomes

    Directory of Open Access Journals (Sweden)

    Christina Erickson

    2011-03-01

    Full Text Available Christina Erickson1, Kendra Kattelmann1, Jessica Remington1, Cuirong Ren2, Carol C Helseth3, Dennis C Stevens31Department of Health and Nutritional Sciences, 2Department of Plant Science, South Dakota State University, Brookings, SD, USA; 3Sanford Children's Hospital, Sioux Falls, SD, USABackground: In contrast to the traditional open-bay–type design of the neonatal intensive care unit (tNICU, infants in developmentally appropriate NICU (dNICU are housed in individual rooms with greater control of light and noise. Previous reports have documented positive influence of the dNICU in cardiorespiratory status, physiologic stability, and weight gain of the infants. The objective of this study was to explore selected nutrition outcomes of infants in the dNICU versus tNICU.Method: A prospective cohort study was conducted on infants with birth weight of 1500 g or less cared for in dNICU (n = 42 or tNICU (n = 31. Differences between days to reach full parenteral nutrition, full enteral nutrition, or full bottling were determined using analysis of covariance controlling for gestational age, birth weight, and clinical risk index for babies (CRIB acuity score.Results: There were no differences between the two groups in days to reach full parenteral and bottle feeding. The infants in the dNICU took fewer days to reach full enteral nutrition (20.8 days, 95% confidence intervals [CI]: 17, 24.6 (dNICU vs 23.3 days, 95% CI: 17.1, 29.6 (tNICU, P = 0.04 than those in the tNICU.Conclusions: Although the two groups of infants only differed in the days to reach full enteral feeding, it is important to remember that the lack of difference may be clinically significant. Clinically, the infants in the dNICU were younger (gestational age and sicker (CRIB acuity score than the infants in the tNICU. Consequently, the results of this study support the change to dNICU, as the private room model provides a supportive environment for growth as evidenced by similar

  11. The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Rasmussen, Lars S.; Lohse, Nicolai

    2017-01-01

    .09, 95% CI 0.79–1.49; p = 0.60). The 30-day mortality was 7.4% with GEMS and 7.9% with HEMS (OR = 1.02, CI 0.53–1.96; p = 0.96). Incidence rate of involuntary early retirement was 6.97 per 100 PYR and 7.58 per 100 PYR in GEMS and HEMS patients, respectively (IRR = 1.19, CI 0.27–5.26; p = 0.81). Work......Background: Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit. Methods: Prospective, observational study with 5...... ability after 2 years and time on social transfer payments did not differ between groups. We found no significant difference in mean modified Rankin Scale score after 3 months (2.21 GEMS vs. 2.09 HEMS; adjusted mean difference = −0.20, CI −0.74–0.33; p = 0.46). Discussion: The possible benefit of HEMS...

  12. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes.

    Science.gov (United States)

    Perman, Sarah M; Stanton, Emily; Soar, Jasmeet; Berg, Robert A; Donnino, Michael W; Mikkelsen, Mark E; Edelson, Dana P; Churpek, Matthew M; Yang, Lin; Merchant, Raina M

    2016-09-29

    In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; Plocations. Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. Outcomes in Ovarian Cancer among Hispanic Women Living in the United States: A Population-Based Analysis

    Directory of Open Access Journals (Sweden)

    Okechukwu A. Ibeanu

    2013-01-01

    Full Text Available Introduction. Ovarian cancer is the deadliest gynecologic cancer in the United States. There is limited data on presentation and outcomes among Hispanic women with ovarian cancer. Objective. To investigate how ovarian cancer presents among Hispanic women in the USA and to analyze differences in presentation, staging, and survival between Hispanic and non-Hispanic women with ovarian cancer. Methods. Data from January 1, 2000 to December 31, 2004 were extracted from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER database. Results. The study sample comprised 1215 Hispanics (10%, 10 652 non-Hispanic whites (83%, and 905 non-Hispanic blacks (7%. Hispanic women were diagnosed with ovarian cancer at a younger age and earlier stage when compared to non-Hispanic whites, non-Hispanic blacks; . Similar proportion of Hispanics (33%, non-Hispanic whites (32%, and non-Hispanic blacks (24% underwent lymphadenectomy; . Hispanics with epithelial ovarian cancer histology had longer five-year survival of 30.6 months compared to non-Hispanic whites (22.8 months and non-Hispanic blacks (23.3 months; . Conclusion. Hispanic women with ovarian cancer have a statistically significantly longer median survival compared to whites and blacks. This survival difference was most apparent in patients with epithelial cancers and patients with stage IV disease.

  14. Milan Criteria and UCSF Criteria: A Preliminary Comparative Study of Liver Transplantation Outcomes in the United States

    Directory of Open Access Journals (Sweden)

    Supriya S. Patel

    2012-01-01

    Full Text Available The application of orthotopic liver transplantation (OLT for patients with hepatocellular cancer (HCC necessitates highly selective criteria to maximize survival and to optimize allocation of a scarce resource. The objective of this study was to compare the outcomes of OLT for HCC in patients transplanted under Milan and UCSF criteria. The United Network of Organ Sharing (UNOS database was queried for patients who had undergone OLT for HCC from 2002 to 2007, and 1,972 patients (Milan criteria, n=1,913; UCSF criteria, n=59 were identified. Patients were stratified by pretransplant criteria (Milan versus UCSF, and clinical and pathologic factors and overall survival were compared. There were no differences in age, gender, diabetes mellitus, body mass index, and hepatitis B, or C status between the two groups. Overall survival was similar between the Milan and UCSF cohorts (1-, 2-, 3-, and 4-year survival rates: 88%, 81%, 76%, and 72% versus 91%, 80%, 68% and 51%, respectively, P=0.21. Although the number of patients within UCSF criteria was small, our results nevertheless suggest that patients with HCC may have equivalent survival when transplanted under Milan and UCSF criteria. Long-term followup may better determine whether UCSF criteria should be widely adopted.

  15. Empirical Combination Antibiotic Therapy Improves the Outcome of Nosocomial Meningitis or Ventriculitis in Neuro-Critical Care Unit Patients.

    Science.gov (United States)

    Li, Zhiqi; Wu, Xing; Yu, Jian; Wu, Xuehai; Du, Zhuoying; Sun, Yirui; Yuan, Qiang; Hu, Jin

    2016-08-01

    Nosocomial meningitis and ventriculitis (MEN) are serious complications in neuro-critical care unit (NCCU) patients. Few data are available on the risk factors and mortality rates among NCCU patients with these disorders caused by multi-drug-resistant (MDR) pathogens. Our aim was to identify the risk factors for MEN caused by such pathogens and in-hospital deaths in critically ill neurologic patients and to evaluate the impact of empirical combination antibiotic therapy (ECAT) on the outcomes of these patients. We conducted a retrospective study of critically ill neurologic patients having nosocomial MEN who were admitted to the NCCU in a university teaching hospital from January 2003 to December 2013, with MEN being defined using the modified U.S. Centers for Disease Control and Prevention criteria for nosocomial infections. In total, 6,149 consecutive NCCU patients were screened; 132 had MEN. Logistic regression analysis demonstrated that MDR MEN was related to infection with gram-negative (GN) bacteria (odds ratio 3.16; 95% confidence interval [CI] 1.08-9.25; p = 0.036), and inadequate initial antibiotic therapy (odds ratio 9.80; 95% CI 3.79-25.32; p nosocomial MEN. Inadequate initial antibiotic therapy and GN infection were associated with MDR MEN.

  16. Pancreas transplant outcomes for United States (US) cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR).

    Science.gov (United States)

    Gruessner, Angelika C; Sutherland, David E R

    2008-01-01

    From December 16, 1966 to December 31, 2008 more than 30,000 pancreas transplants have been reported to the International Pancreas Transplant Registry (IPTR), including > 22,000 from the United States and > 8,000 from outside the US. This report focused on the most recent outcomes for pancreas transplants performed in the US, since we had reliable follow-up information available for US cases only at this time. Between 2004 and 2008 the most common pancreas transplant category was a combined pancreas/kidney transplant (SPK) (73%). Nineteen percent of diabetic patients had already received a kidney transplant before undergoing a pancreas transplant (PAK). In those cases, 76% of all kidneys came from a living donor. Pancreas transplants alone (PTA) accounted for 9% of all pancreas transplants in diabetic patients. The number of pancreas transplants for diabetic patients decreased over the last 5 years, and the decrease was highest in PAK, followed by PTA and SPK. During this time period, the patient age at transplant increased due to an increased number of patients with type 2 diabetes reported as reason for transplantation. The decrease in the number of pancreas transplants provided the opportunity for better selection of deceased donors. We noticed a significant decrease in the age of the deceased donor. Only 6-8% of all reported donors were 45 years of age or older, and the majority of donors were between 15 and 30 years old. In all three pancreas transplant categories (SPK, PAK, and PTA), the majority of patients received antibody therapy for induction and a maintenance protocol of Tacrolimus in combination with MMF. In a growing number of patients, the maintenance protocol was Sirolimus based. In all protocols a strong trend of steroids avoidance could be seen and accounted for one third of all transplants. The overall outcome of pancreas transplantation improved significantly. Patient survival at one year is now better than 95% and reached 90% at 3 years post

  17. Mortality from Circulatory Diseases and other Non-Cancer Outcomes among Nuclear Workers in France, the United Kingdom and the United States (INWORKS).

    Science.gov (United States)

    Gillies, Michael; Richardson, David B; Cardis, Elisabeth; Daniels, Robert D; O'Hagan, Jacqueline A; Haylock, Richard; Laurier, Dominique; Leuraud, Klervi; Moissonnier, Monika; Schubauer-Berigan, Mary K; Thierry-Chef, Isabelle; Kesminiene, Ausrele

    2017-09-01

    Positive associations between external radiation dose and non-cancer mortality have been found in a number of published studies, primarily of populations exposed to high-dose, high-dose-rate ionizing radiation. The goal of this study was to determine whether external radiation dose was associated with non-cancer mortality in a large pooled cohort of nuclear workers exposed to low-dose radiation accumulated at low dose rates. The cohort comprised 308,297 workers from France, United Kingdom and United States. The average cumulative equivalent dose at a tissue depth of 10 mm [Hp(10)] was 25.2 mSv. In total, 22% of the cohort were deceased by the end of follow-up, with 46,029 deaths attributed to non-cancer outcomes, including 27,848 deaths attributed to circulatory diseases. Poisson regression was used to investigate the relationship between cumulative radiation dose and non-cancer mortality rates. A statistically significant association between radiation dose and all non-cancer causes of death was observed [excess relative risk per sievert (ERR/Sv) = 0.19; 90% CI: 0.07, 0.30]. This was largely driven by the association between radiation dose and mortality due to circulatory diseases (ERR/Sv = 0.22; 90% CI: 0.08, 0.37), with slightly smaller positive, but nonsignificant, point estimates for mortality due to nonmalignant respiratory disease (ERR/Sv = 0.13; 90% CI: -0.17, 0.47) and digestive disease (ERR/Sv = 0.11; 90% CI: -0.36, 0.69). The point estimate for the association between radiation dose and deaths due to external causes of death was nonsignificantly negative (ERR = -0.12; 90% CI: disease subtypes, associations with dose were observed for mortality due to cerebrovascular disease (ERR/Sv = 0.50; 90% CI: 0.12, 0.94) and mortality due to ischemic heart disease (ERR/Sv = 0.18; 90% CI: 0.004, 0.36). The estimates of associations between radiation dose and non-cancer mortality are generally consistent with those observed in atomic bomb survivor studies. The findings

  18. Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study.

    Science.gov (United States)

    Rahbaran, S; Gilthorpe, M S; Harrison, S D; Gulabivala, K

    2001-06-01

    The aims of this retrospective study were (1) to compare the outcome of periapical surgery performed in endodontic and in oral surgery units of a teaching dental hospital and (2) to evaluate the influence of factors affecting outcome. A total of 176 teeth (endodontic unit, 83; oral surgery unit, 93) surgically treated more than 4 years previously were examined clinically and radiographically by means of strict criteria. Multiple logistic regression analysis was used. The rate of complete healing for patients treated in the endodontic unit (37.4%) was significantly (P = .009) higher than that for patients treated in the oral surgery unit (19.4%). The technical quality of surgery (P < .001), placement of root-end filling (P = .039), absence of a preoperative periapical lesion (P = .042), absence of a post (P = .047), and presence of an adequate coronal restoration (P = .056, odds ratio = 3.71) had significant effects on treatment outcome. The technical quality of periapical surgery, the presence of a periapical lesion, and adequate apical and coronal seal are important prognostic determinants of successful periapical surgery.

  19. Predicting Outcomes on the Liver Transplant Waiting List in the United States: Accounting for Large Regional Variation in Organ Availability and Priority Allocation Points.

    Science.gov (United States)

    Hart, Allyson; Schladt, David P; Zeglin, Jessica; Pyke, Joshua; Kim, W Ray; Lake, John R; Roberts, John P; Hirose, Ryutaro; Mulligan, David C; Kasiske, Bertram L; Snyder, Jon J; Israni, Ajay K

    2016-10-01

    The probability of liver transplant and death on the waiting list in the United States varies greatly by donation service area (DSA) due to geographic differences in availability of organs and allocation of priority points, making it difficult for providers to predict likely outcomes after listing. We aimed to develop an online calculator to report outcomes by region and patient characteristics. Using the Scientific Registry of Transplant Recipients database, we included all prevalent US adults aged 18 years or older waitlisted for liver transplant, examined on 24 days at least 30 days apart over a 2-year period. Outcomes were determined at intervals of 30 to 365 days. Outcomes are reported by transplant program, DSA, region, and the nation for comparison, and can be shown by allocation or by laboratory model for end-stage liver disease (MELD) score (6-14, 15-24, 25-29, 30-34, 35-40), age, and blood type. Outcomes varied greatly by DSA; for candidates with allocation MELD 25-29, the 25th and 75th percentiles of liver transplant probability were 30% and 67%, respectively, at 90 days. Corresponding percentiles for death or becoming too sick to undergo transplant were 5% and 9%. Outcomes also varied greatly for candidates with and without MELD exception points. The waitlist outcome calculator highlights ongoing disparities in access to liver transplant and may assist providers in understanding and counseling their patients about likely outcomes on the waiting list.

  20. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-01-01

    Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 ‘higher risk’ women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births. Conclusions The babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between

  1. Feasibility assessment of the water energy resources of the United States for new low power and small hydro classes of hydroelectric plants: Main report and Appendix A

    Energy Technology Data Exchange (ETDEWEB)

    Hall, Douglas G. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Reeves, Kelly S. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Brizzee, Julie [Idaho National Lab. (INL), Idaho Falls, ID (United States); Lee, Randy D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Carroll, Gregory R. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sommers, Garold L. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2006-01-01

    Water energy resource sites identified in the resource assessment study reported in Water Energy Resources of the United States with Emphasis on Low Head/Low Power Resources, DOE/ID-11111, April 2004 were evaluated to identify which could feasibly be developed using a set of feasibility criteria. The gross power potential of the sites estimated in the previous study was refined to determine the realistic hydropower potential of the sites using a set of development criteria assuming they are developed as low power (less than 1 MWa) or small hydro (between 1 and 30 MWa) projects. The methodologies for performing the feasibility assessment and estimating hydropower potential are described. The results for the country in terms of the number of feasible sites, their total gross power potential, and their total hydropower potential are presented. The spatial distribution of the feasible potential projects is presented on maps of the conterminous U.S. and Alaska and Hawaii. Results summaries for each of the 50 states are presented in an appendix. The results of the study are also viewable using a Virtual Hydropower Prospector geographic information system application accessible on the Internet at: http://hydropower.inl.gov/prospector.

  2. Practice patterns and outcomes of pediatric partial nephrectomy in the United States: Comparison between pediatric urology and general pediatric surgery.

    Science.gov (United States)

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-08-01

    In the United States, both pediatric urologists (PUROs) and general pediatric surgeons (GPSs) perform nephrectomies in children, with PUROs performing more nephrectomies overall, most commonly for benign causes. GPSs perform more nephrectomies for malignant causes. We questioned whether the same trends persisted for partial nephrectomy. We hypothesized that PUROs performed more partial nephrectomies for all causes, including malignancy. Our primary aim was to characterize the number of partial nephrectomies performed by PUROs and GPSs. We also compared short-term outcomes between subspecialties. We analyzed the Pediatric Health Information System (PHIS), a database encompassing data from 44 children's hospitals. Patients were ≤18 years old and had a partial nephrectomy (ICD-9 procedure code 554) carried out by PUROs or GPSs between 1 January, 2004 and June 30, 2013. Queried data points included surgeon subspecialty, age, gender, 3M™ All Patient Refined Diagnosis Related Groups (3M™ APR DRG) code, severity level, mortality risk, length of stay (LOS), and medical/surgical complication flags. Data points were compared in patients on whom PUROs and GPSs had operated. Statistical analysis included the Student t test, chi-square test, analysis of covariance, and logistic regression. Results are presented in the table. While PUROs performed the majority of partial nephrectomies, GPSs operated more commonly for malignancy. For surgeries performed for non-malignant indications, PURO patients had a shorter LOS and lower complication rate after controlling for statistically identified covariates. There was no difference in LOS or complication rate for patients with malignancy. A Pediatric Health Information System study of pediatric nephrectomy demonstrated PUROs performed more nephrectomies overall, but GPSs performed more surgeries for malignancy. The difference was less dramatic for partial nephrectomies (63% GPS, 37% PURO) than for radical nephrectomies (90% GPS, 10

  3. Neonatal Outcomes of Rh-Negative Pregnancies in a Tertiary Level Neonatal Intensive Care Unit: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Chacham

    2016-07-01

    Full Text Available Background Rhesus incompatibility is a preventable cause for severe neonatal hyperbilirubinemia, hydrops fetalis and still births. The prevalence of the Rh-negative blood group among Indian woman varies from 2% - 10%. Despite declining the incidence of Rhesus incompatibility, due to availability of anti-D immunoglobulin, and improved antenatal care of the Rh-negative pregnant woman, it still accounts for a significant proportion of neonatal hyperbilirubinemia and neuro-morbidity. The prevalence of Rh-negative women having Rh-positive neonates is 60%. Objectives This study aimed to estimate the incidence of Rh iso-immunization and evaluate the outcomes of Rh iso-immunized neonates. Methods This prospective observational study was conducted in a tertiary level neonatal intensive care unit, Princess Esra hospital, Deccan college of medical sciences, Hyderabad, Telangana, India. Consecutive intramural and extramural neonates admitted to neonatal intensive care unit with the Rh-negative mother’s blood group and hyperbilirubinemia were enrolled. Neonates born to Rh+ve mothers were excluded. Neonatal gestational age, birth weight, age at admission, duration of phototherapy, duration of hospitalization, neonatal examination and investigations were recorded in a predesigned, pretested performa. Results A total of 90 neonates were born to Rh-negative mothers, of which 70% (63 had the Rh-positive blood group and 30% had the Rh-negative blood group. Of these 63 neonates, 48 (76.2% had hyperbilirubinemia and 43 neonates (68.3% had significant hyperbilirubinemia (total serum bilirubin > 15mg/dL. Among them, 2%, 75% and 23% were born to primi, multi and grandmutli, respectively. Also, 14.5% of the neonates were large for dates (LFD, 75% appropriate for dates (AFD and 10.5% were small for dates (SFD. Premature and SFD neonates had higher incidence of hyperbilirubinemia. Significantly higher incidence of jaundice occurred within 72 hours of life. The mean

  4. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Beishuizen Albertus

    2011-05-01

    Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

  5. Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes.

    Science.gov (United States)

    Costa, Patrícia de Oliveira; Atta, Elias Hallack; Silva, André Ricardo Araújo da

    2015-01-01

    This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p=0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p=0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  6. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?

    Science.gov (United States)

    Saltürk, Cüneyt; Karakurt, Zuhal; Adiguzel, Nalan; Kargin, Feyza; Sari, Rabia; Celik, M Emin; Takir, Huriye Berk; Tuncay, Eylem; Sogukpinar, Ozlem; Ciftaslan, Nezihe; Mocin, Ozlem; Gungor, Gokay; Oztas, Selahattin

    2015-01-01

    Background COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%–25% of COPD exacerbations are eosinophilic. Aim To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU. Methods This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects’ characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data. Results Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2–7 days) vs 6 days (3–9 days) (P2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management. PMID:26392758

  7. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    Science.gov (United States)

    2011-01-01

    Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU). Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA) score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52%) of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 4,683 mL) were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery. PMID:21624108

  8. Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down’s syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units

    Science.gov (United States)

    Wright, David; Hill, Melissa; Verhoef, Talitha I; Daley, Rebecca; Lewis, Celine; Mason, Sarah; McKay, Fiona; Jenkins, Lucy; Howarth, Abigail; Cameron, Louise; McEwan, Alec; Fisher, Jane; Kroese, Mark; Morris, Stephen

    2016-01-01

    Objective To investigate the benefits and costs of implementing non-invasive prenatal testing (NIPT) for Down’s syndrome into the NHS maternity care pathway. Design Prospective cohort study. Setting Eight maternity units across the United Kingdom between 1 November 2013 and 28 February 2015. Participants All pregnant women with a current Down’s syndrome risk on screening of at least 1/1000. Main outcome measures Outcomes were uptake of NIPT, number of cases of Down’s syndrome detected, invasive tests performed, and miscarriages avoided. Pregnancy outcomes and costs associated with implementation of NIPT, compared with current screening, were determined using study data on NIPT uptake and invasive testing in combination with national datasets. Results NIPT was prospectively offered to 3175 pregnant women. In 934 women with a Down’s syndrome risk greater than 1/150, 695 (74.4%) chose NIPT, 166 (17.8%) chose invasive testing, and 73 (7.8%) declined further testing. Of 2241 women with risks between 1/151 and 1/1000, 1799 (80.3%) chose NIPT. Of 71 pregnancies with a confirmed diagnosis of Down’s syndrome, 13/42 (31%) with the diagnosis after NIPT and 2/29 (7%) after direct invasive testing continued, resulting in 12 live births. In an annual screening population of 698 500, offering NIPT as a contingent test to women with a Down’s syndrome screening risk of at least 1/150 would increase detection by 195 (95% uncertainty interval −34 to 480) cases with 3368 (2279 to 4027) fewer invasive tests and 17 (7 to 30) fewer procedure related miscarriages, for a non-significant difference in total costs (£−46 000, £−1 802 000 to £2 661 000). The marginal cost of NIPT testing strategies versus current screening is very sensitive to NIPT costs; at a screening threshold of 1/150, NIPT would be cheaper than current screening if it cost less than £256. Lowering the risk threshold increases the number of Down’s syndrome cases detected and

  9. 可不停电拼拆柜的环网柜的研究开发%Research and Development of Ring Main Unit with Connecting and Separating Function without Power-Off

    Institute of Scientific and Technical Information of China (English)

    黄冬喜

    2014-01-01

    Increase main busbar’ extended port at the main busbar chamber of ring main unit. In a charged state without load, through pushing or leaving the connection cart of connecting switchgear,connect or separate the ring main unit without power-off,to reduce the probability of planned power cut,improve the reliability of power supply,guarantee the usage of people’s production and living power. It has great significance in the field of power supply and distribution.%在环网柜的主母线室上增加主母线连接扩展口,在带电不带负荷的情况下,通过拼柜连接小车的推进或移开,可不停电进行环网柜的拼拆柜操作,减少了计划性停电的机率,提高了供电可靠性,保证人们的生产、生活用电,在供配电领域具有重要意义。

  10. The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

    Science.gov (United States)

    2012-01-01

    Background The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD) unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results 365 (6%) patients lived ≥100 km from their nearest PD unit (distant group), while 6183 (94%) lived peritonitis in distant patients (1.34 years, 95% CI 1.07-1.61) was significantly shorter than in local patients (1.68 years, 95% CI 1.59-1.77, p = 0.001), whilst overall peritonitis rates were higher in distant patients (incidence rate ratio 1.32, 95% CI 1.20-1.46). Living ≥100 km away from a PD unit was independently associated with a higher risk of S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47). Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008) and receive antifungal prophylaxis (4% vs 10%, p = 0.01), but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p peritonitis outcomes, distant patients were more likely to be cured with antibiotics alone (OR 1.55, 95% CI 1.03-2.24). All other outcomes were comparable between the two groups. Conclusions Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients. PMID:22702659

  11. Clinical outcomes of "complete, partially complete, and incomplete" revascularisation at five-year follow-up after percutaneous intervention of unprotected left main coronary artery disease with drug-eluting stents.

    Science.gov (United States)

    Zhang, Yao-Jun; Iqbal, Javaid; Xu, Bo; Ye, Fei; Zhang, Jun-Jie; Bourantas, Christos V; Pan, Dao-Rong; Tian, Nai-Liang; Kan, Jing; Qian, Xue-Song; Ding, Shi-Qing; Li, Feng; Zhang, Ai-Ping; Liu, Yue-Qiang; Muramatsu, Takashi; Onuma, Yoshinobu; Garcia-Garcia, Hector M; Serruys, Patrick W; Chen, Shao-Liang

    2016-10-10

    The study aimed to examine five-year clinical outcomes of complete (CR), partially complete (PCR), and incomplete revascularisation (ICR) in patients with unprotected left main coronary artery (ULMCA) disease treated with drug-eluting stents (DES). Completeness of revascularisation, defined as revascularisation of all vessels ≥1.5 or 2.5 mm in diameter, has been shown to correlate with outcomes after percutaneous coronary intervention (PCI). There are no data to compare revascularisation strategies on long-term clinical outcomes in patients undergoing PCI of ULMCA disease. This prospective registry enrolled 910 consecutive patients with ULMCA disease undergoing PCI with DES implantation. CR included patients who had a successful revascularisation of all diseased segments with diameter ≥1.5 mm. PCR included patients who had successful revascularisation of all diseased segments with diameter ≥2.5 mm. ICR included patients who did not achieve revascularisation for all diseased segments of diameter ≥2.5 mm. The primary endpoint was the incidence of major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction and repeat revascularisation) at five-year follow-up. CR was achieved in 386 (42.4%), PCR in 227 (25.0%), and ICR in 297 (32.6%) patients. Patients with ICR had a significantly higher rate of MACE (29.6% vs. 22.5% and 15.5%, pfive-year follow-up. After propensity score matching, patients with CR vs. PCR had similar incidences of MACE (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 0.78-1.74, p=0.46), mortality (HR: 1.27, 95% CI: 0.61-2.63, p=0.53), and cardiac death (1.8% vs. 4.5%; HR: 2.56, 95% CI: 0.80-8.17, p=0.11). On multivariable logistic regression analysis, ICR appears to be an outcome of poor clinical characteristics, comorbidities and complex coronary anatomy. In the treatment of patients with ULMCA disease, ICR was associated with worse long-term clinical outcomes than CR and PCR. PCR has clinical outcomes

  12. Resistance in gram-negative bacilli in a cardiac intensive care unit in India: Risk factors and outcome

    Directory of Open Access Journals (Sweden)

    Pawar Mandakini

    2008-01-01

    Full Text Available The objective of this study was to compare the risk factors and outcome of patients with preexisting resistant gram-negative bacilli (GNB with those who develop sensitive GNB in the cardiac intensive care unit (ICU. Of the 3161 patients ( n = 3,161 admitted to the ICU during the study period, 130 (4.11% developed health care-associated infections (HAIs with GNB and were included in the cohort study. Pseudomonas aeruginosa (37.8% was the most common organism isolated followed by Klebsiella species (24.2%, E. coli (22.0%, Enterobacter species (6.1%, Stenotrophomonas maltophilia (5.7%, Acinetobacter species (1.3%, Serratia marcescens (0.8%, Weeksella virosa (0.4% and Burkholderia cepacia (0.4%. Univariate analysis revealed that the following variables were significantly associated with the antibiotic-resistant GNB: females ( P = 0.018, re-exploration ( P = 0.004, valve surgery ( P = 0.003, duration of central venous catheter ( P < 0.001, duration of mechanical ventilation ( P < 0.001, duration of intra-aortic balloon counter-pulsation ( P = 0.018, duration of urinary catheter ( P < 0.001, total number of antibiotic exposures prior to the development of resistance ( P < 0.001, duration of antibiotic use prior to the development of resistance ( P = 0.014, acute physiology and age chronic health evaluation score (APACHE II, receipt of anti-pseudomonal penicillins (piperacillin-tazobactam ( P = 0.002 and carbapenems ( P < 0.001. On multivariate analysis, valve surgery (adjusted OR = 2.033; 95% CI = 1.052-3.928; P = 0.035, duration of mechanical ventilation (adjusted OR = 1.265; 95% CI = 1.055-1.517; P = 0.011 and total number of antibiotic exposure prior to the development of resistance (adjusted OR = 1.381; 95% CI = 1.030-1.853; P = 0.031 were identified as independent risk factors for HAIs in resistant GNB. The mortality rate in patients with resistant GNB was significantly higher than those with sensitive GNB (13.9% vs. 1.8%; P = 0.03. HAI with

  13. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  14. Beyond Trauma: Post-resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States.

    Science.gov (United States)

    Kim, Isok

    2016-08-01

    War-related traumas impact refugees' mental health. Recent literature suggests that structural and sociocultural factors related to the resettlement also become critical in shaping refugees' mental health. So far, there is limited empirical evidence to support this claim among resettled refugees. Resettlement contextual factors that influence mental health outcomes were examined using Latino and Asian refugees (n = 656) from a nationally representative survey. Linear and logistic regressions predicted factors associated with the study's outcomes (self-reported mental health, mood disorders, and anxiety disorders). Post-resettlement traumas were significantly associated with mental health outcomes, but pre-resettlement traumas were not. Unemployment, everyday discrimination, and limited English were significantly associated with mental health outcomes among both Latino and Asian refugees. The outcomes indicate that resettlement contextual factors have a significant association with refugees' mental health. Therefore, future studies with refugees must pay closer attention to structural and sociocultural factors after resettlement.

  15. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India

    OpenAIRE

    2015-01-01

    Background: The increased morbidity and mortality associated with nosocomial infections in the intensive care unit (ICU) is a matter of serious concern today. Aims: To determine the incidence of nosocomial infections acquired in the ICU, their risk factors, the causative pathogens and the outcome in a tertiary care teaching hospital. Materials and Methods: This was a prospective observational study conducted in a 12 bedded combined medical and surgical ICU of a medical college hospital. The s...

  16. 固体绝缘环网柜用直动式永磁机构的研制%Development of Direct-Acting Permanent Magnetic Actuator of Solid-Insulated Ring Main Unit

    Institute of Scientific and Technical Information of China (English)

    王博; 林莘

    2015-01-01

    This paper designed a direct-acting permanent magnetic actuator of solid-insulated ring main unit, adopting the exciting mode in which the charged capacitors discharged to drive the permanent magnetic actuator. According to the contact counter-force of circuit break-ers arc extinguish chamber and separating brakes spring, the counter-forces were carried out reduction and the finite element model was built to carry out dynamic simulation. The action current of direct-acting permanent magnetic actuator was simulated, as well as the divide-shut brake speed of ring main units. Via the assembling debugging of ring main unit prototype, the action current of direct-acting permanent mag-netic actuator was measured, together with mechanical characteristics data of ring main unit switch. The test results verify the accuracy of the theory simulation design.%设计了固体绝缘环网柜用直动式永磁机构,采用充电电容放电的励磁方式来驱动永磁机构,根据断路器灭弧室的触头反力和分闸弹簧的反力进行反力归算,建立了有限元模型并应用有限元法进行动态仿真。仿真模拟了直动式永磁机构的动作电流以及环网柜的分合闸速度等机械特性,通过固体绝缘环网柜样机的装配调试,实际测量了直动式永磁机构的动作电流以及环网柜开关的机械特性数据。试验结果验证了理论仿真设计的准确性。

  17. The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

    Directory of Open Access Journals (Sweden)

    Cho Yeoungjee

    2012-06-01

    Full Text Available Abstract Background The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results 365 (6% patients lived ≥100 km from their nearest PD unit (distant group, while 6183 (94% lived S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47. Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008 and receive antifungal prophylaxis (4% vs 10%, p = 0.01, but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p  Conclusions Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients.

  18. Two Paths to Inequality in Educational Outcomes: Family Background and Educational Selection in the United States and Norway

    Science.gov (United States)

    Reisel, Liza

    2011-01-01

    The United States and Norway represent two distinctively different attempts to equalize educational opportunity. Whereas the United States has focused on expansion and the proliferation of lower-tier open-access institutions, Norway has emphasized institutional streamlining and the equalization of living conditions. At the same time, the two…

  19. Identified metabolic signature for assessing red blood cell unit quality is associated with endothelial damage markers and clinical outcomes

    DEFF Research Database (Denmark)

    Bordbar, Aarash; Johansson, Pär I.; Paglia, Giuseppe;

    2016-01-01

    BACKGROUND: There has been interest in determining whether older red blood cell (RBC) units have negative clinical effects. Numerous observational studies have shown that older RBC units are an independent factor for patient mortality. However, recently published randomized clinical trials have...

  20. Design of the Main Control Unit of the Time Synchronization System Based on ARM and FPGA%基于ARM和FPGA的时间同步仪控制单元设计

    Institute of Scientific and Technical Information of China (English)

    刘鹏

    2012-01-01

    以时间同步仪的功能为出发点,设计了基于ARM和FPGA的控制系统,该系统以ARM芯片S3C2440A为控制核心,在FPGA芯片XCS30的辅助控制下,完成了时间同步仪系统的人机交互、参数设定、电文处理、远程控制等功能。通过键盘操作,LED灯和LCD显示屏,实现了简洁的人机交互控制界面,并在人机交互模块的基础上完成了参数设定模块的设计。通过以太网控制器实现了电文处理,采用CRC校验法,在处理过程中对电文进行检验,确保电文处理的安全可靠,利用Telnet服务器实现了远程控制模块。%This paper presents the design of main control unit of time synchronization system.We have designed main control unit based on ARM and FPGA.S3C2440A is selected as the core control module of main control unit;FPGA is selected as an auxiliary control unit.We have completed the functions of human computer interaction,the parameter settings,message handling and remote control.This paper has researched the mode of human computer interaction,and completed concise HCI as keyboard control,LED and LCD display;We complete the parameter settings based on the mode of human computer interaction;messages are transported by the Ethernet and the CRC checkout is used to checking the messages in the transmission to keep the message transport safety;and the mode of remote control is completed by Telnet.

  1. Risks, Risk Factors, and Outcomes Associated with Phone and Internet Sexting Among University Students in the United States.

    Science.gov (United States)

    Dir, Allyson L; Cyders, Melissa A

    2015-08-01

    Sexting, defined as the exchange of sexually suggestive pictures or messages via mobile phone or social networking sites (SNS), has received media attention for its prevalence and associated negative outcomes; however, research has not yet fully established risk factors for and resulting outcomes from sexting behaviors. The current study was the first empirical test of a causal path model in males and females, in which impulsivity-related traits and expectancies influence sexual behaviors through phone and SNS sexting. We also examined prevalence and perceived likelihood of common negative outcomes associated with sexting. Multiple regression and structural equation modeling (SEM) statistics were conducted on two independent undergraduate samples (n = 611 and 255). The best fitting SEM model (RMSEA = 0.04, CFI = 0.96, TLI = 0.94, and χ(2) = 176.06, df = 75, p sexting behaviors through sex-related sexting expectancies and a significant indirect effect of sensation seeking on sexual hookup behaviors through phone sexting behaviors (b = 0.06, p = .03), but only for females. Reverse mediations and mediation with SNS were not significant. Negative outcomes were rare: sexts being spread to others was the most common negative sexting experience (n = 21, 12 %). This study suggests the viability of personality and expectancies affecting sexual hookup behaviors through engagement in sexting behaviors. It also suggests that although direct negative outcomes associated with sexting are thought to be common, they were rare in the current sample.

  2. Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: a United States national study.

    Science.gov (United States)

    Williams, Nathaniel J; Glisson, Charles

    2014-04-01

    Theories of organizational culture and climate (OCC) applied to child welfare systems hypothesize that strategic dimensions of organizational culture influence organizational climate and that OCC explains system variance in youth outcomes. This study provides the first structural test of the direct and indirect effects of culture and climate on youth outcomes in a national sample of child welfare systems and isolates specific culture and climate dimensions most associated with youth outcomes. The study applies multilevel path analysis (ML-PA) to a U.S. nationwide sample of 2,380 youth in 73 child welfare systems participating in the second National Survey of Child and Adolescent Well-being. Youths were selected in a national, two-stage, stratified random sample design. Youths' psychosocial functioning was assessed by caregivers' responses to the Child Behavior Checklist at intake and at 18-month follow-up. OCC was assessed by front-line caseworkers' (N=1,740) aggregated responses to the Organizational Social Context measure. Comparison of the a priori and subsequent trimmed models confirmed a reduced model that excluded rigid organizational culture and explained 70% of the system variance in youth outcomes. Controlling for youth- and system-level covariates, systems with more proficient and less resistant organizational cultures exhibited more functional, more engaged, and less stressful climates. Systems with more proficient cultures and more engaged, more functional, and more stressful climates exhibited superior youth outcomes. Findings suggest child welfare administrators can support service effectiveness with interventions that improve specific dimensions of culture and climate.

  3. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Science.gov (United States)

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

    2017-01-31

    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units

    Directory of Open Access Journals (Sweden)

    Ulasli Sevinc

    2009-01-01

    Full Text Available Tuberculosis (TB remains a common problem in patients with chronic renal failure. In intensive care units, misdiagnosis or delayed diagnosis of TB is common. Therefore, a description of characteristics of active TB in patients with renal failure followed in intensive care units is important to reduce mortality and transmission of the disease. This study was performed to describe the characteristics of patients with renal failure admitted to the intensive care units and having active TB and evaluate predictive factors for in hospital mortality. The hospital records of 24 patients (11 women, 13 men having ESRD and TB between 2001-2006 were reviewed. Clinical, radiological, and laboratory data on admission were recorded. Possible parameters contributing to in-hospital mortality were obtained from the medical records. In-hospital mortality rate was 66.6%. Factors associated with mortality were decreased partial pressure of oxygen and malnutrition. Fever was reported in 8 patients and hemoptysis was reported in 3 patients. Eight patients had consolidation on chest radiograph, while 4 had normal findings Seventeen patients had pulmonary involvement, and 11 had extra pulmonary involvement. The mortality rate in TB patients followed in intensive care units is high, with 3 factors contributing to in-hospital mortality. Clinicians should consider active TB in renal failure patients being followed in the intensive care unit, even when results of a chest radiograph are normal especially in patients with unexplained poor general health or respiratory failure.

  5. Base deficit-based predictive modeling of outcome in trauma patients admitted to intensive care units in dutch trauma centers

    NARCIS (Netherlands)

    Kroezen, Frank; Bijlsma, Taco S.; Liem, Mike S. L.; Meeuwis, J. Dik; Leenen, Luke P. H.

    2007-01-01

    Background: Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients. Methods: We prospectively recor

  6. Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-04-01

    To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Prospective cohort study. OUs and planned home births in England. 8180 'higher risk' women in the Birthplace cohort. We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John

  7. Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Shiomi, Hiroki; Morimoto, Takeshi; Hayano, Mamoru; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Imai, Masao; Yamaji, Kyohei; Tada, Tomohisa; Natsuaki, Masahiro; Saijo, Sayaka; Funakoshi, Shunsuke; Nagao, Kazuya; Hanazawa, Koji; Ehara, Natsuhiko; Kadota, Kazushige; Iwabuchi, Masashi; Shizuta, Satoshi; Abe, Mitsuru; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Yamazaki, Fumio; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Imoto, Yutaka; Komiya, Tatsuhiko; Horie, Minoru; Fujiwara, Hisayoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi

    2012-10-01

    The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.

  8. Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients.

    Science.gov (United States)

    Kim, Yu Jung; Kim, Mi-Jung; Cho, Young-Jae; Park, Jong Sun; Kim, Jin Won; Chang, Hyun; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Yoon, Ho Il; Bang, Soo-Mee; Lee, Jae Ho; Lee, Choon-Taek; Lee, Jong Seok

    2014-03-01

    Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratiocare. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

  9. Advancement of a soil parameters geodatabase for the modeling assessment of conservation practice outcomes in the United States

    Science.gov (United States)

    US-ModSoilParms-TEMPLE is a database composed of a set of geographic databases functionally storing soil-spatial units and soil hydraulic, physical, and chemical parameters for three agriculture management simulation models, SWAT, APEX, and ALMANAC. This paper introduces the updated US-ModSoilParms-...

  10. Sleep Disturbances among Older Adults in the United States, 2002-2012: Nationwide Inpatient Rates, Predictors, and Outcomes.

    Science.gov (United States)

    Gamaldo, Alyssa A; Beydoun, May A; Beydoun, Hind A; Liang, Hailun; Salas, Rachel E; Zonderman, Alan B; Gamaldo, Charlene E; Eid, Shaker M

    2016-01-01

    Objective/Background: We examined the rates, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of sleep disturbances in older hospitalized patients. Patients/Methods: Using the U.S. Nationwide Inpatient Sample database (2002-2012), older patients (≥60 years) were selected and rates of insomnia, obstructive sleep apnea (OSA) and other sleep disturbances (OSD) were estimated using ICD-9CM. TC, adjusted for inflation, was of primary interest, while MR and LOS were secondary outcomes. Multivariable regression analyses were conducted. Results: Of 35,258,031 older adults, 263,865 (0.75%) had insomnia, 750,851 (2.13%) OSA and 21,814 (0.06%) OSD. Insomnia rates increased significantly (0.27% in 2002 to 1.29 in 2012, P-trend rates and expenditures within hospital settings and the potential hospital expenditures of unrecognized sleep disturbances in the elderly.

  11. Discussion on vibration from main pipe of flare gas in CCR unit%重整火炬气干管振动的原因及处理措施

    Institute of Scientific and Technical Information of China (English)

    刘俊

    2015-01-01

    The piping system in flare gas unit of A refinery is checked thoroughly to find out the causes of the vibration of discharge pipeline to resolve these accidents of reforming flare gas main pipe,which can offer guidance for similar issues.%以某炼厂的火炬排放管道系统为对象,进行全面且深入的排查,找出火炬放空线振动事故原因,并在此基础上采用针对性的处理措施,最终圆满解决了重整火炬气干管振动问题,为同类或者类似问题的解决提供了有益的参考.

  12. Can Sarcopenia Quantified by Ultrasound of the Rectus Femoris Muscle Predict Adverse Outcome of Surgical Intensive Care Unit Patients as well as Frailty? A Prospective, Observational Cohort Study.

    Science.gov (United States)

    Mueller, Noomi; Murthy, Sushila; Tainter, Christopher R; Lee, Jarone; Riddell, Kathleen; Fintelmann, Florian J; Grabitz, Stephanie D; Timm, Fanny P; Levi, Benjamin; Kurth, Tobias; Eikermann, Matthias

    2016-12-01

    To compare sarcopenia and frailty for outcome prediction in surgical intensive care unit (SICU) patients. Frailty has been associated with adverse outcomes and describes a status of muscle weakness and decreased physiological reserve leading to increased vulnerability to stressors. However, frailty assessment depends on patient cooperation. Sarcopenia can be quantified by ultrasound and the predictive value of sarcopenia at SICU admission for adverse outcome has not been defined. We conducted a prospective, observational study of SICU patients. Sarcopenia was diagnosed by ultrasound measurement of rectus femoris cross-sectional area. Frailty was diagnosed by the Frailty Index Questionnaire based on 50 variables. Relationship between variables and outcomes was assessed by multivariable regression analysis NCT02270502. Sarcopenia and frailty were quantified in 102 patients and observed in 43.1% and 38.2%, respectively. Sarcopenia predicted adverse discharge disposition (discharge to nursing facility or in-hospital mortality, odds ratio 7.49; 95% confidence interval 1.47-38.24; P = 0.015) independent of important clinical covariates, as did frailty (odds ratio 8.01; 95% confidence interval 1.82-35.27; P = 0.006); predictive ability did not differ between sarcopenia and frailty prediction model, reflected by χ values of 21.74 versus 23.44, respectively, and a net reclassification improvement (NRI) of -0.02 (P = 0.87). Sarcopenia and frailty predicted hospital length of stay and the frailty model had a moderately better predictive accuracy for this outcome. Bedside diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty. Sarcopenia assessed by ultrasound may be utilized as rapid beside modality for risk stratification of critically ill patients.

  13. Neighborhood-level socioeconomic determinants impact outcomes in nonsmall cell lung cancer patients in the Southeastern United States.

    Science.gov (United States)

    Erhunmwunsee, Loretta; Joshi, Mary-Beth M; Conlon, Debbi H; Harpole, David H

    2012-10-15

    Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC. The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles. Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P = .0167 and P = .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P = .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P = .0455). Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality. Copyright © 2012 American Cancer Society.

  14. Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes.

    Science.gov (United States)

    Kaplan, Alan L; Hu, Jim C

    2013-08-01

    To assess utilization trends and determine the effect of testosterone replacement therapy on outcomes in men who subsequently developed prostate cancer. We used linked Surveillance, Epidemiology, and End Results-Medicare data to identify 149,354 men diagnosed with prostate cancer from 1992 to 2007. Of those, 2,237 men (1.5%) underwent testosterone replacement therapy before their prostate cancer diagnosis. Propensity scoring methods were used to assess cancer-specific outcomes of testosterone replacement vs no replacement therapy. Testosterone replacement was associated with older age at cancer diagnosis, nonwhite race, and higher comorbidity (P testosterone vs testosterone before the prostate cancer diagnosis was associated with higher grade (34% vs 30%, P therapy after initial treatment. Through our observational study design, we show that testosterone use was low throughout the study period. Testosterone use was not associated with aggressive prostate cancer and did not affect overall or disease-specific mortality. Although our findings support growing evidence that testosterone replacement is safe with respect to prostate cancer, confirmatory prospective studies are needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. The impact of probiotics (Lactobacillus reuteri Protectis on the treatment, course and outcome of premature infants in the Intensive Care Unit in Mostar

    Directory of Open Access Journals (Sweden)

    Marjana Jerković Raguž

    2016-09-01

    Full Text Available Aim: The aim of this study was to analyse the treatment, course and outcome of premature infants treated with probiotics (Lactobacillus reuteri Protectis in the Intensive Care Unit (ICU. Study design: This retrospective cohort study included 100 preterm infants of gestational age up to 30-34 + 6/7 weeks. The first group of infants who were given probiotics in their dairy meal in the course of their medical treatment during hospitalization in the year 2014 were compared to a second group of infants who did not receive probiotics in the year 2013.Results: A statistically significant difference in the number of days of treatment in the ICU (p < 0.05, administration of ranitidine (p < 0.05 and feeding intolerance (p < 0.05 was found between the two groups of preterm infants. No statistically significant differences were found in the other variables under study.Conclusion: Probiotics probably have a positive effect on the course and outcome of treatment of premature infants in the ICU. Our newborns who received probiotics spent shorter time in intensive care, they began full peroral intake of milk sooner and received antiulcer medicine for shorter time, which is an important step towards the improvement of treatment outcome in premature infants.

  16. Prevalence, management, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom.

    Science.gov (United States)

    Jairath, Vipul; Kahan, Brennan C; Stanworth, Simon J; Logan, Richard F A; Hearnshaw, Sarah A; Travis, Simon P L; Palmer, Kelvin R; Murphy, Michael F

    2013-05-01

    Coagulopathy after major hemorrhage has been found to be an independent risk factor for mortality after traumatic bleeding. It is unclear whether similar associations are present in other causes of major hemorrhage. We describe the prevalence, use of plasma, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding (NVUGIB). This study was a multicenter UK national audit. Data were collected prospectively on consecutive admissions with upper gastrointestinal bleeding over a 2-month period to 212 UK hospitals. Coagulopathy was defined as an international normalized ratio (INR) of at least 1.5. Logistic regression was used to examine the relationship between coagulopathy and patient-related outcome measures of mortality, rebleeding, and need for surgery and/or radiologic intervention. A total of 4478 patients were included in the study. Coagulopathy was present in 16.4% (444/2709) of patients in whom an INR was recorded. Patients with coagulopathy were more likely to present with hemodynamic shock (45% vs. 36%), have a higher clinical Rockall score (4 vs. 2), receive red blood cell transfusion (79% vs. 48%) and have high-risk stigmata of hemorrhage at endoscopy (34% vs. 25%). After adjustment for confounders the presence of a coagulopathy was associated with a fivefold increased in the odds of mortality (odds ratio, 5.63; 95% confidence interval, 3.09-10.27; p < 0.001). Only 35% of patients with coagulopathy received fresh-frozen plasma transfusion. Coagulopathy was prevalent in 16% of patients after NVUGIB and independently associated with more than a fivefold increase in the odds of in-hospital mortality. Wide variation in plasma use exists indicates clinical uncertainty regarding optimal practice. © 2012 American Association of Blood Banks.

  17. Nationwide inpatient rates, predictors and outcomes of selected sleep disturbances among older adults in the United States, 2002-2012

    Directory of Open Access Journals (Sweden)

    Alyssa A Gamaldo

    2016-11-01

    Full Text Available OBJECTIVE/BACKGROUND: We examined the rates, predictors, and outcomes (mortality risk (MR, length of stay (LOS and total charges (TC of sleep disturbances in older hospitalized patients.PATIENTS/METHODS: Using the U.S. Nationwide Inpatient Sample database (2002-2012, older patients (≥60y were selected and rates of insomnia, obstructive sleep apnea (OSA and other sleep disturbances (OSD were estimated using ICD-9CM. TC, adjusted for inflation, was of primary interest, while MR and LOS were secondary outcomes. Multivariable regression analyses were conducted.RESULTS: Of 35,258,031 older adults, 263,865 (0.75% had insomnia, 750,851 (2.13% OSA and 21,814 (0.06% OSD. Insomnia rates increased significantly (0.27% in 2002 to 1.29 in 2012, P-trend<0.001, with a similar trend observed for OSA (1.47 in 2006 to 5.01 in 2012, P-trend<0.001. TC (2012 for insomnia-related hospital admission increased over time from 22,250 in 2002 to 31,527 in 2012, and increased similarly for OSA and OSD; while LOS and MR both decreased. Women with any sleep disturbance had lower MR and TC than men, while Whites had consistently higher odds of insomnia, OSA, and OSD than older Blacks and Hispanics. Co-morbidities such as depression, cardiovascular risk factors, and neurological disorders steadily increased over time in patients with sleep disturbances. CONCLUSION: TC increased over time in patients with sleep disturbances while LOS and MR decreased. Further research should focus on identifying the mechanisms that explain the association between increasing sleep disturbance rates and expenditures within hospital settings and the potential hospital expenditures of unrecognized sleep disturbances in the elderly.

  18. Association of hyponatremia with in-hospital outcomes in infective endocarditis: A 5-year review from an Indian Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Saraschandra Vallabhajosyula

    2016-01-01

    Full Text Available Hyponatremia is commonly noted with cardiovascular disorders, but its role in infective endocarditis (IE is limited to being a marker of increased morbidity in IE patients with intravenous drug use. This was a 5-year retrospective review from an Indian Intensive Care Unit (ICU. Patients >18 years with IE and available serum sodium levels were included in the study. Pediatric and pregnant patients were excluded from the study. Hyponatremia was defined as admission sodium <135 mmol/L. Detailed data were abstracted from the medical records. Primary outcomes were need for invasive mechanical ventilation, ICU length of stay, and in-hospital mortality. Secondary outcomes included development of acute kidney injury, acute decompensated heart failure (ADHF, acute respiratory distress syndrome, stroke, and severe sepsis in the ICU. Two-tailed P < 0.05 was considered statistically significant. Between January 2010 and December 2014, 96 patients with IE were admitted to the ICU with 85 (88.5% (median age 46 [34.5-55] years, 51 [60.0%] males meeting our inclusion criteria. The comorbidities, echocardiographic, and microbiological characteristics were comparable between patients with hyponatremia (56; 65.9% and eunatremia (29; 34.1%. Median sodium in the hyponatremic cohort was 131 mmol/L (127.25-133 compared to the eunatremic cohort 137 mmol/L (135-139 (P < 0.001. The primary outcomes were not different between the two groups. Hyponatremia was associated more commonly with ADHF (12 [21.4%] vs. 0; P = 0.007 during the ICU stay. Hyponatremia is commonly seen in IE patients and is not associated with worse hospital outcomes. ADHF was seen more commonly in the hyponatremic patients in comparison to those with eunatremia.

  19. Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital.

    Science.gov (United States)

    Queiroz, Luiz Fernando Tibery; Anami, Elza H T; Zampar, Elisangela F; Tanita, Marcos T; Cardoso, Lucienne T Q; Grion, Cintia Magalhaes C

    2016-05-01

    To describe the epidemiologic aspects of burn victims who were hospitalized in the Intensive Care Unit (ICU) at the Burn Center in the University Hospital of the State University of Londrina (UEL). A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%. Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28-52). The mean total body surface area burned was 26.60±18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (pburned (phospital mortality was 34.10%. Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients were considered to be severely burned. Most of the samples had a high mean total body surface area burned. The ABSI score showed the best performance in discriminating non-survivors. Hospital mortality rate was high

  20. The national bowel cancer audit project: the impact of organisational structure on outcome in operative bowel cancer within the United Kingdom.

    Science.gov (United States)

    Cornish, J A; Tekkis, P P; Tan, E; Tilney, H S; Thompson, M R; Smith, J J

    2011-06-01

    To investigate the relationship between organisational structure, process and surgical outcomes for bowel cancer surgery. An e-survey was sent to the members of the Association of Coloproctology of Great Britain and Ireland to determine the organisational structure of their Trusts. Responses were combined with the National Bowel Cancer Audit (NBOCAP) data. Items investigated included; number of consultants, nurse specialists, volume of cases and intensive care facilities. Main outcome measures included: 30-day risk-adjusted mortality, length of stay (LOS), lymph node yield and circumferential margin involvement (CRM). One hundred and seventeen Trusts responded (65.8%), matched to 7666 patient episodes (NBOCAP data) from 54 (62.8%)Trusts who submitted data to the audit. Trusts treating 0.001), 0.001), 0001) and 0001) were more likely to have a 30-day-risk-adjusted mortality twice that of the national mean. Sixty five percent (n = 1603) of Trusts treating ≥ 190 cases/annum harvested ≥ 12 lymph nodes vs. 58.3% (n = 1435) in Trusts organisational infrastructure of hospitals appears to have as great an impact on patient outcomes as the volume of cases performed by hospital Trusts. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

  1. Risk and outcome analysis of 1832 consecutively excised basal cell carcinomas in a tertiary referral plastic surgery unit.

    LENUS (Irish Health Repository)

    Malik, Vinod

    2012-02-01

    BACKGROUND: Basal cell carcinomas are the most prevalent of all skin cancers worldwide and form the majority of the surgical workload for most modern cutaneous malignancy centres. Primary surgical removal of basal cell carcinomas remains the gold standard of treatment but, despite almost two centuries of surgical experience, rates of incomplete surgical excision of up to 50% are still reported. The aim of this study was to assess, quantify and perform comparative analysis of the outcomes and predictive factors of consecutive primarily-excised basal cell carcinomas in a tertiary centre over a six-year period. METHODS: Retrospective audit was conducted on all patients who underwent surgical excision of basal cell carcinomas from January 2000 to December 2005. Assessment parameters included patient biographics, tumour management differences and detailed histopathological analysis of tumour margins and subtypes. RESULTS: One thousand eight hundred and thirty two basal cell carcinomas were excised from 1329 patients over the designated time period. Two hundred and fifty one (14%) lesions were incompletely excised with 135 (7.4%) involving the peripheral margin only, 48 (2.6%) the deep margin only and 41 (2.2%) involving both. Nasal location was the most common predictor of incomplete excision. CONCLUSIONS: Overall basal cell carcinomas excision rates compared favourably with international reported standards but attention to a variety of surgical and histological risk factors may improve this further.

  2. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2011-05-01

    Full Text Available Abstract Background We need to know the scale and underlying causes of surgical adverse events (AEs in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since then surgical technology and quality assurance have changed rapidly. The objective of this study was to provide more recent data on the incidence, consequences, preventability, causes and potential strategies to prevent AEs among hospitalized patients in surgical units. Methods A structured record review study of 7,926 patient records was carried out by trained nurses and medical specialist reviewers in 21 Dutch hospitals. The aim was to determine the presence of AEs during hospitalizations in 2004 and to consider how far they could be prevented. Of all AEs, the consequences, responsible medical specialty, causes and potential prevention strategies were identified. Surgical AEs were defined as AEs attributable to surgical treatment and care processes and were selected for analysis in detail. Results Surgical AEs occurred in 3.6% of hospital admissions and represented 65% of all AEs. Forty-one percent of the surgical AEs was considered to be preventable. The consequences of surgical AEs were more severe than for other types of AEs, resulting in more permanent disability, extra treatment, prolonged hospital stay, unplanned readmissions and extra outpatient visits. Almost 40% of the surgical AEs were infections, 23% bleeding, and 22% injury by mechanical, physical or chemical cause. Human factors were involved in the causation of 65% of surgical AEs and were considered to be preventable through quality assurance and training. Conclusions Surgical AEs occur more often than other types of AEs, are more often preventable and their consequences are more severe. Therefore, surgical AEs have a major impact on the burden of AEs during hospitalizations

  3. Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience.

    Science.gov (United States)

    Galindo-Becerra, Samantha; Labastida-Mercado, Nancy; Rosales-Padrón, Jaime; García-Chavez, Jessica; Soto-Vega, Elena; Rivadeneyra-Espinoza, Liliana; León-Peña, Andres A; Fernández-Lara, Danitza; Dominguez-Cid, Monica; Anthon-Méndez, Javier; Arizpe-Bravo, Daniel; Ruiz-Delgado, Guillermo J; Ruiz-Argüelles, Guillermo J

    2015-01-01

    Admission to the intensive care unit (ICU) of a patient who has been grafted with hematopoietic stem cells is a serious event, but the role of the ICU in this setting remains controversial. Data were analyzed from patients who underwent autologous or allogeneic bone marrow transplantation at the Centro de Hematología y Medicina Interna de Puebla, México, between May 1993 and October 2014. In total, 339 patients were grafted: 150 autografts and 189 allografts; 68 of the grafted patients (20%) were admitted to the ICU after transplantation: 27% of the allografted and 11% of the autografted patients (p = 0.2). Two of 17 autografted patients (12%) and 5 of 51 allografted patients (10%) survived. All patients who required insertion of an endotracheal tube died, whereas 7 of 11 patients without invasive mechanical ventilation survived (p = 0.001). Only 10% of the grafted patients survived their stay in the ICU; this figure is lower than those reported from other centers and may reflect several facts, varying from the quality of the ICU support to ICU admission criteria to the initial management of all the grafts in an outpatient setting, which could somehow delay the arrival of patients to the hospital. © 2015 S. Karger AG, Basel.

  4. Cocaine-related admissions to an intensive care unit: a five-year study of incidence and outcomes.

    LENUS (Irish Health Repository)

    Galvin, S

    2010-02-01

    Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003-05 to 10 in 2007. Their median (IQR [range]) age was 25 (21-35 [17-47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11-27 [5-36]) and length of intensive care stay was 5 (3-9 [1-16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later. One was untraceable. Cocaine toxicity necessitating intensive care is increasingly common in Dublin. Hospital mortality in this series was 52%. These findings may help to inform public attitudes to cocaine.

  5. Meta-analysis on continuous outcomes in minimal important difference units: an application with appropriate variance calculations.

    Science.gov (United States)

    Shrier, Ian; Christensen, Robin; Juhl, Carsten; Beyene, Joseph

    2016-12-01

    To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. Meta-analyses of published data. We calculated the variance of MDMID as a random variable using the delta method and as a constant. We assessed performance under different assumptions. We compare meta-analysis results from data originally used to present the MDMID and data from osteoarthritis studies using different domain instruments. Depending on the data set and depending on the values of rho and coefficient of variation of the MID (CoVMID), estimates of treatment effect and P-values between an approach considering the MID as a constant vs. as a random variable may differ appreciably. Using our data sets, we provide examples of the potential magnitude. When rho = 0.5 and CoVMID = 0.8, considering MID as a constant overestimated the treatment effect by 33-110% and decreased the P-value for heterogeneity from above 0.95 to below 0.08. When rho = 0.8 and CoVMID = 0.5, the magnitude of the effects was similar. Considering MID as a random variable avoids unrealistic assumptions and provides more appropriate treatment effect estimates. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry.

    Science.gov (United States)

    Illmann, Alexander; Riemer, Thomas; Erbel, Raimund; Giannitsis, Evangelos; Hamm, Christian; Haude, Michael; Heusch, Gerd; Maier, Lars S; Münzel, Thomas; Schmitt, Claus; Schumacher, Burghard; Senges, Jochen; Voigtländer, Thomas; Mudra, Harald

    2014-01-01

    The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated. Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS). A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed. A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month followup, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, pCPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.

  7. Epidemiology and outcomes of older patients admitted to Scottish intensive care units: a national database linkage study.

    Science.gov (United States)

    Docherty, Annemarie; Lone, Nazir; Anderson, Niall; Walsh, Timothy

    2015-02-26

    As the general population ages and life expectancy increases, health-care use by elderly people increases, including intensive care. Rationing and variation of access are ethically and politically challenging. We aimed to characterise the population-based incidence of intensive care unit (ICU) admissions of elderly people in Scotland; compare ICU admission and mortality between elderly and younger populations; and compare treatment intensity between these groups. We extracted complete, national 6-year cohort Scottish ICU admissions (Jan 1, 2005, to Dec 31, 2010) from the Scottish Intensive Care Society Audit Group database, which we linked to hospital Scottish Morbidity Record (SMR01) and death records. Annual incidence of ICU admissions of people aged 80 years or older was standardised for sex and socioeconomic status to the standard Scottish population (≥80 years) 2005-10. We compared mortality of elderly and younger people (ICU (4561 patients ≥80 years [9·5%, 35·0/10 000 population], 26 784 patients ICU admissions of elderly people fell from 36·6/10 000 population (95%CI 34·0-39·2) in 2005 to 30·3/10 000 (28·0-32·5) in 2010. ICU mortality was higher in elderly than in younger people (26·4% vs 16·1%, prehabilitation (younger 1063, 5·1%) (χ(2)=525, pICU length of stay was lower (6 days [IQR 3-13] vs 8 [3-16], pICU, where initially they received a higher intensity of treatment than did younger patients; however, duration of ICU stay was shorter. Mortality rates were high, and age was an independent predictor of mortality. Funding assistance for AD's MPH from Scottish Intensive Care Society, Scottish Society of Anaesthetists, Edinburgh Anaesthetics Research and Education Fund. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Delirium in Intensive Care Unit. Factors that affect the appearance of delirium and its importance to the patients’ final outcome

    Directory of Open Access Journals (Sweden)

    Olga Kadda

    2012-10-01

    Full Text Available Delirium is a common cause of acute brain dysfunction in patients treated in the Intensive Care Unit (ICU. Aim: The aim of the present study was to investigate the incidence of delirium in the ICU, to establish risk factors for its development and to determine the effect of delirium on patient’s length of the stay and mortality in the ICU.Material and Methods: The sample studied consisted of 122 patients hospitalized in the ICU of a General Hospital in Attica, having completed 48 hours of stay. In order to diagnose delirium the CAM-ICU delirium scale was used. There were recorded the demographic characteristics of the sample studied, the medical history, the type of sedation, the severity of their illness during admission, the complications, the environment and psychological factors. Moreover, the length of stay, morbidity and mortality of patients were recorded. Data analysis was performed with the statistical package SPSS-ver.17.Results: 62% (n=76 of the sample studied were male. The mean age of the sample was 57±18 years. Intubation and mechanical ventilation was applied in 90% (n=110 of the studied population and seductive drugs in 90% (n=110 of the sample. Delirium frequency was 43%. Risk factors, according to the results, seems to be arterial hypertension (p= 0.009, smoking history (p=0.023, alcohol abuse (p=0.005, severity of illness in admission Apache II (p=0.033. The age and length of stay in ICU doesn’t seem to affect delirium development in ICU. Finally, mortality was clearly increased (p=0.001.Conclusions: The increased frequency of delirium in ICU patients requires measures to prevent it. Factors that seem to be related to delirium development are: arterial hypertension, alcohol abuse, smoking, hyperpyrexia and the usage of sedative drugs., Delirium, also, increases mortality in ICU patients.

  9. Testosterone replacement therapy outcomes among opioid users: the Testim Registry in the United States (TRiUS).

    Science.gov (United States)

    Blick, Gary; Khera, Mohit; Bhattacharya, Rajib K; Nguyen, Dat; Kushner, Harvey; Miner, Martin M

    2012-05-01

    Among patients with hypogonadism-associated comorbidities, opioid users have the highest incidence of hypogonadism. Data from the Testim Registry in the United States were analyzed to determine the efficacy of testosterone replacement therapy in opioid users vs nonusers. Prospective, 12-month observational cohort registry. Hypogonadal men (N = 849) prescribed Testim (but not necessarily testosterone replacement) for the first time. Testim 1% testosterone gel (5-10 g/day). Total and free testosterone, sex hormone-binding globulin, prostate-specific antigen, sexual function, mood/depression, and anthropometric data were assessed. Changes from baseline were analyzed using repeated measures mixed-effects analysis of variance; multiple linear regressions of changes in testosterone levels with sexual function, mood, and opioid use were computed. 90/849 patients (10.6%) reported opioid use at baseline; 75/90 (83%) used opioids for ≥ 30 days prior to baseline. Baseline total testosterone and prostate-specific antigen were not statistically different between opioid users and nonusers; there was a trend for higher sex hormone-binding globulin (P = 0.08) and lower free testosterone (P = 0.05) in opioid users. After 1 month, both opioid users and nonusers had significant (P testosterone, which continued through 12 months. Sexual function and mood improved significantly in both opioid users and nonusers over 12 months, and significantly correlated with change in total testosterone. Testosterone replacement therapy increased serum testosterone in hypogonadal opioid users and nonusers alike. The data suggest that with testosterone replacement, hypogonadal opioid users might be expected to have similar improvements in sexual function and mood as opioid nonusers. Wiley Periodicals, Inc.

  10. Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Directory of Open Access Journals (Sweden)

    Emmanuel Ameyaw

    2014-01-01

    Full Text Available Dysglycaemia (hyper- or hypoglycaemia in critically ill children has been associated with poor outcome. We compared the clinical outcomes in children admitted to Pediatric Emergency Unit (PEU at Komfo Anokye Teaching Hospital (KATH for acute medical conditions and presenting with euglycaemia or dysglycaemia. This is a prospective case matching cohort study. Eight hundred subjects aged between 3 and 144 months were screened out of whom 430 (215 with euglycaemia and 215 with dysglycaemia were enrolled. The median age was 24 months (range: 3–144 months. In the dysglycaemia group, 28 (13% subjects had hypoglycemia and 187 (87% had hyperglycemia. Overall, there were 128 complications in 116 subjects. The number of subjects with complications was significantly higher in dysglycaemia group (n=99, 46% compared to euglycaemia group (n=17, 8% (P<0.001. Forty subjects died out of whom 30 had dysglycaemia (P=0.001. Subjects with dysglycaemia were 3 times (95% CI: 1.5–6.0 more likely to die and 4.8 times (95% CI: 3.1–7.5 more likely to develop complications (P=0.001. Dysglycaemia is associated with increased morbidity and mortality in children with acute medical conditions and should lead to intensive management of the underlying condition.

  11. Effect of diabetes and acute rejection on liver transplant outcomes: An analysis of the organ procurement and transplantation network/united network for organ sharing database.

    Science.gov (United States)

    Kuo, Hung-Tien; Lum, Erik; Martin, Paul; Bunnapradist, Suphamai

    2016-06-01

    The effects of diabetic status and acute rejection (AR) on liver transplant outcomes are largely unknown. We studied 13,736 liver recipients from the United Network for Organ Sharing/Organ Procurement Transplant Network database who underwent transplantation between 2004 and 2007 with a functioning graft for greater than 1 year. The association of pretransplant diabetes mellitus (PDM), new-onset diabetes after transplant (NODAT), and AR rates on allograft failure, all-cause mortality, and cardiovascular mortality were determined. To determine the differential and joint effects of diabetic status and AR on transplant outcomes, recipients were further stratified into 6 groups: neither (reference, n = 6600); NODAT alone (n = 2054); PDM alone (n = 2414); AR alone (n = 1448); NODAT and AR (n = 707); and PDM and AR (n = 513). An analysis with hepatitis C virus (HCV) serostatus was also performed (HCV recipients, n = 6384; and non-HCV recipient, n = 5934). The median follow-up was 2537 days. The prevalence of PDM was 21.3%. At 1 year after transplant, the rates of NODAT and AR were 25.5% and 19.4%, respectively. Overall, PDM, NODAT, and AR were associated with increased risks for graft failure (PDM, hazard ratio [HR] = 1.31, P < 0.01; NODAT, HR = 1.11, P = 0.02; AR, HR = 1.28, P < 0.01). A multivariate Cox regression analysis of the 6 recipient groups demonstrated that NODAT alone was not significantly associated with any study outcomes. The presence of PDM, AR, NODAT and AR, and PDM and AR were associated with higher overall graft failure risk and mortality risk. The presence of PDM was associated with higher cardiovascular mortality risk. The analyses in both HCV-positive and HCV-negative cohorts showed a similar trend as in the overall cohort. In conclusion, PDM and AR, but not NODAT, is associated with increased mortality and liver allograft failure. Liver Transplantation 22 796-804 2016 AASLD.

  12. Antiretroviral Treatment Switching and Its Association With Economic Outcomes and Adverse Treatment Effects Among Commercially Insured and Medicaid-Enrolled Patients With HIV in the United States.

    Science.gov (United States)

    Korsnes, Jennifer S; Goodwin, Bridgett B; Murray, Miranda; Candrilli, Sean D

    2016-12-01

    Antiretroviral therapy (ART) of HIV typically involves the use of 2 nucleoside reverse transcriptase inhibitors plus a third agent (eg, protease inhibitor). It has been shown that over the course of treatment, a proportion of patients switch their ART for various reasons (eg, tolerability, long-term toxicities). We hypothesize that there is a relationship between ART treatment switching and economic and clinical outcomes among HIV patients. To determine whether switching ART regimens is associated with greater health care costs, resource use, and adverse treatment effects. Administrative health care claims were used to identify commercially insured and Medicaid-enrolled patients in the United States who had ≥2 claims containing an HIV/AIDS diagnosis from 2006 to 2011 and received an ART prescription from 2007 to 2010. The final population included patients who were ≥18 years old on their index date (ie, date of first ART prescription) and had continuous health plan enrollment for ≥12 months before and after their index date. Treatment characteristics (eg, switching), adverse treatment effects, and health care resource utilization and costs, were evaluated during a 12-month follow-up period. Multivariable models assessed the relationship between ART switching and economic outcomes (ie, costs, number of health care encounters) and adverse treatment effects. A total of 14 590 commercially insured patients met all inclusion criteria and 12% had an ART switch; further, 5744 Medicaid-enrolled patients met all inclusion criteria, and 14% switched treatment. After adjusting for confounders, ART switching was associated with 64% and 36% (P economic outcomes and certain adverse treatment effects. Efforts to put patients on an optimal ART regimen initially, therefore reducing the need for subsequent switching, may have a positive effect on patients specifically and the health care system in general. © The Author(s) 2016.

  13. Patient characteristics and outcomes of a hip fracture and concomitant fracture compared with hip fracture alone: results from a United Kingdom teaching hospital.

    Science.gov (United States)

    Ong, Terence; Anand, Varun; Tan, Wei; Quah, Edmund; Moran, Chris; Sahota, Opinder

    2016-04-01

    A proportion of patients sustaining hip fractures present with a concomitant fracture. We aimed to evaluate the relationship between patient characteristics and clinical outcomes, in those with a hip and concomitant fracture compared with those sustaining a hip fracture alone from a clinical service registry. Cross-sectional study using data obtained from a clinical service registry (Nottingham Hip Fracture Database) on patients aged 50 and above who suffered a hip fracture between 1/1/2003 and 31/12/2012. Data was collected on patient demographics, fracture information and healthcare outcomes. 7338 patients of which 75 % were female (mean age 82 (SD 9.4), had a hip fracture with 334 (4.6 %) patients having a concomitant fracture. The majority (58 %) were distal radius or proximal humeral fractures. Only females (p = 0.002), those taking three or fewer medications (p = 0.018) and those on long term steroids (p = 0.048) were more likely to suffer a concomitant fracture. There was no difference in mortality, rates of postoperative complication, intensive care unit or care home admission between both groups. Patients with a concomitant fracture have a 16 % longer average length of stay in hospital (mean difference 1.16; 95 % CI 1.07-1.25, p fractures have similar patient characteristics, except gender, polypharmacy and long term steroid use; and outcomes to those presenting with hip fracture alone, except a longer average inpatient stay.

  14. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

    Science.gov (United States)

    López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

    2015-11-01

    Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.

  15. Epidemiologia e desfecho de pacientes cirúrgicos não cardíacos em unidades de terapia intensiva no Brasil Epidemiology and outcomes of non-cardiac surgical patients in Brazilian intensive care units

    Directory of Open Access Journals (Sweden)

    Suzana Margareth Lobo

    2008-12-01

    , cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%. Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2. Multiple organ failure was the main cause of death (53%. CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.

  16. Development of a project on North Unit Irrigation District’s Main Canal at the Monroe Drop, using a novel low-head hydropower technology called the SLH100

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Abraham [Natel Energy, Inc., Alameda, CA (United States); Schneider, Gia [Natel Energy, Inc., Alameda, CA (United States); McKinstry, Katherine [Natel Energy, Inc., Alameda, CA (United States); Harwood, Meghan [Natel Energy, Inc., Alameda, CA (United States)

    2017-03-14

    Natel Energy is a low­-head, distributed hydropower company based out of Alameda, CA. Natel manufactures and sells proprietary hydroelectric turbines called hydroEngines® that are suitable for low-­head, high-­flow settings, and range from 30kW to 1 MW of capacity per unit. Natel’s hydroEngine is a state­-of­the-­art two stage impulse turbine, using blades mounted symmetrically on two belts perpendicular to the axis of travel, and using linearly­-moving foils, rather than a rotor, to enable efficient conversion of kinetic energy of large volumes of water at low head with no risk of cavitation. In addition, the hydroEngine can be installed at or above tailwater level, reducing the excavation necessary to build the powerhouse and thus reducing total installed cost and project footprint. Thus, the hydroEngine technology enables a new generation of small hydro installations with low cost of project development, fish-­friendly operations, and small project footprint. In September of 2015, Natel Energy formally commissioned its first project installation in Madras, Oregon, installing 1 SLH100 turbine at an existing drop structure on the North Unit Irrigation District (NUID) Main Canal. The water falls between 13.5 feet to 16.5 feet at this structure, depending on flow. The plant has an installed capacity of 250 kW and an expected annual generation of approximately 873 MWh. The plant operates at an annual capacity factor of 40%, and a capacity factor over the irrigation season, or period of available flow, of 80%. Annual capacity factor is calculated as a percentage of plant operating hours relative to a total of 8,760 hours in a year; because the irrigation canal in which the Project is located only runs water from April to October, the available flow capacity factor is higher. Net greenhouse gas reductions from the Monroe Project are estimated to be 602 tCO2/year. The purpose of this report is to provide an overview of the specifications for Natel’s first

  17. Collection of main international documents on the ethical principles of research and the main regulations on bioethics of the United States and of European Community; Raccolta sui principali documenti internazionali sui principi etici della ricerca e dei principali documenti legislativi degli Stati Uniti e della Comunita` Europea sulla bioetica

    Energy Technology Data Exchange (ETDEWEB)

    Scuderi, G. [Istituto Superiore di Sanita`, Rome (Italy). Lab. di Immunologia

    1998-12-31

    The collection includes an Italian translation of the main international documents on ethical principles of scientific research (the Nuremberg Code, the Helsinki Declaration, the Belmont Report) as well as the regulatory text of the United States (the Code of Federal Regulation Title 45, Part 46, that is the 45 Cfr 46) and the regulations of the European Community (the Good Clinical Practice and the Convention for the protection of human rights and dignity of the human being regards to the application of biology and medicine: convention on human rights and biomedicine). The informed consent and the human rights of human subjects involved in a clinical trial are discussed. Moreover, in the regulatory texts, legal rights of particular subjects, i.e. pregnant women, minors, fetuses, embrions, prisoners, are discussed; as well as the bioethics of organ transplantations. [Italiano] Contiene una traduzione in lingua italiana dei principali documenti internazionali sui principi etici della ricerca scientifica: il Codice di Norimberga, la dichiarazione di Helsinki e il rapporto Belmont; il testo legislativo degli Stati Uniti Code of Federal Regulation, capitolo 45 parte 46 (detto il 45 CFR 46) e la normativa della Comunita` Europea relativa alle norme di Good Clinical Practice e alla Convenzione per la protezione dei diritti dell`uomo e la dignita` dei soggetti umani relativamente alle applicazioni della biologia e medicina: Convenzione sui diritti dell`uomo e la biomedicina. Vengono trattati il consenso informato e i diritti umani delle persone che sono coinvolte in una sperimentazione clinica. Inoltre, nei testi normativi ci si riferisce anche ai diritti legali di soggetti particolari, ad esempio: donne in stato di gravidanza, minori, feti, embrioni, prigionieri; viene trattata, infine, l`etica dei trapianti d`organo.

  18. Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease: An Analysis of Outcomes in the United States.

    Science.gov (United States)

    Maximus, Steven; Phelan, Michael; Joe, Victor C

    2016-01-01

    With the incidence of burns decreasing nationally, burn units are caring for more patients with nonburn conditions. The American Burn Association National Burn Repository does not currently report data regarding patients cared for in burn units without a diagnosis of burn. Using the National Inpatient Sample, we examined if there was a difference in characteristics and outcomes of patients admitted for burns compared with those with a primary admitting diagnosis of necrotizing skin infections and soft-tissue infections and exfoliative skin conditions. This is a retrospective study querying the National Inpatient Sample database to identify 56,102 patients from 2007 to 2012 who were admitted with a diagnosis of a burn (burn group). This group was then compared with 375,857 patients who had a primary admitting diagnosis of a necrotizing skin and/or soft-tissue infection or exfoliative skin conditions (nonburn group). Clinical and demographic variables were analyzed to determine characteristics of each patient group including length of stay, disposition, complications, comorbidities, and mortality. The average age of the nonburn group was 63.7 years, whereas the average age of the burn group was 40.1 years. Overall length of stay was higher in the nonburn patients than in burn patients (10.5 vs 8.4 days, P Burn patients were more likely to undergo a major operating room procedure (39.3% vs 28.1%) and routine discharge (68.4% vs 26.3%) compared with the nonburn group. Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions are older, have more comorbidities, higher complication rates, and higher mortality rates than burn patients. Given these findings, burn units may need to adjust their resource utilization, competencies, and research priorities to improve the quality of care being delivered to these two different populations.

  19. The United Kingdom Infantile Spasms Study (UKISS) comparing hormone treatment with vigabatrin on developmental and epilepsy outcomes to age 14 months: a multicentre randomised trial.

    Science.gov (United States)

    Lux, Andrew L; Edwards, Stuart W; Hancock, Eleanor; Johnson, Anthony L; Kennedy, Colin R; Newton, Richard W; O'Callaghan, Finbar J K; Verity, Christopher M; Osborne, John P

    2005-11-01

    Infantile spasms is a severe infantile seizure disorder that is difficult to treat and has a high morbidity. Absence of spasms on days 13 and 14 after randomisation is more common in infants allocated hormone treatments than in those allocated vigabatrin. We sought to assess whether early control of spasms is associated with improved developmental or epilepsy outcomes. Infants enrolled in the United Kingdom Infantile Spasms Study (UKISS) were randomly assigned hormone treatment (n=55) or vigabatrin (n=52) and were followed up until clinical assessment at 12-14 months of age. We assessed neurodevelopment with the Vineland adaptive behaviour scales (VABS) at 14 months of age on an intention to treat basis. Of 107 infants enrolled, five died and 101 survivors reached both follow-up assessments. Absence of spasms at final clinical assessment (hormone 41/55 [75%] vs vigabatrin 39/51 [76%]) was similar in each treatment group (difference 1.9%, 95% CI -18.3% to 14.4%; chi(2)=0.05; p=0.82). Mean VABS score did not differ significantly (hormone 78.6 [SD 16.8] vs vigabatrin 77.5 [SD 12.7]; difference 1.0, 95% CI -4.9 to 7.0; t(99)=0.35, p=0.73). In infants with no identified underlying aetiology, the mean VABS score was higher in those allocated hormone treatment than in those allocated vigabatrin (88.2 [17.3] vs 78.9 [14.3]; difference 9.3, 95% CI 1.2 to 17.3; t(95)=2.28, p=0.025). Hormone treatment controls spasms better than does vigabatrin initially, but not at 12-14 months of age. Better initial control of spasms by hormone treatment in those with no identified underlying aetiology may lead to improved developmental outcome.

  20. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit

    Directory of Open Access Journals (Sweden)

    Sunanda Gupta

    2011-01-01

    Full Text Available A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II at admission for predicting maternal mortality was also assessed.During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries. There were 24 ICU admissions (ICU utilization ratio 0.14% with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05 with more patients presenting with obstetric complications (91.66%, n=22, P<0.01 as compared to medical complications (8.32% n=2. Obstetric haemorrhage (n=15, 62.5% and haemodynamic instability (n=20, 83.33% were considered to be significant risk factors for ICU admission (P=0.000. Inotropic support was required in 22 patients (91.66% while 17 patients (70.83% required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h and ICU stay (39.42±33.70 h were of significantly longer duration in survivors (P=0.01, P=0.00 respectively versus non-survivors. The observed mortality (n=10, 41.67% was significantly higher than MPM II predicted death rate (26.43%, P=0.002. We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

  1. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit.

    Science.gov (United States)

    Gupta, Sunanda; Naithani, Udita; Doshi, Vimla; Bhargava, Vaibhav; Vijay, Bhavani S

    2011-03-01

    A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, Pobstetric complications (91.66%, n=22, PObstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

  2. Unintentional childhood injury patterns, odds, and outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

    Science.gov (United States)

    Mutto, Milton; Lawoko, Stephen; Nansamba, Catherine; Ovuga, Emilio; Svanstrom, Leif

    2011-01-01

    Abstract: Background: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Methods: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). Results: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Conclusions: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could

  3. Unintentional Childhood Injury Patterns, Odds, and Outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

    Directory of Open Access Journals (Sweden)

    Emilio Ovuga

    2011-01-01

    Full Text Available BACKGROUND: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. METHODS: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years. RESULTS: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. CONCLUSIONS: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention

  4. Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Cyriacus Anaele

    2017-01-01

    Full Text Available Background: Acute kidney injury (AKI is often one component of multiple organ failure (MOF in the intensive care unit (ICU. However, not all patients with MOF develop AKI, and AKI may develop in the absence of MOF. We compared the impact of AKI alone and in combination with MOF on the survival of patients admitted to a large tertiary care medical intensive care unit (MICU.  Methods: We abstracted data from the electronic medical records of patients admitted to the MICU from April 2012 through June 2013 and categorized patients as either high-risk or low- risk status based on use of vasopressor support or mechanical ventilation during the ICU stay. The outcomes we considered were in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Results: Of the 834 critically ill patients, 743 (89% developed some degree of AKI. Ninety-one percent of the high-risk cohort developed AKI and 87% of the low-risk cohort developed AKI. Patients with AKI had higher mortality at 1-year than patients without AKI (adjusted odds ratio [OR], 2.5; 95% confidence interval [CI], 1.38 to 4.53; P interaction 0.0026.  Hospital mortality was greater for high-risk patients without AKI than for low-risk patients with AKI. Conclusion: Acute kidney injury occurs at similar frequency in high and low-risk ICU patients and has significant impact on survival in both groups.  Cardiovascular collapse or respiratory failure has greater impact on short term mortality than AKI, but this effect diminishes over time. Conversely, the impact of AKI on mortality increased over time and remained an independent risk factor for mortality.

  5. Remedial Investigation Report on Chestnut Ridge Operable Unit 2 (Filled Coal Ash Pond/Upper McCoy Branch) at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 1. Main Text

    Energy Technology Data Exchange (ETDEWEB)

    1994-08-01

    This document is a report on the remedial investigation (RI) of Chestnut Ridge Operable Unit (OU) 2 at the Oak Ridge Y-12 Plant. Chestnut Ridge OU 2 consists of Upper McCoy Branch (UMB), the Filled Coal Ash Pond (FCAP), and the area surrounding the Sluice Channel formerly associated with coal ash disposal in the FCAP. Chestnut Ridge OU 2 is located within the U.S. Department of Energy`s (DOE`s) Oak Ridge Reservation in Anderson County, Tennessee, approximately 24 miles west of Knoxville. The pond is an 8.5-acre area on the southern slope of Chestnut Ridge, 0.5 mile south of the main Y-12 Plant and geographically separated from the Y-12 Plant by Chestnut Ridge. The elevation of the FCAP is {approximately} 950 ft above mean sea level (msl), and it is relatively flat and largely vegetated. Two small ponds are usually present at the northeast and northwest comers of the FCAP. The Sluice Channel Area extends {approximately}1000 ft from the northern margin of the FCAP to the crest of Chestnut Ridge, which has an elevation of {approximately}1100 ft above msl. The Sluice Channel Area is largely vegetated also. McCoy Branch runs from the top of Chestnut Ridge across the FCAP into Rogers Quarry and out of the quarry where it runs a short distance into Milton Hill Lake at McCoy Embayment, termed UMB. The portion south of Rogers Quarry, within Chestnut Ridge OU 4, is termed Lower McCoy Branch. The DOE Oak Ridge Y-12 Plant disposed of coal ash from its steam plant operations as a slurry that was discharged into an ash retention impoundment; this impoundment is the FCAP. The FCAP was built in 1955 to serve as a settling basin after coal ash slurried over Chestnut Ridge from the Y-12 Plant. The FCAP was constructed by building an earthen dam across the northern tributary of McCoy Branch. The dam was designed to hold 20 years of Y-12 steam plant ash. By July 1967, ash had filled up the impoundment storage behind the dam to within 4 ft of the top.

  6. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit.

    Science.gov (United States)

    Beck, D H; Taylor, B L; Millar, B; Smith, G B

    1997-01-01

    To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. Prospective cohort study. A mixed medical and surgical intensive care unit (ICU) in the United Kingdom. A total of 1,144 patients consecutively admitted to the study. None. Acute Physiology and Chronic Health Evaluation (APACHE) II and III prognostic systems were applied to assess probabilities of hospital mortality, which were compared with the actual outcome. The overall goodness-of-fit of both models was assessed. Hospital death rates were higher than those predicted by each system. Risk estimates showed a strong positive correlation between both systems (nonsurvivors r2 = 0.756, p best overall total correct classification rate was 80.6% for APACHE III and 77.9% for APACHE II (both for a decision criterion of 40%). The areas under the receiver operating characteristic curves were 0.806 and 0.847 for APACHE II and III, respectively, confirming the better discrimination of APACHE III. When patients were classified by diagnostic categories, risk predictions did not fit uniformly across the spectrum of disease groups. For both models, mortality ratios were highest for trauma patients and lowest for the group with respiratory disease. APACHE II predictions for patients with gastrointestinal disease were significantly better. Risk estimates for surgical admissions were superior with APACHE II (MR = 1.27) compared with APACHE III (MR = 1.56), but were similar for medical patients (1.22 vs. 1.28 for APACHE II and III, respectively). Bias induced by factors reflecting the clinical practice in an individual ICU (e.g., admission criteria, treatment before admission) may have considerable impact on risk estimates. The identification of such factors appears to be a prerequisite for the meaningful interpretation of observed and predicted death rates on the individual ICU level. Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE

  7. Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: effects on patient safety and patient outcome.

    Science.gov (United States)

    Blum, Franziska E; Lund, Elisa Takalo; Hall, Heather A; Tachauer, Allan D; Chedrawy, Edgar G; Zilberstein, Jeffrey

    2015-04-01

    Arterial blood gas (ABG) analysis is a useful tool to evaluate hypercapnia in the context of conditions and diseases affecting the lungs. Oftentimes, indications for ABG analysis are broad and nonspecific and lead to frequent testing without test results influencing patient management. Electronic charts of 300 intensive care unit (ICU) patients at a single institution were reviewed retrospectively. Reassessment of indications for ABGs led to a decrease of the number of ABGs in the ICU between March and November 2012. Data relating to ventilator days, length of stay, number of reintubations, mortality, complications after arterial puncture, demographics, and medications in 159 ICU patients between December 2011 and February 2012 (group 1) were compared with 141 ICU patients between December 2012 and February 2013 (group 2). Subgroup analysis in ventilated patients was performed. A decrease of number of ABGs per patient (6.12 ± 5.9, group 1 vs 2.03 ± 1.66, group 2 in ventilated patients; P = .007) was found along with a decrease in the number of ventilator days per patient (P = .004) and a shorter length of stay for ventilated patients in group 2 compared with group 1 (P = .04). A significant decrease of ABGs obtained in the ICU does not negatively impact patient outcome and safety. A decrease in the number of ABGs per patient allows cost-efficient patient care with a lower risk for complications. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Economic outcomes of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with left main or three-vessel coronary artery disease: One-year results from the SYNTAX trial

    NARCIS (Netherlands)

    D.J. Cohen (David J.); T.A. Lavelle (Tara); B.A. van Hout (Ben); H. Li (Haiying); Y. Lei (Yang); J.L. Robertus; D. Pinto (Duane); E.A. Magnuson (Elizabeth); T.F. McGarry (Thomas); S.K. Lucas (Scott); R.I. Horwitz (Ralph); C.A. Henry (Carl); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); A.P. Kappetein (Arie Pieter)

    2012-01-01

    textabstractObjectives: To evaluate the cost-effectiveness of alternative approaches to revascularization for patients with three-vessel or left main coronary artery disease (CAD). Background: Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery

  9. Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting. Five Year Clinical Outcome in The Nordic-Baltic Bifurcation Study III

    DEFF Research Database (Denmark)

    Niemelä, Matti; Holm, Niels R; Kervinen, Kari

    2015-01-01

    Background- It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with...

  10. Maine's Employability Skills Program

    Science.gov (United States)

    McMahon, John M.; Wolffe, Karen E.; Wolfe, Judy; Brooker, Carrie

    2013-01-01

    This Practice Report describes the development and implementation of the "Maine Employability Skills Program," a model employment program developed by the Maine Division for the Blind and Visually Impaired (DBVI). The program was designed to support the efforts of the chronically unemployed or underemployed. These consumers were either…

  11. Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole.

    Science.gov (United States)

    Heimann, S M; Cornely, O A; Wisplinghoff, H; Kochanek, M; Stippel, D; Padosch, S A; Langebartels, G; Reuter, H; Reiner, M; Vierzig, A; Seifert, H; Vehreschild, M J G T; Glossmann, J; Franke, B; Vehreschild, J J

    2015-02-01

    Direct treatment costs caused by candidemia in German intensive care unit (ICU) patients are currently unknown. We analyzed treatment costs and the impact of antifungal drug choice. Comprehensive data of patients who had at least one episode of candidemia while staying in the ICU between 01/2005 and 12/2010 were documented in a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). A detailed analysis of all disease-associated treatment costs was performed. Patients treated with echinocandins (i.e., anidulafungin, caspofungin, micafungin) or fluconazole were analyzed separately and compared. Forty-one and 64 patients received echinocandins and fluconazole, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score was 114 (95 % confidence interval [CI]: 106-122) vs. 95 (95 % CI: 90-101, p = fluconazole groups, the mean costs per patient of ICU treatment were 20,338 (95 % CI: 12,893-27,883) vs. 11,932 (95 % CI: 8,016-15,849, p = 0.110), and the total direct treatment costs per patient were 37,995 (95 % CI: 26,614-49,376) vs. 22,305 (95 % CI: 16,817-27,793, p = 0.012), resulting in daily costs per patient of 1,158 (95 % CI: 1,036-1,280) vs. 927 (95 % CI: 828-1,026, p = 0.001). Our health economic analysis shows the high treatment costs of patients with candidemia in the ICU. Sicker patients had a prolonged hospitalization and were more likely to receive echinocandins, leading to higher treatment costs. Outcomes were comparable to those achieved in less sick patients with fluconazole.

  12. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit.

    Science.gov (United States)

    Nour, I; Eldegla, H E; Nasef, N; Shouman, B; Abdel-Hady, H; Shabaan, A E

    2017-09-01

    Carbapenem-resistant (CR), Gram-negative (GN), late-onset sepsis (LOS) is a serious threat in the neonatal intensive care unit (NICU). To assess the prevalence of CR-GN-LOS in NICU patients and to identify the risk factors and outcomes associated with its acquisition. Neonates with carbapenem-susceptible (CS)-GN-LOS were compared with those with CR-GN-LOS in a two-year observational study. A total of 158 patients had GN-LOS; 100 infants had CS-GN-LOS and 58 infants had CR-GN-LOS. The incidence rate of CR-GN-LOS was 6.5 cases per 1000 patient-days. The most frequent bacterial strain in both groups was Klebsiella pneumoniae. The duration of total parenteral nutrition (TPN) (P=0.006) and prior carbapenem use (P=0.01) were independent risk factors for CR-GN-LOS acquisition. CR-GN-LOS was associated with higher mortality than CS-GN-LOS (P=0.04). Birth weight, small for gestational age, time to start enteral feeding, exclusive formula feeding, previous surgery, previous antifungal use, central venous device before onset, duration of central venous device, and infectious complications were identified as dependent risk factors for overall mortality. However, only male gender (P=0.04) and infectious complications (P < 0.001) were independent risk factors associated with mortality. Infectious complication rates, duration of mechanical ventilation, and length of hospital stay were significantly higher in infants with CR compared to CS-GN-LOS. The duration of TPN and carbapenem use were the independent predictors for CR-GN-LOS acquisition. CR-GN-LOS is associated with higher mortality, infectious complication rates, longer mechanical ventilation, and longer hospital stay. Male gender and infectious complications were the independent risk factors for mortality in neonates with GN-LOS. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  13. Power and persuasion in the vaccine debates: an analysis of political efforts and outcomes in the United States, 1998-2012.

    Science.gov (United States)

    Lillvis, Denise F; Kirkland, Anna; Frick, Anna

    2014-09-01

    This article examines trends in state-level childhood vaccine policies in the United States from 1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization legislative efforts. Successful mobilization by vaccine critics during the height of the autism and thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most permissive type of exemption from vaccine mandates for public school attendance, those based on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How has vaccine critics' ability to advance preferred policies and prevent the passage of unfavorable legislation changed over time? We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to 2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate, mercury ban, and information policies) and outcome. We then mapped out the trends in vaccine policies over time. In order to contextualize the trends we identified, we also reviewed numerous primary sources and conducted interviews with stakeholders. In general, we found that vaccine critics' legislative success has begun to wane. In only 20 bills in our data set were vaccine critics able to change policy in their preferred direction via the legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical exemption to vaccine mandates), and the last of these was in 2007. Critics were more successful at preventing passage of proimmunization legislation, such as mandates for the human papillomavirus (HPV) vaccine. Recent legislation in California, Oregon, and Washington that tightened philosophical exemptions by means of informational requirements suggests that vaccine politics may be entering another phase, one in which immunization supporters may be able to counter increasing opt-out rates, particularly in states with recent outbreaks and politicians favoring science

  14. Evaluation of neuro-intensive care unit performance in China:predicting outcomes of Simplified Acute Physiology Score Ⅱ or Glasgow Coma Scale

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiao-xia; SU Ying-ying; WANG Miao; ZHANG Yan; YE Hong; FENG Huan-huan; ZHANG Yun-zhou

    2013-01-01

    Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome.This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)and Glasgow Coma Scale (GCS) in neuro-intensive care unit (N-ICU) patients.Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1,2005and December 31,2011 were enrolled in this study.The data-base included admission data,at 24-,48-,and 72-hour SAPS Ⅱ and GCS.Repeated measure data analysis of variance,Logistic regression analysis,the Hosmer-Lemeshow goodness-of-fit statistic,and the area under the receiver operating characteristic were used to evaluate the performance.Results There was a significant difference between the SAPS Ⅱ or GCS score at four time points (F=16.110,P=0.000or F=8.108,P=0.000).The SAPS Ⅱ scores or GCS score at four time points interacted with the outcomes with significant difference (F=116.771,P=0.000 or F=65.316,P=0.000).Calibration of the SAPS Ⅱ or GCS score at each time point on all patients was good.The percentage of a risk estimate prediction corresponding to observed mortality was also good.The 72-hour score have the greatest consistency.Discriminations of the SAPS Ⅱ or GCS score at each time were all satisfactory.The 72-hour score had the greatest discriminative power.The cut-off value was 33 (sensitivity of 85.2% and specificity of 74.3%) and 6 (sensitivity of 70.6% and specificity of 65.0%).The SAPS Ⅱ at each time point on all patients showed better calibration,consistency and discrimination than GCS.The binary Logistic regression analysis identified physiological variables,GCS,age,and disease category as significant independent risk factors of death.After the two variables including underlying disease and type of admission were excluded,we built the simplified SAPS Ⅱ model.A correlation was suggested between the simplified SAPS

  15. Turbine main engines

    CERN Document Server

    Main, John B; Herbert, C W; Bennett, A J S

    1965-01-01

    Turbine Main Engines deals with the principle of operation of turbine main engines. Topics covered include practical considerations that affect turbine design and efficiency; steam turbine rotors, blades, nozzles, and diaphragms; lubricating oil systems; and gas turbines for use with nuclear reactors. Gas turbines for naval boost propulsion, merchant ship propulsion, and naval main propulsion are also considered. This book is divided into three parts and begins with an overview of the basic mode of operation of the steam turbine engine and how it converts the pressure energy of the ingoing ste

  16. Use of simulators for virtual commissioning of main DCS on retrofitting projects. Case study. Neurath power plant Unit D, RWE Power AG; Einsatz von Simulatoren zur virtuellen Inbetriebnahme der Hauptleittechnik bei Modernisierungsprojekten. Am Beispiel des Kraftwerks Neurath Block D der RWE Power AG

    Energy Technology Data Exchange (ETDEWEB)

    Wuellenweber, Heinz-Juergen [RWE Power AG, Kraftwerk Niederaussen (Germany). Anlagentechnik; Brunner, Juergen [Siemens AG, Erlangen (Germany); Kueppers, Ludger [Kraftwerksschule e.V., Essen (Germany). Projekt Simulatoren

    2011-07-01

    Due to the positive experiences with the use of modern simulator development systems and virtual distributed control systems for training, simulators of the main distributed control systems (DCS) in the Neurath power station unit D were used with a specially adapted simulation system. The aims of the project were largely reached. The potentials of virtual commissioning could be demonstrated for the first time. (orig.)

  17. Maine Field Station

    Data.gov (United States)

    Federal Laboratory Consortium — In 2000 NOAA's National Marine Fisheries Service established the Maine Field Station in Orono, ME to have more direct involvement in the conservation of the living...

  18. 2004 Maine Lidar

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This metadata document describes the collection and processing of Light Detection and Ranging (LIDAR) data over an area along the coast of Maine. Data was collected...

  19. Cyclical parthenogenetic reproduction in the Russian wheat aphid (Hemiptera: Aphididae) in the United States: sexual reproduction and its outcome on biotypic diversity.

    Science.gov (United States)

    Puterka, G J; Hammon, R W; Burd, J D; Peairs, F B; Randolph, T L; Cooper, W R

    2012-06-01

    In 1986, the Russian wheat aphid, Diuraphis noxia (Kurdjumov) (Hemiptera: Aphididae), became an invasive species of United States. Nearly 20 yr later, new biotypes appeared that were capable of overcoming most sources of resistance and became a renewed threat to wheat, Triticum aestivum L., production. Cyclical (CP) and obligate (OP) parthenogenesis enables aphids to both adapt to changing environments and exploit host resources. We documented these forms of reproduction for Russian wheat aphid in wheat and wild grasses in the Central Great Plains and Rocky Mountain regions during falls 2004-2009. Colonies from sample sites also were held under unheated greenhouse conditions and observed for the presence of sexual morphs and eggs through the winter. Russian wheat aphid populations were mainly OP and attempted to overwinter as adults, regardless of region sampled. A few populations contained oviparae but no males (gynocyclic) and were not specific to any particular region. Observation of the Russian wheat aphid colonies under greenhouse conditions failed to produce males or eggs. In spring 2007, CP was confirmed in a small population of Russian wheat aphid that eclosed from eggs (fundatricies) on wild grasses and wheat near Dove Creek, CO, in the Colorado Plateau region where other aphid species undergo CP. Lineages from ninety-three fundatricies were screened against 16 resistant and susceptible cereal entries to determine their biotypic classification. A high degree of biotypic diversity (41.4%) was detected in this population. Although CP was a rare in Russian wheat aphid populations, genetic recombination during the sexual cycle creates new biotypes and can have significant effects on population genetics.

  20. Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit: A pilot study.

    Science.gov (United States)

    Garinis, Angela C; Liao, Selena; Cross, Campbell P; Galati, Johnathan; Middaugh, Jessica L; Mace, Jess C; Wood, Anna-Marie; McEvoy, Lindsey; Moneta, Lauren; Lubianski, Troy; Coopersmith, Noe; Vigo, Nicholas; Hart, Christopher; Riddle, Artur; Ettinger, Olivia; Nold, Casey; Durham, Heather; MacArthur, Carol; McEvoy, Cynthia; Steyger, Peter S

    2017-06-01

    Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2-15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. This was a prospective pilot outcomes study of 82 infants (sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. The mean level of ambient sound was 62.9 dBA (range 51.8-70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of 4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding

  1. The main cubioid

    Science.gov (United States)

    Blokh, Alexander; Oversteegen, Lex; Ptacek, Ross; Timorin, Vladlen

    2014-08-01

    The connectedness locus in the parameter space of quadratic polynomials is called the Mandelbrot set. A good combinatorial model of this set is due to Thurston. By definition, the principal hyperbolic domain of the Mandelbrot set consists of parameter values, for which the corresponding quadratic polynomials have an attracting fixed point. The closure of the principal hyperbolic domain of the Mandelbrot set is called the main cardioid. Its topology is completely described by Thurston's model. Less is known about the connectedness locus in the parameter space of cubic polynomials. In this paper, we discuss cubic analogues of the main cardioid and establish relationships between them.

  2. Ladybugs of Maine

    Science.gov (United States)

    Color images are presented for the 57 species of Coccinellidae, commonly known as ladybugs, that are documented from Maine. Images are displayed in taxonomic order. Information on each species includes its genus-species name, length, and an actual-size silhouette beside a grid matched to the scale...

  3. Abstracts of Main Essays

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    On Engels'Dialectics of "Theoretical Thinking" Sun Zheng-yu The main significant contribution to Marxist dialectics of Engels is to formulate dialectics on the level of theoretical thinking. This contribution is expressed in three aspects: 1 ) generalizing thoroughly the historical evolution of the way of thinking embodied in science history, philosophy history and human history;

  4. Retrospective study of severe cases of leptospirosis admitted in the intensive care unit

    OpenAIRE

    Ittyachen A; Krishnapillai T; Nair M; Rajan A

    2007-01-01

    Objectives: Evaluate patient demographics, risk factors, complications, seropositivity, treatment and outcome among leptospirosis patients. Design: Retrospective analysis of 104 patients admitted in the intensive care unit (ICU) with a clinical suspicion of leptopirosis. Setting: Ten-bedded medical ICU in a medical school situated in a rural area endemic for leptospirosis. Main Outcome Measures: Seropositivity for leptospirosis, patient demographics, risk factors, complications, treatment a...

  5. Predictors of outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies.

    Science.gov (United States)

    Trotman, Helen; Garbutt, Andrea

    2011-02-01

    This was a retrospective review to determine predictors of outcome in term infants with hypoxic ischaemic encephalopathy (HIE) at the University Hospital of the West Indies. Ninety-five neonates fulfilled criteria for entry into the study of these 34 (36%) had a poor outcome. The stage of encephalopathy, seizures on admission, the need for more than one antiepileptic for seizure control and an abnormal neurological examination at hospital discharge were found to be associated with poor outcome. Multiple logistic regression analyses showed that an abnormal neurological examination at discharge was the only independent predictor of poor outcome. Babies who had an abnormal neurological examination at hospital discharge were more likely to have a poor outcome (odds ratio 2.6, confidence interval 0.03-0.4). An abnormal neurological examination at discharge had a positive predictive value of 88% and a negative predictive value of 84% for poor outcome, with a sensitivity and specificity of 60 and 96%, respectively. We recommend that if post-HIE, an infant has an abnormal neurological examination at the time of discharge from hospital, that infant should be followed up and monitored in a specialist neurology clinic and parents counselled about the guarded prognosis for normal neurodevelopmental outcome.

  6. Renovating the Main Building

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    CERN's "Main Building" is exactly that. The Organization's central hub, with hundreds of staff and visitors passing through its doors every day, will soon be getting a well-earned facelift. Refurbishment work will proceed in phases, starting with the Salle des Pas Perdus, the concourse between the Council Chamber and the Main Auditorium. By the end of August, informal seating areas will be installed, electronic display panels will provide practical information and improved sound insulation will enhance conditions in the auditoria and surrounding meeting rooms.   In light green the area that will undergo the facelift. Work will start in July. The ground floor is home to the entrance to Restaurant No. 1, the bank, the post office, the travel agent, the Users Office, the Staff Association, the notice boards etc. Step up to the first floor to access CERN's largest lecture theatre, the Council Chamber and its "Pas Perdus" lobby. Everyone who works at or visits CERN i...

  7. Maine coast winds

    Energy Technology Data Exchange (ETDEWEB)

    Avery, Richard

    2000-01-28

    The Maine Coast Winds Project was proposed for four possible turbine locations. Significant progress has been made at the prime location, with a lease-power purchase contract for ten years for the installation of turbine equipment having been obtained. Most of the site planning and permitting have been completed. It is expect that the turbine will be installed in early May. The other three locations are less suitable for the project, and new locations are being considered.

  8. Lodging Update: Portland, Maine

    Directory of Open Access Journals (Sweden)

    Rachel J. Roginsky

    2013-01-01

    Full Text Available Each quarter, Pinnacle Advisory Group prepares an analysis of the New England lodging industry, which provides a regional summary and then focuses in depth on a particular market. These reviews look at recent and proposed supply changes, factors affecting demand and growth rates, and the effects of interactions between such supply and demand trends. In this issue, the authors summarize regional performance for 2012, offer projections for 2013, and spotlight the lodging market in Portland, Maine.

  9. What design condition affect the outcomes of voluntary environmental programs, and how? A fuzzy-set analysis of 35 cases from Australia, the Netherlands and the United States

    NARCIS (Netherlands)

    van der Heijden, J.

    2014-01-01

    Voluntary Environmental Programs (VEPs) have become increasingly popular in addressing environmental risks that are too complex to solve through traditional direct regulatory interventions. Whilst VEPs have attracted much scholarly attention, still little is known how they cause their outcomes. Taki

  10. A retrospective study of analysis of various factors affecting the outcome of sepsis in neonates admitted to a tertiary care neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Krishnakumar Chinnusamy

    2016-04-01

    Conclusions: In our study, we found low birth weight, prematurity, abnormal leukocyte counts and thrombocytopenia on admission were found to be associated with poor outcome. [Int J Res Med Sci 2016; 4(4.000: 1154-1157

  11. Addendum to the remedial investigation report on Bear Creek Valley Operable Unit 2 (Rust Spoil Area, Spoil Area 1, and SY-200 Yard) at the Oak Ridge Y-12 Plant Oak Ridge, Tennessee. Volume 1: Main text

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-04-01

    This addendum to the Remedial Investigation (RI) Report on Bear Creek Valley Operable Unit (OU) 2 at the Oak Ridge Y-12 Plant was prepared in accordance with requirements under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) for reporting the results of a site characterization for public review. This addendum is a supplement to a document that was previously issued in January 1995 and that provided the Environmental Restoration Program with information about the results of the 1993 investigation performed at OU 2. The January 1995 D2 version of the RI Report on Bear Creek Valley OU 2 included information on risk assessments that have evaluated impacts to human health and the environment. Information provided in the document formed the basis for the development of the Feasibility Study Report. This addendum includes revisions to four chapters of information that were a part of the document issued in January 1995. Specifically, it includes revisions to Chaps. 2, 3, 4, and 9. Volume 1 of this document is not being reissued in its entirety as a D3 version because only the four chapters just mentioned have been affected by requested changes. Note also that Volume 2 of this RI Report on Bear Creek Valley OU 2 is not being reissued in conjunction with Volume 1 of this document because there have been no changes requested or made to the previously issued version of Volume 2 of this document.

  12. Reduction of [Cp*Sb]4 with Subvalent Main-Group Metal Reductants: Syntheses and Structures of [(L(1) Mg)4 (Sb4 )] and [(L(2) Ga)2 (Sb4 )] Containing Edge-Missing Sb4 Units.

    Science.gov (United States)

    Ganesamoorthy, Chelladurai; Krüger, Julia; Wölper, Christoph; Nizovtsev, Anton S; Schulz, Stephan

    2017-02-16

    [Cp*Sb]4 (Cp*=C5 Me5 ) reacts with [L(1) Mg]2 and L(2) Ga with formation of [(L(1) Mg)4 (μ4 ,η(1:2:2:2) -Sb4 )] (L(1) =iPr2 NC[N(2,6-iPr2 C6 H3 )]2 , 1) and [(L(2) Ga)2 (μ,η(2:2) -Sb4 )] (L(2) =HC[C(Me)N(2,6-iPr2 C6 H3 )]2 , 2). The cleavage of the Sb-Sb and Sb-C bonds in [Cp*Sb]4 are the crucial steps in both reactions. The formation of 1 occurred by elimination of the Cp* anion and formation of Cp*MgL(1) , while 2 was formed by reductive elimination of Cp*2 and oxidative addition of L(2) Ga to the Sb4 unit. 1 and 2 were characterized by heteronuclear NMR spectroscopy and single-crystal X-ray diffraction, and their bonding situation was studied by quantum chemical calculations.

  13. Evaluation of potential severe accidents during low power and shutdown operations at Grand Gulf, Unit 1: Evaluation of severe accident risks for plant operational state 5 during a refueling outage. Main report and appendices, Volume 6, Part 1

    Energy Technology Data Exchange (ETDEWEB)

    Brown, T.D.; Kmetyk, L.N.; Whitehead, D.; Miller, L. [Sandia National Labs., Albuquerque, NM (United States); Forester, J. [Science Applications International Corp., Albuquerque, NM (United States); Johnson, J. [GRAM, Inc., Albuquerque, NM (United States)

    1995-03-01

    Traditionally, probabilistic risk assessments (PRAS) of severe accidents in nuclear power plants have considered initiating events potentially occurring only during full power operation. Recent studies and operational experience have, however, implied that accidents during low power and shutdown could be significant contributors to risk. In response to this concern, in 1989 the Nuclear Regulatory Commission (NRC) initiated an extensive program to carefully examine the potential risks during low power and shutdown operations. Two plants, Surry (pressurized water reactor) and Grand Gulf (boiling water reactor), were selected as the plants to be studied. The program consists of two parallel projects being performed by Brookhaven National Laboratory (Surry) and Sandia National Laboratories (Grand Gulf). The program objectives include assessing the risks of severe accidents initiated during plant operational states other than full power operation and comparing the estimated risks with the risk associated with accidents initiated during full power operation as assessed in NUREG-1150. The scope of the program is that of a Level-3 PRA. The subject of this report is the PRA of the Grand Gulf Nuclear Station, Unit 1. The Grand Gulf plant utilizes a 3833 MWt BUR-6 boiling water reactor housed in a Mark III containment. The Grand Gulf plant is located near Port Gibson, Mississippi. The regime of shutdown analyzed in this study was plant operational state (POS) 5 during a refueling outage, which is approximately Cold Shutdown as defined by Grand Gulf Technical Specifications. The entire PRA of POS 5 is documented in a multi-volume NUREG report (NUREG/CR-6143). The internal events accident sequence analysis (Level 1) is documented in Volume 2. The Level 1 internal fire and internal flood analyses are documented in Vols 3 and 4, respectively.

  14. Main Oxidizer Valve Design

    Science.gov (United States)

    Addona, Brad; Eddleman, David

    2015-01-01

    A developmental Main Oxidizer Valve (MOV) was designed by NASA-MSFC using additive manufacturing processes. The MOV is a pneumatically actuated poppet valve to control the flow of liquid oxygen to an engine's injector. A compression spring is used to return the valve to the closed state when pneumatic pressure is removed from the valve. The valve internal parts are cylindrical in shape, which lends itself to traditional lathe and milling operations. However, the valve body represents a complicated shape and contains the majority of the mass of the valve. Additive manufacturing techniques were used to produce a part that optimized mass and allowed for design features not practical with traditional machining processes.

  15. Abstracts of Main Essays

    Institute of Scientific and Technical Information of China (English)

    Feng Zi-yi

    2011-01-01

    On Deepening the Research on the Law of the Social Horizontal Development Feng Zi-yi The further development of globalization makes it urgent to deepen the research on the law of social hori- zontal development. Historical development of human society has experienced periods of isolation, multi-cen- ter, and globalization, while the truly horizontal development began from modernity. This kind of development is driven mainly by the logic of capital. The transforming process of capital, from dominating the whole process of economic development toward all aspects of social life, and from dominating nations toward the whole world, is also the logical process of capital pursuing itself and the process of social horizontal and wholly development as well. Horizontal and vertical developments of the society are interacting always. Researching on the law of social horizontal development is important for us to adapt to the historical trend consciously, to grasp the logic of capital rationally and to choose the right road of development.

  16. Understanding the importance of medical student clerkships in poor health outcome regions served by Area Health Education Centers (AHECs) in impoverished locations of Southern United States.

    Science.gov (United States)

    Patel, Ashruta

    2017-01-01

    Area Health Education Centers provide health professional students the opportunity to explore the benefits of practicing in a rural and underserved location. The status of health conditions in chronic disease patients residing in impoverished regions of the US provides the chance to understand the factors that are responsible for constant inadequate outcomes in underserved and rural communities. Many limiting barriers to positive health outcomes occur in disproportionate numbers in the Southern Black Belt. Students should consider participating in rural and underserved clerkships, and ultimately a career as a health care provider in a poor health outcome region. In addition, promising programs (e.g. telemedicine, community health workers) to help implement patient-centered evidence-based interventions can tackle current chronic disease issues commonly encountered by health professionals who work with diverse patient populations.

  17. Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Bertaso, Angela Gallina [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Bertol, Daniela [Programa de Pós-Graduação em Epidemiologia - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Duncan, Bruce Bartholow; Foppa, Murilo, E-mail: mfoppa@cardiol.br [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Programa de Pós-Graduação em Epidemiologia - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil)

    2013-07-15

    Epicardial fat (EF) is a visceral fat deposit, located between the heart and the pericardium, which shares many of the pathophysiological properties of other visceral fat deposits, It also potentially causes local inflammation and likely has direct effects on coronary atherosclerosis. Echocardiography, computed tomography and magnetic resonance imaging have been used to evaluate EF, but variations between methodologies limit the comparability between these modalities. We performed a systematic review of the literature finding associations of EF with metabolic syndrome and coronary artery disease. The summarization of these associations is limited by the heterogeneity of the methods used and the populations studied, where most of the subjects were at high cardiovascular disease risk. EF is also associated with other known factors, such as obesity, diabetes mellitus, age and hypertension, which makes the interpretation of its role as an independent risk marker intricate. Based on these data, we conclude that EF is a visceral fat deposit with potential implications in coronary artery disease. We describe the reference values of EF for the different imaging modalities, even though these have not yet been validated for clinical use. It is still necessary to better define normal reference values and the risk associated with EF to further evaluate its role in cardiovascular and metabolic risk assessment in relation to other criteria currently used.

  18. Epicardial fat: definition, measurements and systematic review of main outcomes.

    Science.gov (United States)

    Bertaso, Angela Gallina; Bertol, Daniela; Duncan, Bruce Bartholow; Foppa, Murilo

    2013-07-01

    Epicardial fat (EF) is a visceral fat deposit, located between the heart and the pericardium, which shares many of the pathophysiological properties of other visceral fat deposits, It also potentially causes local inflammation and likely has direct effects on coronary atherosclerosis. Echocardiography, computed tomography and magnetic resonance imaging have been used to evaluate EF, but variations between methodologies limit the comparability between these modalities. We performed a systematic review of the literature finding associations of EF with metabolic syndrome and coronary artery disease. The summarization of these associations is limited by the heterogeneity of the methods used and the populations studied, where most of the subjects were at high cardiovascular disease risk. EF is also associated with other known factors, such as obesity, diabetes mellitus, age and hypertension, which makes the interpretation of its role as an independent risk marker intricate. Based on these data, we conclude that EF is a visceral fat deposit with potential implications in coronary artery disease. We describe the reference values of EF for the different imaging modalities, even though these have not yet been validated for clinical use. It is still necessary to better define normal reference values and the risk associated with EF to further evaluate its role in cardiovascular and metabolic risk assessment in relation to other criteria currently used.

  19. The Development Round: Main Outcomes, Challenges and Implementation Prospects

    Directory of Open Access Journals (Sweden)

    Volomymyr Vashchenko

    2004-04-01

    Full Text Available The article touches upon current issues in the development of a WTO-based multilateral trade system and the participation of the broadest possible range of nations in this system, with special attention to the agenda of the Fourth and Fifth Ministerial Conferences of WTO memberstates, progress on negotiations and their current status. Bottlenecks in specific areas of the negotiations that have arisen in the course of the discussions, the positions of groups and individual countries are also identified. The article outlines the possibilities of activating and accelerating efforts towards the completion of the liberalization of world trade as envisaged in the agenda of the Development Round.

  20. Applying Memories of Reinforcement Outcomes Mainly to Pavlovian Conditioning

    Science.gov (United States)

    Capaldi, E. J.; Martins, Ana P. G.

    2010-01-01

    A theory devised initially on the basis of instrumental reward schedule data, such as the PREE, was extended to deal with various Pavlovian findings. These Pavlovian findings include blocking, unblocking, relative validity, positive and negative patterning, renewal, reinstatement, reacquisition, and inhibition. In addition, the sequential model…

  1. Longitudinal Investigation of the Curricular Effect: An Analysis of Student Learning Outcomes from the LieCal Project in the United States

    Science.gov (United States)

    Cai, Jinfa; Wang, Ning; Moyer, John C.; Wang, Chuang; Nie, Bikai

    2011-01-01

    In this article, we present the results from a longitudinal examination of the impact of a "Standards"-based or reform mathematics curriculum (called CMP) and traditional mathematics curricula (called non-CMP) on students' learning of algebra using various outcome measures. Findings include the following: (1) students did not sacrifice basic…

  2. A retrospective analysis of clinical outcome of patients with chemo-refractory metastatic breast cancer treated in a single institution phase I unit

    NARCIS (Netherlands)

    Brunetto, A T; Sarker, D; Papadatos-Pastos, D; Fehrmann, R; Kaye, S B; Johnston, S; Allen, M; De Bono, J S; Swanton, C

    2010-01-01

    BACKGROUND AND METHODS: Novel approaches to treat chemo-refractory metastatic breast cancer (MBC) are currently under investigation. This retrospective series reviews the outcome of 70 MBC patients who have participated in 30 phase I trials at the Royal Marsden Hospital from 2002 to 2009. RESULTS:

  3. Main Development Targets for CNOOC in 2000

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    @@ In order to obtain stable reserves and create scope economic management, the China National Offshore Oil Corporation (CNOOC) officially put forward the main development target and main sci-tech sector target of the Ninth Five-Year Plan in July, 1995. These targets aim to make CNOOC as an international group corporation,including exploration and development of oil and gas,refining, petrochemicals, chemical fertilizer, power generation, unitizing sales network of up and down stream.

  4. Diarrhea in neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani

    2010-01-01

    AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...

  5. Simulating long-term impacts of cover crops and climate change on crop production and environmental outcomes in the midwestern United States

    Science.gov (United States)

    It is critical to evaluate conservation practices that protect soil and water resources from climate change in the Midwestern United States, a region that produces one-quarter of the world’s soybeans and one-third of the world’s maize. An over-winter cover crop in a maize-soybean rotation offers mul...

  6. Dravet syndrome: the main issues.

    Science.gov (United States)

    Guerrini, Renzo

    2012-09-01

    Dravet syndrome (DS) is a severe form of infantile onset epilepsy characterized by multiple seizure types, prolonged convulsive seizures and frequent episodes of status epilepticus. Seizures precipitated by fever are a main characteristic. Affected children exhibit normal early development. Cognitive impairment, behavioral disturbances with hyperactivity and sometimes autistic traits occur after seizure onset. Seizures persist into adulthood but become less frequent. In about 85% of patients, a mutation of the SCN1A gene is present. DS fully illustrates the concept of epileptic encephalopathy. However, it is difficult to determine the causative role of the underlying sodium channel dysfunction and that of the consequent seizures in influencing cognitive outcome. An overwhelmingly high number of SCN1A mutations have been associated with DS. Intragenic or whole gene deletions, duplications and amplifications are additional rare molecular mechanisms. Most mutations are de novo, but familial mutations also occur. Somatic mosaic mutations should be considered when estimating the recurrence. MRI imaging is usually normal, and no neuropathologic signature of the condition seems to exist. In heterozygous Scn1a+/- mice, GABAergic interneurons exhibit substantially reduced sodium current density with reduced ability for sustained action potential firing. GABAergic output is reduced and excitability of downstream synaptic targets increased. Stiripentol was effective in combination with valproate and clobazam in two pivotal phase III trials. Phenytoin, carbamazepine, and lamotrigine can worsen seizures and should be avoided. Prospective studies will clarify to what extent earlier diagnosis and efforts at seizure control with the most appropriate drug combinations will reduce clinical deterioration.

  7. Spiropyran main-chain conjugated polymers.

    Science.gov (United States)

    Sommer, Michael; Komber, Hartmut

    2013-01-11

    The first main-chain conjugated copolymers based on alternating spiropyran (SP) and 9,9-dioctylfluorene (F8) units synthesized via Suzuki polycondensation (SPC) are presented. The reaction conditions of SPC are optimized to obtain materials of type P(para-SP-F8) with appreciably high molecular weights up to M(w) ≈ 100 kg mol(-1). (13)C NMR is used to identify the random orientation of the non-symmetric SP unit in P(p-SP-F8). Ultrasound-induced isomerization of P(p-SP-F8) to the corresponding merocyanine form P(p-MC-F8) yields a deep-red solution. This isomerization reaction is followed by (1)H NMR in solution using sonication, whereby the color increasingly changes to deep red. The possibility to incorporate multiple SP units into main-chain polymers significantly broadens existing SP-based polymeric architectures.

  8. A Study to Assess the Association of Aseptic Practices Being Followed and its Effect on the Overall Outcome of Selected Special Care Newborn Units (SCNUs of Madhya Pradesh at Different Levels.

    Directory of Open Access Journals (Sweden)

    Mahore RK

    2015-04-01

    Full Text Available The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs have been set up at different levels of Health Care Delivery System to provide quality newborn-care services in several hospitals to meet this challenge. Many units are located in the districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in six centers of India. The evaluation was based on an analysis of secondary data from the six units that had been functioning for at least three year. A cross-sectional survey was also conducted to assess the availability of Quality care and Aseptic practices implemented at different levels of SNCUs. Descriptive statistics were used for analyzing the inputs (Quality care and aseptic practices and outcomes (morbidity and mortality. The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2012 to 19.5 per 100 deliveries in 2014. The case-fatality rate shows progressive decline in all the units in Last 3 years. Proportional mortality due to sepsis and low birthweight (LBW declined significantly over two years (LBW <2.5 kg. The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:1-1:2.14. The bed occupancy rate ranged from 83% to 121% (median 115%, and the average duration of stay

  9. Conjugated polymers containing diketopyrrolopyrrole units in the main chain

    OpenAIRE

    Bernd Tieke; A. Raman Rabindranath; Kai Zhang; Yu Zhu

    2010-01-01

    Research activities in the field of diketopyrrolopyrrole (DPP)-based polymers are reviewed. Synthetic pathways to monomers and polymers, and the characteristic properties of the polymers are described. Potential applications in the field of organic electronic materials such as light emitting diodes, organic solar cells and organic field effect transistors are discussed.

  10. Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

    Science.gov (United States)

    Pareja, Rene; Nick, Alpa M; Schmeler, Kathleen M; Frumovitz, Michael; Soliman, Pamela T; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; Reis, Ricardo Dos; Ramirez, Pedro T

    2012-05-01

    To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Outcome of ICU survivors: a comprehensive review. The role of patient-reported outcome studies.

    Science.gov (United States)

    Granja, C; Amaro, A; Dias, C; Costa-Pereira, A

    2012-10-01

    Problems survivors face after intensive care unit (ICU) discharge begin while they are still in the ward, where many of their specific problems may run unrecognized, but they assume a heavy weight when they arrive at their homes and face several kind of limitations, from being unable to climb stairs because of weight loss, asthenia, dyspnea or joint stiffness to anxiety, depression or post-traumatic stress disorder. Follow-up consultations have given us a better understanding of these specific problems, and the information gained has been used to improve intensive care itself and promote a quality service for patients and relatives. The aim of this article is to provide an overview on adult ICU outcome studies and discuss how they have influenced and improved the delivery of intensive care. We will explain how we went from real patients to outcome studies and what we have learned concerning the consequences of critical illness and critical care. Development of outcome studies, what we have learned through them and our own experience will be outlined focusing mainly in four topics: mortality, physical disability, neuropsychological disability and health-related quality of life. Interventions to improve outcome on these main topics will be presented, and we will explain how we went from outcome studies to clinical interventions, focusing on the most recent proposals of intervention to improve outcome. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  12. Trends in Outcomes, Financial Burden, and Mortality for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in the United States from 2002 to 2010.

    Science.gov (United States)

    Jinjuvadia, Chetna; Jinjuvadia, Raxitkumar; Mandapakala, Chaitanya; Durairajan, Navin; Liangpunsakul, Suthat; Soubani, Ayman O

    2017-02-01

    Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We evaluated the temporal trends of hospitalizations from acute exacerbation of COPD and determined its outcome and financial impact using the National (Nationwide) Inpatient Sample (NIS) databases (2002-2010). Individuals aged ≥ 18 years were included. Subjects who were hospitalized with primary diagnosis of COPD exacerbation and those who were admitted for other causes but had underlying acute exacerbation of COPD (secondary diagnosis) were captured by International Classification of Diseases-Ninth Revision (ICD-9) codes. The hospital outcomes and length of stay were determined. Multivariate logistic regression was used to identify the independent predictors of inpatient mortality. Overall acute exacerbation of COPD-related hospitalizations accounted for nearly 3.31% of all hospitalizations in the year 2002. This did not change significantly to year 2010 (3.43%, p = 0.608). However, there was an increase in hospitalization with secondary diagnosis of COPD. Elderly white patients accounted for most of the hospitalizations. Medicare was the primary payer source for most of the hospitalizations (73-75%). There was a significant decrease in inpatient mortality from 4.8% in 2002 to 3.9% in 2010 (slope -0.096, p < 0.001). Similarly, there was a significant decrease in average length of stay from 6.4 days in 2002 to 6.0 days in 2010 (slope -0.042, p < 0.001). Despite this, the hospitalization cost was increased substantially from $22,187 in 2002 to $38,455 in 2010. However, financial burden has increased over the years.

  13. Musculoskeletal disorders in main battle tank personnel

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Guldager, Bernadette; Gyntelberg, Finn

    2009-01-01

    PURPOSE: To compare the prevalence of musculoskeletal disorders of personnel in the main battle tank (MBT) units in the Danish army with those of personnel in other types of army units, and to investigate associations between job function in the tank, military rank, and musculoskeletal problems......, and ankle. RESULTS AND CONCLUSIONS: There were only 4 women in the MBT group; as a consequence, female personnel were excluded from the study. The participation rate was 58.0% (n = 184) in the MBT group and 56.3% (n = 333) in the reference group. The pattern of musculoskeletal disorders among personnel...

  14. For better or worse? Long-term outcome of critical illness in childhood : Long-term outcome of critical illness in childhood

    NARCIS (Netherlands)

    L. van Zellem (Lennart)

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis was to investigate the long-term outcome of critically ill children admitted to the pediatric intensive care unit (PICU) of the Erasmus MC – Sophia Children’s’ Hospital in Rotterdam, the Netherlands. Our main focus was to investigate the long-term

  15. For better or worse? Long-term outcome of critical illness in childhood : Long-term outcome of critical illness in childhood

    NARCIS (Netherlands)

    L. van Zellem (Lennart)

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis was to investigate the long-term outcome of critically ill children admitted to the pediatric intensive care unit (PICU) of the Erasmus MC – Sophia Children’s’ Hospital in Rotterdam, the Netherlands. Our main focus was to investigate the long-term

  16. Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States

    Science.gov (United States)

    Agarwal, Rishi; Sendilnathan, Arun; Siddiqi, Nabeela Iffat; Gulati, Shuchi; Ghose, Abhimanyu; Xie, Changchun

    2016-01-01

    Background Gemcitabine plus cisplatin (GC) is currently the standard regimen for advanced biliary tract cancers (BTC) based on the outcomes in ABC-02 trial. Multiple factors can affect outcomes in these patients. This retrospective review evaluates the University of Cincinnati experience with GC in advanced intrahepatic (IHC)/extrahepatic cholangiocarcinoma (EHC) and gall bladder carcinoma (GBC). Methods In this study approved by University of Cincinnati IRB, retrospective analysis of advanced BTC patients seen between 01/2008 and 01/2015 was done. Kaplan Meyer method was used to calculate progression free survival (PFS), and overall survival (OS). Cox model was used to test the association between baseline variables and OS/PFS, adjusting for gender and age at diagnosis. Patients were identified using ICD code for BT tumors, 26 patients met inclusion criteria: histologically proven advanced BTC that received GC as their initial chemotherapy. GC was given as per ABC-02 protocol with appropriate modifications until disease progression or unacceptable toxicities. Results Median age at diagnosis was 62 years (range, 31–81 years). Eighteen (69%) were IHC, 5 EHC, 3 GBC, 61% male, 73% whites. Performance status (PS): 0–1: 69%, PS 2: 31%. Baseline CA19-9 data was available for 21 patients, (range 1 to 69,543), and abnormal CA19-9 was seen in 14 patients (54%). PFS was 4.5 months (95% CI: 3.1–8.9 months) and OS was 10.5 months (95% CI: 7.9–18.8 months). OS at 6 and 12 months was 69% (18/26) and 42% (11/26). Thirty-eight percent (10/26) received 2nd line chemotherapy, of these 9/10 received 5FU based chemotherapy. Eleven percent (3/26) received 3rd line chemotherapy. Increase in baseline carcinoembryonic antigen (CEA), alanine aminotransferase, alkaline phosphatase (ALP) and total bilirubin was associated with increased risk of death while increase in baseline CEA and ALP was associated with increased risk of progression (P valve 3, and stage IVb), the median

  17. Disease features and outcomes in United States lupus patients of Hispanic origin and their Mestizo counterparts in Latin America: a commentary.

    Science.gov (United States)

    Ugarte-Gil, Manuel F; Pons-Estel, Guillermo J; Molineros, Julio; Wojdyla, Daniel; McGwin, Gerald; Nath, Swapan K; Pons-Estel, Bernardo A; Alarcón-Riquelme, Marta; Alarcón, Graciela S

    2016-03-01

    To evaluate disease features and outcomes in two populations with significant Amerindian ancestry. Hispanic patients (from Texas) from the Lupus in Minorities: Nature versus Nurture (LUMINA) cohort and Mestizo patients from the Grupo Latino Americano De Estudio del Lupus or Latin American Group for the Study of Lupus (GLADEL) cohort were included. Disease features and outcomes were evaluated at baseline and last visit. Admixture informative markers of Mestizo Genoma de Lupus Eritematoso Sistémico Network consortium (GENLES) patients and Hispanic LUMINA patients were compared. Univariable analyses were performed using Chi square or Student's t test as appropriate. Multivariable analyses adjusting for possible confounders were carried out using Poisson, logistic or Cox regression models as appropriate. A total of 114 LUMINA and 619 GLADEL patients were included. GLADEL patients had accrued more damage at baseline, but the opposite was the case at last visit. Being from LUMINA was a risk factor for damage accrual, even after adjusting for possible confounders [relative risk (RR) 1.33, 95% CI 1.12, 1.58]. Also, LUMINA patients have a higher risk of mortality than GLADEL patients [hazard ratio (HR) 2.37, 95% CI 1.10, 5.15], having 5-year survival of 85.6% and 94.5%, respectively. In addition, 79 LUMINA patients and 744 Mestizo GENLES patients were evaluated in order to compare genetic ancestry between the two groups; GENLES patients had a higher proportion of European ancestry (48.5% vs 43.3%, P = 0.003) and a lower proportion of Asian ancestry (3.7% vs 4.9%, P = 0.048), but the proportions of Amerindian and African ancestry were comparable in both. USA Hispanic patients seemed to have a poorer prognosis than their counterparts from Latin America, despite having a comparable genetic background. Socioeconomic factors may account for these observations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights

  18. Use of citation analysis to predict the outcome of the 2001 Research Assessment Exercise for Unit of Assessment (UoA 61: Library and Information Management

    Directory of Open Access Journals (Sweden)

    Alison Holmes

    2001-01-01

    Full Text Available A citation study was carried out to predict the outcome of the 2001 Research Assessment Exercise. The correlation between scores achieved by academic departments in the UK in the 1996 Research Assessment Exercise, and the number of citations received by academics in those departments for articles published in the period 1994-2000, using the Institute for Scientific Information’s citation databases, was assessed. A citation study was carried out on all three hundred and thirty eight academics that teach in the UK library and information science schools. These authors between them received two thousand three hundred and one citations for articles they had published between 1994 and the present. The results were ranked by Department, and compared to the ratings awarded to the departments in the 1996 Higher Education Funding Council Research Assessment Exercise. On the assumption that RAE scores and citation counts are correlated, predictions were made for the likely RAE scores in the 2001 RAE. Comments were also made on the impact of staff movements from one Higher Education Institution to another.

  19. The Impact of Race in Male Breast Cancer Treatment and Outcome in the United States: A Population-Based Analysis of 4,279 Patients

    Directory of Open Access Journals (Sweden)

    Jacob Y. Shin

    2014-01-01

    Full Text Available The purpose of this study is to compare the racial differences in treatment and overall survival (OS of male breast cancer (MBC patients. Data were extracted from the NCI SEER database that included population-based registries from 1988 to 2010 and analyzed using SPSS 20.0. 4,279 MBC patients were identified. 3,266 (76.3% patients were White, 552 (12.9% Black, 246 (5.7% Hispanic, and 215 (5.0% Asian. Black patients were more likely to be diagnosed at younger age (P<0.001, have advanced stage disease (P=0.001, and be unmarried (P<0.001 and less likely to undergo lymph node dissection (P=0.006. When stratified by stage, there was no difference in receipt of primary treatment by race. The 5-year OS for White, Black, Hispanic, and Asian races was 73.8%, 66.3%, 74.0%, and 85.3% (P<0.001. This significant worse 5-year OS for Blacks persisted regardless of age, stage II or III disease, and grade 2 or 3 disease. On multivariate analysis, Black race was a significant independent prognostic factor for worse OS. Blacks were less likely to receive lymph node dissection of which patients may derive benefit, though we did not observe receipt of primary treatment, after stratifying for disease stage, to be an underlying factor contributing to racial outcome differences.

  20. Is it time for elective left main percutaneous coronary intervention to become 'main stream'?

    Institute of Scientific and Technical Information of China (English)

    Joshua Cohen; Andrew D.Michaels

    2006-01-01

    @@ Left main (LM) stenting is considered by many to be one of the last frontiers of interventional cardiology. Beginning with the VA cooperative study published in 1976 demonstrating a mortality benefit for patients undergoing coronary artery bypass grafting (CABG), i the standard of care for treatment of left main coronary artery disease has been surgical.The most recent 2005 update of the ACC/AHA/SCAI Practice Guidelines on PCI 2 again notes that "CABG using IMA grafting is the 'gold standard' for treatment of unprotected left main disease and has proven benefit on long-term outcomes."

  1. Cell-free DNA increase over first 48 hours in emergency intensive care unit predicts fatal outcome in patients with shock.

    Science.gov (United States)

    Xia, Dun Ling; Zhang, Hong; Luo, Qing Li; Zhang, A Fang; Zhu, Li Xin

    2016-10-01

    Objective To investigate whether circulating cell-free (cf)-DNA levels are a useful biomarker for survival in patients with shock in the emergency intensive care unit (EICU). Methods This prospective observational study enrolled patients admitted to the EICU diagnosed with shock. Blood cf-DNA levels were analysed on admission, and after 24 and 48 h. As a measure of circulating cf-DNA, copy number of the β-globin gene in plasma was assessed using quantitative real-time polymerase chain reaction. Results Circulating cf-DNA levels were higher at hospital admission and after 24 h in EICU patients with shock who died than in those who recovered. Change in cf-DNA levels over the first 48 h in critical care was independently associated with 28-day mortality. The critical cut-off value for cf-DNA change over 48 h in predicting 28-day mortality was +16.12% (sensitivity 68.9%, specificity 89.7%). Conclusions Increased circulating cf-DNA levels in EICU patients with shock are associated with risk of death and measuring cf-DNA change over 48 h improves risk prediction. The present study suggests that cf-DNA may serve as a viable plasma biomarker of mortality risk in EICU patients with shock.

  2. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    Science.gov (United States)

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  3. Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States

    Directory of Open Access Journals (Sweden)

    Timothy Fitzgerald

    2015-01-01

    Full Text Available Study Objective. To measure the association of symptoms attributed to residual effects of sleep medication (e.g., drowsiness, difficulty concentrating, and impaired memory on self-reported functioning and satisfaction with these medications. Methods. Individuals using prescription medications for insomnia were invited to complete an Internet-based survey. Respondents were compared according to the presence of self-reported residual effects; relationships between severity of these effects and outcomes were modeled using regression. Measures included the Brief Insomnia Questionnaire, Work Productivity and Activity Impairment Questionnaire, and SATMED-Q. Subgroup analyses were conducted with patients aged ≥65 years. Approximately 80% reported experiencing ≥1 residual effect. The severity of residual effects was associated with increased residual effect-related work impairment, including absenteeism (RR = 1.46, p<0.001, presenteeism (RR = 1.12, p<0.001, overall work impairment (RR = 1.13, p<0.001, and nonwork activity impairment (RR = 1.11, p<0.001. More severe residual symptoms were also associated with increased difficulty in home management (Beta = .31, p<0.001, ability to work (Beta = .31, p<0.001, social relationships, (Beta = .32, p<0.001, close personal relationships (Beta = .30, p<0.001, and lower medication satisfaction (Beta = -.37, p<0.001. Conclusions. Individuals using medications for insomnia commonly experience symptoms considered as residual effects, and these symptoms are associated with greater interference of sleep-related problems at work, at home, and with social relationships.

  4. 46 CFR 108.419 - Fire main capacity.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Fire main capacity. 108.419 Section 108.419 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Fire Extinguishing Systems Fire Main System § 108.419 Fire main capacity. The diameter of the...

  5. [Multicenter study on the treatment and outcome of patients admitted to intensive care units in Italy. Presentation of the research project and the study protocol. GiViTI (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva)].

    Science.gov (United States)

    Apolone, G; Brazzi, L; Pesce, C

    1992-12-01

    Although Intensive Care Units (ICU) are present in most of the Italian Hospitals for acute patients, the heterogeneity of the patients case-mix and the large variation in structural, organizational and staffing arrangements have limited the feasibility and precision of evaluation studies aimed at assessing the quality of health care delivered and its impact on patients outcomes. To our knowledge there has been no nationwide study aimed at assessing the quality and effectiveness of the delivered care in samples of ICUs and patients that are representative of the source populations. To study the effects of variations in health care practices on the outcome of the patients admitted in ICU, we designed a multicentric observational study involving 120 ICUs within the country. The present study is the first part of a project involving a network of Intensive Care Units gathered under the name of GiViTI-Italian Group for the Evaluation of the Interventions in Intensive Care-that is representative of the national Italian reality in the field. The idea of a large collaborative group acting in the field of Intensive Care stands in line with several quality, effectiveness and resource utilization studies that are ongoing in other European countries and is also the result of a series of smaller-scale experiences carried out by other Italian groups eventually emboied in the GiViTI project. In the framework of the ongoing long term, multisite, and multidisciplinary project, the present study calls for the recruitment of all consecutive patients seen at the participant centers during a two months period.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes

    Directory of Open Access Journals (Sweden)

    Phillips CJ

    2015-10-01

    Full Text Available Cameron J Phillips,1–3 David L Gordon3,4 1Division of Pharmacy, SA Pharmacy, Flinders Medical Centre, Bedford Park, 2School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 3Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, 4Department of Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia Background: Vancomycin is the antibiotic of choice for the treatment of serious infections such as methicillin-resistant Staphylococcus aureus (MRSA. Inappropriate prescribing of vancomycin can lead to therapeutic failure, antibiotic resistance, and drug toxicity. Objective: To examine the effectiveness of pharmacist-led implementation of a clinical practice guideline for vancomycin dosing and monitoring in a teaching hospital. Methods: An observational pre–post study design was undertaken to evaluate the implementation of the vancomycin guideline. The implementation strategy principally involved education, clinical vignettes, and provision of pocket guidelines to accompany release of the guideline to the hospital Intranet. The target cohort for clinical behavioral change was junior medical officers, as they perform the majority of prescribing and monitoring of vancomycin in hospitals. Assessment measures were recorded for vancomycin prescribing, therapeutic drug monitoring, and patient outcomes. Results: Ninety-nine patients, 53 pre- and 46 post-implementation, were included in the study. Prescribing of a loading dose increased from 9% to 28% (P=0.02, and guideline adherence to starting maintenance dosing increased from 53% to 63% (P=0.32. Dose adjustment by doctors when blood concentrations were outside target increased from 53% to 71% (P=0.12, and correct timing of initial concentration measurement increased from 43% to 57% (P=0.23. Appropriately timed trough concentrations improved from 73% to 81% (P=0.08. Pre-dose (trough

  7. The effect of lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms: evidence from the United Kingdom Infantile Spasms Study.

    Science.gov (United States)

    O'Callaghan, Finbar J K; Lux, Andrew L; Darke, Katrina; Edwards, Stuart W; Hancock, Eleanor; Johnson, Anthony L; Kennedy, Colin R; Newton, Richard W; Verity, Christopher M; Osborne, John P

    2011-07-01

    Infantile spasms is a severe infantile seizure disorder. Several factors affect developmental outcome, especially the underlying etiology of the spasms. Treatment also affects outcome. Both age at onset of spasms and lead time to treatment (the time from onset of spasms to start of treatment) may be important. We investigated these factors. Developmental assessment using Vineland Adaptive Behaviour Scales (VABS) at 4 years of age in infants enrolled in the United Kingdom Infantile Spasms Study. Date of or age at onset of spasms was obtained prospectively. Lead time to treatment was then categorized into five categories. The effects of lead time to treatment, age of onset of spasms, etiology, and treatment on developmental outcome were investigated using multiple linear regression. Age of onset ranged (77 infants) from 2 months in 21 and not known in 6. Each month of reduction in age at onset of spasms was associated with a 3.1 [95% confidence interval (CI) 0.64-5.5, p = 0.03] decrease, and each increase in category of lead time duration associated with a 3.9 (95% CI 7.3-0.4, p = 0.014) decrease in VABS, respectively. There was a significant interaction between treatment allocation and etiology with the benefit in VABS in those allocated steroid therapy being in children with no identified etiology (coefficient 29.9, p=0.004). Both prompt diagnosis and prompt treatment of infantile spasms may help prevent subsequent developmental delay. Younger infants may be more at risk from the epileptic encephalopathy than older infants. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  8. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit.

    Science.gov (United States)

    Finkelsztein, Eli J; Jones, Daniel S; Ma, Kevin C; Pabón, Maria A; Delgado, Tatiana; Nakahira, Kiichi; Arbo, John E; Berlin, David A; Schenck, Edward J; Choi, Augustine M K; Siempos, Ilias I

    2017-03-26

    The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU. The Weill Cornell Medicine Registry and Biobank of Critically Ill Patients is an ongoing cohort of critically ill patients, for whom biological samples and clinical information (including vital signs before and during ICU hospitalization) are prospectively collected. Using such information, qSOFA and SIRS scores outside the ICU (specifically, within 8 hours before ICU admission) were calculated. This study population was therefore comprised of patients in the emergency department or the hospital wards who had suspected infection, were subsequently admitted to the medical ICU and were included in the Registry and Biobank. One hundred fifty-two patients (67% from the emergency department) were included in this study. Sixty-seven percent had positive cultures and 19% died in the hospital. Discrimination of in-hospital mortality using qSOFA [area under the receiver operating characteristic curve (AUC), 0.74; 95% confidence intervals (CI), 0.66-0.81] was significantly greater compared with SIRS criteria (AUC, 0.59; 95% CI, 0.51-0.67; p = 0.03). The qSOFA performed better than SIRS regarding discrimination for ICU-free days (p = 0.04), but not for ventilator-free days (p = 0.19), any organ dysfunction-free days (p = 0.13), or renal dysfunction-free days (p = 0.17). In patients with suspected infection who eventually required admission to the ICU, qSOFA calculated before their ICU admission had greater

  9. The association between pretest probability of coronary artery disease and stress test utilization and outcomes in a chest pain observation unit.

    Science.gov (United States)

    Napoli, Anthony M

    2014-04-01

    Cardiology consensus guidelines recommend use of the Diamond and Forrester (D&F) score to augment the decision to pursue stress testing. However, recent work has reported no association between pretest probability of coronary artery disease (CAD) as measured by D&F and physician discretion in stress test utilization for inpatients. The author hypothesized that D&F pretest probability would predict the likelihood of acute coronary syndrome (ACS) and a positive stress test and that there would be limited yield to diagnostic testing of patients categorized as low pretest probability by D&F score who are admitted to a chest pain observation unit (CPU). This was a prospective observational cohort study of consecutively admitted CPU patients in a large-volume academic urban emergency department (ED). Cardiologists rounded on all patients and stress test utilization was driven by their recommendations. Inclusion criteria were as follows: age>18 years, American Heart Association (AHA) low/intermediate risk, nondynamic electrocardiograms (ECGs), and normal initial troponin I. Exclusion criteria were as follows: age older than 75 years with a history of CAD. A D&F score for likelihood of CAD was calculated on each patient independent of patient care. Based on the D&F score, patients were assigned a priori to low-, intermediate-, and high-risk groups (90%, respectively). ACS was defined by ischemia on stress test, coronary artery occlusion of ≥70% in at least one vessel, or elevations in troponin I consistent with consensus guidelines. A true-positive stress test was defined by evidence of reversible ischemia and subsequent angiographic evidence of critical stenosis or a discharge diagnosis of ACS. An estimated 3,500 patients would be necessary to have 1% precision around a potential 0.3% event rate in low-pretest-probability patients. Categorical comparisons were made using Pearson chi-square testing. A total of 3,552 patients with index visits were enrolled over a 29

  10. Maine Agricultural Foods. Project SEED.

    Science.gov (United States)

    Beaulieu, Peter; Ossenfort, Pat

    This paper describes an activity-based program that teaches students in grades 4-12 about the importance of Maine agriculture in their lives. Specifically, the goal is to increase student awareness of how the foods they eat are planted, harvested, and processed. The emphasis is on crops grown in Maine such as potatoes, broccoli, peas, blueberries,…

  11. The American Eider in Maine

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The American eider, Maine's only breeding sea duck, is known to have nested on 215 coastal islands of the State in 1976. In Maine, eiders seem to prefer to nest on...

  12. Main Propulsion Test Article (MPTA)

    Science.gov (United States)

    Snoddy, Cynthia

    2010-01-01

    Scope: The Main Propulsion Test Article integrated the main propulsion subsystem with the clustered Space Shuttle Main Engines, the External Tank and associated GSE. The test program consisted of cryogenic tanking tests and short- and long duration static firings including gimbaling and throttling. The test program was conducted on the S1-C test stand (Position B-2) at the National Space Technology Laboratories (NSTL)/Stennis Space Center. 3 tanking tests and 20 hot fire tests conducted between December 21 1 1977 and December 17, 1980 Configuration: The main propulsion test article consisted of the three space shuttle main engines, flightweight external tank, flightweight aft fuselage, interface section and a boilerplate mid/fwd fuselage truss structure.

  13. Cyclical Behavior of Inventories and Growth Projections Recent Evidence From Europe and the United States

    OpenAIRE

    Alexander W. Hoffmaister; Jens R Clausen

    2010-01-01

    In the United States and a few European countries, inventory behavior is mainly the outcome of demand shocks: a standard buffer-stock model best characterizes these economies. But most European countries are described by a modified buffer-stock model where supply shocks dominate. In contrast to the United States, inventories boost growth with a one-year lag in Europe. Moreover, inventories provide limited information to improve growth forecasts particularly when a modified buffer-stock model ...

  14. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  15. Gulf of Maine intermediate water

    Energy Technology Data Exchange (ETDEWEB)

    Hopkins, T.S. (Brookhaven National Lab., Upton, NY); Garfield, N. III

    1979-01-01

    The thermohaline dynamics of the Gulf of Maine are analyzed from the two year, eight cruise, data set of Colton, Marak, Nickerson, and Stoddard (1968). Six water masses are described: the Maine Surface Water, Maine Intermediate Water, and the Maine Bottom Water as interior water masses; and the Scotian Shelf Water, the Slope Water, and the Georges Bank Water as exterior water masses. Particular attention is given to the formation and disposition of the Maine Intermediate Water. Salt balance, T-S volume, and T-S drift analyses are used to provide transport and mixing estimates for the year 1966. The Slope Water entered at depth through the Northeast Channel at a rate of 2600 km/sup 3//yr; while the Scotian Shelf Water entered the surface and intermediate layers, mostly during winter intrusions, at a rate of 5200 km/sup 3//yr. The surface and intermediate layers exported a total of 7900 km/sup 3//yr in a 3:5 ratio, respectively. The Maine Intermediate Water tends to collect over the Wilkinson Basin during the stratified season, to exit via the Great South Channel during early spring, and to exit via the Northeast Channel during spring and summer. Comparisons are made between the estimated winter heat loss of 280 Ly/d and the observed heat losses of 230 Ly/d (surface layers) and 360 Ly/d (surface and intermediate layers). A limit for the Scotian Shelf Water contribution is about -70 Ly/d. It is concluded that the Maine Intermediate Water is produced locally and that it is exported in significant quantities.

  16. Comparison of outcome predictions by the Glasgow coma scale and the Full Outline of UnResponsiveness score in the neurological and neurosurgical patients in the Intensive Care Unit

    Science.gov (United States)

    Khanal, Kishor; Bhandari, Sanjeeb Sudarshan; Shrestha, Ninadini; Acharya, Subhash Prasad; Marhatta, Moda Nath

    2016-01-01

    Assessment of level of consciousness is very important in predicting patient's outcome from neurological illness. Glasgow coma scale (GCS) is the most commonly used scale, and Full Outline of UnResponsiveness (FOUR) score is also recently validated as an alternative to GCS in the evaluation of the level of consciousness. We carried out a prospective study in 97 patients aged above 16 years. We measured GCS and FOUR score within 24 h of Intensive Care Unit admission. The mean GCS and the FOUR scores were lower among nonsurvivors than among the survivors and were statistically significant (P < 0.001). Discrimination for GCS and FOUR score was fair with the area under the receiver operating characteristic curve of 0.79 and 0.82, respectively. The cutoff point with best Youden index for GCS and FOUR score was 6.5 each. Below the cutoff point, mortality was higher in both models (P < 0.001). The Hosmer-Lemeshow Chi-square coefficient test showed better calibration with FOUR score than GCS. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.91 (P < 0.001). PMID:27630460

  17. Non-main Stream Plays Main Role in Shipbuilding Market

    Institute of Scientific and Technical Information of China (English)

    Qin Ping

    2009-01-01

    @@ Comparing with both the major shipyards and shipping companies that were facing an market decline and hard time,the non-mainstream ship types,non-mainstream ship manufacturers and non-mainstream ship owners,as main roles,made a wonderful show of living and developing in 2009.

  18. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease

    OpenAIRE

    2002-01-01

    Background: The 1997 BTS/RCP national audit of acute chronic obstructive pulmonary disease (COPD) in terms of process of care has previously been reported. This paper describes from the same cases the outcomes of death, readmission rates within 3 months of initial admission, and length of stay. Identification of the main pre-admission predictors of outcome may be used to control for confounding factors in population characteristics when comparing performance between units.

  19. Architectural Portfolio 2001: Main Winners.

    Science.gov (United States)

    American School & University, 2001

    2001-01-01

    Presents descriptions and photographs of the following two American School and University Architectural Portfolio main winners for 2001: Chesterton, Indiana's Chesterton High School and Lied Library at the University of Nevada, Las Vegas. Included are each project's vital statistics, the architectural firm involved, and a list of designers.(GR)

  20. The four main LHC experiments

    CERN Multimedia

    AC Team

    1999-01-01

    This diagram shows the locations of the four main experiments (ALICE, ATLAS, CMS and LHCb) that will take place at the LHC. Located between 50 m and 150 m underground, huge caverns have been excavated to house the giant detectors. The SPS, the final link in the pre-acceleration chain, and its connection tunnels to the LHC are also shown.

  1. Comparison of clinical outcomes of domestic Sirolimus and imported Zotalimus eluting stents for unprotected left main coronary artery disease%国产西罗莫司洗脱支架与进口佐他莫司洗脱支架治疗无保护左主干病变临床疗效的对比分析

    Institute of Scientific and Technical Information of China (English)

    魏敬飞; 鄢华; 宋丹; 彭剑; 郭卉; 汪敏; 苏晞

    2015-01-01

    -Eluting Stents group (Resolute group, n = 34) . We analyzed the baseline characteristics, coronary artery lesion characteristics, stenting strategies and any changes in left ventricular ejection fraction ( LVEF) in both groups and investigated the long-term clinical outcomes. Results There were no significant differences in the baseline characteristics, the SYNTAX scores of the coronary artery lesion and the rate of complete revascularization between the two groups. Compared with that in Firebird group, there were more cases involving the distal left main (79. 4% vs. 45. 2% , P ﹤ 0. 05) and more patients using two stents strategies (29. 4% vs. 7. 1% , P ﹤ 0. 05) in the Resolute group. The change in LVEF post-PCI had no difference between the two groups. The patients were followed up for a mean of (23. 3 ± 10. 7) months. During the follow-up period, the occurrence of MACCE had no significant difference between the two groups. In the Firebird group, there were one sudden cardiac death, one nonfatal myocardial infarction, one stroke and five patients with recurrence of angina pectoris. In the Resolute group there were one sudden cardiac death, one target lesion revascularization and four patients with recurrence of angina pectoris. Conclusions Compared with the imported Zotalimus-Eluting Stents, the domestic Sirolimus-Eluting Stents are safe and effective in the treatment of patients with unprotected left main lesions under the guidance of IVUS. The two kinds of stent showed similar long-term clinical outcomes.

  2. Theoretical Base for Multidimensional Classification of Learning Outcomes In Reforming Qualifications Frameworks

    Directory of Open Access Journals (Sweden)

    Mile Dzelalija

    2014-04-01

    Full Text Available This article provides analysis and a reflection on basic measurable properties of qualifications, modules, units and other groups of learning outcomes, as a theoretical base for their multidimensional classifications in emerging reforming qualifications frameworks. Learning outcomes, as the main elements of a qualification, are written and organised within units of learning outcomes and different groups, giving a transparent structure to the qualification from the user's point of view (students, employers, teachers, etc.. Units of learning outcomes, modules and qualifications have a set of basic measurable properties, for example: reference level, volume of workload, academic or professional profile and quality. Reference level denotes the depth and the complexity of the acquired learning outcomes, while volume denotes the total amount of workload in ideal conditions, and profiles the field of work and study associated with this. Quality denotes the reliability of the specified reference level, volume and profile of learning outcomes. It is particularly important to take account of these reflections when considering the impact of the implementation of reforming qualifications frameworks, quality assurance, validation of non-formal and informal learning, recognition of learning outcomes and qualifications, and other European tools in qualifications systems.

  3. Las unidades de hemodiálisis en México: una evaluación de sus características, procesos y resultados An evaluation of the characteristics, processes and outcomes of hemodialysis units in Mexico

    Directory of Open Access Journals (Sweden)

    Laura Leticia Tirado-Gómez

    2011-01-01

    Full Text Available OBJETIVO. Evaluar las características, procesos y resultados, así como, la estructura de una muestra de unidades de hemodiálisis (UH en México. Material y métodos. Estudio transversal en 83 UH públicas y privadas del país. Las UH fueron estratificadas, de acuerdo con el puntaje obtenido, en cinco categorías: muy buena, buena, regular, mala y muy mala. Resultados. El 48% de las UH se clasificaron en las categorías mala y muy mala y atendieron 58% de los pacientes. El promedio de sesiones/paciente en los seis meses evaluados fue de 1.2 por semana. El 46.5% de las sesiones con determinación de Kt/V reportaron valores inferiores al valor recomendado (Kt/V≥1.2. En infraestructura, tres cuartas partes de las unidades obtuvieron puntajes menores a 70%. Conclusiones. La mitad de las unidades de hemodiálisis no cumplieron los criterios de proceso y resultado establecidos por el Consejo de Salubridad de la Secretaría de Salud.OBJECTIVE. To evaluate the characteristics, processes, outcomes and structure of a sample of hemodialysis units (HU in Mexico. MATERIAL AND METHODS. Cross-sectional study in 83 public and private HU from the 32 states in Mexico. The HU were stratified, according to a score, in five categories: very good, good, regular, poor and very poor. RESULTS. 48% of the HU were classified as poor and very poor, and they granted medical attention to 58% of the patients. The average number of sessions per patient in the last six months assessed was 1.2 per week. 46.5% of the sessions with determination of Kt/V reported values inferior to the recommended value (Kt/ V≥1.2. 75% of the units scored less than 70% in infrastructure. CONCLUSIONS. Half of the HU did not fulfill the process and result criteria defined by the Consejo de Salubridad de la Secretaría de Salud.

  4. Use of energy piles in the Main Tower high-rise building, Frankfurt/Main; Einsatz von Energiepfaehlen am Beispiel des Main Tower im Frankfurt am Main

    Energy Technology Data Exchange (ETDEWEB)

    Hude, N. von der [Bilfinger und Berger Bauaktiengesellschaft, Mannheim (Germany). Service Center Technik; Kapp, C. [NEK Umwelttechnik AG, Zuerich (Switzerland)

    1998-03-01

    The ``Main Tower``, with a height of 198 m, is one of Europe`s highest and most innovative office buildings. The building has a pile foundation which is at the same time a component of the energy supply concept: The piles are equipped with heat exchanger tubes, so that the soil can be utilized for heat supply down to a depth of 50 m. There are several interfaces between foundation work and technical facilities. The number of cogeneration units required for supply of the building could be reduced accordingly. (orig.) [Deutsch] Im Bankenviertel der Innenstadt von Frankfurt am Main entsteht eines der hoechsten und modernsten Buerogebaeude Europas. Der 198 m hohe Neubau des Main Tower zeichnet sich dadurch aus, dass durch die Nutzung des Energiepotentials im Untergrund ein innovatives Energiekonzept verwirklicht wird. Das Hochhaus ist auf Grossbohrpfaehlen gegruendet. Sie dienen der Lastabtragung und sind, wie die Pfaehle der ueberschnittenen Bohrpfahlwand zur Baugrubensicherung, Bestandteil des Energiekonzeptes. Die Pfaehle wurden mit Waermetauscherrohren ausgestattet, um den Boden unterhalb des Hochhauses bis in eine Tiefe von 50 m unter Gelaendeoberkante zur umweltfreundlichen Energiegewinnung zu nutzen. Daraus ergeben sich eine Vielzahl von Schnittstellen zwischen Gruendungsarbeiten und technischer Gebaeudeausruestung. Dem Bauherrn wurde es ermoeglicht, die Zahl der erforderlichen Blockheizkraftwerke zur Versorgung des Gebaeudes nennenswert zu reduzieren. (orig.)

  5. A random walk down Main Street

    Directory of Open Access Journals (Sweden)

    David Matthew Levinson

    2016-08-01

    Full Text Available US suburbs have often been characterized by their relatively low walk accessibility compared to more urban environments, and US urban environments have been char- acterized by low walk accessibility compared to cities in other countries. Lower overall density in the suburbs implies that activities, if spread out, would have a greater distance between them. But why should activities be spread out instead of developed contiguously? This brief research note builds a positive model for the emergence of contiguous development along “Main Street” to illustrate the trade-offs that result in the built environment we observe. It then suggests some policy interventions to place a “thumb on the scale” to choose which parcels will develop in which sequence to achieve socially preferred outcomes.

  6. Main Elements for Upscaling Recreation

    DEFF Research Database (Denmark)

    Zandersen, Marianne; Termansen, Mette

    2012-01-01

    This report provides information on the main elements used to scale up modelled local visitor flow data to regional level based on recreational de-mand models. These models are described in Report #1. This report also provides information on data sources such as spatial data (e.g. land cov......-er/land use information), demographic information. The report is accom-pagnied with a spatial database for the regional case of forest recreation in Northern Zealand, Denmark. The spatial database contains forest polygons; forest attribute; estimation of total annual number of visits per site; and es...

  7. Burden in the main caregiver

    Directory of Open Access Journals (Sweden)

    Fabiola Yonte Huete

    2010-09-01

    Full Text Available Objectives: The main objective is to determine the degree of burden in the main caregivers of dependent patients, to analyse the profile of informal caregivers and dependent patients. Their claims and help received with caring, the influence of mental deteriorate and duration of care giving regarding the burden of caregivers.Methods: Descriptive cross-sectional observational study amongst 50 caregivers and dependents. We used descriptive statistics and correlational studies. Results: 86 % of caregivers were women, middle aged, son/daughter of the dependent, married, with basic studies, no work outside the home, the average time in the role of caregiver was 16,96 hours a day and 2,1 free hours a day. 64 % of them received family support and 68 % wish to receive economic aid. It was found that for 38 % of the caregivers there was no burden at all, 34 % of them had a minimum burden and 28 % a greater burden.Conclusion: There are some caregivers with moderate or great burden. Our caregiver wishes to receive economic help. Our research shows that the decrease of mental health and the years of evolution do not have a significant statistically influence on caregivers. It is necessary prioritize the interventions and its recipients, provide solutions for caregivers with a greater burden, trying to keep away “caregiver syndrome”.

  8. Severe and fatal obstetric injury claims in relation to labor unit volume

    DEFF Research Database (Denmark)

    Milland, Maria; Mikkelsen, Kim L; Christoffersen, Jens K

    2015-01-01

    with decreasing annual delivery volume. Face value incidence rate ratios of approved severe injuries increased with decreasing labor unit volume, but the association did not reach statistical significance. CONCLUSION: High volume labor units appear associated with fewer approved and fewer fatal injury claims...... quintiles as annual volume per labor unit: (10-1377), (1378-2016), (2017-2801), (2802-3861), (3862-6659). MAIN OUTCOME MEASURES: Five primary measures of outcome were used. Incidence rate ratios of (A) Submitted claims, (B) Approved claims, (C) Approved severe injury claims (120% degree of disability), (D......) Approved fatal injury claims, and (C+D) Combined. RESULTS: 1 151 734 deliveries in 51 labor units and 1872 submitted claims were included. The incidence rate ratios of approved claims overall, of approved fatal injury claims, and of approved severe and fatal injuries combined increased significantly...

  9. The introduction to the main points of the unit tax review and internal management of cash audit%浅谈单位税金审查工作的要点及现金审计的内部管理

    Institute of Scientific and Technical Information of China (English)

    韩纪梅

    2014-01-01

    Objective To investigate the effect of main points of unit tax review and cash audit of internal management. Methods Firstly, we should strengthen the focal points and profi t of the work in unit tax review. Secondly, we should discuss on the cash audit of internal management again. Cash audit refers to the examination and supervision on the authenticity, validity and legality of cash on hand and its receipts and payment matters and custody.Results Carrying out the cash audit and tax audit, promote the hospital legitimate business activities, strengthen the hospital scientifi c management consciousness, promote self -development, continuously enhance the competitiveness of the hospital, upgrade the level of hospital administration, strengthen the legal construction of hospital management, strengthen fund management, enhance effi ciency, strengthen the management of fi xed assets of hospitals, strengthen the construction of system and enhance the quality of personnel construction.Conclusion Carrying out cash audit and tax audit actively, has brought new hope to solve the existing problems of internal audit of hospital, will greatly improve our hospital internal audit work quality and effi ciency, so as to promote the rapid development of hospital.%目的:探讨单位税金审查工作的要点及现金审计的内部管理的效果。方法首先加强单位税金审查的工作要点及利润。再次对现金审计的内部管理进行探讨。现金审计是指对库存现金及其收付事项和保管情况的真实性、正确性和合法性进行的审查监督。结果开展现金审计及税金审查工作,促进了医院合法业务活动,增强医院科学管理意识,促进自我发展,不断增强医院竞争实力,能够提升医院监督管理水平,加强医院管理法制建设,加强资金管理、提升使用效率,加强医院固定资产管理,加强制度建设及增强人员素质建设。结论积极开展现金审计

  10. MAIN TOPICS,ABSTRACTS & KEY WORDS

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Design and implementation of a power control system for electron beam welder HE Shaojia, LI Jianling, MO Jinhai, LI Haibiao (School of Mechanical & Electrical Engineering, Guilin University of Electronic Technology, Guilin 541004, China). ppl-5, 12 Abstract: Stability of output voltage of high-voltage accelerating stabilized power supply for electron beam welder (EBW) is a prerequisite to ensure the electron beam welding quality. The common power supplies have the disadvantages of circuit complexity and bulkiness. A novel control system of higholtage accelerating stabilized power supply for EBW was designed. Its main circuit is based on pulse-width modulation (PWM) buckboost converter topology. Compared with common EBW power supplies, this new power supply requires a much lower voltage grade transformer because of the converter's effect for rising voltage, so its volume is smaller and the circuit is simpler. The sys- tem main circuit characteristics and its working process were analyzed. The system circuit's small-signal mathematical model was created, and lag-lead correction compensation control was em- ployed in the system to achieve static and dynamic performance requirements. The results displayed that this unit had the characteristics of fast response, high reliability, high control precision and anti-interference capability.

  11. Forensic entomology and main challenges in Brazil.

    Science.gov (United States)

    Gomes, Leonardo; Von Zuben, Cláudio J

    2006-01-01

    Apart from an early case report from China (13th century), the first observations on insects and other arthropods as forensic indicators were documented in Germany and France during mass exhumations in the 1880s by Reinhard, who is considered a co-founder of the discipline. After the French publication of Mégnin's popular book on the applied aspects of forensic entomology, the concept quickly spread to Canada and United States. At that time, researchers recognized that the lack of systematic observations of insects of forensic importance jeopardized their use as indicators of postmortem interval. General advances in insect taxonomy and ecology helped to fill this gap over the following decades. After World Wars, few forensic entomology cases were reported in the scientific literature. From 1960s to the 1980s, Leclercq and Nuorteva were primarily responsible for maintaining the method in Central Europe, reporting isolated cases. Since then, basic research in the USA, Russia and Canada opened the way to the routine use of Entomology in forensic investigations. Identifications of insects associated with human cadavers are relatively few in the literature of the Neotropical region and have received little attention in Brazil. This article brings an overview of historic developments in this field, the recent studies and the main problems and challenges in South America and mainly in Brazil.

  12. Main challenges of residential areas

    Directory of Open Access Journals (Sweden)

    Oana Luca

    2017-06-01

    Full Text Available The present article is a position paper aiming to initiate a professional debate related to the aspects related to the urban dysfunctions leading to the wear of the residential areas. The paper proposes a definition of the wear process, identify the main causes leading to its occurrence and propose a number of solutions to neutralise the dysfunctions. The three wearing phases of residential areas components are emphasized, exploring their lifecycle. In order to perform the study of urban wear, the status of the residential areas components can be established and monitored, and also the variables of the function that can mathematically model the specific wear process may be considered. The paper is considered a first step for the model adjustment, to be tested and validated in the following steps. Based on the mathematical method and model, there can be created, in a potential future research, the possibility of determining the precarity degree for residential areas/neighbourhoods and cities, by minimising the subjective component of the analyses preceding the decision for renovation or regeneration.

  13. Unprotected Left Main Disease and Percutaneous Intervention: A Prototype for Precision Medicine.

    Science.gov (United States)

    Chatterjee, Arka; Hillegass, William B

    2017-01-01

    The SYNTAX Score based on angiographic findings is an actionable risk prediction model helping guide treatment for significant unprotected left main disease. Adding the clinical factor based EuroSCORE to SYNTAX improves outcome prediction for percutaneous coronary intervention of unprotected left main disease. Prediction models are an increasingly useful tool permitting cardiologists to optimize patient outcomes through "personalized" or precision medicine.

  14. Education and Occupational Outcomes

    DEFF Research Database (Denmark)

    Johnes, Geraint; Freguglia, Ricardo; Spricigo, Gisele

    2016-01-01

    Purpose: The purpose of this paper is to examine the dynamic relationship between policies related to educational provision and both educational participation and occupational outcomes in Brazil, using PNAD and RAIS-Migra data. Design/methodology/approach: Outcomes are examined using: static...... multinomial logit analysis, and structural dynamic discrete choice modelling. The latter approach, coupled with the quality of the RAIS-Migra data source, allows the authors to evaluate the education policy impacts over time. Findings: The main results show that the education level raises the propensity...... that the individual will be in formal sector work or still in education, and reduces the probability of the other outcomes. Transition into non-manual formal sector work following education may, however, occur via a spell of manual work. Originality/value: This is the first study of occupational destination...

  15. A study on the neurodevelopmental outcome of preterm infants discharged from neonatal intensive care unit and the influencing factors for neurodevelopmental outcome%新生儿重症监护病房出院早产儿神经发育预后及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    廖承琳; 潘家华; 黄金华

    2011-01-01

    Objective To study the neurodevelopmental outcome of preterm infants who were discharged from neonatal intensive care unit ( NICU) and the impact factors contributing to the neurodevelopmental outcome.The purpose of this study is to find the high risk factors on prognosis of preterm infants and take them as the benchmark in early intervention.Methods A total of 140 preterm infants who accepted treatment in our department from Jan.2007 to Jan.2008 were followed up and analyzed retrospectively at six months to a year and a half in the study.Their clinical data and prenatal data were integrated.The infants received the infant development test of 0-6year-old children Intelligence Developmental Scale for neurological development The neurodevelopmental outcome was evaluated based on Developmental quotient (DQ).DQ > 85 was defined as normal, DQ between 70 and 85 as critical and DQ < 70 as abnormal.Meanwhile their DQ and influencing factors were researched.Social-domestic and clinical factors related to neurological development were analyzed by Independent-samples T Test or Chisquare Test.Potential high risk factors were analyzed with Logistic regression.The data were arranged and analyzed with SPSS 11.5.Results This study consisted of 140 preterm infants, with a mean gestational age of (34.4 ± 1.8) weeks and a mean birth weight of (2206 ±564) g.Normal, critical and abnormal neurological development occurred in 75 cases (53.6% ) , 56 cases (40.0% ) and 9 cases (6.4% ) respectively.Logistic regression showed birth weight, the economic input which parents gave to their children and education level of father were related to DQ scores.Conclusions Preterm infants discharged from NICU are a high risk group of neurodevelopmental disablement.It is closely related to the perinatal high risk factors, which causes nervous system lesions.First of all, health care should be strengthened during pregnancy pregnancy.At the same time proper adequate nutrition and early

  16. Determination of Main Noise Sources in a Thermal Power plant

    Directory of Open Access Journals (Sweden)

    M. Jahangiri

    2014-09-01

    Full Text Available Introduction: The Power plants are as the major industries that have a large number of workers, providing they health is important. Exposure to occupational noise is the pervasive physical agent in industries like power plants and may impact health and for safety status for people. Determination of the sources of noise in workplaces is important step in noise control plans. This study aimed to assess noise pollution and determine the main sources of noise in a power plant for. .Material and Method: This descriptive cross-sectional study was conducted on the ground floor of the turbine unit of a thermal power plant. Measurements was done based on the ISO-9612 and ISO-11200 standard using by the calibrated sound level meter model TES-1389 on “A” frequency weighting and “Slow” mode for time response. Surfer V.10 software was used for interpolation and noise maps producing. Based on grid method measuring for indicating of noise propagation, we set buffer of danger areas to determine main sources of noise. Also, we used the minimized grid method for measuring and study of noise denotation in vertical surface in each main sources. .Result: The results showed that the measured indoor sound pressure level in all areas where at the risk category of the units. The highest average sound pressure level was belonged to the unit 2, with 93.1 dB(A. We find the feed water pumps were the main sources in all of the studied units. Among the four main components of the main sources, the highest noise levels associated with the main pump and the gearbox section with about 100 9B(L and dominant frequency of 2000 Hz. .Conclusion: Considering that feed water pumps had major sources in indoor power plant noise pollution, engineering noise control such as providing enclosures is necessary to reduce noise pollution to safe levels in the studied plant it is necessary.

  17. Allocating multiple units

    DEFF Research Database (Denmark)

    Tranæs, Torben; Krishna, Kala

    2002-01-01

    This paper studies the allocation and rent distribution in multi-unit, combinatorial-bid auctions under complete information. We focus on the natural multi-unit analogue of the first-price auction, where buyers bid total payments, pay their bids, and where the seller allocates goods to maximize his...... revenue. While there are many equilibria in this auction, only efficient equilibria remain when the truthful equilibrium restriction of the menu-auction literature is used. Focusing on these equilibria we first show that the first-price auction just described is revenue and outcome equivalent to a Vickrey...

  18. GAS MAIN SENSOR AND COMMUNICATIONS NETWORK SYSTEM

    Energy Technology Data Exchange (ETDEWEB)

    Hagen Schempf, Ph.D.

    2003-02-27

    Automatika, Inc. was contracted by the Department of Energy (DOE) and with co-funding from the New York Gas Group (NYGAS), to develop an in-pipe natural gas prototype measurement and wireless communications system for assessing and monitoring distribution networks. A prototype system was built for low-pressure cast-iron mains and tested in a spider- and serial-network configuration in a live network in Long Island with the support of Keyspan Energy, Inc. The prototype unit combined sensors capable of monitoring pressure, flow, humidity, temperature and vibration, which were sampled and combined in data-packages in an in-pipe master-slave architecture to collect data from a distributed spider-arrangement, and in a master-repeater-slave configuration in serial or ladder-network arrangements. It was found that the system was capable of performing all data-sampling and collection as expected, yielding interesting results as to flow-dynamics and vibration-detection. Wireless in-pipe communications were shown to be feasible and valuable data was collected in order to determine how to improve on range and data-quality in the future.

  19. Influence of pre-existing inflammation on the outcome of acute coronary syndrome

    DEFF Research Database (Denmark)

    Odeberg, J.; Freitag, M.; Forssell, Henrik

    2016-01-01

    associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with ACS. Design: Cross-sectional study. Setting: Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992-1996). Participants: In a substudy...... of Carlscrona Heart Attack Prognosis Study (CHAPS) of 5292 patients admitted to the coronary care unit, we identified 908 patients aged 30-74 years, who at discharge had received the diagnosis of either MI (527) or UA (381). Main outcome measures: MI or UA, based on the diagnosis set at discharge from hospital...

  20. Generating Units

    Data.gov (United States)

    Department of Homeland Security — Generating Units are any combination of physically connected generators, reactors, boilers, combustion turbines, and other prime movers operated together to produce...

  1. Constructing Outcomes in Teacher Education

    Directory of Open Access Journals (Sweden)

    Marilyn Cochran-Smith

    2001-04-01

    Full Text Available As we enter the twenty-first century, the outcomes, consequences, and results of teacher education have become critical topics in nearly all of the state and national policy debates about teacher preparation and licensure as well as in the development of many of the privately and publicly funded research agendas related to teacher and student learning. In this article, I argue that teacher education reform over the last fifty years has been driven by a series of questions about policy and practice. The question that is currently driving reform and policy in teacher education is what I refer to as "the outcomes question." This question asks how we should conceptualize and define the outcomes of teacher education for teacher learning, professional practice, and student learning, as well as how, by whom, and for what purposes these outcomes should be documented, demonstrated, and/or measured. In this article, I suggest that the outcomes question in teacher education is being conceptualized and constructed in quite different ways depending on the policy, research, and practice contexts in which the question is posed as well as on the political and professional motives of the posers. The article begins with an overview of the policy context, including those reforms and initiatives that have most influenced how outcomes are currently being constructed, debated, and enacted in teacher education. Then I identify and analyze three major "takes" on the outcomes question in teacher education—outcomes as the long-term or general impacts of teacher education, outcomes as teacher candidates' scores on high stakes teacher tests, and outcomes as the professional performances of teacher candidates, particularly their demonstrated ability to influence student learning. For each of these approaches to outcomes, I examine underlying assumptions about teaching and schooling, the evidence and criteria used for evaluation, units of analysis, and consequences for the

  2. New resist materials based on polyacetal main chain scission

    Science.gov (United States)

    Manouras, Theodoros; Olziersky, Antonis; Argitis, Panagiotis

    2016-03-01

    The main target of the current work was to develop new polymeric materials for lithographic applications, the main chain of which is cleaved under the influence of photogenerated acid. Acetals have been chosen as functional groups in the main polymer chain since they can be cleaved in the presence of an acid while they remain untouched in alkaline ambient. The synthesized polymers were designed to bear in addition suitable functional groups for the achievement of desirable lithographic characteristics (thermal stability, acceptable glass transition temperature, etch resistance, proper dissolution behaviour). The synthesis was carried out via polyaddition of a vinyloxyl compound and a diol compound to produce novel polymers with acetal repeating units in their backbone. We chose polyaromatic hydrocarbons as diol units to achieve increased etch resistance. In addition, the polyaromatic units allow exposure at 193 nm as well, where the absorption of simple aromatics is prohibitively high. Good solubility and increased surface adhesion were achieved by choosing cycloaliphatic vinyloxyl ethers as the second component for the polyaddition. In addition, the same route can be followed to incorporate chromophores that can tune the resist absorbance in different spectral regions. Furthermore, single component systems can be designed following this approach by the incorporation of suitable PAGs in the main chain.

  3. Risk Factors Related to Outcome of Patients with Severe Massive Hemorrhage in Intensive Care Unit%重症医学科严重大出血患者预后危险因素

    Institute of Scientific and Technical Information of China (English)

    周翔; 刘大为; 隆云; 姚波; 苏龙翔

    2016-01-01

    目的:探讨影响重症医学科病房( Intensive Care Unit,ICU)严重大出血患者预后的危险因素。方法回顾性分析北京协和医院2013年1月至2015年12月全部收住ICU 24 h内输注红细胞( red blood cell,RBC)超过20 U的大出血患者的临床资料,比较生存组与死亡组的差异,并采用Logistic回归分析影响这些患者预后的危险因素。结果研究共纳入严重大出血患者141例,生存组和死亡组患者分别为78例和63例,住院死亡率44.7%。其中非手术相关大出血78例,手术相关大出血63例。全部严重大出血患者死亡组ICU输RBC量( P=0.002)、非手术相关大出血患者的比例( P=0.002)以及来自急诊的大出血患者的比例(P=0.010)均显著高于生存组,而来自手术科室患者的比例低于生存组(P=0.001),输RBC前凝血功能,肝、肾功能明显较生存组差(P均﹤0.05)。在非手术相关大出血患者中,死亡组感染造成大出血患者的比例显著高于生存组(P=0.009),而应激性溃疡导致大出血患者的比例(P=0.048)、输RBC前血小板水平(P=0.003)和采用手术止血措施的患者比例(P=0.039)均显著低于生存组。在手术相关大出血患者中,死亡组ICU输RBC量显著多于生存组( P=0.019),输RBC前基线肝、肾功能受损的比例显著高于生存组( P均﹤0.05)。Logistic回归分析显示患者凝血功能紊乱(P=0.014,OR=3.594)及入ICU后仍存在活动性大出血(P=0.025,OR=2.680)为全部严重大出血患者死亡危险因素。结论患者凝血功能紊乱及入ICU后仍存在活动性大出血是严重大出血患者的死亡危险因素。%Objective To investigate the risk factors related to outcome of patients with severe massive hemorrhage in Intensive Care Unit( ICU ). Methods Clinical data of all patients receiving transfusion of red blood cell( RBC)of ﹥20 U for

  4. Maine Students Learn to Appreciate Diversity.

    Science.gov (United States)

    Flood, Pamela S.

    1994-01-01

    The Maine studies program at a rural Maine middle school begins in the sixth grade and expands through the eighth grade. Students camp out, explore Maine's geography, and learn about themselves, their state's history, and the state's diverse populations. Two multischool programs, Exchanging Maine's Cultures and the Curriculum Integration…

  5. Evolved expendable launch vehicle system: RS-68 main engine development

    Energy Technology Data Exchange (ETDEWEB)

    Conley, David [USAF SMC/MVB (United States); Lee, Norman Y.; Portanova, Peter L. [Aerospace Corp. (United States); Wood, Byron K. [Boeing Co., Rocketdyne Propulsion and Power (United States)

    2003-11-01

    Delta IV is one of two competing Evolved Expendable Launch Vehicle (EELV) systems being developed in an industry/United States Government partnership to meet the needs of the new era of space launch for the early decades of the 21st Century. The Rocketdyne Division of The Boeing Company and the United States Air Force have developed a 650 Klbf sea-level (2.9 MN) class liquid hydrogen/liquid oxygen main engine for the Delta IV family of EELV. The purpose of this paper is to present the innovative approach to the design, development, testing and certification of the RS-68 engine. (Author)

  6. UNIT, TIBET.

    Science.gov (United States)

    Louisiana Arts and Science Center, Baton Rouge.

    THE UNIT OF STUDY DESCRIBED IN THIS BOOKLET DEALS WITH THE GEOGRAPHY AND HISTORY OF TIBET. THE UNIT COVERS SOME OF THE GENERAL FEATURES OF THE COUNTRY AND THEIR EFFECT UPON THE LIVES OF THE TIBETAN PEOPLE. DISCUSSION QUESTIONS ARE INSERTED TO STIMULATE THOUGHT. THE RELIGION OF TIBET IS DISCUSSED IN RELATION TO ITS INFLUENCE ON THE ART AND CULTURE…

  7. Evaluation of potential severe accidents during low power and shutdown operations at Grand Gulf, Unit 1. Volume 2, Part 1C: Analysis of core damage frequency from internal events for plant operational State 5 during a refueling outage, Main report (Sections 11--14)

    Energy Technology Data Exchange (ETDEWEB)

    Whitehead, D. [Sandia National Labs., Albuquerque, NM (United States); Darby, J. [Science and Engineering Associates, Inc., Albuquerque, NM (United States); Yakle, J. [Science Applications International Corp., Albuquerque, NM (United States)] [and others

    1994-06-01

    This document contains the accident sequence analysis of internally initiated events for Grand Gulf, Unit 1 as it operates in the Low Power and Shutdown Plant Operational State 5 during a refueling outage. The report documents the methodology used during the analysis, describes the results from the application of the methodology, and compares the results with the results from two full power analyses performed on Grand Gulf.

  8. Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy

    DEFF Research Database (Denmark)

    Rogozinska, Ewelina; D'Amico, M. I.; Khan, Khalid S

    2016-01-01

    of intrauterine death, small for gestational age, large for gestational age, and admission to a neonatal intensive care unit (NICU). Conclusions Our work has identified the components of maternal, fetal, and neonatal composite outcomes required for the assessment of diet and lifestyle interventions in pregnancy......Objective To develop maternal, fetal, and neonatal composite outcomes relevant to the evaluation of diet and lifestyle interventions in pregnancy by individual patient data (IPD) meta-analysis. Design Delphi survey. Setting The International Weight Management in Pregnancy (i-WIP) collaborative...... care. The final components of the composite outcomes were identified using pre-specified criteria. Main outcome measures Composite outcomes considered to be important for the evaluation of the effect of diet and lifestyle in pregnancy. Results Of the 36 maternal outcomes, nine were prioritised...

  9. Assistant pullback technique for main span closure of Sutong Bridge

    Institute of Scientific and Technical Information of China (English)

    Chen Ming; Luo Chengbin; Wu Qihe; Zhang Yongtao; You Xinpeng

    2009-01-01

    Sutong Bridge is a cable-stayed steel box girder bridge with a main span of 1 088 m. The erection of upper structure adopts geometry control method and requires no change to the unit's size and the structure's none-stress geometry. Before main span closure, the cantilever of girder reaches 540.8 m, the structure state is noticeably influenced by external circumstances, the main span closure face great difficulty. By abstracting the advantage of the pullback method abroad and the domestic temperature-cutting method, a new assistant pullback method have put forward and bring into practice actually. In this paper, the analysis key point of practice conditions, key parameter of practice, main measures of the method and the performance is introduced.

  10. The advanced main control console for next japanese PWR plants

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, A. [Hokkaido Electric Power Co., Inc., Sapporo (Japan); Ito, K. [Mitsubishi Heavy Industries, Ltd., Nuclear Energy Systems Engineering Center, Yokohama (Japan); Yokoyama, M. [Mitsubishi Electric Corporation, Energy and Industrial Systems Center, Kobe (Japan)

    2001-07-01

    The purpose of the improvement of main control room designing in a nuclear power plant is to reduce operators' workload and potential human errors by offering a better working environment where operators can maximize their abilities. In order to satisfy such requirements, the design of main control board applied to Japanese Pressurized Water Reactor (PWR) type nuclear power plant has been continuously modified and improved. the Japanese Pressurized Water Reactor (PWR) Utilities (Electric Power Companies) and Mitsubishi Group have developed an advanced main control board (console) reflecting on the study of human factors, as well as using a state of the art electronics technology. In this report, we would like to introduce the configuration and features of the Advanced Main Control Console for the practical application to the next generation PWR type nuclear power plants including TOMARI No.3 Unit of Hokkaido Electric Power Co., Inc. (author)

  11. MAIN PROBLEMS OF CONTROLLING OF THE QUALITY

    Directory of Open Access Journals (Sweden)

    Orlov A. I.

    2015-09-01

    Full Text Available Controlling of statistical methods to ensure product quality is the special case of controlling organizational and economic methods of management. Today, controlling in the practice of management of Russian companies is understood as "the system of information-analytical and methodological support to achieve their goals." The controller is developing a decision-making rules, the head takes decisions on the basis of these rules. We proved the concept of "controlling of methods". Innovation in management is based, in particular, on the use of new adequate organizational-economic (as well as economicmathematical and statistical methods. Controlling in this area - is the development and application procedures of compliance management used and newly developed (implemented organizationaleconomic methods for the task. Thus, the methodology for controlling is of great practical value in any field in which the actions (operations must be carried out in accordance with certain rules (regulations, standards, guidelines, as in any such area in which we need to use development and application procedures of compliance management used and the newly established (implemented rules for solution of tasks assigned to the organization. In this article, we select a area of controlling as controlling quality, and we discuss its main issues. This is about controlling of organizational-economic methods to ensure product quality, especially about the statistical methods based on probability theory and mathematical statistics. We consider the analysis and synthesis of plans of statistical quality control, optimization options plans of statistical control, truncated plans. Are discussed the differences control plans provider and the consumer, the allocation of units formless (liquid, gas products, the selection of a random sample of the statistical quality control of products, lower estimate of the required sample size. It is established, that is not always necessary

  12. Main points for 1991 family planning work.

    Science.gov (United States)

    1991-06-01

    The main points for 1991 Family Planning (FP) Work in China are discussed as follows: 1) strengthen leadership, 2) strengthen grass roots buildup, 3 intensify population plan management and improve the responsibility system, 4) strengthen publicity and promote population and FP education in rural areas, 5) strengthen and establish the legal system for FP management, 6) provide excellent contraceptive and birth control services, 7 perform inservice training conscientiously and technical secondary education earnestly, and 8) coordinate efforts among related departments. Leadership changes involve the 2 top leaders of the Communist Party Committees and governments at each level taking personal responsibility for the implementation of their local population plans and FP work. FP work must have a prominent place on all agendas. The FP service network needs to be accelerated in countries, townships, and villages and grass roots units strengthened in urban areas. Provinces, autonomous regions, and municipalities must work out their local population plans for 1991-95 and 1991-99 according to the national population target. Rational apportionment needs to be considered for prefectures and counties. The emphasis should be on timely and accurate feedback and statistical supervision. The 1990 national population census data should be used to inform everyone about the current population situation. Legal needs entail standardizing documentation and developing local laws and regulations within a comprehensive system. Improvements are needed in such areas as rules and regulations pertaining to the administration of charges for unplanned births, identification of disabled children and approval of the birth quota. Abortion and unplanned births are to be averted through prepregnancy management. The emphasis is on voluntary use of contraception by couples of childbearing age. Inservice training should improve the political, ideological, professional proficiency, and ability to

  13. GAS MAIN SENSOR AND COMMUNICATIONS NETWORK SYSTEM

    Energy Technology Data Exchange (ETDEWEB)

    Hagen Schempf

    2004-09-30

    Automatika, Inc. was contracted by the Department of Energy (DOE) and with co-funding from the New York Gas Group (NYGAS), to develop an in-pipe natural gas prototype measurement and wireless communications system for assessing and monitoring distribution networks. In Phase II of this three-phase program, an improved prototype system was built for low-pressure cast-iron and high-pressure steel (including a no-blow installation system) mains and tested in a serial-network configuration in a live network in Long Island with the support of Keyspan Energy, Inc. The experiment was carried out in several open-hole excavations over a multi-day period. The prototype units (3 total) combined sensors capable of monitoring pressure, flow, humidity, temperature and vibration, which were sampled and combined in data-packages in an in-pipe master-repeater-slave configuration in serial or ladder-network arrangements. It was verified that the system was capable of performing all data-sampling, data-storage and collection as expected, yielding interesting results as to flow-dynamics and vibration-detection. Wireless in-pipe communications were shown to be feasible and the system was demonstrated to run off in-ground battery- and above-ground solar power. The remote datalogger access and storage-card features were demonstrated and used to log and post-process system data. Real-time data-display on an updated Phase-I GUI was used for in-field demonstration and troubleshooting.

  14. Turnley Unit

    Data.gov (United States)

    Federal Laboratory Consortium — Facilities at this unit include cattle working pens, hydraulic squeeze chute and electronic scale, a maintenance building, and four hay storage sheds. There is one...

  15. Operable Units

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset consists of operable unit data from multiple Superfund sites in U.S. EPA Region 8. These data were acquired from multiple sources at different times and...

  16. Detector Unit

    CERN Multimedia

    1960-01-01

    Original detector unit of the Instituut voor Kernfysisch Onderzoek (IKO) BOL project. This detector unit shows that silicon detectors for nuclear physics particle detection were already developed and in use in the 1960's in Amsterdam. Also the idea of putting 'strips' onto the silicon for high spatial resolution of a particle's impact on the detector were implemented in the BOL project which used 64 of these detector units. The IKO BOL project with its silicon particle detectors was designed, built and operated from 1965 to roughly 1977. Detector Unit of the BOL project: These detectors, notably the ‘checkerboard detector’, were developed during the years 1964-1968 in Amsterdam, The Netherlands, by the Natuurkundig Laboratorium of the N.V. Philips Gloeilampen Fabrieken. This was done in close collaboration with the Instituut voor Kernfysisch Onderzoek (IKO) where the read-out electronics for their use in the BOL Project was developed and produced.

  17. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  18. Nancy Rowe and George Curtis: Deaf Lives in Maine 150 Years Ago

    Science.gov (United States)

    Lane, Harlan; Pillard, Richard; Hedberg, Ulf

    2007-01-01

    This article is based on some findings in a larger project concerned with Deaf settlement in Maine. Maine is the site of one of the oldest and largest extended Deaf families in the United States: the Lovejoy-Jellison-Berry family (Jones 1996). However, in the late eighteenth and early nineteenth century, many extended Deaf families lived in Maine.…

  19. 30 CFR 57.6160 - Main facilities.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main facilities. 57.6160 Section 57.6160...-Underground Only § 57.6160 Main facilities. (a) Main facilities used to store explosive material underground... facilities will not prevent escape from the mine, or cause detonation of the contents of another storage...

  20. Ramadan, Fasting and Educational Outcomes

    Science.gov (United States)

    Oosterbeek, Hessel; van der Klaauw, Bas

    2013-01-01

    Using a difference-in-differences framework, we estimate the impact of Ramadan on educational outcomes of Muslim students living in a non-Muslim country. For identification we exploit that the number of Ramadan weeks during the course that we study, varies from year to year, ranging from zero to four. Our main finding is that Ramadan observance…

  1. Ramadan, Fasting and Educational Outcomes

    Science.gov (United States)

    Oosterbeek, Hessel; van der Klaauw, Bas

    2013-01-01

    Using a difference-in-differences framework, we estimate the impact of Ramadan on educational outcomes of Muslim students living in a non-Muslim country. For identification we exploit that the number of Ramadan weeks during the course that we study, varies from year to year, ranging from zero to four. Our main finding is that Ramadan observance…

  2. Analysis of Main Steam Safety Valve Improvement for Qinshan Nuclear Power Plant Phase 2 Unit 1 & 2%秦山第二核电厂1 & 2号机组主蒸汽安全阀改进分析

    Institute of Scientific and Technical Information of China (English)

    任春明; 陈坚刚; 黄代顺

    2015-01-01

    秦山第二核电厂1&2号机组拟将其加能助动式主蒸汽安全阀改为弹簧加载式安全阀。通过比对秦山第二核电厂3&4号机组主蒸汽安全阀设计,提出了1&2号机组主蒸汽安全阀改进方案,即第1组阀门采用弹簧加载式并调整开启整定值,并从机械设计、仪控设计和安全分析等方面论证了该方案的可行性。新的改进方案在保证安全的前提下,简化了设计,大幅减少了工程投入,同时降低了系统和控制逻辑复杂化后带来的潜在停堆风险的增加。%An improvement for Qinshan Nuclear Power Plant Phase 2 unit 1&2 ,in which the power‐operated valves are replaced with the spring‐loaded valve with setpoint adjustment for the 1st group safety valves of steam generators ,would be adpoted on the basis of comparison with similar improvement implemented in Qinshan Nuclear Power Plant Phase 2 unit 3&4 .The feasibility was evaluated from several aspects ,including mechanical design ,instrument & control design and safety analysis .On the premise of guaranteeing safety ,this improvement can simplify design ,observably reduce project costs and avoid increasing the potential probability of the reactor trip risk induced by complication of the system and control logic .

  3. Outcomes in Endoscopic Ear Surgery.

    Science.gov (United States)

    Kiringoda, Ruwan; Kozin, Elliott D; Lee, Daniel J

    2016-10-01

    Endoscopic ear surgery (EES) provides several advantages compared with traditional binocular microscopy, including a wide-field view, improved resolution with high magnification, and visual access to hidden corridors of the middle ear. Although binocular microscopic-assisted surgical techniques remain the gold standard for most otologists, EES is slowly emerging as a viable alternative for performing otologic surgery at several centers in the United States and abroad. In this review, we evaluate the current body of literature regarding EES outcomes, summarize our EES outcomes at the Massachusetts Eye and Ear Infirmary, and compare these results with data for microscopic-assisted otologic surgery.

  4. High parity and fetal morbidity outcomes.

    Science.gov (United States)

    Aliyu, Muktar H; Salihu, Hamisu M; Keith, Louis G; Ehiri, John E; Islam, M Aminul; Jolly, Pauline E

    2005-05-01

    We investigated the association between high parity and fetal morbidity outcomes. We analyzed 22,463,141 singleton deliveries at 20 weeks or more of gestation in the United States from 1989 through 2000. Adjusted odds ratios generated from logistic regression models were used to approximate relative risk for neonatal morbidity in women with 1-4 (moderate parity or type I; referent group), 5-9 (high parity or type II), 10-14 (very high parity or type III) and 15 or more (extremely high parity or type IV) prior live births. Main outcome measures included low and very low birth weight, preterm and very preterm birth, and small and large for gestational age delivery. The overall crude rates for low birth weight, very low birth weight, preterm birth, very preterm birth, and small and large for gestational age were 55, 11, 97, 19, 83, and 129 per 1,000 live births, respectively. The adjusted odds ratios for low birth weight, very low birth weight, preterm, and very preterm delivery increased consistently and in a dose-effect fashion with ascending parity (P for trend < .001). In the case of large for gestational age delivery, the adjusted odds ratio showed an inverted-U pattern, being highest among women in the type III parity cluster. The findings with respect to small for gestational age were inconclusive. High parity is a risk factor for adverse fetal outcomes. However, the impact of heightened parity is more manifest as shortened gestation rather than physical size restriction. These findings could prove beneficial for counseling women of high parity.

  5. [Management of maxillofacial injuries in an emergency unit: our experience].

    Science.gov (United States)

    Famà, Fausto; Beccaria, Antonio; Malara, Consolato; Placanica, Pantaleone; Cucinotta, Francesco; Caruso, Antonino; Estollere, Concetta; Versace, Giuseppina; Latorre, Nadia; Foti, Donatella; Falzea, Roberto; De Ponte, Francesco; Gioffrè-Florio, Maria Antonietta

    2009-01-01

    Maxillofacial injuries are relatively frequent. These may be complicated by cranioencephalic injuries or large facial wounds. We report our experience with the initial management of these lesions in an emergency unit setting. In 2007, we observed 105 patients with maxillofacial injuries. Maxillofacial injuries were associated with cranio-encephalic injuries in 69 patients (65.7%) and with polytrauma in 31(29.5%), while in 5 cases (4.8%) they were isolated. The main causes of trauma were motorcycle accidents (60%). All patients were treated in accordance with the Advanced Trauma Life Support guidelines and assessed by computed tomography. No mortality was observed after diagnosis in the emergency unit or in the month following the trauma. Seventy-seven patients (73.3%) were admitted and 28 (26.7%) were treated and discharged. Accurate diagnosis and appropriate initial management yield good clinical outcomes with functional restoration and fewer aesthetic complications.

  6. [Conservation Units.

    Science.gov (United States)

    Texas Education Agency, Austin.

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

  7. [Conservation Units.

    Science.gov (United States)

    Texas Education Agency, Austin.

    Instructional units deal with each aspect of conservation: forests, wildlife, rangelands, water, minerals, and soil. The area of the secondary school curriculum with which each is correlated is indicated. Lists of general and specific objectives are followed by suggested teaching procedures, including ideas for introducing the topic, questions to…

  8. Environmental Assessment Cross Island Complex Maine

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The United States Fish and Wildlife Service proposes to acquire fee title rights to approximately 1,355 acres by donation and 130 acres by purchase of coastal island...

  9. Clinimetrics & determinants of outcome after stroke

    NARCIS (Netherlands)

    Schepers, V.P.M.

    2006-01-01

    This thesis is based on findings of the Functional Prognostication and disability study on stroke, which had two main objectives: (1) to examine which outcome measures are most appropriate, and especially most responsive, for the assessment of functional outcome in stroke patients and (2) to study p

  10. Mapping health outcomes from ecosystem services

    NARCIS (Netherlands)

    Keune, Hans; Oosterbroek, Bram; Derkzen, Marthe; Subramanian, Suneetha; Payyappalimana, Unnikrishnan; Martens, Pim; Huynen, Maud; Burkhard, Benjamin; Maes, Joachim

    The practice of mapping ecosystem services (ES) in relation to health outcomes is only in its early developing phases. Examples are provided of health outcomes, health proxies and related biophysical indicators. This chapter also covers main health mapping challenges, design options and

  11. The Caspian energy game: views from the United States and United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Bird, H

    2003-07-01

    The importance of the Caspian Sea region to energy production is increasing and the forces influencing it are changing. The attention on this region focuses on its oil and natural gas reserves. A series of interviews with Western experts mainly from the United States and United Kingdom, including those in international organizations, academia, policy institutions, and government and industry officials identified key trends and issues that are important to their future policies and the significance of the Caspian oil and gas to the world energy market. The overriding issues are: The influence of Russia on regional security, stability, and the transportation of oil and gas products in the Caspian region. The outcome of the test between the United States and Iraq and the major effects it could have on commercial interests in the region and on who will be the major actors. Tensions caused by Iran refusal to settle the international demarcation of the Caspian Sea. Turkey position as a player, the affect of its new islamic-dominated government and its energy policies. Europe need to import gas and to diversify its supply. The construction of a pipeline to China. The impact of September 11, 2001 and terrorism on the Caspian region issues. The stability of the former Soviet Republics in the region. (author)

  12. Remedial investigation work plan for Bear Creek Valley Operable Unit 1 (S-3 Ponds, Boneyard/Burnyard, Oil Landfarm, Sanitary Landfill 1, and the Burial Grounds, including Oil Retention Ponds 1 and 2) at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 1, Main text

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-01

    The intent and scope of the work plan are to assemble all data necessary to facilitate selection of remediation alternatives for the sites in Bear Creek Valley Operable Unit 1 (BCV OU 1) such that the risk to human health and the environment is reduced to acceptable levels based on agreements with regulators. The ultimate goal is to develop a final Record Of Decision (ROD) for all of the OUs in BCV, including the integrator OU. However, the initial aim of the source OUs is to develop a ROD for interim measures. For source OUs such as BCV OU 1, data acquisition will not be carried out in a single event, but will be carried out in three stages that accommodate the schedule for developing a ROD for interim measures and the final site-wide ROD. The three stages are as follows: Stage 1, Assemble sufficient data to support decisions such as the need for removal actions, whether to continue with the remedial investigation (RI) process, or whether no further action is required. If the decision is made to continue the RI/FS process, then: Stage 2, Assemble sufficient data to allow for a ROD for interim measures that reduce risks to the human health and the environment. Stage 3, Provide input from the source OU that allows a final ROD to be issued for all OUs in the BCV hydrologic regime. One goal of the RI work plan will be to ensure that sampling operations required for the initial stage are not repeated at later stages. The overall goals of this RI are to define the nature and extent of contamination so that the impact of leachate, surface water runoff, and sediment from the OU I sites on the integrator OU can be evaluated, the risk to human health and the environment can be defined, and the general physical characteristics of the subsurface can be determined such that remedial alternatives can be screened.

  13. Riigikogu maine ja armastus / Aune Past

    Index Scriptorium Estoniae

    Past, Aune, 1954-

    2007-01-01

    Autor arutleb Riigikogu maine üle, toetudes TÜ ajakirjanduse ja kommunikatsiooni osakonna 2007. aastal tehtud uuringu tulemustele. Riigikogu liikmete maine paraneks, kui neil endil oleks selge, mis eesmärgil Toompeale mindi ja sellest siis ka rahvale kõneldaks

  14. Riigikogu maine ja armastus / Aune Past

    Index Scriptorium Estoniae

    Past, Aune, 1954-

    2007-01-01

    Autor arutleb Riigikogu maine üle, toetudes TÜ ajakirjanduse ja kommunikatsiooni osakonna 2007. aastal tehtud uuringu tulemustele. Riigikogu liikmete maine paraneks, kui neil endil oleks selge, mis eesmärgil Toompeale mindi ja sellest siis ka rahvale kõneldaks

  15. 78 FR 34701 - Maine Disaster #ME-00037

    Science.gov (United States)

    2013-06-10

    ... ADMINISTRATION Maine Disaster ME-00037 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the State of Maine dated 05/30/2013. Incident: Commercial and Residential Building Complex Fire. Incident Period: 05/03/2013. Effective Date:...

  16. 78 FR 34701 - Maine Disaster #ME-00036

    Science.gov (United States)

    2013-06-10

    ... ADMINISTRATION Maine Disaster ME-00036 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the State of Maine dated 05/30/2013. Incident: Apartment Complex Fire. Incident Period: 04/29/2013. Effective Date: 05/30/2013. Physical...

  17. Maine's Employability Skills Program

    Science.gov (United States)

    McMahon, John M.; Wolffe, Karen E.; Wolfe, Judy; Brooker, Carrie

    2013-01-01

    This Practice Report describes the development and implementation of the "Maine Employability Skills Program," a model employment program developed by the Maine Division for the Blind and Visually Impaired (DBVI). The program was designed to support the efforts of the chronically unemployed or underemployed. These consumers were either…

  18. FLYING UNITED

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Apart from selling hundreds of airplanes to China, Boeing buys locally made aircraft parts and transfers technology, in the true spirit of partnership Whenever Boeing's senior manager hear of a visit by one of China's state leaders, it's no doubt cause for celebration. Since China and the United States established diplomatic ties in 1978, every official trip by China's top statesmen has included a meeting with Boeing that

  19. U.S. hydropower resource assessment for Maine

    Energy Technology Data Exchange (ETDEWEB)

    Francfort, J.E.; Rinehart, B.N.

    1995-07-01

    The Department of Energy is developing an estimate of the undeveloped hydro-power potential in the United States. The Hydropower Evaluation Software (HES) is a computer model that was developed by the Idaho National Engineering Laboratory for this purpose. The software measures the undeveloped hydropower resources available in the United States, using uniform criteria for measurement. The software was developed and tested using hydropower information and data provided by the Southwestern Power Administration. It is a menu-driven software program that allows the personal computer user to assign environmental attributes to potential hydropower sites, calculate development suitability factors for each site based on the environmental attributes present, and generate reports based on these suitability factors. This report details the resource assessment results for the State of Maine.

  20. LIQUID PHASE FISCHER-TROPSCH (III & IV) DEMONSTRATION IN THE LAPORTE ALTERNATIVE FUELS DEVELOPMENT UNIT. Final Topical Report. Volume I/II: Main Report. Task 1: Engineering Modifications (Fischer-Tropsch III & IV Demonstration) and Task 2: AFDU Shakedown, Operations, Deactivation (Shut-Down) and Disposal (Fischer-Tropsch III & IV Demonstration).

    Energy Technology Data Exchange (ETDEWEB)

    Bharat L. Bhatt

    1999-06-01

    Slurry phase Fischer-Tropsch technology was successfully demonstrated in DOE's Alternative Fuels Development Unit (AFDU) at LaPorte, Texas. Earlier work at LaPorte, with iron catalysts in 1992 and 1994, had established proof-of-concept status for the slurry phase process. The third campaign (Fischer-Tropsch III), in 1996, aimed at aggressively extending the operability of the slurry reactor using a proprietary cobalt catalyst. Due to an irreversible plugging of catalyst-wax separation filters as a result of unexpected catalyst fines generation, the operations had to be terminated after seven days on-stream. Following an extensive post-run investigation by the participants, the campaign was successfully completed in March-April 1998, with an improved proprietary cobalt catalyst. These runs were sponsored by the U. S. Department of Energy (DOE), Air Products & Chemicals, Inc., and Shell Synthetic Fuels, Inc. (SSFI). A productivity of approximately 140 grams (gm) of hydrocarbons (HC)/ hour (hr)-liter (lit) of expanded slurry volume was achieved at reasonable system stability during the second trial (Fischer-Tropsch IV). The productivity ranged from 110-140 at various conditions during the 18 days of operations. The catalyst/wax filters performed well throughout the demonstration, producing a clean wax product. For the most part, only one of the four filter housings was needed for catalyst/wax filtration. The filter flux appeared to exceed the design flux. A combination of use of a stronger catalyst and some innovative filtration techniques were responsible for this success. There was no sign of catalyst particle attrition and very little erosion of the slurry pump was observed, in contrast to the Fischer-Tropsch III operations. The reactor operated hydrodynamically stable with uniform temperature profile and gas hold-ups. Nuclear density and differential pressure measurements indicated somewhat higher than expected gas hold-up (45 - 50 vol%) during Fischer

  1. Total Phosphorus Loads for Selected Tributaries to Sebago Lake, Maine

    Science.gov (United States)

    Hodgkins, Glenn A.

    2001-01-01

    The streamflow and water-quality datacollection networks of the Portland Water District (PWD) and the U.S. Geological Survey (USGS) as of February 2000 were analyzed in terms of their applicability for estimating total phosphorus loads for selected tributaries to Sebago Lake in southern Maine. The long-term unit-area mean annual flows for the Songo River and for small, ungaged tributaries are similar to the long-term unit-area mean annual flows for the Crooked River and other gaged tributaries to Sebago Lake, based on a regression equation that estimates mean annual streamflows in Maine. Unit-area peak streamflows of Sebago Lake tributaries can be quite different, based on a regression equation that estimates peak streamflows for Maine. Crooked River had a statistically significant positive relation (Kendall's Tau test, p=0.0004) between streamflow and total phosphorus concentration. Panther Run had a statistically significant negative relation (p=0.0015). Significant positive relations may indicate contributions from nonpoint sources or sediment resuspension, whereas significant negative relations may indicate dilution of point sources. Total phosphorus concentrations were significantly larger in the Crooked River than in the Songo River (Wilcoxon rank-sum test, pestimate the annual total phosphorus load for Crooked River, Northwest River, and Rich Mill Pond Outlet for water years 1996-98. The MOVE.1 method was used to estimate daily streamflows for the regression method at Northwest River and Rich Mill Pond Outlet, where streamflows were not continuously monitored. An averaging method also was used to compute annual loads at the three sites. The difference between the regression estimate and the averaging estimate for each of the three tributaries was consistent with what was expected from previous studies.

  2. Synthesis and characterization of novel main chain bisazobenzene polyphosphonates

    Science.gov (United States)

    Vlad-Bubulac, Tǎchiţǎ; Serbezeanu, Diana; Carja, Ionela-Daniela

    2016-12-01

    Preparation and experimental studies on the phase transition and morphology of novel phosphorus-containing copolymers, having bisazobenzene units and variable molar ratio of aliphatic segments in the main chain, were performed. The chemical structure of the novel compounds has been confirmed by Fourier transform infrared and 1H-NMR spectroscopy. The thermal stability was investigated by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) while the mesomorphic behavior was closely observed with polarized light microscope (PLM) and by X-ray diffraction measurements, structure-properties relationships being established and discussed.

  3. Alcid Nesting Habitat on the Maine Coast

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Maine supports an extensive seabird population because of the abundance of relatively inaccessible rocky coastal islands which are ideal nesting grounds for many...

  4. Distributed PV Adoption in Maine Through 2021

    Energy Technology Data Exchange (ETDEWEB)

    Gagnon, Pieter; Sigrin, Ben

    2015-11-06

    NREL has used its dSolar (distributed solar) model to generate low-medium-high estimates of distributed PV adoption in Maine through 2021. This presentation gives a high-level overview of the model and modeling results.

  5. Hillshades for the main 8 Hawaiian Islands

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These hillshade datasets were derived from USGS 7.5' DEM Quads for the main 8 Hawaiian Islands. Individual DEM quads were first converted to a common datum, and...

  6. Libraries in Maine: MedlinePlus

    Science.gov (United States)

    ... 602-2386 http://www.une.edu/library/ Lewiston Bates College Ladd Library 48 Campus Avenue Lewiston, ME 04240-6087 207-786-6471 http://abacus.bates.edu/Library/ Central Maine Medical Center Gerrish-True ...

  7. Superconducting magnets for the LHC main lattice

    CERN Document Server

    Rossi, L

    2004-01-01

    The main lattice of the Large Hadron Collider (LHC) will employ about 1600 main magnets and more than 4000 corrector magnets. All superconducting and working in pressurized superfluid helium bath, these impressive line of magnets will fill more than 20 km of the underground tunnel. With almost 70 main dipoles already delivered and 10 main quadrupoles almost completed, we passed the 5% of the production and now all manufacturers have fully entered into series production. In this paper the most critical issues encountered in the ramping up in such a real large scale fabrication will be addressed: uniformity of the coil size and of prestress, special welding technique, tolerances on curvature (dipoles) or straightness (quadrupoles) and of the cold mass extremities, harmonic content and, most important, the integrated field uniformity among magnets. The actual limits and the solution for improvements will be discussed. Finally a realistic schedule based on actual achievements is presented.

  8. Mercury in bird eggs from coastal Maine

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Maine's coastal islands and beaches provide important nesting habitat for piping plover (Charadrius melodus), least tern (Sterna antillarum), common tern (Sterna...

  9. Station Management Plan Maine Coastal Refuges

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This management plan outlines how four Maine refuges and twelve islands and one peninsula should be managed over the next three to five years. Plan results are...

  10. Effects of acute rejection vs new-onset diabetes after transplant on transplant outcomes in pediatric kidney recipients: analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database.

    Science.gov (United States)

    Mehrnia, Alireza; Le, Thuy X; Tamer, Tamer R; Bunnapradist, Suphamai

    2016-11-01

    Improving long-term transplant and patient survival is still an ongoing challenge in kidney transplant medicine. Our objective was to identify the subsequent risks of new-onset diabetes after transplant (NODAT) and acute rejection (AR) in the first year post-transplant in predicting mortality and transplant failure. A total of 4687 patients without preexisting diabetes (age 2-20 years, 2004-2010) surviving with a functioning transplant for longer than 1 year with at least one follow-up report were identified from the OPTN/UNOS database as of September 2014. Study population was stratified into four mutually exclusive groups: Group 1, patients with a history of AR; Group 2, NODAT+; Group 3, NODAT+ AR+; and Group 4, the reference group (neither). Multivariate regression was used to analyze the relative risks for the outcomes of transplant failure and mortality. The median follow-up time was 1827 days after 1 year post-transplant. AR was associated with an increased risk of adjusted graft and death-censored graft failure (HR 2.87, CI 2.48-3.33, P < .001 and HR 2.11, CI 1.81-2.47, P < .001), respectively. NODAT and AR were identified in 3.5% and 14.5% of all study patients, respectively. AR in the first year post-transplant was a major risk factor for overall and death-censored graft failure, but not mortality. However, NODAT was not a risk factor on graft survival or mortality.

  11. Investigation of Tidal Power, Cobscook Bay, Maine.

    Science.gov (United States)

    1980-08-01

    240 megawatt project on the Rance River in France and a 400 kilowatt station on the Kislaya Guba Gulf in the Soviet Union. Recently, studies have taken...Tidal Power Project, Maine" October 1979. 44. Ploch, Lousi A. and Nelson L. LeRoy, "Social and Economic Consequen- ces of the Dickey- Lincoln School...Regional Planning Commission," Machias, Maine, 1977. 47. U.S. Department of Energy, Southeast Power Administration, Dickey- Lincoln School Project

  12. Molecular clusters of the main group elements

    CERN Document Server

    Driess, Matthias

    2008-01-01

    ""To summarize, Molecular Clusters of the Main Group Elements is certainly not a popular science book, nor is it a textbook; it is a very good, up-to-date collection of articles for the specialist. Als Fazit bleibt: Molecular Clusters of the Main Group Elements ist sicher kein populissenschaftliches Werk, auch kein Lehrbuch, aber eine gelungene, hoch aktuelle Zusammenstellung fen interessierten Fachmann."" -Michael Ruck, TU Dresden, Angewandte Chemie, 2004 - 116/36 + International Edition 2004 - 43/36

  13. Aneurysm of the left main coronary artery

    Directory of Open Access Journals (Sweden)

    Ênio E. Guérios

    2000-12-01

    Full Text Available Aneurysm of the left main coronary artery is a rare angiographic finding, with few cases described in the international literature. We report the case of a 42-year-old male with a previous history of acute myocardial infarction, whose coronariography indicated triple vessel coronary disease and an aneurysm of the left main coronary artery. A review of the etiology, clinical aspects, and surgical management of coronary arterial aneurysm is presented.

  14. Menstrual patterns, fertility and main pregnancy outcomes after allogeneic haematopoietic stem cell transplantation.

    Science.gov (United States)

    Chiodi, Sandra; Spinelli, Simonetta; Bruzzi, Paolo; Anserini, Paola; Di Grazia, Carmen; Bacigalupo, Andrea

    2016-08-01

    Two-hundred and sixty-nine females aged ≤42 and undergoing an allogeneic stem cell transplant were retrospectively studied to assess the effect of age, conditioning regimen and chronic graft-versus-host disease (cGVHD) on resumption of stable menstrual cyclicity. Overall, a stable menstrual cyclicity was observed in 22% of cases. The cumulative probability of menses resumption was significantly age and conditioning regimen related. A statistically significant inverse correlation between cGVHD severity and menses resumption was observed only in univariate analysis. In patients with residual ovarian function, infertility was found in 43% and early menopause in 45%. An increased incidence of prematurity and low birth weight (LBW) was observed among the single spontaneous pregnancies. Follicle-stimulating hormone (FSH) and 17 beta-oestradiol levels were found to be inadequate to detect both early signs of menses resumption and menstrual stability. Our study confirms the crucial role of full dose total body irradiation (TBI) and age on menses recovery and fertility after haematopoietic stem cell transplantation (HSCT). The impact of severe cGVHD remains unclear.

  15. Pulsation Solution to the Equation of Earth's Gravitational Field (Main Outcome)

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Using d'Alembert equation as the approximation of Einstein's equation, a solution is given in this paper to the time-dependent gravitational equation of the Earth in consideration of the Earth's features, which describes the characteristics of pulsation of the Earth and the structures of spherical layers of its interior, thus providing a theoretical basis for establishing the idea of mantle pulsation.

  16. Clinical case reviews and poster sessions in multiple sclerosis spasticity: main outcomes and highlights.

    Science.gov (United States)

    Trojano, Maria; Celius, Elisabeth G; Donzé, Cecile; Izquierdo, Guillermo; Patti, Francesco; Pöhlau, Dieter

    2014-01-01

    Individuals with multiple sclerosis (MS) spasticity present with a range of symptoms and disability levels that are frequently challenging to manage. Summary : Clinical case reviews in treatment-resistant MS spasticity were presented in five country-specific sessions conducted in parallel at the MS Experts Summit. Attendees at the Norwegian session discussed early response to new treatments for severe spasticity and highlighted the importance of titrating THC:CBD oromucosal spray (Sativex®) when adding it to baclofen. The French group focussed on MS symptoms and patient characteristics that interact with spasticity and agreed on a list of minimum ratings for diagnosis of MS spasticity symptoms. Attendees at the Spanish session concurred that THC:CBD oromucosal spray is effective and well tolerated as add-on therapy in treatment-resistant MS spasticity, particularly for pain, spasms and gait disturbances. The Italian group discussed the use of add-on THC:CBD oromucosal spray and other possible combination therapies for treatment-resistant MS spasticity. Attendees at the German session highlighted the need to address trigger factors for MS spasticity to reduce the potential for impact on activities of daily living (ADL) and quality of life (QoL). Three innovative studies of MS spasticity from the poster session were selected for closer review. The MOVE 1 EU epidemiological study indicated that, across western Europe, patients with MS spasticity continue to have unmet management needs. A literature review demonstrated that symptomatic relief of MS spasticity in patients who respond to THC:CBD oromucosal spray translates into sustainable improvements in ADL and QoL. Enriched-design studies of medications targeting the endocannabinoid system require careful interpretation due to possible pharmacodynamic 'priming', i.e. carry-over effects of successful active treatment during the enrichment phase. Key Messages: Sharing experiences of clinical practice, including experience with the use of THC:CBD oromucosal spray, may be useful to overcome some of the challenges in the overall management of patients with moderate to severe treatment-resistant MS spasticity. © 2014 S. Karger AG, Basel.

  17. Join Cost for Unit Selection Speech Synthesis

    OpenAIRE

    Vepa, Jithendra

    2004-01-01

    Undoubtedly, state-of-the-art unit selection-based concatenative speech systems produce very high quality synthetic speech. this is due to a large speech database containing many instances of each speech unit, with a varied and natural distribution of prosodic and spectral characteristics. the join cost, which measures how well two units can be joined together is one of the main criteria for selecting appropriate units from this large speech database. The ideal join cost is one that measur...

  18. Functional outcome after thrombolytic therapy.

    Science.gov (United States)

    Miljković, Sinisa; Prtina, Drasko; Rabi Zikić, Tamara; Vujković, Zoran; Racić, Dusko; Dajić, Vlado; Jesić, Aleksandar; Arbutina, Milan; Zikić, Milorad

    2010-06-01

    In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score > or=90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score < or =2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a 'door-to-needle' time of less than 60 minutes and emphasize that 'time is brain'.

  19. Water resources of the Penobscot River basin, Maine

    Science.gov (United States)

    Barrows, Harold Kilbrith; Babb, Cyrus Cates

    1912-01-01

    This report on the Penobscot River drainage system, the largest and one of the most important in Maine, has been compiled chiefly from the records, reports, and maps of the United States Geological Survey and from the results of surveys made in cooperation with the Maine State Survey Commission. The report includes all data on precipitation, stream flow, water storage, and water power that were available at the end of the calendar year 1909 and is accompanied by plans and profiles of the principal rivers, lakes, and ponds in the basin (Pis. XIII-XIX, at end of volume). Stream-flow data for 1910 and 1911 will be published in Water-Supply Papers 281 and 301, respectively.

  20. A Mixed-Methods Study of Immigrant Somali Women's Health Literacy and Perinatal Experiences in Maine.

    Science.gov (United States)

    Jacoby, Susan D; Lucarelli, Monique; Musse, Fowsia; Krishnamurthy, Ashok; Salyers, Vince

    2015-01-01

    Research on health care provided to clients with limited English proficiency in the United States has revealed poor satisfaction and increased use of the health care system. This mixed-methods study explored health literacy and the perinatal experiences of Somali and Somali Bantu women living in Lewiston, Maine. The study also describes the development and validation of historietas (comic-book style health education brochure) used to increase knowledge and awareness of why emergency cesareans may be required and the symptoms of postpartum depression (PPD). During phase 1, a focus group to discuss the perinatal experiences of Somali women (n = 4) was undertaken and 2 historietas were developed to create greater understanding of emergency cesareans and PPD. In phase 2, Somali and Somali Bantu women (n = 19) completed a health literacy questionnaire and a perinatal experiences questionnaire. A focus group was also conducted during phase 2 to determine the perinatal experiences of the participants. Phase 2 participants validated the historietas developed in phase 1. Responses from focus groups were triangulated with data from the perinatal experiences questionnaire completed during phase 2. Overall, none of the phase 2 participants demonstrated adequate health literacy. Problems with gudnin (Somali word for cutting) related to female genital mutilation/cutting and PPD yielded statistically significant results. Somali women expressed dissatisfaction with certain obstetric interventions, especially emergency cesareans. Phase 2 participants unanimously validated the usefulness of the historietas as a clinical teaching tool. Poor health literacy due to language barriers may place Somali women living in the United States at risk for adverse outcomes during pregnancy and/or birth. Complications related to emergency cesareans and PPD were identified as significant problems for which Somali women require further knowledge. Historietas addressing knowledge gaps related to

  1. Main: 1BA7 [RPSD[Archive

    Lifescience Database Archive (English)

    Full Text Available ; Glycine Max Molecule: Trypsin Inhibitor (Kunitz); Chain: A, B; Biological_unit: Monomer Serine Protease In...ion, Resolution: 2.5 Angstrom, R-Factor: 0.160, R-Free: 0.223 Length: 216 AA, Molecular weight: 24005 Da MKSTIFFLFLFCAFTTSYLPSAI

  2. Main: 1QDM [RPSD[Archive

    Lifescience Database Archive (English)

    Full Text Available phytepsin; Chain: A, B, C; Biological_unit: Monomer Hydrolase 3.4.23.40 (Prophytepsin) J.Kervinen, G.J.Tobin..., J.Costa, D.S.Waugh, A.Wlodawer, A.Zdanov J.Kervinen, G.J.Tobin, J.Costa, D.S.Waugh, A.Wlodawer, A.Zdanov C

  3. Practice and outcomes of appointment visiting system in the intensive care units%ICU限制性探视结合预约探视制度的实施及安全管理

    Institute of Scientific and Technical Information of China (English)

    冯素萍; 宿艳琴; 方慧玲; 王荃声; 王江东; 王玉伟

    2012-01-01

    为了更好地满足ICU患者和家属的探视需求,贯彻以人为本的服务理念,采用限制性探视与预约探视相结合的方法,接受5160名家属对综合ICU 853例患者进行探视.效果:患者对护理工作的满意度由95.0%提高到98.5%,感染率由2.5%下降为2.3%,纠纷发生率为0.ICU实施限制式探视与预约探视相结合的方法,更好地满足了患者和家属的需要.%In order to meet the visit demands of ICU patients and their families,and achieve patient-oriented service con cept, the appointment visiting system combined with restrictive visiting was implemented in the intensive care units (ICU). In this way,the ICU has accepted 5160 patients' family members to visit 853 patients. The patient satisfaction rate increased from 95% to 98.5%; the infection rate decreased from 2.5% to 2.3%; the incidence of medical dispute was zero. This approach can meet the needs of patients and their families.It is a good way for visiting management.

  4. Variability in plasma concentration of cefotaxime in critically ill patients in an Intensive Care Unit of India and its pharmacodynamic outcome: A nonrandomized, prospective, open-label, analytical study

    Directory of Open Access Journals (Sweden)

    B Abhilash

    2016-01-01

    Full Text Available Background: Cefotaxime is a widely utilized cephalosporin in most intensive care units of India. However, no data are available about its pharmacokinetic/pharmacodynamic variability in critically ill patients of the Indian population. Aim: To investigate the variability in the plasma concentration and pharmacodynamic profile of intermittent dosing of cefotaxime in critically ill patients, according to their locus of infection and causative organism. Materials and Methods: Cefotaxime levels were determined using high-performance liquid chromatography by grouping patients according to their locus of infection as hepatobiliary, renal, pulmonary, and others. Patients with cefotaxime concentration below the minimum inhibitory concentration (MIC and 5 times below the MIC for the isolated organism were determined. Results: The difference in the plasma cefotaxime concentration between the hepatobiliary and the nonhepatobiliary groups was significant at 1 h (P = 0.02 following drug dosing, while the difference was significant between the renal and nonrenal group at 1 h (P = 0.001, 4 h (P = 0.009, and 8 h (P = 0.02 after drug dosing. The pulmonary group showed significantly (P < 0.05 lower plasma cefotaxime levels than the nonpulmonary group at all-time points. The cefotaxime levels were below the MIC and below 5 times the MIC for the isolated organism in 16.67% and 43.33% of the patients, respectively. Conclusion: The concentration of cefotaxime differs according to the locus of an infection in critically ill patients. Use of another class of antibiotic or shifting to continuous dosing of cefotaxime, for organisms having MIC values above 1 mg/L, is advisable due to the fear of resistance.

  5. United States

    Directory of Open Access Journals (Sweden)

    Stephen Bernow

    1998-12-01

    Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.

  6. 77 FR 40147 - Boston and Maine Corporation-Abandonment Exemption-in Worcester County, MA

    Science.gov (United States)

    2012-07-06

    ... Surface Transportation Board Boston and Maine Corporation--Abandonment Exemption--in Worcester County, MA Boston and Maine Corporation (B&M) has filed a verified notice of exemption under 49 CFR part 1152....\\1\\ The line traverses United States Postal Service Zip Code 01440. \\1\\ On June 20, 2012, the...

  7. Main building fire drill safely concluded

    CERN Multimedia

    CERN Bulletin

    2015-01-01

    Last week, a simulated fire in the stairwell of the Main Building put CERN’s emergency response procedures to the test.   Firefighters descend the stairwell in the Main Building as the simulated fire rises.   At 2 p.m. on 22 September, alarms sounded around CERN’s Main Building as an evacuation exercise got underway. A simulated fire in the  stairwell, complete with very realistic smoke, led to the evacuation of one of the busiest places at CERN. The Main Building complex includes the Carlson Wagonlit travel agency, the post office, UBS, Uniqa, the Users Office, the Staff Association and the Novae restaurant as well as the Main Auditorium, the Council Chamber and the Charpak meeting room. It was impressive to see how quickly the smoke propagated in the staircase as well as into the corridors, and equally impressive to see how smoothly, quickly and efficiently the evacuation proceeded. The...

  8. Fecal Carriage of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Strains Is Associated with Worse Outcome in Patients Hospitalized in the Pediatric Oncology Unit of Beni-Messous Hospital in Algiers, Algeria.

    Science.gov (United States)

    Medboua-Benbalagh, Chafiaa; Touati, Abdelaziz; Kermas, Rachida; Gharout-Sait, Alima; Brasme, Lucien; Mezhoud, Halima; Touati, Djamila; Guillard, Thomas; de Champs, Christophe

    2017-09-01

    The current study aimed to investigate extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) fecal carriage in children with different cancers admitted in the pediatric oncology unit of Beni-Messous Hospital (Algiers, Algeria). Rectal swabs from children with cancer were sampled from February 2012 to May 2013 within 48 hours following their admission. After species identification and detection of ESBL production by double-disk synergy test (DD test), antibiotic susceptibility was determined by the standard disk diffusion method. Antibiotic resistance genes, including bla genes and plasmid-mediated quinolone resistance (PMQR) genes, were investigated by polymerase chain reaction (PCR). The phylogenetic grouping of Escherichia coli strains was determined by PCR. Of the 171 children studied, 93 (54%) were ESBL carriers. An antibiotic treatment for the last 3 months before admission (p = 0.01), hematological malignancies (p = 0.003), and death (p = 0.0003) were more frequent in the ESBL-E group than in the non-ESBL group. Multivariate analysis showed that hematological malignancies (odds ratio [OR]: 3.9; confidence interval [CI]: 1.1-14.1; p = 0.04) and ESBL-E carriage (OR: 6.2; CI: 1.7-22.00; p = 0.005) were two independent factors associated with increased risk of death. A total of 103 ESBL-E isolates were obtained. Klebsiella pneumoniae and E. coli isolates were the most frequently isolated. PCR amplification showed that all the isolates produced a CTX-M ESBL (CTX-M-15, CTX-M-14, and CTX-M-3). The PMQR genes detected were qnrB, qnrS, and aac(6')-Ib-cr. E. coli isolates were assigned to four major extraintestinal pathogenic E. coli phylogroups, including B2 and D. This study provides, for the first time, insight into epidemiology of the ESBL-E fecal carriage among children with cancer in Algeria.

  9. AUDIT OF MUNICIPALITIES AND LOCAL GOVERNMENT UNITS - THE CASE STUDY OF THE CZECH REPUBLIC

    Directory of Open Access Journals (Sweden)

    Richard POSPISIL

    2017-05-01

    Full Text Available Public economics examines the influence of the state on economic equality and efficiency, and on conduction of business entities in connection with the various tax systems and individual behavior in private consumption. To manage the public economy is thorough knowledge of the real decision-making and allocation mechanisms. From a budgetary perspective, the public economy in the Czech Republic is characterized mainly by the state budget, 6,249 municipal budgets and 14 budgets of local government units. These all units are together subject to annual statutory audit, which mainly represents the analysis of the system of the Audit informative and monitoring indicators (ASIMI. The paper analyzes the outcome of the audit with the use of absolute and relative indicators and suggests possible changes and consolidation of municipal and local government budgets in the Czech Republic.

  10. Parents' experiences of caring for preterm infants after discharge with grandmothers as their main support.

    Science.gov (United States)

    Adama, Esther Abena; Bayes, Sara; Sundin, Deborah

    2017-05-05

    To explore parents of preterm infants' experiences of caring for their preterm infants with the grandmother as their primary support after discharge. Preterm delivery is the major cause of high neonatal mortality in sub-Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not-for-hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. Qualitative narrative inquiry methodology was used. Face-to-face interviews using semi-structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three-dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. Three themes emerged from the data, namely (i) Grandmother's prescriptions, (ii) Fighting for the well-being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents' mental health. As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants. © 2017 John Wiley & Sons Ltd.

  11. Main Coast Winds - Final Scientific Report

    Energy Technology Data Exchange (ETDEWEB)

    Jason Huckaby; Harley Lee

    2006-03-15

    The Maine Coast Wind Project was developed to investigate the cost-effectiveness of small, distributed wind systems on coastal sites in Maine. The restructuring of Maine's electric grid to support net metering allowed for the installation of small wind installations across the state (up to 100kW). The study performed adds insight to the difficulties of developing cost-effective distributed systems in coastal environments. The technical hurdles encountered with the chosen wind turbine, combined with the lower than expected wind speeds, did not provide a cost-effective return to make a distributed wind program economically feasible. While the turbine was accepted within the community, the low availability has been a negative.

  12. The double main sequence of Omega Centauri

    CERN Document Server

    Bedin, L R

    2004-01-01

    Recent, high precision photometry of Omega Centauri, the biggest Galactic globular cluster, has been obtained with Hubble Space Telescope. The color magnitude diagram reveals an unexpected bifurcation of colors in the main sequence (MS). The newly found double MS, the multiple turnoffs and subgiant branches, and other sequences discovered in the past along the red giant branch of this cluster add up to a fascinating but frustrating puzzle. Among the possible explanations for the blue main sequence an anomalous overabundance of helium is suggested. The hypothesis will be tested with a set of FLAMES@VLT data we have recently obtained (ESO DDT program), and with forthcoming ACS@HST images.

  13. [Risk factors of main cancer sites].

    Science.gov (United States)

    Uleckiene, Saule; Didziapetriene, Janina; Griciūte, Liudvika Laima; Urbeliene, Janina; Kasiulevicius, Vytautas; Sapoka, Virginijus

    2008-01-01

    Cancer prevention is a system of various measures devoted to avoid this disease. Primary cancer prevention means the identification, avoidance, or destruction of known risk factors. The main risk factors are smoking, diet, alcohol consumption, occupational factors, environmental pollution, electromagnetic radiation, infection, medicines, reproductive hormones, and lack of physical activity. Approximately one-third of cancers can be avoided by implementing various preventive measures. The aim of this article was to acquaint medical students, family doctors with risk factors of main cancer sites (lung, breast, colorectal, and prostate).

  14. Design and Analysis of the Main AC/DC Converter System for ITER

    Institute of Scientific and Technical Information of China (English)

    盛志才; 许留伟; 傅鹏

    2012-01-01

    A design of the main AC/DC converter system for ITER is described and the configuration of the main AC/DC converters is presented. To reduce the reactive power absorbed from the converter units, the main AC/DC converters are designed to be series-connected and work in a sequential mode. The structure of the regulator of the converter system is described. A simulation model was built up for the PSCAD/EMTDC code, and the design was validated accordingly. Harmonic analysis and reactive power calculation of the converters units are presented. The results reveal the advantage of sequential control in reducing reactive power and harmonics.

  15. The burden and outcome of in utero transfers.

    Science.gov (United States)

    Musson, Rebecca E; Harrison, Catherine M

    2016-05-01

    To quantify the number of intrauterine transfers (IUTs) arranged by Embrace Yorkshire and Humber Infant and Children's Transport Service and, to determine the outcome of when women delivered their babies, or when they were discharged following transfer. Identification of all IUTs Embrace arranged between January 1, 2011 and February 29, 2012 with data collection to determine delivery time or date of discharge. There were 623 IUT referrals with a mean time taken to arrange a transfer of 109 minutes. The mean distance of IUT was 42.5 miles, and the main reason for IUT request was capacity of referring unit. 247 (52%) women delivered during the same admission and 156 delivered within 48 hours of transfer. Of those undelivered, 111 (48.7%) were discharged within 48 hours. Fibronectin test was used in 51 patients. The IUT service provided by Embrace is busy, with significant demands on administrative staff time. Neonatal cot capacity and gestation are the main reasons for transfer. There is potentially a cohort of women who may not have benefitted from IUT. We suggest the use of obstetric expertise will enhance the service, while ongoing work looking at neonatal unit cot capacity problems continues. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  16. Main: 1HSS [RPSD[Archive

    Lifescience Database Archive (English)

    Full Text Available m Molecule: 0.19 Alpha-Amylase Inhibitor; Chain: A, B, C, D; Biological_unit: Dimer Cereal Inhibitor Y.Oda, K.Fukuyama Y.Oda, T.Ma...tsunaga, K.Fukuyama, T.Miyazaki, T.Morimoto Tertiary And Quaternary Structures Of 0.19... Resolution Biochemistry V. 36 13503 1997 Cereal Inhibitor, Animal Amylase SWS:IAA1_WHEAT,P01085|EMBL; AB003

  17. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil Estudo comparativo dos desfechos entre uma unidade de AVC e uma enfermaria geral: estudo randomizado em Joinville, Brasil

    Directory of Open Access Journals (Sweden)

    Norberto L. Cabral

    2003-06-01

    Full Text Available BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU on acute phase treatment when compared to a conventional general ward treatment (GW. METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW. We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41, whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24, 17.4% and 28.7% on the 3rd month (p= 0.39, and 25.7% and 30.7% on the 6th month (p= 0.41. Thirty-day survival curve achieved 1.8 log rank (p= 0.17, with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.OBJETIVO: Avaliar se o tratamento da fase aguda em uma unidade de acidente vascular cerebral (U-AVC reduz a morbi-mortalidade quando comparado a uma enfermaria geral. MÉTODO: Pacientes com AVC agudo foram randomizados entre a U-AVC e uma enfermaria geral (EG. Comparou-se tempo de internação, letalidade e dependência funcional e clínica no período de 6 meses. RESULTADOS: Obtivemos 35 pacientes na U-AVC e 39 pacientes na EG. A letalidade encontrada na U-VAC e na EG foram respectivamente 8,5% e 12,8% no décimo dia (p=,41, 14,2% e 28,2% no trigésimo dia (p=,24

  18. 78 FR 42556 - Maine Yankee Atomic Power Company; Maine Yankee Atomic Power Plant Issuance of Environmental...

    Science.gov (United States)

    2013-07-16

    ... COMMISSION Maine Yankee Atomic Power Company; Maine Yankee Atomic Power Plant Issuance of Environmental..., 2011, with various implementation dates for each of the rule changes. Maine Yankee Atomic Power Company... ADAMS, which provides text and image files of NRC's public documents. If you do not have access to...

  19. MAINS: MULTI-AGENT INTELLIGENT SERVICE ARCHITECTURE FOR CLOUD COMPUTING

    Directory of Open Access Journals (Sweden)

    T. Joshva Devadas

    2014-04-01

    Full Text Available Computing has been transformed to a model having commoditized services. These services are modeled similar to the utility services water and electricity. The Internet has been stunningly successful over the course of past three decades in supporting multitude of distributed applications and a wide variety of network technologies. However, its popularity has become the biggest impediment to its further growth with the handheld devices mobile and laptops. Agents are intelligent software system that works on behalf of others. Agents are incorporated in many innovative applications in order to improve the performance of the system. Agent uses its possessed knowledge to react with the system and helps to improve the performance. Agents are introduced in the cloud computing is to minimize the response time when similar request is raised from an end user in the globe. In this paper, we have introduced a Multi Agent Intelligent system (MAINS prior to cloud service models and it was tested using sample dataset. Performance of the MAINS layer was analyzed in three aspects and the outcome of the analysis proves that MAINS Layer provides a flexible model to create cloud applications and deploying them in variety of applications.

  20. 76 FR 59177 - Maine Disaster #ME-00029

    Science.gov (United States)

    2011-09-23

    ... ADMINISTRATION Maine Disaster ME-00029 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major ] disaster for Public Assistance Only for the... Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of...

  1. Kommunikatsioon ja maaelu maine / Ants Laansalu

    Index Scriptorium Estoniae

    Laansalu, Ants, 1938-2011

    2005-01-01

    Ilmunud ka: Agriculture and the development of rural life : overview 2004/2005. - Tallinn, 2005, lk. 156-159. Autori hinnangul mõjutas meedias EL-i põllumajanduspoliitika kohta loodud negatiivne maine oluliselt Eesti põllumajanduspoliitika kujundamist riigi tasandil kuni 2000. a. ja ettevõtlus tasandil kuni 2003. a.

  2. Water Hammer in Pumped Sewer Mains

    DEFF Research Database (Denmark)

    Larsen, Torben

    This publication is intended for engineers seeking an introduction to the problem of water hammer in pumped pressure mains. This is a subject of increasing interest because of the development of larger and more integrated sewer systems. Consideration of water hammer is essential for structural...

  3. Main Strategies for Autonomous Robotic Controller Design

    OpenAIRE

    Paterega, I.

    2011-01-01

    This review gives an overall introduction to the artificial evolution mechanism. It presents the main strategies for robotic controller design. It gives a review of the pertinent literature, focusing on approaches that use neural networks, evolutionary computing, and fuzzy logic. Various applications of artificial evolution in robotics are surveyed and classified.

  4. Main facts 1995; Faits marquants 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    This report presents the main facts of the studies carried out by the Direction des Etudes et Recherches (DER) of Electricite de France: new applications of electricity, classical and nuclear thermal power plants, electrical equipment, environment protection, monitoring and plants operations.

  5. Rotor dynamic analysis of main coolant pump

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chong Won; Seo, Jeong Hwan; Kim, Choong Hwan; Shin, Jae Chul; Wang, Lei Tian [Korea Advanced Institute of Science and Technology, Taejon (Korea)

    1999-03-01

    A rotor dynamic analysis program DARBS/MCP, for the main coolant pump of the integral reactor, has been developed. The dynamic analysis model of the main coolant pump includes a vertical shaft, three grooved radial journal bearings and gaps that represent the structure-fluid interaction effects between the rotor and the lubricant fluid. The electromagnetic force from the motor and the hydro-dynamic force induced by impeller are the major sources of vibration that may affect the rotor system stability. DARBS/MCP is a software that is developed to effectively analyze the dynamics of MCP rotor systems effectively by applying powerful numerical algorithms such as FEM with modal truncation and {lambda}-matrix method for harmonic analysis. Main design control parameters, that have much influence to the dynamic stability, have been found by Taguchi's sensitivity analysis method. Design suggestions to improve the stability of MCP rotor system have been documented. The dynamic bearing parameters of the journal bearings used for main coolant pump have been determined by directly solving the Reynolds equation using FDM method. Fluid-structure interaction effect that occurs at the small gaps between the rotor and the stator were modeled as equivalent seals, the electromagnetic force effect was regarded as a linear negative radial spring and the impeller was modeled as a rigid disk with hydrodynamic and static radial force. Although there exist critical speeds in the range of operational speeds for type I and II rotor systems, the amplitude of vibration appears to be less than the vibration limit set by the API standards. Further more, it has been verified that the main design parameters such as the clearance and length of journal bearings, and the static radial force of impeller should be properly adjusted, in order to the improve dynamic stability of the rotor system. (author). 39 refs., 81 figs., 17 tabs.

  6. Rapidly- growing firms and their main characteristics: a longitudinal study from United States

    DEFF Research Database (Denmark)

    Keen, Christian; Etemad, Hamid

    2011-01-01

    This paper explores the topic of high-growth phenomenon and its agents. High-growth enterprises are primarily small and medium sized firms that attain very high-growth rates for at least five years. The paper presents a review of the pertinent literature to guide its formulation of hypotheses con...... research and public policy analysis and formulation....

  7. Physics Education Research in the United States: A Summary of Its Rationale and Main Findings.

    Science.gov (United States)

    Gonzales-Espada, Wilson J.

    2003-01-01

    Recognizes how difficult it is for secondary and post-secondary students to make connections between physics and everyday phenomena, rationalize the use of a particular formula for a given problem, and go beyond algebraic substitutions to really make sense of physics in a meaningful way. Provides a rationale for physicists to become involved in…

  8. Physics Education Research in the United States: A Summary of Its Rationale and Main Findings.

    Science.gov (United States)

    Gonzales-Espada, Wilson J.

    2003-01-01

    Recognizes how difficult it is for secondary and post-secondary students to make connections between physics and everyday phenomena, rationalize the use of a particular formula for a given problem, and go beyond algebraic substitutions to really make sense of physics in a meaningful way. Provides a rationale for physicists to become involved in…

  9. [Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses

    NARCIS (Netherlands)

    Baat, C. de; Loveren, C. van; Maarel-Wierink, C.D. van der; Witter, D.J.; Creugers, N.H.J.

    2013-01-01

    An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine

  10. Trend of hydraulic units

    Energy Technology Data Exchange (ETDEWEB)

    Deshimaru, Jun' ichi

    1988-11-01

    The gear, vane and piston pumps occupy a more then 90% share in the hydraulic pumps. Comparatively large pumps are mainly variable delivery piston pumps. The piston pumps are comparatively high in output density (output per unit weight), indicating the hydraulic pump in performance, and tend to become higher and higher in it. Though they are mainly 210 to 350kgf/cm/sup 2/ in rated pressure, some of them come to surpass 400kgf/cm/sup 3/ in it. While the progress in computation also requires the high speed operation, high accuracy and other severe conditions for the hydraulic units, which accordingly and increasingly intensify the requirement for hydraulic oil in abrasion resistibility, oxidation stability and response characteristics. While cavitation comes to easily occur, which considerably and disadvantageously influences hydraulic oil in life through degradation, noise level and respondingness. From now on, the development of high performance oil and study of mechanical structure are important. 19 references, 9 figures, 2 tables.

  11. Termination unit

    Energy Technology Data Exchange (ETDEWEB)

    Traeholt, Chresten; Willen, Dag; Roden, Mark; Tolbert, Jerry C.; Lindsay, David; Fisher, Paul W.; Nielsen, Carsten Thidemann

    2016-05-03

    Cable end section comprises end-parts of N electrical phases/neutral, and a thermally-insulation envelope comprising cooling fluid. The end-parts each comprises a conductor and are arranged with phase 1 innermost, N outermost surrounded by the neutral, electrical insulation being between phases and N and neutral. The end-parts comprise contacting surfaces located sequentially along the longitudinal extension of the end-section. A termination unit has an insulating envelope connected to a cryostat, special parts at both ends comprising an adapter piece at the cable interface and a closing end-piece terminating the envelope in the end-section. The special parts houses an inlet and/or outlet for cooling fluid. The space between an inner wall of the envelope and a central opening of the cable is filled with cooling fluid. The special part at the end connecting to the cryostat houses an inlet or outlet, splitting cooling flow into cable annular flow and termination annular flow.

  12. Long-term outcomes after severe shock.

    Science.gov (United States)

    Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

    2015-02-01

    Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.

  13. THE MAIN PRINCIPLES OF TOTAL QUALITY MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Andrei DIAMANDESCU

    2016-06-01

    Full Text Available Nowadays the industry is one of the main economic sectors, with a major contribution to achieving and maintaining a high rate of economic growth. The processing industry operation to high economic performance requires changes in structural terms, the re-engineering of processes and management. In this regard, one of the main actions taken at the level of companies in the manufacturing industry is the implementation of quality systems. Practicing quality management system not only allows businesses to react to changes taking place in business, but also to inflict them by the controlling of the future. This paper aims to analyze the principles of Total Quality Management – TQM and will highlight the advantages that organizations could obtain by applying each principle separately in the process of management.

  14. MAIN APPROACHES TO BUSINESS DEVELOPMENT STRATEGY FORMATION

    Directory of Open Access Journals (Sweden)

    D. B. Smirnov

    2015-01-01

    Full Text Available Article tasks: defi ne main approaches to business development strategy formation. Methodology: methodological basis includes systemic, replication and dialectic general scientifi c approaches. Results: it is established that the activity approach as a leading methodology of strategy development assumes correlation between the activity category and the concepts: needs, interests, incentives, goals, refl ection (evaluation, and self-development. Systemic approach assumes to consider strategy as a system having a defi nite structure and interconnections within the system components. Conclusions/relevance: for Russian businesses the main goal in the management system is not a prompt response to current environmental changes, but formation of a strategic vision of the business’ future, elaboration of a fl exible and viable development strategy, to foresee tactical and strategic threats for the business activity, to remove them timely, as well as to use strategic management ideas in practice for sustainable growth.

  15. Early history of the Fermilab Main Ring

    Energy Technology Data Exchange (ETDEWEB)

    Malamud, E.; /Fermilab

    1983-10-01

    This note is written in response to a request from Phil Livdahl for corrections, and additions to a TM he is writing on Staffing Levels at Fermilab during Initial Construction Years and to a note that Hank Hinterberger is preparing on milestones. In my spare time over the past few years I have taken the original files of the Main Ring Section, my own notes from that period, and various other collections of relevant paper, and arranged them in a set of 44 large loose leaf binders in chronological order. I call this set of volumes the 'Main Ring Chronological Archives'. In response to Phil's request I have recently skimmed through these records of the period and extracted a small subset of documents which relate to the specific questions that Phil is addressing: staffing. administration, and milestones.

  16. Asteroid fission, binaries and the small main belt population

    Science.gov (United States)

    Rossi, A.; Jacobson, S.; Marzari, F.; Scheeres, D.

    2011-10-01

    Using a Monte Carlo method we model the spin evolution of small Main Belt asteroids under the joint effects of YORP and collisions. Our simulations allow us to estimate the fraction of asteroids undergoing rotational fission in different size ranges. When an asteroid reaches its disruption spin limit we determine the outcome of its subsequent evolution based on accumulated statistics on their evolution based on numerical integrations (i.e., binary or ternary formation, binary disruption, etc..). Our aim is to predict the percentage of binary asteroids and their properties in the Belt, the number of objects like P/2010 A2 per year and the effects of YORP-induced fission on the overall asteroid size distribution at the small size end.

  17. The geomagnetic main field and the geodynamo

    Science.gov (United States)

    Bloxham, Jeremy; Roberts, Paul H.

    1991-01-01

    Information available on the geomagnetic main field and the geodynamo is presented. Attention is given to the process of mapping the magnetic field, the last version of International Geomagnetic Reference Field Model, and maps of the magnetic field at the core-mantle boundary and their interpretation. Particular consideration is given to the existing geodynamo theories, with special relation given to the Braginsky and Meytlis theory of core turbulence in which the turbulence differs fundamentally from classical turbulence of Kolmogorov type.

  18. DR21 Main: A Collapsing Cloud

    OpenAIRE

    Kirby, Larry

    2008-01-01

    The molecular cloud, DR21 Main, is an example of a large-scale gravitational collapse about an axis near the plane of the sky where the collapse is free of major disturbances due to rotation or other effects. Using flux maps, polarimetric maps, and measurements of the field inclination by comparing the line widths of ion and neutral species, we estimate the temperature, mass, magnetic field, and the turbulent kinetic, mean magnetic, and gravitational potential energies, and present a 3D model...

  19. INNOVATION DIFFUSION THEORY MAIN DEVELOPMENT STAGES

    Directory of Open Access Journals (Sweden)

    S. V. Lisafiev

    2011-01-01

    Full Text Available Abstract: Main innovation diffusion development theory stages are: Rogers model of moving new products to the market including characteristics of its segments; mathematic substantiation of this model by Bass; Moor model taking into account gaps between adjacent market segments; Goldenberg model making it possible to predict sales drops at new product life cycle initial stages. It is reasonable to use this theory while moving innovative products to the market.

  20. MAIN DIRECTIONS OF ELECTRONIC LINGUODIDACTIС DEVELOPMENT

    OpenAIRE

    Oksana A. Kucheruk

    2014-01-01

    Article considers the problem of electronic linguistics. In the article it is grounded topicality of creating and using of new software tools of information and communication technologies to improve the quality of Ukrainian-language education. By the analysis and synthesis of scientific and methodological ideas we have defined the main directions of development of the domestic electronic linguistics. These areas relate to the development of electronic lexicographic works for educational purpo...

  1. Nitrogen chronology of massive main sequence stars

    CERN Document Server

    Köhler, K; Brott, I; Langer, N; de Koter, A

    2012-01-01

    Rotational mixing in massive main sequence stars is predicted to monotonically increase their surface nitrogen abundance with time. We use this effect to design a method for constraining the age and the inclination angle of massive main sequence stars, given their observed luminosity, effective temperature, projected rotational velocity and surface nitrogen abundance. This method relies on stellar evolution models for different metallicities, masses and rotation rates. We use the population synthesis code STARMAKER to show the range of applicability of our method. We apply this method to 79 early B-type main sequence stars near the LMC clusters NGC 2004 and N 11 and the SMC clusters NGC 330 and NGC 346. From all stars within the sample, 17 were found to be suitable for an age analysis. For ten of them, which are rapidly rotating stars without a strong nitrogen enhancement, it has been previously concluded that they did not evolve as rotationally mixed single stars. This is confirmed by our analysis, which fla...

  2. Isolated systems with wind power. Main report

    Energy Technology Data Exchange (ETDEWEB)

    Lundsager, P.; Bindner, H.; Clausen, N.E.; Frandsen, S.; Hansen, L.H.; Hansen, J.C.

    2001-06-01

    The overall objective of this research project is to study the development of methods and guidelines rather than 'universal solutions' for the use of wind energy in isolated communities. The main specific objective of the project is to develop and present a more unified and generally applicable approach for assessing the technical and economical feasibility of isolated power supply systems with wind energy. As a part of the project the following tasks were carried out: Review of literature, field measurements in Egypt, development of an inventory of small isolated systems, overview of end-user demands, analysis of findings and development of proposed guidelines. The project is reported in one main report and four topical reports, all of them issued as Risoe reports. This is the Main Report Risoe-R-1256, summing up the activities and findings of the project and outlining an Implementation Strategy for Isolated Systems with Wind Power, applicable for international organisations such as donor agencies and development banks. (au)

  3. ELECTRE METHODS: MAIN FEATURES AND RECENT DEVELOPMENTS

    Directory of Open Access Journals (Sweden)

    Jose Rui Figueira

    2010-12-01

    Full Text Available We present main characteristics of Electre family methods, designed for multiple criteria decision aiding. These methods use as a preference model an outranking relation in the set of actions – it is constructed in result of concordance and non-discordance tests involving a specific input preference information. After a brief description of the constructivist conception in which the Electre methods are inserted, we present the main features of these methods. We discuss such characteristic features as: the possibility of taking into account positive and negative reasons in the modeling of preferences, without any need for recoding the data; using of thresholds for taking into account the imperfect knowledge of data; the absence of systematic compensation between “gains” and “losses”. The main weaknesses are also presented. Then, some aspects related to new developments are outlined. These are related to some new methodological developments, new procedures, axiomatic analysis, software tools, and several other aspects. The paper ends with conclusions.

  4. Main aspects of geothermal energy in Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Hiriart, G.; Gutierrez-Negrin, L.C.A. [Comision Federal de Electridad, Morelia (Mexico)

    2003-12-01

    With an installed geothermal electric capacity of 853 MW{sub e}, Mexico is currently the third largest producer of geothermal power worldwide, after the USA and the Philippines. There are four geothermal fields now under exploitation: Cerro Prieto, Los Azufres, Los Humeros and Las Tres Virgenes. Cerro Prieto is the second largest field in the world, with 720 MW{sub e} and 138 production wells in operation; sedimentary (sandstone) rocks host its geothermal fluids. Los Azufres (88 MW{sub e}), Los Humeros (35 MW{sub e}) and Las Tres Virgenes (10 MW{sub e}) are volcanic fields, with fluids hosted by volcanic (andesites) and intrusive (granodiorite) rocks. Four additional units, 25 MW{sub e} each, are under construction in Los Azufres and due to go into operation in April 2003. One small (300 kW) binary-cycle unit is operating in Maguarichi, a small village in an isolated area with no link to the national grid. The geothermal power installed in Mexico represents 2% of the total installed electric capacity, but the electricity generated from geothermal accounts for almost 3% of the national total. (author)

  5. International Student Migration: Outcomes and Implications

    Science.gov (United States)

    McGill, Jenny

    2013-01-01

    The present study examined the possible correlation between six life circumstances of international students (N = 124) admitted entry into the United States for the purpose of academic study and their geographic choice of location upon graduation. This paper improves upon the current literature by offering actual migration outcomes (rather than…

  6. LIDAR COMBINED SCANNING UNIT

    Directory of Open Access Journals (Sweden)

    V. V. Elizarov

    2016-11-01

    Full Text Available Subject of Research. The results of lidar combined scanning unit development for locating leaks of hydrocarbons are presented The unit enables to perform high-speed scanning of the investigated space in wide and narrow angle fields. Method. Scanning in a wide angular field is produced by one-line scanning path by means of the movable aluminum mirror with a frequency of 20Hz and amplitude of 20 degrees of swing. Narrowband scanning is performed along a spiral path by the deflector. The deflection of the beam is done by rotation of the optical wedges forming part of the deflector at an angle of ±50. The control function of the scanning node is performed by a specialized software product written in C# programming language. Main Results. This scanning unit allows scanning the investigated area at a distance of 50-100 m with spatial resolution at the level of 3 cm. The positioning accuracy of the laser beam in space is 15'. The developed scanning unit gives the possibility to browse the entire investigated area for the time not more than 1 ms at a rotation frequency of each wedge from 50 to 200 Hz. The problem of unambiguous definition of the beam geographical coordinates in space is solved at the software level according to the rotation angles of the mirrors and optical wedges. Lidar system coordinates are determined by means of GPS. Practical Relevance. Development results open the possibility for increasing the spatial resolution of scanning systems of a wide range of lidars and can provide high positioning accuracy of the laser beam in space.

  7. Period Determination of Six Main Belt Asteroids

    Science.gov (United States)

    Ferrero, Andrea

    2014-07-01

    Observations of six main-belt asteroids (MBA) produced lightcurve parameters of: 487 Venetia, P = 13.34 ± 0.01 h, A = 0.20 mag; 684 Hildburg, P = 15.89 ± 0.01 h, A = 0.22 mag; 772 Tanete, P = 8.629 ± 0.001 h, A = 0.18 mag.; 1181 Lilith, P = 15.04 ± 0.01 h, A = 0.11 mag.; 1246 Chaka, P = 25.44 ± 0.01 h, A = 0.25 mag.; and 2834 Christy Carol, P = 12.79 ± 0.01 h, A = 0.39 mag.

  8. The main determinants affecting economic growth

    Directory of Open Access Journals (Sweden)

    Florin Teodor BOLDEANU

    2015-12-01

    Full Text Available Growth theories highlight the evolution and trends in economic thought that shaped the way economic growth is perceived. From the early works of Adam Smith and Malthus to the present day researchers have tried to find the most important determinates that influence growth by formulating new and improved theories and models. In this article we try to offer our point of view in the evolution of the main factors that have an impact on economic growth. There is still not a consensus on the key determinants of growth and an all-encompassing model that includes all the influences has not yet been elaborated.

  9. Electrochemistry of Main-Group Phthalocyanines.

    Science.gov (United States)

    1981-07-30

    to follow a linear relationship with the function r/(ze) (radius/charge). This reltionshlp may be used to facilitate the design of photocatalysts with...ze) and a function of central metal ion has been published. We have recently completed a study of the electrochemistry of main- us n i. Figure I for...SiV 54 0.074 -540 CIA 111 67.5 0.044 915 -655 1570Experimental Secfio* CiGat el 76 0.040 865 -735 1600Clintl! 94 0.032 830 -715 1545The r.-:m grUp

  10. Conceptual SPL RF Main Power Coupler design

    CERN Document Server

    Montesinos, Eric

    2011-01-01

    While the upgrade plans of the LHC injectors had to be reduced in scope in 2010, the Superconducting Proton Linac (SPL) remains a fundamental element of plans for a possible future neutrino facility. Prototyping work is therefore continuing at CERN and the current focus is on the test of a first four cavity SPL-like cryomodule with full power. This report summarizes the parameters for the Main Power Coupler design as discussed and approved within the ‘Review of SPL RF power couplers’, held at CERN in March 2010.

  11. Main Ocular Manifestations in Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Sandra Saray Quignon Santana

    2009-12-01

    Full Text Available Rheumatoid arthritis is considered an autoimmune disease in which articular and extra articular manifestations are produced and contribute to alter the functional capacity of the individual. This study consists on performing a bibliographical review showing the main ocular manifestations in patients with rheumatoid arthritis. It is our purpose to give you our experiences to the students as well as the internal medicine, ophthalmology and rheumatologist residents about this topic. The ophthalmological consultation of sick patients contributes to the prevention of ocular illnesses which are characteristic of the base disease and improve the ocular health.

  12. Space shuttle main engine hardware simulation

    Science.gov (United States)

    Vick, H. G.; Hampton, P. W.

    1985-01-01

    The Huntsville Simulation Laboratory (HSL) provides a simulation facility to test and verify the space shuttle main engine (SSME) avionics and software system using a maximum complement of flight type hardware. The HSL permits evaluations and analyses of the SSME avionics hardware, software, control system, and mathematical models. The laboratory has performed a wide spectrum of tests and verified operational procedures to ensure system component compatibility under all operating conditions. It is a test bed for integration of hardware/software/hydraulics. The HSL is and has been an invaluable tool in the design and development of the SSME.

  13. Space Shuttle Main Engine Public Test Firing

    Science.gov (United States)

    2000-01-01

    A new NASA Space Shuttle Main Engine (SSME) roars to the approval of more than 2,000 people who came to John C. Stennis Space Center in Hancock County, Miss., on July 25 for a flight-certification test of the SSME Block II configuration. The engine, a new and significantly upgraded shuttle engine, was delivered to NASA's Kennedy Space Center in Florida for use on future shuttle missions. Spectators were able to experience the 'shake, rattle and roar' of the engine, which ran for 520 seconds - the length of time it takes a shuttle to reach orbit.

  14. Impact of Main Macroeconomic Indicators on Happiness

    Directory of Open Access Journals (Sweden)

    Yavuz Agan

    2016-01-01

    Full Text Available The relationship between economic welfare and happiness has been compounded by different conceptualizations and statistical approaches. Economic conditions influence the welfare and social well-being of the society. While the literature indicates a positive relationship between income levels and life satisfaction, it indicates negative relationships between inflation, unemployment and life satisfaction. In this paper we analyze the relationship between main macroeconomic variables of unemployment, inflation, per capita GDP and life satisfaction using data from 57 countries. We make use of the standard regression analysis and conclude that our method is sufficient to examine the relations and the stated macro variables are significantly affecting life satisfaction towards expected directions.

  15. Isolated systems with wind power. Main report

    DEFF Research Database (Denmark)

    Lundsager, P.; Bindner, Henrik W.; Clausen, Niels-Erik;

    2001-01-01

    approach for assessing the technical and economical feasibility of isolated power supply systems with wind energy. As a part of the project the following tasks were carried out: Review of literature, fieldmeasurements in Egypt, development of an inventory of small isolated systems, overview of end......The overall objective of this research project is to study the development of methods and guidelines rather than "universal solutions" for the use of wind energy in isolated communities. The main specific objective of the project is to develop and present amore unified and generally applicable...... for Isolated Systems with Wind Power, applicable for international organisations such as donoragencies and development banks....

  16. Impact of Main Macroeconomic Indicators on Happiness

    Directory of Open Access Journals (Sweden)

    Yavuz Agan

    2009-10-01

    Full Text Available The relationship between economic welfare and happiness has been compounded by different conceptualizations and statistical approaches. Economic conditions influence the welfare and social well-being of the society. While the literature indicates a positive relationship between income levels and life satisfaction, it indicates negative relationships between inflation, unemployment and life satisfaction. In this paper we analyze the relationship between main macroeconomic variables of unemployment, inflation, per capita GDP and life satisfaction using data from 57 countries. We make use of the standard regression analysis and conclude that our method is sufficient to examine the relations and the stated macro variables are significantly affecting life satisfaction towards expected directions

  17. A gap clearing kicker for Main Injector

    CERN Document Server

    Kourbanis, I; Biggs, J; Brown, B; Capista, D; Jensen, C C; Krafczyk, G E; Morris, D K; Scott, D; Seiya, K; Ward, S R; Wu, G; Yang, M -J

    2012-01-01

    Fermilab Main Injector has been operating at high Beam Power levels since 2008 when multi-batch slip stacking became operational. In order to maintain and increase the beam power levels the localized beam loss due to beam left over in the injection kicker gap during slip stacking needs to be addressed. A set of gap clearing kickers that kick any beam left in the injection gap to the beam abort have been built. The kickers were installed in the summer of 2009 and became operational in November of 2010. The kicker performance and its effect on the beam losses will be described.

  18. Incidence Causes and Outcome

    African Journals Online (AJOL)

    GB

    causes and outcome of obstructed labor in Jimma University Specialized Hospital. METHODS: ... Obstructed labor is an important cause of ... and outcome on the mother and baby. Data .... to this hospital after onset of labor as compared to the.

  19. Onshore equivalents of the main Kudu gas reservoir in Namibia

    Energy Technology Data Exchange (ETDEWEB)

    Stanistreet, I.G. [University of Liverpool (United Kingdom). Department of Earth Sciences; Stollhofen, H. [Institut fur Geologie, Universitat Wuerzburg (Germany)

    1999-07-01

    Radiometric dates of Jurassic and Cretaceous flood basalts of the southern South Atlantic maritimes have thrown the stratigraphic contexts of Karoo and post-Karoo sequences into considerable question. Central to the problem is the status of volcano-sedimentary units, characterized by aeolian-related sedimentary interlayer, containing evaporites and other lacustrine elements. The main Kudu gas reservoir ('Lower Gas Sand') offshore Namibia, interleaved with undated flood basalts, is a prime example. A previously proposed onshore correlate is the fluvio-aeolian Etjo Sandstone, with a central Namibian type area, and comparisons have been made, particularly with units traditionally classified as Etjo Sandstone, near the Etendeka Plateau base in northwest Namibia, now recognised to be of younger age. We time-correlate the main Kudu Sandstone reservoir, however, with evaporitic fluvio-lacustrine and aeolian interlayers beneath and interleaved with Early Jurassic Kalkrand flood basalts of southern Namibia, situated onshore almost directly opposite the Kudu Field. The main Kudu Sandstone reservoir is transitional in palaeoenvironmental setting between Early Jurassic onshore analogues. Main Kudu reservoir geometries and associated lithologies can be better constrained with knowledge derived from Kalkrand sedimentary interlayers and their tectonic and volcanic controls. Kalkrand interlayer thicknesses are controlled primarily by down-to-the-east extensional fault system half-graben geometries, antithetic to an inferred down-to-the-west master detachment. Within resulting sub-basinal accommodation space, lava topography controlled thickness variation. When Kalkrand insights are taken into account with radiometric dating and biostratigraphy, a Namibian Mesozoic framework fixes Kudu reservoirs and analogues into a southern Gondwanan context. At least in its type area in central Namibia, the Etjo Formation is Early Jurassic, discounting a previously proposed widespread

  20. Debris disks in main sequence binary systems

    CERN Document Server

    Trilling, D E; Stapelfeldt, K R; Rieke, G H; Su, K Y L; Gray, R O; Corbally, C J; Bryden, G; Chen, C H; Boden, A; Beichman, C A

    2006-01-01

    We observed 69 A3-F8 main sequence binary star systems using the Multiband Imaging Photometer for Spitzer onboard the Spitzer Space Telescope. We find emission significantly in excess of predicted photospheric flux levels for 9(+4/-3)% and 40(+7/-6)% of these systems at 24 and 70 microns, respectively. Twenty two systems total have excess emission, including four systems that show excess emission at both wavelengths. A very large fraction (nearly 60%) of observed binary systems with small (<3 AU) separations have excess thermal mission. We interpret the observed infrared excesses as thermal emission from dust produced by collisions in planetesimal belts. The incidence of debris disks around main sequence A3-F8 binaries is marginally higher than that for single old AFGK stars. Whatever combination of nature (birth conditions of binary systems) and nurture (interactions between the two stars) drives the evolution of debris disks in binary systems, it is clear that planetesimal formation is not inhibited to a...

  1. Main areas of the national economy modernization

    Directory of Open Access Journals (Sweden)

    Valeriy Anatolyevich Tsvetkov

    2011-06-01

    Full Text Available This paper shows the concept of modernization, its main areas related to the commodity sector and transport infrastructure are identified, it is proposed to consider the application in relation to the modernization of modernization of the commodity sector. The author connects the need to modernize the Russian economy with the task of doubling GDP, correcting structural imbalances, reducing the technological gap with the developed world, overcoming social polarization in income, fighting inflation and smoothing the growth of inter-regional contrasts. The aim of modernizing the Russian economy is to achieve high competitiveness of the national economy, which would put the Russian Federation in terms of living standards among the most developed countries, and would provide a decent position in the world. The fact that "breakthrough" sectors of the sixth technological structure cannot be the starting point of modernization is substantiated. The concept of national competitiveness is reviewed. The lack of a complete model of modernization in the world is highlighted. Two main areas in relation to the modernization of the Russian Federation are identified: modernization of the commodity sector, which should represent applied modernization based on the comparative advantages of the Russian economy; with respect to functionally interrelated industries (fuel and energy complex and the oil-gas and upgrading of transport infrastructure, which is so effective because of unique transit facilities and prospects of Russia.

  2. Maine Tidal Power Initiative: Environmental Impact Protocols For Tidal Power

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Michael Leroy [Univ. of Maine, Orono, ME; Zydlewski, Gayle Barbin [Univ. of Maine, Orono, ME; Xue, Huijie [Univ. of Maine, Orono, ME; Johnson, Teresa R. [Univ. of Maine, Orono, ME

    2014-02-02

    The Maine Tidal Power Initiative (MTPI), an interdisciplinary group of engineers, biologists, oceanographers, and social scientists, has been conducting research to evaluate tidal energy resources and better understand the potential effects and impacts of marine hydro-kinetic (MHK) development on the environment and local community. Project efforts include: 1) resource assessment, 2) development of initial device design parameters using scale model tests, 3) baseline environmental studies and monitoring, and 4) human and community responses. This work included in-situ measurement of the environmental and social response to the pre-commercial Turbine Generator Unit (TGU®) developed by Ocean Renewable Power Company (ORPC) as well as considering the path forward for smaller community scale projects.

  3. The International Dermatology Outcome Measures initiative as applied to psoriatic disease outcomes

    DEFF Research Database (Denmark)

    Gottlieb, Alice B; Armstrong, April W; Christensen, Robin

    2014-01-01

    In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performa......, payers, and pharmaceutical scientists. As reported herein, the group's goal is to develop outcome measures in dermatology that address the needs of all involved....

  4. [Antibiotics and artificial nutrition in the cardiac intensive care unit].

    Science.gov (United States)

    De Gaudio, Raffaele; Selmi, Valentina; Chelazzi, Cosimo

    2010-04-01

    Patients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome. A deep understanding of antibacterial agents pharmacology in the critically ill is essential in order to treat severe infections; moreover, it is necessary to know routes of administration and composition of artificial nutrition solutions. The aim of this review is to define main and specific aspects of antibiotic therapy and nutritional support in cardiac critical care patients in light of recent literature data.

  5. Food Insecurity And Health Outcomes.

    Science.gov (United States)

    Gundersen, Craig; Ziliak, James P

    2015-11-01

    Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.

  6. Water Hammer in Pumped Sewer Mains

    DEFF Research Database (Denmark)

    Larsen, Torben

    This publication is intended for students and engineers seeking an introduction to the problem of water transients in pumped sewer and water mains. This is a subject of increasing interest because of the development of larger and more integrated systems. Consideration of transients is essential...... for the structural design of pipelines and for the planning of the proper function of the systems. The text is written by Torben Larsen, who is a professor of environmental hydraulics at the Department of Civil Engineering, Aalborg University. Torben Larsen has many years of experience with computer simulations...... of transients in pumped pipeline systems. This present publication can be understood as the second and revised edition of the pamphlet ”Transients in pumped sewer mains” (2006) which was published as a technical report by The EVA committee under The Danish Water Pollution Committee (The Danish Society...

  7. PS main supply: motor-generator set.

    CERN Multimedia

    Maximilien Brice

    2002-01-01

    In picture 04 the motor is on the right in the background and the main view is of the generator. The peak power in each PS cycle drawn from the generator, up to 96 MW, is taken from the rotational kinetic energy of the rotor (a heavy-weight of 80 tons), which makes the rotational speed drop by only a few percent. The motor replenishes the average power of 2 to 4 MW. Photo 05: The motor-generator set is serviced every year and, in particular, bearings and slip-rings are carefully checked. To the left is the motor with its slip-rings visible. It has been detached from the axle and moved to the side, so that the rotor can be removed from the huge generator, looming at the right.

  8. Siberian snakes for the Fermilab Main Injector

    Energy Technology Data Exchange (ETDEWEB)

    Anferov, V.A.; Baiod, R.; Courant, E.D. [and others

    1993-04-01

    Appropriate Siberian snakes were designed to maintain the proton beam polarization during acceleration in the Fermilab Main Injector from 8 to 150 GeV. Various snake designs were investigated to find one fitting into the 14 m straight section spaces with the required spin rotation axis and the minimum orbit excursion. The authors studied both cold and warm discrete magnet snakes as well as warm snakes with helical magnets. For the warm discrete magnet snake, obtaining small orbit excursions required a nearly longitudinal snake axis, while axes near {+-}45{degrees} are needed when using two snakes in a ring. The authors found acceptable snakes either by using superconducting magnets or by using warm magnets with a helical dipole field.

  9. Main injector particle production experiment at Fermilab

    Indian Academy of Sciences (India)

    Sonam Mahajan; Ashok Kumar; Rajendran Raja

    2012-11-01

    The main injector particle production (MIPP) experiment at Fermilab uses particle beams of charged pions, kaons, proton and antiproton with beam momenta of 5–90 GeV/c to measure particle production cross-sections of various nuclei including liquid hydrogen, MINOS target and thin targets of beryllium, carbon, bismuth and uranium. The physics motivation to perform such cross-section measurements is described here. Recent results on the analysis of NuMI target and forward neutron cross-sections are presented here. Preliminary cross-section measurements for 58 GeV/c proton on liquid hydrogen target are also presented. A new method is described to correct for low multiplicity inefficiencies in the trigger using KNO scaling.

  10. Eccentricity distribution in the main asteroid belt

    CERN Document Server

    Malhotra, Renu

    2016-01-01

    The observationally complete sample of the main belt asteroids now spans more than two orders of magnitude in size and numbers more than 64,000 (excluding collisional family members). We undertook an analysis of asteroids' eccentricities and their interpretation with simple physical models. We find that Plummer's (1916) conclusion that the asteroids' eccentricities follow a Rayleigh distribution holds for the osculating eccentricities of large asteroids, but the proper eccentricities deviate from a Rayleigh distribution: there is a deficit of eccentricities smaller than $\\sim0.1$ and an excess of larger eccentricities. We further find that the proper eccentricities do not depend significantly on asteroid size but have strong dependence on heliocentric distance: the outer asteroid belt follows a Rayleigh distribution, but the inner belt is strikingly different. Eccentricities in the inner belt can be modeled as a vector sum of a primordial eccentricity vector of random orientation and magnitude drawn from a Ra...

  11. Natural syntax : English interrogative main clauses

    Directory of Open Access Journals (Sweden)

    Janez Oresnik

    2007-12-01

    Full Text Available Natural Syntax is a developing deductive theory, a branch of Naturalness Theory. The naturalnessjudgements are couched in naturalness scales, whichfollow from the basic parameters (or «axioms» listed at the beginning of the paper. The predictions of the theory are calculated in deductions, whose chief components are apair of naturalness scales and the rules governing the alignment of corresponding naturalness values. Parallel and chiastic alignments are distinguished, in complementary distribution. Chiastic alignment is mandatory in deductions limited to unnatural environments. The paper deals with English interrogative main clauses. Within these, only the interrogatives containing wh-words exclusively insitu constitute an extremely unnatural environment and require chiastic alignment. Otherwiseparallel alignment is used. Earlier publications on Natural Syntax: Kavcic 2005a,b, Oresnik 1999, 2000a,b, 200la-f   2002, 2003a-c, 2002/03, 2004. This list cites only works written in English.

  12. Photographic Volume Estimation of CPAS Main Parachutes

    Science.gov (United States)

    Ray, Eric S.

    2017-01-01

    Capsule Parachute Assembly System (CPAS) flight tests regularly stage a helicopter to observe inflation of 116 ft D o ringsail Main parachutes. These side views can be used to generate 3-D models of inflating canopies to estimate enclosed volume. Assuming a surface of revolution is inadequate because reefed canopies in a cluster are elongated due to mutual aerodynamic interference. A method was developed to combine the side views with upward looking HD video to account for non-circular cross sections. Approximating the cross sections as elliptical greatly improves accuracy. But since that correction requires manually tracing projected outlines, the actual irregular shapes can be used to generate high fidelity models. Compensation is also made for apparent tilt angle. Validation was accomplished by comparing perimeter and projected area with known line lengths and/or high quality photogrammetry.

  13. BANKING ETHICS: MAIN CONCEPTIONS AND PROBLEMS

    Directory of Open Access Journals (Sweden)

    VALENTINA FETINIUC

    2014-10-01

    Full Text Available Banking ethics is a specialized set of ethical standards and rules that should be followed in the activities of financial institutions and employees of the banking sector. But despite the simplicity of the definition, in the modern world, this concept becomes complex and ambiguous. The importance of studying this subject is defined by the fact that the ethical behavior of the bank and bank employees promotes banking. At present there are several conceptions of banking ethics: general ethics, regulated ethics and ethical bank. The most common practice is to regulate internal and external relations of banks and bank workers with ethical codes. At the same time, studies show the existence of problems in the banking standards of ethics, which negatively affects the financial institution. This article is intended to reflect main tendencies and problems of banking ethics at international level and experience of Republic of Moldova in this field.

  14. UK pneumonectomy outcome study (UKPOS: a prospective observational study of pneumonectomy outcome

    Directory of Open Access Journals (Sweden)

    Davies Paul

    2009-07-01

    Full Text Available Abstract Background In order to assess the short term risks of pneumonectomy for lung cancer in contemporary practice a one year prospective observational study of pneumonectomy outcome was made. Current UK practice for pneumonectomy was observed to note patient and treatment factors associated with major complications. Methods A multicentre, prospective, observational cohort study was performed. All 35 UK thoracic surgical centres were invited to submit data to the study. All adult patients undergoing pneumonectomy for lung cancer between 1 January and 31 December 2005 were included. Patients undergoing pleuropneumonectomy, extended pneumonectomy, completion pneumonectomy following previous lobectomy and pneumonectomy for benign disease, were excluded from the study. The main outcome measure was suffering a major complication. Major complications were defined as: death within 30 days of surgery; treated cardiac arrhythmia or hypotension; unplanned intensive care admission; further surgery or inotrope usage. Results 312 pneumonectomies from 28 participating centres were entered. The major complication incidence was: 30-day mortality 5.4%; treated cardiac arrhythmia 19.9%; unplanned intensive care unit admission 9.3%; further surgery 4.8%; inotrope usage 3.5%. Age, American Society of Anesthesiologists physical status ≥ P3, pre-operative diffusing capacity for carbon monoxide (DLCO and epidural analgesia were collectively the strongest risk factors for major complications. Major complications prolonged median hospital stay by 2 days. Conclusion The 30 day mortality rate was less than 8%, in agreement with the British Thoracic Society guidelines. Pneumonectomy was associated with a high rate of major complications. Age, ASA physical status, DLCO and epidural analgesia appeared collectively most associated with major complications.

  15. Heat piles: the `MAIN TOWER` in Frankfurt on the Main; Einsatz von Energiepfaehlen am Beispiel des MAIN TOWER in Frankfurt am Main

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, C. [NEK Umwelttechnik AG, Zuerich (Switzerland); Hude, N. von der [Bilfinger und Berger Bauaktiengesellschaft, Mannheim (Germany). Service Center Technik

    1997-12-01

    In the inner-city banking quarter of Frankfurt on the Main, one of the highest and most modern office buildings of Europe has been being erected since the summer of 1996. The intersecting rows of drill-foundation piles required to secure the deep excavation and the load-bearing piles were designed as heat piles. Thereby the harnessing of shallow geothermal energy was integrated into the overall HVAC concept, realizing a highly innovative project. Although the erection of heat piles had only been decided on when planning for a conventional energy system was completed, the decision permitted to dispense with some of the usual components in the control station. As executed simulations show, integration of the piles into the overall concept of the building is not easy because the piles are exclusively used to provide cooling energy. But the project demonstrates that heat piles can nowadays be used also on a large scale. (orig.) [Deutsch] Im Bankenviertel in der Innenstadt von Frankfurt am Main entsteht seit dem Sommer 1996 eines der hoechsten und modernsten Buerogebaeude Europas. Die zur Sicherung der tiefen Baugrube erforderlichen Pfaehle der ueberschnittenen Bohrpfahlwand sowie diejenigen zum Lastabtrag wurden als Energiepfaehle ausgebildet. Damit wurde die Nutzung der untiefen Geothermie in das Gesamtkonzept der Haustechnik integriert und so ein innovatives Energiekonzept umgesetzt. Obwohl der Einsatz der Energiepfaehle erst dann beschlossen worden ist, als bereits eine konventionelle Energieversorgung vorgesehen und planerisch umgesetzt worden war, konnte dank der Energiepfaehle auf einige herkoemmliche Komponenten in der Energiezentrale verzichtet werden. Aufgrund der durchgefuehrten Simulationsberechnungen gestaltet sich die Einbindung ins Gesamtgebaeudekonzept nicht einfach, da die Energiepfaehle lediglich zu Kuehlzwecken verwendet werden. Trotzdem zeigt dieses Beispiel, dass heute Energiepfahlsysteme auch in grossem Massstab eingesetzt werden koennen. (orig.)

  16. Eccentricity distribution in the main asteroid belt

    Science.gov (United States)

    Malhotra, Renu; Wang, Xianyu

    2017-03-01

    The observationally complete sample of the main belt asteroids now spans more than two orders of magnitude in size and numbers more than 64 000 (excluding collisional family members). We undertook an analysis of asteroids' eccentricities and their interpretation with simple physical models. We find that a century old conclusion that the asteroids' eccentricities follow a Rayleigh distribution holds for the osculating eccentricities of large asteroids, but the proper eccentricities deviate from a Rayleigh distribution; there is a deficit of eccentricities smaller than ∼0.1 and an excess of larger eccentricities. We further find that the proper eccentricities do not depend significantly on asteroid size but have strong dependence on heliocentric distance; the outer asteroid belt follows a Rayleigh distribution, but the inner belt is strikingly different. Eccentricities in the inner belt can be modelled as a vector sum of a primordial eccentricity vector of random orientation and magnitude drawn from a Rayleigh distribution of parameter ∼0.06, and an excitation of random phase and magnitude ∼0.13. These results imply that when a late dynamical excitation of the asteroids occurred, it was independent of asteroid size and was stronger in the inner belt than in the outer belt. We discuss implications for the primordial asteroid belt and suggest that the observationally complete sample size of main belt asteroids is large enough that more sophisticated model-fitting of the eccentricities is warranted and could serve to test alternative theoretical models of the dynamical excitation history of asteroids and its links to the migration history of the giant planets.

  17. Remotely triggered earthquakes following moderate main shocks

    Science.gov (United States)

    Hough, S.E.

    2007-01-01

    Since 1992, remotely triggered earthquakes have been identified following large (M > 7) earthquakes in California as well as in other regions. These events, which occur at much greater distances than classic aftershocks, occur predominantly in active geothermal or volcanic regions, leading to theories that the earthquakes are triggered when passing seismic waves cause disruptions in magmatic or other fluid systems. In this paper, I focus on observations of remotely triggered earthquakes following moderate main shocks in diverse tectonic settings. I summarize evidence that remotely triggered earthquakes occur commonly in mid-continent and collisional zones. This evidence is derived from analysis of both historic earthquake sequences and from instrumentally recorded M5-6 earthquakes in eastern Canada. The latter analysis suggests that, while remotely triggered earthquakes do not occur pervasively following moderate earthquakes in eastern North America, a low level of triggering often does occur at distances beyond conventional aftershock zones. The inferred triggered events occur at the distances at which SmS waves are known to significantly increase ground motions. A similar result was found for 28 recent M5.3-7.1 earthquakes in California. In California, seismicity is found to increase on average to a distance of at least 200 km following moderate main shocks. This supports the conclusion that, even at distances of ???100 km, dynamic stress changes control the occurrence of triggered events. There are two explanations that can account for the occurrence of remotely triggered earthquakes in intraplate settings: (1) they occur at local zones of weakness, or (2) they occur in zones of local stress concentration. ?? 2007 The Geological Society of America.

  18. Surgical procedure of Free Flap. Main nursing care

    Directory of Open Access Journals (Sweden)

    Manuel Molina López

    2010-05-01

    Full Text Available The free flap surgical technique is used to cover extensive skin loss areas and situations where no flap is available, or in axial zones. The great breackthrough in the field of reconstructive surgical techniques and the creation of new units where these complex techniques are used, means that the nursing staff who work in these hospital units are adquiring greater protagonism in caring for, and the subsequent success of this type of surgery in which the problems of collaboration in all the perioperative phases depend entirely on the nursing team.The collaborative nursing problems could be defined as real or potential health problems, where users need nursing staff to follow the treatment and control procedures prescribed by other professional, generally doctors, who control and are responsible for the final outcome.While planning collaborative objectives and activities it should be taken into account that the function of the nursing staff is twofold: on the one hand, the patient must be taken care of as prescribed by other professionals and, on the other hand, it should bring into play cognitive elements (knowledge and know-how and clinical judgment when executing these in controlling the patients evolution.In this article our intention is to give an interesting and comprehensive description of the free flap surgical technique, its pros and cons, and identify the principal collaborative problems which nursing will have to deal with in each one of the perioperative phases, the number and specific nature of such oblige nursing on many occasions, to update and/or acquire new skills.

  19. Outcome predictability biases learning.

    Science.gov (United States)

    Griffiths, Oren; Mitchell, Chris J; Bethmont, Anna; Lovibond, Peter F

    2015-01-01

    Much of contemporary associative learning research is focused on understanding how and when the associative history of cues affects later learning about those cues. Very little work has investigated the effects of the associative history of outcomes on human learning. Three experiments extended the "learned irrelevance" paradigm from the animal conditioning literature to examine the influence of an outcome's prior predictability on subsequent learning of relationships between cues and that outcome. All 3 experiments found evidence for the idea that learning is biased by the prior predictability of the outcome. Previously predictable outcomes were readily associated with novel predictive cues, whereas previously unpredictable outcomes were more readily associated with novel nonpredictive cues. This finding highlights the importance of considering the associative history of outcomes, as well as cues, when interpreting multistage designs. Associative and cognitive explanations of this certainty matching effect are discussed.

  20. PLACENTAL SIZE AND PERINATAL OUTCOMES

    Directory of Open Access Journals (Sweden)

    Nagamani

    2015-03-01

    Full Text Available BACKGROUND : The human placenta, a transient organ or pregnancy provides information about fetal well - being and pregnancy outcome . AIMS: To study the placental ultrasound characters in relation to perinatal outcomes . SETTINGS: Tertiary care hospital in southern India . METHODS AND MATERIAL S: The study sample comprised 500 consecutive women who presented to the Depart ment of Obstetrics and Gynecology at the King George Hospital who met the inclusion criteria. Ultrasonographic study was performed using a transabdominal 3.5 MHz volume transducer. Post natally the weight of the baby and of the placenta was recorded. Perina tal outcome was assessed by birth weight, APGAR score and the need for admission in neonatal intensive care unit. STATISTICAL ANALYSIS : Pearson’s correlation analysis and Chi square test was used. Statistical significance was considered at a p value <0.05 . RESULTS: The mean placental thickness was 3.10 cm; 76% (n:380 had normal thickness. Mean placental diameter was 21.306 cm, and its weight varied from 310 women 62% (n:310. Correlation of placental thickness (normal and abnormal, with birth weight, the difference was significant ( <0.001. CONCLUSION: Ultrasound forms a readily available, fairly safe, effective non - invasive method to identify and prevent fetal malnutrition in a cost - effective way.