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Sample records for unit pacu stay

  1. [Patient dissatisfaction following prolonged stay in the post-anesthesia care unit due to unavailable ward bed in a tertiary hospital].

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    Dolkart, Oleg; Amar, Eyal; Weisman, Daniela; Flaishon, Ron; Weinbroum, Avi A

    2013-08-01

    The present study aimed to evaluate subjective reactions of post-surgery and anesthesia patients who stay in post-anesthesia care units (PACU) longer than necessary medically, due to administrative causes. We interviewed consenting postoperative patients during an 18-month period. All patients who remained in the PACU twice our obligatory PACU length of stay (> 4 hours) due to lack of an available bed in the appropriate hospital ward, were interviewed at the time of discharge. The study group consisted of those who remained > 4 hours after surgery and a control group of patients who were discharged within 4 hours. The questions were chosen from different sources, including generic and condition-specific questionnaires. A total of 67 patients stayed > 4 hours and 63 Irritability due to lack of independence were statistically higher, and satisfaction rates were lower in patients who stayed > 12 hours compared to those who were discharged after 4-12 hours (P irritate the patient. Patients' irate behavior may distract the medical staff from effectively performing their duties and interferes with optimal medical care in the PACU.

  2. Effect of Intravenous Acetaminophen on Post-Anesthesia Care Unit Length of Stay, Opioid Consumption, Pain, and Analgesic Drug Costs After Ambulatory Surgery

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    Khobrani, Moteb A.; Camamo, James M.; Patanwala, Asad E.

    2017-01-01

    Objectives The primary objective was to assess whether the use of intravenous acetaminophen (APAP) in the ambulatory surgery setting is associated with a decreased length of stay in the post-anesthesia care unit (PACU). The secondary outcomes evaluated were pain scores, opioid consumption, and total cost of analgesics used in the PACU. Methods This was a retrospective cohort study conducted in adult patients (18 years of age or older) who received an eye, ear, nose, or throat (EENT) procedure at an outpatient surgery center between January 2014 and January 2015. Patients were consecutively included until the desired sample was reached during two six-month time periods: 1) intravenous APAP available on the formulary (APAP group) and 2) intravenous APAP not available on the formulary (non-APAP group). Results The cohort included 174 patients who received an EENT procedure (87 patients in the APAP group and 87 patients in the non-APAP group). The median PACU length of stay was 66 minutes (interquartile range [IQR], 48–92) in the APAP group and 71 minutes (IQR, 52–89) in the non-APAP group (P = 0.269). Mean pain score categories in the APAP versus non-APAP group were mild (85% versus 53%, respectively; P < 0.001), moderate (13% versus 33%, respectively; P = 0.002), and severe (2% versus 14%, respectively; P = 0.005). The median opioid consumption in morphine equivalents was 9 mg (IQR, 5–13) in the APAP group and 8 mg (IQR, 5–12) in the non-APAP group (P = 0.081). The total cost of analgesics used in the PACU was significantly greater in the APAP group ($15 versus $1; P < 0.001). Conclusions Intravenous APAP use in EENT ambulatory surgery is not associated with decreased PACU length of stay. However, it may decrease postoperative pain following EENT procedures. PMID:28163558

  3. 全麻术后患者在PACU期间的临床评估%Clinical evaluation of patient's staying in PACU after general anesthesia

    Institute of Scientific and Technical Information of China (English)

    吕凯; 陈肖敏

    2006-01-01

    目的探讨全麻术后患者在麻醉恢复室(PACU)中全身恢复和并发症的发生情况.方法将收入PACU的1 532例全麻术后患者分别分成老年组、中年组和青年组,用Aldrete麻醉后恢复评分法记录患者出室和入室时的评分,同时观察、记录患者在PACU期间的相关生命指证、留室时间和并发症的发生情况.结果三组的出室评分比入室评分显著改善.出室评分与入室评分呈显著正相关(r=0.432,P<0.01),留室时间呈负相关(r=-0.383,P<0.05).留室时间老年组最长.ASA评级分别与入室、出室评分呈显著负相关(r=-0.371,P<0.01和r=-0.401,P<0.01),留室时间呈正相关(r=0.363,P<0.05).病人入室后有10.1%的患者出现低氧血症、高血压、恶心呕吐等各类并发症.结论麻醉医师和手术医师术前应对患者病情作全面评估,以确保围麻醉期的安全.PACU可为所有全麻术后病人的平顺恢复提供良好的监测和处理,是保证病人完全恢复的重要单位.老年病人宜适当延长在PACU内的停留时间.

  4. Postanesthesia care unit visitation decreases family member anxiety.

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    Carter, Amy J; Deselms, JoAnn; Ruyle, Shelley; Morrissey-Lucas, Marcella; Kollar, Suzie; Cannon, Shelly; Schick, Lois

    2012-02-01

    Despite advocacy by professional nursing organizations, no randomized controlled trials (RCTs) have evaluated the response of family members to a visit with an adult patient during a postanesthesia care unit (PACU) stay. Therefore, the purpose of this RCT was to evaluate the impact of a brief PACU visitation on the anxiety of family members. The study was conducted in a phase I PACU of a large community-based hospital. Subjects were designated adult family members or significant others of an adult PACU patient who had undergone general anesthesia. A pretest-posttest RCT design was used. The dependent variable was the change in anxiety scores of the visitor after seeing his or her family member in the PACU. Student t test (unpaired, two tailed) was used to determine if changes in anxiety scores (posttest score-pretest score) were different for the PACU visit and no visit groups. A total of 45 participants were studied over a 3-month period, with N=24 randomly assigned to a PACU visit and N=21 assigned to usual care (no PACU visit). Participants in the PACU visit group had a statistically significant (P=.0001) decrease in anxiety after the visitation period (-4.11±6.4); participants in the usual care group (no PACU visit) had an increase in anxiety (+4.47±6.6). The results from this study support the value and importance of PACU visitation for family members.

  5. Modeling the effect of short stay units on patient admissions

    NARCIS (Netherlands)

    Zonderland, Maartje E.; Boucherie, Richard J.; Carter, Michael W.; Stanford, David A.

    2015-01-01

    Two purposes of Short Stay Units (SSU) are the reduction of Emergency Department crowding and increased urgent patient admissions. At an SSU urgent patients are temporarily held until they either can go home or transferred to an inpatient ward. In this paper we present an overflow model to evaluate

  6. Effect of anesthesia depth monitoring on the nursing quality of patients in the postanesthesia care unit (PACU)%麻醉深度监测对麻醉恢复室护理工作的影响

    Institute of Scientific and Technical Information of China (English)

    简晓敏; 许立新; 阮祥才; 刘焕仪

    2016-01-01

    Objective To investigate the effect of anesthesia depth monitoring on the recovery quality and nursing qual-ity of patients treated with lower abdominal surgery under general anesthesia. Methods A total of 1 20 patients who underwent the lower abdominal surgeries from June 201 5 to December 201 5 were randomly divided into 2 groups:non-Narcotrend monitoring group (non NT group)and Narcotrend monitoring group (NT group).And each group contains 60 cases.All patients were set in the same induce plan,and maintained by propofol-fentanyl during the operation.The dosage of propofol,the time of tracheal ex-tubation,the PACU staying time,the Ricker sedation-agitation scale,the incidence of PONV and POD,the nursing quality and nursing working load were recorded in the project. Results Using Narcotrend to monitor the anesthesia depth could significant-ly decrease the dosage of propofol (P <0.05).The tracheal extubation time and the PACU staying time of patients in NT group were much shortened than patients in non NT group (P <0.05).In NT group the Ricker scores of patients were much lower than patients in non NT group (P <0.05).And the effective anesthesia depth monitoring using Narcotrend could significantly de-crease the nursing working load and improve the nursing quality (P <0.05). Conclusion Effective anesthesia depth monito-ring using Narcotrend may improve the recovery quality in the PACU,which may decrease the working load of nurses and improve the nursing quality in PACU.%目的:研究术中麻醉深度监测在全麻下行下腹部手术患者苏醒质量和护理工作应用。方法选取择期全麻下行下腹部手术患者120例(ASAⅠ~Ⅱ级),随机分成 NT 组和 NNT 组,NT 组患者(60)术中用 Narco-trend 监测,NNT 组患者(60)术中不用 Narcotrend 监测。记录术中丙泊酚用量;记录术后气管导管拔管时间和麻醉恢复室(postanesthesia care unit,PACU)留观时间;记录恢复室 Ricker 镇静—躁

  7. Joint contracture following prolonged stay in the intensive care unit

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    Clavet, Heidi; Hébert, Paul C.; Fergusson, Dean; Doucette, Steve; Trudel, Guy

    2008-01-01

    Background Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer. Methods We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005. Results At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29–38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14–0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture. Interpretation Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home. PMID:18332384

  8. Obese patients: respiratory complications in the post-anesthesia care unit.

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    Mendonça, J; Pereira, H; Xará, D; Santos, A; Abelha, F J

    2014-01-01

    Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU). The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs) in obese patients during their stay in the PACU METHODS: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI)<30 (non-obese control group); the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011). The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test were used for comparisons. Associations with AREs were studied using univariate and multivariate logistic regression models. There was a higher frequency of STOP-BANG ≥3 (89% vs. 11%, P<.001) among obese patients and they were less frequently scheduled to undergo high-risk surgery (7% vs. 41%, P=.005) and major surgery (4% vs. 15%, P=.008). Obese patients had more frequent AREs in the PACU (33% vs. 7%, P<.018). Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs. Stay in the PACU was longer for obese patients (120min vs. 84min, P<.01). Obesity was considered an independent risk factor for AREs in the PACU. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  9. The effects of parental presence in the postanesthetic care unit on children's postoperative behavior: a prospective, randomized, controlled study.

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    Lardner, David R; Dick, Bruce D; Crawford, Susan

    2010-04-01

    The effects on children of parental presence in the postanesthesia care unit (PACU) have not been extensively studied. The few published studies are retrospective, nonrandomized, or lack adequate controls. They suggest that parental presence in the PACU decreases crying and negative behavior change postoperatively. We performed this prospective, randomized, controlled study to determine whether the presence of a parent affected crying behaviors in the PACU and behavior change 2 weeks postoperatively. Randomly selected patients, aged 2.0 to 8 years 11 months, ASA physical status I or II, and scheduled for elective outpatient surgery with an anticipated PACU stay of >10 minutes were randomly assigned to the parent present group (n = 150) or parent absent group (n = 150) in the PACU. All parents underwent the same preparation program. Reunification occurred once children's eyes had opened for the parent present group. In the PACU, crying was scored each minute after eye opening using a 5-point scale. Negative behavior change 2 weeks after discharge was determined using the Post Hospitalization Behavior Questionnaire. Because the anesthesia technique to be used was not determined a priori, data on the technique used were collected to ensure that groups were similar. Multiple and logistic regression techniques were used to determine predictors of crying in the PACU and behavior change 2 weeks postoperatively. Parental presence in the PACU made no difference in crying in the PACU. Negative behavior change 2 weeks postoperatively occurred more frequently in the parent absent group than the parent present group (45.8% vs 29.3%; P = 0.007). Multiple regression identified the following significant factors as predictive of larger proportion of time spent crying in the PACU (R(2) = 0.256, F[5, 273] = 15.66, P < 0.001): age <5 years (P < 0.001) and higher Children's Hospital of Eastern Ontario Pain Scale score at 15 minutes after arrival in day surgery (P < 0.001). Parental

  10. Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Jørgensen, Christoffer Calov; Laursen, Mogens Berg

    2017-01-01

    BACKGROUND: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations....... METHODS: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. The primary outcome was frequency of a successful fast.......70 to 1.35). Adverse events in the ward during the first 24 h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). CONCLUSIONS: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip...

  11. Quality of life after stay in surgical intensive care unit

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    Castro Maria A

    2007-07-01

    Full Text Available Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL six months after discharge from an Intensive Care Unit (ICU, and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in

  12. A study in time: performance improvement to reduce excess holding time in PACU.

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    Bruce, M

    2000-08-01

    The early 1990s saw prolonged patient stays in the PACU at St Joseph's Hospital of Atlanta, a 350-bed tertiary-care hospital. PACU discharge was delayed for various reasons: no room available, no receiving nurse, no help to transport patients, and prolonged recovery from anesthesia. These prolonged stays resulted in occasional backups in receiving patients from the OR, as well as having alert patients among arriving patients, unstable patients, and patients with nausea or pain. These delays were perceived to be stressful to the patient, their families, and to the staff. It was also expensive for the patient and costly in terms of nursing care. A multiyear, intermittent study was conducted to seek and implement solutions to this problem and evaluate the results. This article details these efforts and the resulting accomplishments.

  13. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox?

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    Marco Ranucci

    Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.

  14. Shorter length of stay in the stroke unit

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    Tistad, Malin; Ytterberg, Charlotte; Sjöstrand, Christina

    2012-01-01

    was seen at 6 or 12 months post stroke. CONCLUSION: It seems possible to reduce the number of days spent in the stroke unit after mild to moderate stroke and instead spend days in a rehabilitation unit, and yet achieve similar patient satisfaction and faster recovery in ADL....... the first year post stroke in 2 groups of patients with mild to moderate stroke who received care in the same stroke unit. METHOD: The patients (1993/96, n=40; 2006/07, n=43) in this study received care in the stroke unit at Karolinska University Hospital, Huddinge, Sweden. Data on LOS and on the use...... of health-related services were collected from the Stockholm County Council computerized registers. Satisfaction with health related services was assessed using a questionnaire covering different dimensions of care, while ADLs were assessed using Katz Extended Index of ADL. RESULTS: The LOS in the stroke...

  15. Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital.

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    Bruins, Suze Dominique; Leong, Pauline Meng Choo; Ng, Shin Yi

    2017-08-01

    We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition. A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form. There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU. A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated.

  16. [Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

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    Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

    2009-01-01

    To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

  17. Continuous intraoperative epidural infusions affect recovery room length of stay and analgesic requirements: a single-center observational study.

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    Shah, Aalap C; Nair, Bala G; Spiekerman, Charles F; Bollag, Laurent A

    2017-08-01

    Continuous intraoperative epidural analgesia may improve post-operative pain control and decrease opioid requirements. We investigate the effect of epidural infusion initiation before or after arrival in the post-anesthesia care unit on recovery room duration and post-operative opioid use. We performed a retrospective chart review of abdominal, thoracic and orthopedic surgeries where an epidural catheter was placed prior to surgery at the University of Washington Medical Center during a 24 month period. Patients whose epidural infusions were started prior to PACU arrival (Group 2: n = 540) exhibited a shorter PACU length of stay (p = .004) and were less likely to receive intravenous opioids in the recovery room (34 vs. 48%; p < .001) compared to patients whose infusions were started after surgery (Group 1: n = 374). Although the highest patient-reported pain scores were lower in Group 2 (5.3 vs. 6.0; p = .030), no differences in the pain scores prior to PACU discharge were observed. Intraoperative continuous epidural infusions decrease PACU LOS as discharge criteria for patient-reported NRS pain scores are met earlier.

  18. Very prolonged stay in the intensive care unit after cardiac operations: early results and late survival.

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    Silberman, Shuli; Bitran, Daniel; Fink, Daniel; Tauber, Rachel; Merin, Ofer

    2013-07-01

    Prolonged intensive care unit (ICU) stay is a surrogate for advanced morbidity or perioperative complications, and resource utilization may become an issue. It is our policy to continue full life support in the ICU, even for patients with a seemingly grim outlook. We examined the effect of duration of ICU stay on early outcomes and late survival. Between 1993 and 2011, 6,385 patients were admitted to the ICU after cardiac surgery. Patients were grouped according to length of stay in the ICU: group 1, 2 days or less (n = 4,631; 73%); group 2, 3 to 14 days (n = 1,423; 22%); group 3, more than 14 days (n = 331; 5%). Length of stay in ICU for group 3 patients was 38 ± 24 days (range, 15 to 160; median 31). Clinical profile and outcomes were compared between groups. Patients requiring prolonged ICU stay were older, underwent more complex surgery, had greater comorbidity, and a higher predicted operative mortality (p < 0.0001). They had a higher incidence of adverse events and increased mortality (p < 0.0001). Of the 331 group 3 patients, 60% were discharged: survival of these patients at 1, 3, and 5 years was 78%, 65%, and 52%, respectively. Operative mortality as well as late survival of discharged patients was proportional to duration of ICU stay. Current technology enables keeping sick patients alive for extended periods of time. Nearly two thirds of patients requiring prolonged ICU leave hospital, and of these, 50% attain 5-year survival. These data support offering full and continued support even for patients requiring very prolonged ICU stay. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dihmis Walid C

    2006-05-01

    Full Text Available Abstract Objective Patients who have prolonged stay in intensive care unit (ICU are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG. Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004. The area under the receiver operating characteristic (ROC curve was calculated to assess the performance of the prediction tool. Results 475(9.2% patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.

  20. Estimulantes alimentares para larvas de pacu Feeding stimulants for pacu lavae

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    Marcelo Borges Tesser

    2011-09-01

    Full Text Available Este estudo foi realizado com o objetivo de investigar o efeito estimulante de cinco aminoácidos (alanina, arginina, glicina, histidina e lisina da betaína e de suas misturas sobre a taxa de ingestão de dieta microencapsulada durante o desenvolvimento larval de pacu Piaractus mesopotamicus. Os resultados da análise estatística comprovaram a existência de efeito significativo, tanto da idade das larvas como dos aminoácidos, sobre a taxa de ingestão. No entanto, não houve significância estatística para a interação dos dois fatores. A glicina, a lisina e a beta��na foram considerados bons estimuladores do comportamento alimentar de larvas de pacu.The present study aimed to investigate the stimulant effect of five amino acids (alanine, arginine, glycine, histidine and lysine from betaine and their mixtures on the ingestion rates of formulated diet during the larval development of pacu Piaractus mesopotamicus. The statistical results showed significant effect of age and treatment. However, no significant effect was observed for the interaction of both factors. Glycine, lysine and betaine are considered good stimulants of the pacu feeding behavior.

  1. Effect of adverse drug reactions on length of stay in intensive care units.

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    Vargas, E; Simón, J; Martin, J C; Puerro, M; Gonzalez-Callejo, M A; Jaime, M; Gomez-Mayoral, B; Duque, F; Gomez-Delgado, A; Moreno, A

    1998-01-01

    The objective of the present study was to determine the frequency of adverse drug reactions (ADRs) in intensive care units (ICUs) and to evaluate their effect on the length of stay. We performed a prospective study to detect ADRs in 420 patients hospitalised in 10 predetermined beds in the ICU of our hospital between the months of March and December 1996. While the patients were staying in the ICU, data was gathered regarding suspected ADRs and on different variables related to the length of stay. 96 different ADRs were detected in 85 of the 420 patients seen [20.2%, 95% confidence intervals (95% CI) 16.5 to 24.4]. The ADRs were most frequently caused by the following drugs: nitrates (n = 25), opiates (n = 21) and ultrashort-acting benzodiazepines (n = 10). Eight ADRs were severe, the suspected medication had to be discontinued in 51 cases and new drugs were necessary to manage the ADRs in 73 cases. The crude estimation of the effect of the number of ADRs performed with a bivariant regression model indicated that each ADR was related to a 2.38-day increase (95% CI 1.31 to 3.45) in the length of stay. Although this estimation was reduced to 1.76 days (95% CI 0.72 to 2.79), when other confounding variables associated with the length of stay were considered, it was still important.In conclusion, the ADRs were a significant clinical problem in the ICUs and were responsible for a significant increase in the length of stay.

  2. Predictors for Prolonged Intensive Care Unit Stay After Adult Orthotopic Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Aycan Kundakcı

    2011-04-01

    Full Text Available Objective: Intensive care unit (ICU stay consumes physical and financial resources and may increase the risk of complications and possibly mortality. The purpose of this study was to evaluate the factors predicting prolonged ICU length of stay (LOS after orthotopic liver transplantation (OLT. Materials and Methods: We reviewed the data of 112 adult patients who underwent OLT between January 2000 and February 2009. The data included the demographic and clinical features, preoperative laboratory values, intraoperative hemodynamic parameters and transfusions, and mortalities. Prolonged ICU LOS was defined as more than 3 days stay in the ICU after OLT. Results: Out of 112 patients 59 (53% of them required prolonged ICU LOS. Patients who required prolonged ICU LOS compared to those who did not had higher model for end stage liver disease (MELD and Child-Pugh scores (p<0.001, had a lower mean preoperative hemoglobin level (p=0.04, had a higher mean preoperative blood urea nitrogen level (p=0.013, less frequently had coronary artery disease (p=0.046, required higher amounts of blood products transfusions intraoperatively (p=0.004, and had a longer duration of anesthesia (p=0.010. Multivariate logistic regression revealed that only higher MELD scores (odds ratio: 1.4, CI%95:1.2-1.7, p=0.010 was an independent risk factor for prolonged ICU stay after liver transplantation Patients who had developed renal failure in the early postoperative period according to the RIFLE criteria had stayed in the ICU longer [74% (23 vs 44%(36, p=0.006]. Patients who had stayed in the ICU for more than 3 days had higher rates of mortalities [41% (24 vs 9% (5, p<0.001]. Conclusion: In conclusion, 53% of our liver transplant recipients required prolonged ICU stay postoperatively and a higher MELD score was an independent risk factor for prolonged ICU requirement. (Journal of the Turkish Society of Intensive Care 2011; 9: 14-8

  3. Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents

    Science.gov (United States)

    Banerjee, Geetanjoli; Zullo, Andrew R.; Berry, Sarah D.; Lee, Yoojin; McConeghy, Kevin; Kiel, Doug P.; Mor, Vincent

    2016-01-01

    Introduction Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents. Design and setting Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases. Participants A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old. Measurements Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010. Results The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest. Conclusions We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation. PMID:27461867

  4. Factors associated with mortality and length of stay in the Oporto burn unit (2006-2009).

    Science.gov (United States)

    Bartosch, Isabel; Bartosch, Carla; Egipto, Paula; Silva, Alvaro

    2013-05-01

    Retrospective studies are essential to evaluate and improve the efficiency of care of burned patients. This study analyses the work done in the burn unit of Hospital de S. João in the north of Portugal. A retrospective review was performed in patients admitted from 2006 to 2009. The study population was characterised regarding patient demographics, admissions profile, burn aetiology, burn site, extension and treatment. Multiple linear and logistic regression models were done in order to elucidate which of these factors influenced the mortality and length of stay. The characteristics before and after the creation of the burn unit, as well as the similarities and differences with the published data of other national and international burn units, are analysed.

  5. Serum bactericidal activity as indicator of innate immunity in pacu Piaractus mesopotamicus (Holmberg, 1887

    Directory of Open Access Journals (Sweden)

    J.D. Biller-Takahashi

    2013-12-01

    Full Text Available The immune system of teleost fish has mechanisms responsible for the defense against bacteria through protective proteins in several tissues. The protein action can be evaluated by serum bactericidal activity and this is an important tool to analyze the immune system. Pacu, Piaractus mesopotamicus, is one of the most important fish in national aquaculture. However there is a lack of studies on its immune responses. In order to standardize and assess the accuracy of the serum bactericidal activity assay, fish were briefly challenged with Aeromonas hydrophila and sampled one week after the challenge. The bacterial infection increased the concentration of protective proteins, resulting in a decrease of colony-forming unit values expressed as well as an enhanced serum bactericidal activity. The protocol showed a reliable assay, appropriate to determine the serum bactericidal activity of pacu in the present experimental conditions.

  6. The Short Stay Unit as a new option for hospitals: A review of the scientific literature

    Science.gov (United States)

    Damiani, Gianfranco; Pinnarelli, Luigi; Sommella, Lorenzo; Vena, Valentina; Magrini, Patrizia; Ricciardi, Walter

    2011-01-01

    Summary Background The short stay unit (SSU) is a ward providing targeted care for patients requiring brief hospitalization and dischargeable as soon as clinical conditions are resolved. Therefore, SSU is an alternative to the ordinary ward (OW) for the treatment of selected patients. The SSU model has been tested in only a few hospitals, and the literature lacks systematic evaluation of the impact of SSU use. The aim of our study was to evaluate the use of SSUs in terms of length of hospital stay, mortality and readmission rate. Material/Methods A random effect meta-analysis was carried out by consulting electronic databases. Studies were selected that focused on comparison between use of SSUs and OWs. Mean difference of length of stay was calculated within 95% confidence intervals. Results Six articles were selected, for a total of 21 264 patients. The estimated mean difference was −3.06 days (95% CI −4.71, −1.40) in favor of the SSU. The selected articles did not show any differences in terms of mortality and readmission rate. Conclusions Use of SSUs could reduce patient length of stay in hospital, representing an alternative to the ordinary ward for selected patients. A shorter period of hospitalization could reduce the risk of hospital-acquired infections, increase patient satisfaction and yield more efficient use of hospital beds. Findings of this study are useful for institutional, managerial and clinical decision-makers regarding the implementation of the SSU in a hospital setting, and for better management of continuity of care. PMID:21629205

  7. Prolonged stays in hospital acute geriatric care units: identification and analysis of causes.

    Science.gov (United States)

    Parent, Vivien; Ludwig-Béal, Stéphanie; Sordet-Guépet, Hélène; Popitéan, Laura; Camus, Agnès; Da Silva, Sofia; Lubrano, Anne; Laissus, Frederick; Vaillard, Laurence; Manckoundia, Patrick

    2016-06-01

    In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were women and the SMDHG comprised 315 with a mean age of 86.6 years, of whom 63.2% were women. The two groups were statistically similar for age, sex, living conditions at home (alone or not, help), medical history and number of drugs. Patients in the LMDHG were more dependent (p=0.005), and were more likely to be hospitalized for social reasons (p=0.024) and to have come from their homes (p=0.011) than those in the SMDHG. The reasons for the prolonged stay, more frequent in the LMDHG than the SMDHG (p<0.05), were principally: waiting for imaging examinations, medical complications, and waiting for discharge solutions, assistance from social workers and/or specialist consultations. In order to reduce the MDH in acute geriatric care unit, it is necessary to consider the particularities of the patients who are admitted, their medico-socio-psychological management, access to technical facilities/consultations and post-discharge accommodation.

  8. What factors predict length of stay in a neonatal unit: a systematic review

    Science.gov (United States)

    Seaton, Sarah E; Barker, Lisa; Jenkins, David; Draper, Elizabeth S; Abrams, Keith R; Manktelow, Bradley N

    2016-01-01

    Objective In the UK, 1 in 10 babies require specialist neonatal care. This care can last from hours to months depending on the need of the baby. The increasing survival of very preterm babies has increased neonatal care resource use. Evidence from multiple studies is crucial to identify factors which may be important for predicting length of stay (LOS). The ability to predict LOS is vital for resource planning, decision-making and parent counselling. The objective of this review was to identify which factors are important to consider when predicting LOS in the neonatal unit. Design A systematic review was undertaken which searched MEDLINE, EMBASE and Scopus for papers from 1994 to 2016 (May) for research investigating prediction of neonatal LOS. Strict inclusion and exclusion criteria were applied. Quality of each study was discussed, but not used as a reason for exclusion from the review. Main outcome measure Prediction of LOS in the neonatal unit. Results 9 studies were identified which investigated the prediction of neonatal LOS indicating a lack of evidence in the area. Inherent factors, particularly birth weight, sex and gestational age allow for a simple and objective prediction of LOS, which can be calculated on the first day of life. However, other early occurring factors may well also be important and estimates may need revising throughout the baby's stay in hospital. Conclusions Predicting LOS is vital to aid the commissioning of services and to help clinicians in their counselling of parents. The lack of evidence in this area indicates a need for larger studies to investigate methods of accurately predicting LOS. PMID:27797978

  9. Respiratory complications in the pediatric postanesthesia care unit.

    Science.gov (United States)

    von Ungern-Sternberg, Britta S

    2014-03-01

    This article focuses on common respiratory complications in the postanesthesia care unit (PACU). Approximately 1 in 10 children present with respiratory complications in the PACU. The article highlights risk factors and at-risk populations. The physiologic and pathophysiologic background and causes for respiratory complications in the PACU are explained and suggestions given for an optimization of the anesthesia management in the perioperative period. Furthermore, the recognition, prevention, and treatment of these complications in the PACU are discussed.

  10. Wound Botulism in Injection Drug Users: Time to Antitoxin Correlates with Intensive Care Unit Length of Stay

    Directory of Open Access Journals (Sweden)

    Offerman, Steven R

    2009-11-01

    Full Text Available Objectives: We sought to identify factors associated with need for mechanical ventilation (MV, length of intensive care unit (ICU stay, length of hospital stay, and poor outcome in injection drug users (IDUs with wound botulism (WB.Methods: This is a retrospective review of WB patients admitted between 1991-2005. IDUs were included if they had symptoms of WB and diagnostic confirmation. Primary outcome variables were the need for MV, length of ICU stay, length of hospital stay, hospital-related complications, and death.Results: Twenty-nine patients met inclusion criteria. Twenty-two (76% admitted to heroin use only and seven (24% admitted to heroin and methamphetamine use. Chief complaints on initial presentation included visual changes, 13 (45%; weakness, nine (31%; and difficulty swallowing, seven (24%. Skin wounds were documented in 22 (76%. Twenty-one (72% patients underwent mechanical ventilation (MV. Antitoxin (AT was administered to 26 (90% patients but only two received antitoxin in the emergency department (ED. The time from ED presentation to AT administration was associated with increased length of ICU stay (Regression coefficient = 2.5; 95% CI 0.45, 4.5. The time from ED presentation to wound drainage was also associated with increased length of ICU stay (Regression coefficient = 13.7; 95% CI = 2.3, 25.2. There was no relationship between time to antibiotic administration and length of ICU stay.Conclusion: MV and prolonged ICU stays are common in patients identified with WB. Early AT administration and wound drainage are recommended as these measures may decrease ICU length of stay.[West J Emerg Med. 2009;10(4:251-256.

  11. The Effect of Physiotherapy on Ventilatory Dependency and the Length of Stay in an Intensive Care Unit

    Science.gov (United States)

    Malkoc, Mehtap; Karadibak, Didem; Yldrm, Yucel

    2009-01-01

    The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained…

  12. Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment

    NARCIS (Netherlands)

    S. Naghib (Sara); C. van der Starre (Cynthia); S.J. Gischler (Saskia); K.F.M. Joosten (Koen); D. Tibboel (Dick)

    2010-01-01

    textabstractBackground: The mortality for children with prolonged stay in pediatric intensive care units (PICU) is much higher than overall mortality. The incidence of withdrawal or limitation of therapy in this group is unknown. Purpose: To assess mortality and characteristics of children admitted

  13. The Effect of Physiotherapy on Ventilatory Dependency and the Length of Stay in an Intensive Care Unit

    Science.gov (United States)

    Malkoc, Mehtap; Karadibak, Didem; Yldrm, Yucel

    2009-01-01

    The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained…

  14. Health-related quality of life after prolonged pediatric intensive care unit stay.

    LENUS (Irish Health Repository)

    Conlon, Niamh P

    2012-02-01

    OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.

  15. Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    M.N. Saulez

    2007-06-01

    Full Text Available Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU. This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate. The WBC count, total CO2 (TCO2 and alkaline phosphatase (ALP were significantly higher (P < 0.05 and anion gap lower in survivors compared with nonsurvivors. A logistic regression model that included WBC count, hematocrit, albumin / globulin ratio, ALP, TCO2, potassium, sodium and lactate, was able to correctly predict mortality in 84 % of cases. Only anion gap proved to be an independent predictor of neonatal mortality in this study. In the study population, the overall mortality rate was 34 % with greatest mortality rates reported in the first 48 hours and again on day 6 of hospitalisation. Amongst the various clinical diagnoses, mortality was highest in foals after forced extraction during correction of dystocia. Median cost per day was higher for nonsurvivors while total cost was higher in survivors.

  16. Relationship of opioid analgesic protocols to assessed pain and length of stay in the pediatric postanesthesia unit following tonsillectomy.

    Science.gov (United States)

    Smith, Jana; Newcomb, Patricia; Sundberg, Erin; Shaffer, Paul

    2009-04-01

    After tonsillectomy and adenoidectomy in children, postoperative pain management is an essential, yet often challenging, task. In addition to discomfort, lack of pain management can lead to delays in oral intake of patients, resulting in extended stays and increased costs. At one North Texas pediatric facility, postoperative coblation tonsillectomy and adenoidectomy pain management orders include the as-needed use of both intravenous fentanyl and intravenous morphine. Both drugs are effective and both have potential side effects that might prolong the recovery period. Nurses in the postanesthesia care unit retrospectively compared a fentanyl and morphine regimen with a morphine-only regimen to determine whether either protocol made a difference in length-of-stay or pain relief. Analysis of available data revealed no statistically significant differences in length of stay between the groups and trivial differences thought to be clinically irrelevant on other variables.

  17. False alarm rates of three third-generation pulse oximeters in PACU, ICU and IABP patients.

    Science.gov (United States)

    Lutter, Norbert O; Urankar, Sabine; Kroeber, Steffi

    2002-01-01

    The objective of this clinical study was to determine alarm rates--in particular the frequency of false positive alarms--of three third-generation pulse oximeters in the postanesthesia care unit (PACU), the intensive care unit (ICU), and in patients with an intra-aortic balloon pump (IABP): Nellcor Symphony N-3000, a Masimo IVY 2000, and Agilent Viridia CMS 2000. All alarms were classified into technical/physiological and false/correct. 235 consecutive ASA physical status I-IV patients after surgery were included into the study. In the PACU false positive alarms were rare: CMS n = 60, N-3000 n = 60, Masimo n = 87. Bland-Altman testing discovered only negligible differences of alarm rates and dropout times. Out of a total of 728 alarms 67.3% were classified as false positive in ICU-patients: 97 alarms by CMS, 176 by N-3000 and 218 by Masimo SET. If IABP was present, CMS indicated a significant smaller number of false positive alarms (n = 35, 7.2%) when compared to Masimo SET (n = 188, 38.9%) and N-3000 (n = 229, 47.4%), consecutively the majority of false positive alarms (76.2%) can be rated as a result of the interference of IABP. Unless IABP (and to a considerably smaller extent cardiac arrhythmia) is present the pulse oximeters do not differ significantly regarding sensitivity and specificity.

  18. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  19. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  20. Processed soybean in diets for pacu (Piaractus mesopotamicus

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    Marcia Regina Stech

    2015-02-01

    Full Text Available Changes in development and in physiological parameters of fingerlings of the pacu (Piaractus mesopotamicus fed on diets with high levels of integral crude, extruded, toasted soybean and soybean meal were assessed. The products were evaluated in practical diets for pacu, initially weighing 70 ± 2.19 g, during 82 days. Nine treatments were studied in a 2 × 4 + 1 factorial scheme which corresponded to two fish meal protein replacement levels (50 and 100% and four soybean products, plus control (100% of fish meal - FM. Development, organosomatic indexes and physiological parameters were evaluated. No differences were reported with regard to weight gain, food intake, food conversion, protein efficiency ratio and specific growth rate. A significant interaction was registered for plasma protein between the evaluated ingredients and replacement percentage of fish meal protein. Results showed that the ingredients assessed did not affect the development of the pacu when compared to fish fed on control diet. Protein retention was favored when toasted soybean and when 50% of the diet’s protein fraction from fish meal were employed.

  1. Embriões de pacu submetidos a diferentes protocolos de resfriamento Pacu embryos submitted to different cooling protocols

    Directory of Open Access Journals (Sweden)

    Danilo Pedro Streit Júnior

    2007-08-01

    Full Text Available O objetivo deste trabalho foi avaliar a taxa de eclosão de larvas de pacu (Piaractus mesopotamicus, após o resfriamento dos embriões a -8ºC durante seis horas, utilizando soluções crioprotetoras, para obter um protocolo de resfriamento para a espécie. Utilizaram-se 2.400 embriões em estádio de pós-gástrula, em sete tratamentos de soluções crioprotetoras, mais um controle, com três repetições, em delineamento inteiramente casualizado. Os crioprotetores etilenoglicol e geléia real foram inapropriados. A substituição de 50% da sacarose não produziu resultados positivos. A combinação metanol (9% e sacarose (17,5% possibilitou eclosão de 69,2%, sendo recomendada para o resfriamento a -8ºC de embriões de pacu por seis horas.The objective of this work was to evaluate the percentage of hatching after cooling of pacu (Piaractus mesopotamicus embryos at -8ºC for six hours, treated with cryoprotectant solutions, to obtain a cooling protocol for the specie. There were 2.400 embryos in post-gastrula stage development, in seven cryoprotectants solutions and control with three replicates, in completely randomized design. Ethylene glycol and honey-jelly were inappropriate. The substitution of 50% sucrose did not produce positive results. The combination of methanol (9% and sucrose (17.5% performed 69.2% of hatching and is recommended for cooling of pacu embryos at -8 ºC for six hours.

  2. What factors predict length of stay in a neonatal unit: a systematic review

    OpenAIRE

    Seaton, Sarah E.; Barker, Lisa; Jenkins, David; Draper, Elizabeth S; Keith R Abrams; Manktelow, Bradley N.

    2016-01-01

    Objective In the UK, 1 in 10 babies require specialist neonatal care. This care can last from hours to months depending on the need of the baby. The increasing survival of very preterm babies has increased neonatal care resource use. Evidence from multiple studies is crucial to identify factors which may be important for predicting length of stay (LOS). The ability to predict LOS is vital for resource planning, decision-making and parent counselling. The objective of this review was to identi...

  3. What can the postanesthesia care unit manager do to decrease costs in the postanesthesia care unit?

    Science.gov (United States)

    Macario, A; Glenn, D; Dexter, F

    1999-10-01

    The economic structure of the PACU dictates whether a cost-reducing intervention (e.g., reducing the length of time patients stay in the PACU) is likely to decrease hospital costs. Cost-reducing interventions, such as changes in medical practice patterns (e.g., to reduce PACU length of stay), only impact variable costs. How PACU nurses are paid (e.g., salaried v hourly) affects which strategies to decrease PACU staffing costs will actually save money. For example, decreases in PACU labor costs resulting from increases in the number of patients that bypass the PACU vary depending on how the staff is compensated. The choice of anesthetic drugs and the elimination of low morbidity side effects of anesthesia, such as postoperative nausea, are likely to have little effect on the peak numbers of patients in a PACU and PACU staffing costs. Because the major determinant of labor productivity in the PACU is hour-to-hour and day-to-day variability in the timing of admissions from the operating room, a more even inflow of patients into the PACU could be attained by appropriate sequencing of cases in the operating room suite (e.g., have long cases scheduled at the beginning of the day). However, this mathematically proven solution may not be desirable. Surgeons, for example, may not want to lose control over the order of their cases. Guidelines for analysis of past daily peak numbers of patients are provided that will provide data to predict the minimum adequate number of nurses needed. Though many managers already do this manually on an ad hoc basis statistical methods summarized in this article may increase the accuracy.

  4. Length of stay of general psychiatric inpatients in the United States: systematic review.

    LENUS (Irish Health Repository)

    Tulloch, Alex D

    2011-05-01

    Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.

  5. Early Mobilization Reduces Duration of Mechanical Ventilation and Intensive Care Unit Stay in Patients With Acute Respiratory Failure.

    Science.gov (United States)

    Lai, Chih-Cheng; Chou, Willy; Chan, Khee-Siang; Cheng, Kuo-Chen; Yuan, Kuo-Shu; Chao, Chien-Ming; Chen, Chin-Ming

    2017-05-01

    To evaluate the effects of a quality improvement program to introduce early mobilization on the outcomes of patients with mechanical ventilation (MV) in the intensive care unit (ICU). A retrospective observational study. Nineteen-bed ICU at a medical center. Adults patients with MV (N=153) admitted to a medical ICU. A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, patient's family) initiated the protocol within 72 hours of MV when patients become hemodynamically stable. We did early mobilization twice daily, 5d/wk during family visits (30min each time), and cooperated with family, if possible. MV duration, rate of successful weaning, and length of ICU and hospital stay. We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body weight, body mass index, disease severity, cause of intubation, number of comorbidities, and most underlying diseases. After protocol group patients had shorter MV durations (4.7d vs 7.5d; PICU stays (6.9d vs 9.9d; P=.001) than did before protocol group patients. Early mobilization was negatively associated with the duration of MV (β=-.269; PICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient's family can work together to improve the patient's clinical outcomes. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Partnered medication review and charting between the pharmacist and medical officer in the Emergency Short Stay and General Medicine Unit.

    Science.gov (United States)

    Tong, Erica Y; Roman, Cristina P; Smit, De Villiers; Newnham, Harvey; Galbraith, Kirsten; Dooley, Michael J

    2015-08-01

    A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.

  7. Shock in the first 24 h of intensive care unit stay: observational study of protocol-based fluid management.

    Science.gov (United States)

    See, Kay Choong; Mukhopadhyay, Amartya; Lau, Samuel Chuan-Xian; Tan, Sandra Ming-Yien; Lim, Tow Keang; Phua, Jason

    2015-05-01

    Precision in fluid management for shock could lead to better clinical outcomes. We evaluated the association of protocol-based fluid management with intensive care unit (ICU) and hospital mortality. We performed an observational study of mechanically ventilated patients admitted directly from our emergency department to the ICU from August 2011 to December 2013, who had circulatory shock in the first 24 h of ICU stay (systolic blood pressure 4 mmol/L). Patients with onset of shock beyond 24 h of ICU stay were excluded. Protocol-based fluid management required close physician-nurse cooperation and computerized documentation, checking for fluid response (≥10% arterial pulse pressure or stroke volume increase after two consecutive 250-mL crystalloid boluses), and fluid loading with repeated 500-mL boluses until fluid response became negative. Six hundred twelve mechanically ventilated patients with shock (mean [±SD] age, 63.0 years [16.5]; 252 or 41.2% females; mean Acute Physiology and Chronic Health Evaluation II score, 30.2 [8.8]) were studied. The fluid management protocol was used 455 times for 242 patients (39.5% of 612 patients) within the first 24 h of ICU stay, with 244 (53.6% of 455) positive responses. Adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II score, comorbidity, and admission year, protocol use was associated with reduced ICU mortality (odds ratio, 0.60; 95% confidence interval, 0.39-0.94; P = 0.025) but not hospital mortality (odds ratio, 0.82; 95% confidence interval, 0.54-1.23; P = 0.369). Among mechanically ventilated patients with shock within the first 24 h of ICU stay, about half had positive fluid responses. Adherence to protocol-based fluid management was associated with improved ICU survival.

  8. [The factors associated with a lengthy hospital stay in a third-level unit].

    Science.gov (United States)

    Aguirre-Gas, H; García-Melgar, M; Garibaldi-Zapatero, J

    1997-01-01

    A descriptive, cross-sectional and retrospective design was developed in order to assess the frequency of patients with lengthy hospital stay (LHS) and associated factors at the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, in Mexico City from January to April, 1993. Some 2,488 patients were discharged during this period and 541 were selected at random. There were 23.9% (n = 131) of patients who had LHS, with a specific mean of 7.7 days and a total mean of 18 days of hospital stay compared with 5 days for those patients who did not have LHS. The associated factors were: patient's origin, admission conditions, complications, hospital infections, category and specialty of attending physician, delay in laboratory and diagnostic imaging exams and results, delay in surgical interventions, and need of outside transportation at time of discharge. Characteristics of patients with greater probabilities of having LHS are outside origin, diagnosis of malignant tumor, complications, hospital infections, and delay in laboratory exams and in surgical interventions. Some of these characteristics can be modified in order to improve LHS and quality of medical care. Further investigations are required to individually analyze these characteristics as well as the justification for LHS and its costs.

  9. A Study of Improvement of Working Efficiency of PACU with Lean Management%用精益管理方法提高麻醉复苏室运转效率的研究

    Institute of Scientific and Technical Information of China (English)

    刘红波; 许少玲; 邱带妹

    2015-01-01

    Objective: To improve the working efficiency of PACU through lean management. Methods:Make analysis ,evaluation and improvement for the work in PACU following lean management. Make assessment on the ef-fect of workload before improvement in 2012 and after improvement improvement in 2013, nurse overtime work , PACU satisfaction and otherwise.Results: The case of palinesthesia increase by 98.4% ,length of overtime of nurse in NACU decrease by 63.1%, the time that patients have to stay in PACU decrease by 14.8%, anesthetists’s satisfy in operating room on work in PACU increase a lot. Conclusion: It is available to improve the working effience in PACU through lean management.%目的:应用精益管理方法提升麻醉复苏室的运转效率。方法:按照精益管理的方法评估、分析、改进复苏室工作,对改进前2012年和改进后2013年的工作量,护士加班超时及复苏室满意度等情况进行效果评价。结果:改进后复苏例数增长了98.4%,复苏室护士超时数下降了63.1%,病人在复苏室的逗留时间下降了14.8%,手术室麻醉科人员对复苏室工作的满意度均有明显的提高。结论:应用精益管理方法能有效地提高复苏室的运转效率。

  10. The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    2014-01-01

    Full Text Available Introduction. Length of stay (LOS in the intensive care unit (ICU of spontaneous intracerebral hemorrhage (sICH patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

  11. Polyurethane cuffed versus conventional endotracheal tubes: Effect on ventilator-associated pneumonia rates and length of Intensive Care Unit stay

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    P Suhas

    2016-01-01

    Full Text Available Background and Aims: Ventilator-associated pneumonia (VAP is a major cause of morbidity and mortality among patients in the Intensive Care Units (ICUs and results in added healthcare costs. One of the methods of preventing VAP is to use polyurethane (PU-cuffed endotracheal tube (ETT. This study compares the incidence of VAP and length of ICU stay in patients intubated with conventional polyvinyl chloride (PVC ETT and PU-cuffed ETT. Methods: Eighty post-laparotomy patients who were mechanically ventilated for >48 h in the ICU were included in this randomised controlled trial. Patients with moderate to severe pre-existing lung conditions were excluded from the study. Patients in group PVC (n = 40 were intubated with conventional PVC-cuffed ETT and those in group PU (n = 40 with PU-cuffed ETT. VAP was defined as a Clinical Pulmonary Infection Score of >6 with a positive quantitative endotracheal culture in patients on ventilator for >48 h. Results: Overall VAP rates were 23.75%. Thirteen (32.5% patients in group PVC and six (15% patients in group PU developed VAP. ICU stay was significantly lesser in patients intubated with PU-cuffed ETT (group PU (median, 6 days; range: 4–8.5 compared to patients intubated with conventional ETT (group PVC (median, 8; range: 6–11. Conclusion: No statistically significant reduction in the incidence of VAP could be found between the groups. The length of ICU stay was significantly lesser with the use of ultra thin PU-cuffed ETTs.

  12. Correlation of APACHE II and SOFA scores with length of stay in various surgical intensive care units.

    Science.gov (United States)

    Milić, Morena; Goranović, Tatjana; Holjevac, Jadranka Katancić

    2009-09-01

    The aim of this study was to evaluate the usefulness of using Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score as the predictors of length of stay (LOS) in various surgical intensive care units (ICUs) and to test the hypothesis that the significance of scoring for predicting LOS is greater in specialized surgical ICUs. We scored patients in a non-specialized general surgical ICU (n = 328) and in a specialized cardiosurgical ICU (n = 158) consecutively on admission (APACHE II-1st day; SOFA-1st day) and on third day of stay (APACHE II-3rd day; SOFA-3rd day) in a 4-month period. LOS and APACHE II/SOFA scores were significantly correlated both on admission and on third day of stay in the general surgical ICU (APACHE II-1st day r = 0.289; SOFA-1st day r = 0.306; APACHE II-3rd day r = 0.728; SOFA-3rd day r = 0.725). LOS and APACHE II on admission were not significantly correlated in the cardiosurgical ICU (APACHE II-1st day r = 0.092), while SOFA on admission and APACHE II and SOFA on third day were significantly correlated (SOFA-1st day r = 0.258; APACHE II-3rd day r = 0.716; SOFA-3rd day r = 0.719). Usefulness of scoring for predicting LOS in ICU varied between different surgical ICUs. Contrary to our hypothesis, scoring had greater value for predicting LOS in the non-specialized general surgical ICU. APACHE II score on admission had no value for predicting LOS in the cardiosurgical ICU.

  13. Effect of extubation with PACU patients under deep anesthesia%PACU 患者深麻醉状态下拔管的效果观察

    Institute of Scientific and Technical Information of China (English)

    洪黎霞; 张骐; 崔雯

    2016-01-01

    ①目的探讨麻醉恢复室(post-anesthesia care unit,PACU)患者深麻醉状态下拔管的效果。②方法选择气管插管全麻术后带管送入 PACU 患者72例,采用随机数字表法分为观察组和对照组,各36例。观察组手术结束不停用丙泊酚,待自主呼吸恢复、潮气量、每分钟通气量在正常范围,脱氧呼吸5分钟、脉搏血氧饱和度(SPO2)>95%、有吞咽动作,拔管后再停药;对照组则完全停用丙泊酚,自主呼吸恢复、潮气量、每分钟通气量在正常范围、脱氧呼吸5分钟、SPO 2>95%、有吞咽动作、意识清醒后再拔除气管导管。比较两组患者拔除气管插管前后5分钟的呼吸频率、心率、平均动脉压,评估患者镇静评分(Ramsay sedation scale RSS)和拔管后相关并发症的发生率。③结果观察组拔除气管导管前后5分钟的呼吸频率、心率、平均动脉压较对照组低,镇静评分均较对照组高;观察组患者拔管后相关并发症的发生率较对照组低,差异均有统计学意义(P <0.05)。④结论PACU 患者深麻醉状态下拔管,血流动力学稳定,拔管后相关并发症的发生率明显降低,保证了患者顺利渡过麻醉苏醒期。%Objective To explore the effects of extubation with post - anesthesia care unit (PACU)patients under deep anesthesia.Methods A total of 72 PACU patients were selected,all of whom were with tubes after general anesthesia surgery with endotracheal intubation.The patients were randomly divided into the observation group(n =36)and the control group(n =36).For the observa-tion group,propofol was continued to be used after surgery,spontaneous respiration was recovered. Tidal volume and minute volume were among the normal range,deoxidization breathing was 5 minitus, SPO2 > 95%.The patients had swallowing act.After extubation,the patients stopped medication.The control group stopped using propofol completely

  14. Solving the negative impact of congestion in the postanesthesia care unit: a cost of opportunity analysis.

    Science.gov (United States)

    Ruiz-Patiño, Alejandro; Acosta-Ospina, Laura Elena; Rueda, Juan-David

    2017-04-01

    Congestion in the postanesthesia care unit (PACU) leads to the formation of waiting queues for patients being transferred after surgery, negatively affecting hospital resources. As patients recover in the operating room, incoming surgeries are delayed. The purpose of this study was to establish the impact of this phenomenon in multiple settings. An operational mathematical study based on the queuing theory was performed. Average queue length, average queue waiting time, and daily queue waiting time were evaluated. Calculations were based on the mean patient daily flow, PACU length of stay, occupation, and current number of beds. Data was prospectively collected during a period of 2 months, and the entry and exit time was recorded for each patient taken to the PACU. Data was imputed in a computational model made with MS Excel. To account for data uncertainty, deterministic and probabilistic sensitivity analyses for all dependent variables were performed. With a mean patient daily flow of 40.3 and an average PACU length of stay of 4 hours, average total lost surgical opportunity time was estimated at 2.36 hours (95% CI: 0.36-4.74 hours). Cost of opportunity was calculated at $1592 per lost hour. Sensitivity analysis showed that an increase of two beds is required to solve the queue formation. When congestion has a negative impact on cost of opportunity in the surgical setting, queuing analysis grants definitive actions to solve the problem, improving quality of service and resource utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Castro-Avila, Ana Cristina; Serón, Pamela; Fan, Eddy; Gaete, Mónica; Mickan, Sharon

    2015-01-01

    Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU) patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU) patients. Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data. 5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness. Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation outcomes, although it seems to improve walking

  16. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Ana Cristina Castro-Avila

    Full Text Available Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU patients.Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data.5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72. There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness.Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation outcomes, although it seems to

  17. A COMPARATIVE STUDY OF RECOVERY TIME AFTER GENERAL ANESTHESIA AND SUBARCHNOID BLOCK FOR INGUINAL HERNIORRAPHY IN PACU

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    Dipalisingh

    2014-06-01

    Full Text Available BACKGROUND: Inguinal herniorraphy is commonly performed on an outpatient basis under nerve blocks, local, spinal or general anesthesia (GA. We have selected inguinal herniorraphy under general anesthesia and spinal anesthesia (SA. OBJECTIVE: To compare the recovery time, postoperative pain and patient satisfaction in the Post Anesthetic Care Unit (PACU. METHODS: A prospective, single blinded, controlled study involved total 60 patients belonging to American Society of Anesthesiologists (ASA I/II scheduled for elective repair of unilateral inguinal hernia. Randomization was done using computer generated random numbers. GA group received intravenous (IV propofol (2mg/kg, butorphanol (40μg/kg and skeletal muscle relaxation was achieved with vecuronium bromide (0.1 mg/kg. Patient was maintained with nitrous oxide and oxygen (66:33 and sevoflurane. SA group received 2ml of 0.5% of hyperbaric bupivacaine intrathecal in lateral decubitus position with 0.04mg/kg midazolam injection IV for sedation. Modified Aldrete scoring system, Visual Analogue Scale (VAS and modified Bromage score were employed to assess recovery time. When pain score was more than 5, rescue analgesia was given with IV injection ketorolac 30mg. All data were analyzed statistically. RESULTS: Patients in GA group (136.23 ±17.82 minutes showed a statistically significant (p< 0.05 recovery time to get shifted from PACU compared with patients in the SA group (176.00 ± 11.92 minutes. But patients in the SA group had significantly less VAS score pain (1.30±1.76 vs. 3.23±2.88, less number of patient received rescue analgesia (16.7% vs. 50% and satisfaction was higher than GA group. CONCLUSIONS: We conclude that GA group resulted in faster recovery time from PACU but SA group had less post-operative pain and better satisfied

  18. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

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    Hantikainen Virpi

    2011-09-01

    Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little

  19. Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit

    Science.gov (United States)

    Langlotz, Curtis P.; Kundel, Harold L.; Brikman, Inna; Pratt, Hugh M.; Redfern, Regina O.; Horii, Steven C.; Schwartz, J. Sanford

    1996-05-01

    Our purpose was to determine the economic effects associated with the introduction of PACS and computed radiology (CR) in a medical intensive care unit (MICU). Clinical and financial data were collected over a period of 6 months, both before and after the introduction of PACS/CR in our medical intensive care unit. Administrative claims data resulting from the MICU stay of each patient enrolled in our study were transferred online to our research database from the administrative databases of our hospital and its affiliated clinical practices. These data included all charge entries, sociodemographic data, admissions/discharge/transfer chronologies, ICD9 diagnostic and procedure codes, and diagnostic related groups. APACHE III scores and other case mix adjusters were computed from the diagnostic codes, and from the contemporaneous medical record. Departmental charge to cost ratios and the Medicare Resource-Based Relative Value Scale fee schedule were used to estimate costs from hospital and professional charges. Data were analyzed using both the patient and the exam as the unit of analysis. Univariate analyses by patient show that patients enrolled during the PACS periods were similar to those enrolled during the Film periods in age, sex, APACHE III score, and other measures of case mix. No significant differences in unadjusted median length of stay between the two Film and two PACS periods were detected. Likewise, no significant differences in unadjusted total hospital and professional costs were found between the Film and PACS periods. In our univariate analyses by exam, we focused on the subgroup of exams that had triggered primary clinical actions in any period. Those action-triggering exams were divided into two groups according to whether the referring clinician elected to obtain imaging results from the workstation or from the usual channels. Patients whose imaging results were obtain from the workstation had significantly lower professional costs in the 7 days

  20. Fósforo na alimentação de pacu (Piaractus mesopotamicus Phosphorus in feed for pacu (Piaractus mesopotamicus

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    Arcangelo Augusto Signor

    2011-12-01

    Full Text Available Objetivou-se avaliar o uso de fósforo na dieta de juvenis de pacu (Piaractus mesopotamicus sobre a qualidade da água, o desempenho zootécnico, o rendimento corporal e a composição química da carcaça. Foram utilizados 100 juvenis com peso médio inicial de 25,9±1,32 g, distribuídos em delineamento inteiramente ao acaso, em 20 tanques de fibra de vidro, com cinco tratamentos e quatro repetições. Os peixes foram alimentados quatro vezes ao dia, às 8; 11; 14 e 17 h, com dietas extrusadas contendo 0,40; 0,55; 0,70; 0,85 e 1,0% de fósforo total. Não foram observadas diferenças nos parâmetros de qualidade de água, com exceção da concentração de ortofosfato na água, que apresentou aumento linear. Os parâmetros de desempenho zootécnico, rendimento corporal e composição química da carcaça não diferiram entre os níveis de suplementação de fósforo na dieta. A utilização de 0,40% de fósforo total atende às exigências de fósforo de juvenis de pacu (Piaractus mesopotamicus, além de disponibilizar menor concentração de ortofosfato da água.The objective of the present research was to evaluate phosphorus in diet for pacu (Piaractus mesopotamicus juveniles on water quality, livestock performance, body yield and carcass chemical composition. A total of 100 juveniles, 25.9±1.32 g average weight were randomly assigned into 20 fiberglass tanks, with five treatments and four replications. The fish were fed four times a day (8 and 11 a.m.; 2 and 5 p.m., with extruded diets containing 0.40; 0.55; 0.70; 0.85 and 1.0 % total phosphorus. No differences were observed in water quality parameters, except for the concentration of orthophosphate in water, which presented linear increase. The parameters livestock performance, body yield and carcass chemical composition showed no differences for the levels of supplementation of phosphorus in diet. The use of 0.40% total phosphorus meets the requirements of phosphorus for pacu (Piaractus

  1. An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.

    Science.gov (United States)

    Johnson, J L; Sagraves, S G; Feild, C J; Block, E F; Cheatham, M L

    2000-10-01

    We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.

  2. Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

    2016-11-29

    Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

  3. Serotonin Transporter Gene ("SLC6A4") Methylation Associates with Neonatal Intensive Care Unit Stay and 3-month-old Temperament in Preterm Infants

    Science.gov (United States)

    Montirosso, Rosario; Provenzi, Livio; Fumagalli, Monica; Sirgiovanni, Ida; Giorda, Roberto; Pozzoli, Uberto; Beri, Silvana; Menozzi, Giorgia; Tronick, Ed; Morandi, Francesco; Mosca, Fabio; Borgatti, Renato

    2016-01-01

    Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene ("SLC6A4"), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study…

  4. Health-related quality of life and rehabilitation cost following intensive care unit stay in multiple trauma patients.

    Science.gov (United States)

    Stergiannis, Pantelis; Katsoulas, Theodoros; Fildissis, George; Intas, George; Galanis, Peter; Kosta, Natalia; Zidianakis, Vasilios; Baltopoulos, George

    2014-01-01

    The objective of this study was to assess changes in health-related quality of life (HRQOL) in multiple trauma patients due to motor vehicle crashes during a follow-up period of 2 years after discharge from an intensive care unit (ICU) and the effect of income and financial cost of rehabilitation in HRQOL. The study was a prospective observational study of multiple trauma patients from January 2009 to January 2011 who were hospitalized in a general, medical, and surgical ICU of a district hospital in Athens, Greece. Eighty-five patients with multiple traumas due to motor vehicle crashes and with an ICU stay of more than 24 hours were included in the study. HRQOL was assessed by a general questionnaire, the EuroQol 5D. Increased monthly household income and absence of traumatic brain injuries were associated with an improved EQ-VAS score. The frequency of severe problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression decreased over time. The financial cost of rehabilitation was initially high but decreased over time. Severely injured victims of motor vehicle crashes suffer from serious problems in terms of HRQOL which is gradually improved even 2 years after hospital discharge. In addition, HRQOL is significantly related to income. Resources used for rehabilitation decrease over time, but even at 24 months, the patients still use half of the amount as compared with the cost of the first 6 months after trauma.

  5. The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Cherry AS

    2016-06-01

    Full Text Available Amanda S Cherry,1 Melissa R Mignogna,1 Angela Roddenberry Vaz,1 Carla Hetherington,2 Mary Anne McCaffree,2 Michael P Anderson,3 Stephen R Gillaspy1 1Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2Neonatal Perinatal Medicine, Department of Pediatrics, University of Oklahoma, College of Medicine, Oklahoma City, OK, 3Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK, USA Objective: Assess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU and its contribution to neonate length of stay (LOS in the NICU.Study design: Mothers of infants admitted to the NICU (n=111 were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB.Results: Postpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620, which was significantly correlated with LOS (r=0.227. Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score.Conclusion: Significant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS. Keywords: NICU, postpartum depression, postpartum anxiety, parental stress, CRIB

  6. Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study.

    Science.gov (United States)

    Roque, Keroulay Estebanez; Tonini, Teresa; Melo, Enirtes Caetano Prates

    2016-10-20

    This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19

  7. Associate Statehood for Scotland as the Way to Stay in both the United Kingdom and the European Union: the Liechtenstein Example

    Directory of Open Access Journals (Sweden)

    Hakan Kolçak

    2017-06-01

    Full Text Available The Brexit Referendum in which the United Kingdom (UK voted to leave the European Union (EU without a nation-wide consensus upon this vote has resulted in a new constitutional crisis in Britain. As an outcome, Scotland, which strongly backed the Remain vote, is now searching for a constitutional option that enables it to stay in both the UK and the EU. As an interdisciplinary study which pays a particular attention to the confederal relationship between Liechtenstein and Switzerland, this article emphasises that associate statehood might be a constitutional option that would allow Scotland to stay in both of the unions. 

  8. Seletividade alimentar de organismos-alimento por formas jovens de pacu Piaractus mesopotamicus (Holmberg, 1887 e curimba Prochilodus lineatus (Valenciennes, 1836 = Selective feeding of food organisms by fish larvae of Piaractus mesopotamicus (Holmberg, 1887 and Prochilodus lineatus (Valenciennes, 1836

    Directory of Open Access Journals (Sweden)

    Nandeyara Ribeiro Marques

    2007-04-01

    Full Text Available Objetivou-se avaliar a seleção alimentar de organismos-alimento por formas jovens de pacu (Piaractus mesopotamicus e curimba (Prochilodus lineatus com diferentes idades (6, 12, 19 e 26 dias, na presença e ausência de Pistia stratiotes. Foram utilizados quatrotratamentos (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba e quatro repetições. A cada sete dias, foram coletadas 24 larvas de cada espécie de peixe dos tanques, sendo estas mantidas em jejum por 24 horas. Depois de distribuídas nos aquários com plâncton, as larvas permaneceram por três horas, sendocoletadas e fixadas para análise, juntamente com as amostras de água. Os tratos digestórios das larvas foram retirados e analisados sob microscópio óptico. Observaram-se diferenças estatísticas na seletividade alimentar de organismos planctônicos por larvas de mesmaespécie, em diferentes idades e também entre larvas de espécies diferentes, com mesma idade, não diferindo quanto à presença ou ausência de P. stratiotes. As formas jovens de pacu e curimba selecionaram organismos similares aos seis dias de idade, passando por alterações até o 26º dia. À medida que se desenvolveram, as larvas de pacu passaram a selecionar cladóceros e ostrácodos e as de curimba, protozoários e algas.Theobjective was to evaluate the feeding selection of food organisms for two species of fish larvae (pacu and curimba at different ages (6, 12, 19 and 26 days after eclosion, in the presence or absence of Pistia stratiotes. Four treatments were used (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba and four replications. Every seven days, 24 fish larvae of each species were collected, and kept without food for 24 hours. Afterbeing distributed in the aquariums with plankton, the larvae stayed for three hours, and were collected and prepared for analysis, along with the water samples. The digestive tract of the fish larvae were

  9. Project STAY.

    Science.gov (United States)

    Smith, Bert Kruger

    Project STAY (Scholarships to Able Youth), located in the barrio of San Antonio, Texas, helps young people stay in school beyond the secondary grades. The project provides outreach services to meet the needs of the students. Its primary service is to act as an advocate for these young people. The project recruits all types of youth from families…

  10. Length of Stay in Ambulatory Surgical Oncology Patients at High Risk for Sleep Apnea as Predicted by STOP-BANG Questionnaire

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    Diwakar D. Balachandran

    2016-01-01

    Full Text Available Background. The STOP-BANG questionnaire has been used to identify surgical patients at risk for undiagnosed obstructive sleep apnea (OSA by classifying patients as low risk (LR if STOP-BANG score < 3 or high risk (HR if STOP-BANG score ≥ 3. Few studies have examined whether postoperative complications are increased in HR patients and none have been described in oncologic patients. Objective. This retrospective study examined if HR patients experience increased complications evidenced by an increased length of stay (LOS in the postanesthesia care unit (PACU. Methods. We retrospectively measured LOS and the frequency of oxygen desaturation (<93% in cancer patients who were given the STOP-BANG questionnaire prior to cystoscopy for urologic disease in an ambulatory surgery center. Results. The majority of patients in our study were men (77.7%, over the age of 50 (90.1%, and had BMI < 30 kg/m2 (88.4%. STOP-BANG results were obtained on 404 patients. Cumulative incidence of the time to discharge between HR and the LR groups was plotted. By 8 hours, LR patients showed a higher cumulative probability of being discharged early (80% versus 74%, P=0.008. Conclusions. Urologic oncology patients at HR for OSA based on the STOP-BANG questionnaire were less likely to be discharged early from the PACU compared to LR patients.

  11. Tecnologia do pescado de água doce: aproveitamento do pacu (Piaractus mesopotamicus Freshwater fish technology: utilization of "pacu"(Piaractus mesopotamicus

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    E.R. Szenttamásy

    1993-09-01

    Full Text Available Para o estudo da viabilidade do Pacu (Piaractus mesopotamicus para processamento tecnológico, foram testados os processos de defumação, salga e secagem e enlatamento. Analisou-se também a farinha dos resíduos. Utilizou-se peixes provenientes de tanques de piscicultura do município de Piracicaba-SP e o produto final foi avaliado para o consumo na merenda escolar municipal. Foram feitas análises quanto aos teores de lipídeos, umidade, proteína e cinza. Os produtos processados por salga, defumação e enlatamento foram analisados também quanto ao teor de sal (NaCl; os defumados e enlatados foram submetidos a análise sensorial com avaliação de aparência, cor, aroma, sabor e textura. O pacu "in natura", defumado, salgado seco e enlatado apresentou, em porcentagem, respectivamente, 18,99; 23,80; 52,53; 18,59 de proteína, 3,79; 2,69; 18,31; 14,34 de lipídeos e 1,82; 3,13; 17,76; 2,79 de cinza. Para o pacu enlatado 56% e 33% dos degustadores o classificaram como um produto de excelente e bom sabor. O pacu defumado foi classificado como de excelente sabor por 25% dos provadores e de bom sabor por 55%.

  12. Association of Bystander Interventions and Hospital Length of Stay and Admission to Intensive Care Unit in Out-of-Hospital Cardiac Arrest Survivors

    DEFF Research Database (Denmark)

    Riddersholm, Signe; Sørensen, Kristian Dahl Kragholm; Mortensen, Rikke Nørmark

    2017-01-01

    BACKGROUND: The impact of bystander interventions on post-arrest hospital course is sparsely studied. We examined the association between bystander interventions and length of hospital stay and admission to intensive care unit (ICU) in one-day survivors after OHCA. METHODS: This cohort study linked...... data of 4641 one-day OHCA survivors from 2001 to 2014 to data on hospital length of stay and ICU admission. We examined associations between bystander efforts and outcomes using regression, adjusted for age, sex, comorbidities, calendar year and witnessed status. We divided bystander efforts into three...... categories: 1. No bystander interventions; 2.Bystander CPR only; 3. Bystander defibrillation with or without bystander CPR. RESULTS: For patients surviving to hospital discharge, hospital length of stay was 20days for patients without bystander interventions, compared to 16 for bystander CPR, and 13...

  13. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

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    Jitender Sodhi

    2016-01-01

    Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

  14. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation.

    Science.gov (United States)

    Bhattacharya, Bishwajit; Maung, Adrian; Barre, Kimberly; Maerz, Linda; Rodriguez-Davalos, Manuel I; Schilsky, Michael; Mulligan, David C; Davis, Kimberly A

    2017-01-01

    Delirium is increasingly recognized as a common and important postoperative complication that significantly hinders surgical recovery. However, there is a paucity of data examining the incidence and impact of delirium after liver transplantation. Retrospective case series in a tertiary care center examining all (n = 144) adult patients who underwent liver transplantation during a 6-y period. Delirium occurred in 25% of the patients with an average duration of 4.56 d. Patients who developed delirium were older (P = 0.007), had higher preoperative model for end-stage liver disease score (P = 0.019) and longer pretransplant hospital length of stay (LOS; P = 0.003). Patients with delirium were also more likely to have alcohol ingestion as an etiology of the liver failure (P = 0.033). Delirious patients had a trend toward increased ventilator days (P = 0.235) and significantly longer postoperative hospital (P = 0.001) and intensive care unit LOS (P = 0.001). Delirium was also associated with an increased frequency of hospital acquired infections including urinary tract infections (P = 0.005) and pneumonias (P = 0.001). Delirium is a common occurrence among liver transplant patients associated with increased complications and LOSs. Further prospective studies are needed to determine the specific risk factors in this complex population and to determine if delirium has an impact on long-term outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Clinical Effectiveness of Modified SOFA (MSOFA scoring system for predicting mortality and length of stay in patients hospitalized in intensive care unit

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    Hassan Babamohamadi

    2016-10-01

    Full Text Available Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of MSOFA scale to predict mortality and length of stay in ICU patients respectively. Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit of Kowsar Hospital of Semnan. The data collection tool was a demographic questionnaire and MSOFA scale. Finally, data were analyzed using SPSS version 16 by logistic regression and ROC curve. Results: The study of 105 patients' records of the intensive care unit in 2015 showed that 45/7% of patients were died, 15/2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and ROC curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0/635, CI= 0/527-0/743( and each unit increase in MSOFA score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P=0.001(. Also each unit increase in MSOFA score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P=0.015(. Conclusion: The results of this study showed that the MSOFA scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

  16. Staying Mobile

    Science.gov (United States)

    ... article Staying Behind the Wheel - Momentum article Animal Attraction - Momentum article Association for Driver Rehabilitation Specialists (ADED) ... two part vidoe series offers comprehensive fall prevention strategies. Part 1 Part 2 Video Series Choosing the ...

  17. Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

    Science.gov (United States)

    Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

    2013-12-01

    When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was system to mitigate

  18. Development of an Open-Heart Intraoperative Risk Scoring Model for Predicting a Prolonged Intensive Care Unit Stay

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    Sirirat Tribuddharat

    2014-01-01

    Full Text Available Background. Based on a pilot study with 34 patients, applying the modified sequential organ failure assessment (SOFA score intraoperatively could predict a prolonged ICU stay, albeit with only 4 risk factors. Our objective was to develop a practicable intraoperative model for predicting prolonged ICU stay which included more relevant risk factors. Methods. An extensive literature review identified 6 other intraoperative risk factors affecting prolonged ICU stay. Another 168 patients were then recruited for whom all 10 risk factors were extracted and analyzed by logistic regression to form the new prognostic model. Results. The multivariate logistic regression analysis retained only 6 significant risk factors in the model: age ≥ 60 years, PaO2/FiO2 ratio ≤ 200 mmHg, platelet count ≤ 120,000/mm3, requirement for inotrope/vasopressor ≥ 2 drugs, serum potassium ≤ 3.2 mEq/L, and atrial fibrillation grading ≥2. This model was then simplified into the Open-Heart Intraoperative Risk (OHIR score, comprising the same 6 risk factors for a total score of 7—a score of ≥3 indicating a likely prolonged ICU stay (AUC for ROC of 0.746. Conclusions. We developed a new, easy to calculate OHIR scoring system for predicting prolonged ICU stay as early as 3 hours after CPB. It comprises 6 risk factors, 5 of which can be manipulated intraoperatively.

  19. Effect of graded early mobilization versus routine physiotherapy on the length of intensive care unit stay in mechanically ventilated patients: A randomized controlled study

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    Priyakshi Bezbaruah

    2012-01-01

    Full Text Available Background: Early mobilization is an important component of physiotherapy used to prevent and decrease pulmonary and immobilization complications, which are the major goals of physiotherapy in the intensive care unit (ICU. Prolonged bed rest and hospitalization leads to deconditioning and weakness which can further increase the length of the ICU stay. This study was conducted to find an answer to whether early mobilization is as effective as or better than routine physiotherapy in reducing the length of ICU stay in mechanically ventilated patients. Study Design: Randomized controlled study. Study Setting: Medical ICU, Father Muller Medical College Hospital. Mangalore, Karnataka, India. Aim: To detect the effectiveness of graded early mobilization and routine physiotherapy and to compare these techniques with respect to the length of ICU stay in mechanically ventilated patients. Materials and Methods: Fifteen subjects of both gender who were on mechanical ventilators fulfilling the inclusion criteria were randomly assigned to two groups, group 1 (graded early mobilization, n = 8 and Group 2 (routine physiotherapy, n = 7 by using the randomization plan from the website www.randomization.com. All the vitals of the subjects were noted as they were made to perform particular maneuvers depending on the group they belonged to. Participants recruited into the early mobilization group were mobilized as soon as their vitals were stable and were able to participate in the therapy. The patients who underwent routine physiotherapy were mobilized once they were extubated. At the time of discharge from the ICU, days of weaning, days first out of bed, and length of ICU stay were noted. Results: A significant difference was observed between early mobilization and routine physiotherapy groups with respect to the length of ICU stay. Conclusion: Early mobilization showed better outcome compared to routine physiotherapy in reducing the length of ICU stay in

  20. Leukocytes respiratory burst activity as indicator of innate immunity of pacu Piaractus mesopotamicus

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    JD Biller-Takahashi

    Full Text Available The present study evaluated the assay to quantify the respiratory burst activity of blood leukocytes of pacu as an indicator of the innate immune system, using the reduction of nitroblue tetrazolium (NBT to formazan as a measure of the production of reactive oxygen species (ROS. In order to assess the accuracy of the assay, fish were challenged by Aeromonas hydrophila and sampled one week after challenge. The A. hydrophila infection increased the leukocyte respiratory burst activity. The protocol showed a reliable and easy assay, appropriate to determine the respiratory burst activity of blood leukocytes of pacu, a neotropical fish, in the present experimental conditions.

  1. Eficácia do fembendazole no controle de nematódeos de pacu Piaractus mesopotamicus (Holmberg, 1987 The efficiency of fembendazole in the control of nematodes in pacu Piaractus mesopotamicus (Holmberg, 1987

    Directory of Open Access Journals (Sweden)

    Jorge Erick Garcia Parra

    1997-06-01

    Full Text Available O presente trabalho foi realizado no Centro de Pesquisa e Treinamento em Aquicultura (CEPTA/1BAMA, município de Pirassununga, SP. Foram utilizados 60 pacus, dos viveiros da Estação de Piscicultura do CEPTA, com peso médio de 600g. Foi realizado um teste visando avaliar o efeito do Femben-dazote (adicionado no alimento em diferentes dosagens, sobre os nematódeos presentes no tubo intestinal do pacu, utilizando três tratamentos: Tl - grupo testemunha (ração sem Fembendazole, T2 - 20mg de Fembendazole/kg de ração e T3 - 40mg de Fembendazo-le/kg de ração. O delineamento foi inteiramente casualizado. A unidade experimental foi o peixe. Não houve diferença significativa (P 0,05 entre os tratamentos com anti-helmintico Fembendazole nas dosagens de 20mg/kg e 40/ng/kg de ração e o grupo testemunha.This study was done at lhe Agricultural Centre for Training and Research (CEPTA/IBAMA m the municipality of Pirassununga, São Paulo. Sixty pacus, wilh an average weight of 600g were obtained from the nurseries of the fish statíon at CEPTA. An experiment to determine the ejfect of fenbendazole (added to the ration in varíous doses on nematodes in the alimentary canal ofthe pacu was realized using three treatments. Tl - contrai group (ration without fenbendazole, T2 - 20mg fenbendazole/kg ration, and T3 - 40mgfenbendazole/kg ration. The experimental ouüine was totally random. The fish was the experimental unit. There was no significam dijference (P 0.05 befween the treatments wilh the anti-helminthic fenbendazole added to the ration in doses of 20 and 40 mg/kg and the contrai group.

  2. Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors.

    Science.gov (United States)

    Riddersholm, Signe; Kragholm, Kristian; Mortensen, Rikke Nørmark; Pape, Marianne; Hansen, Carolina Malta; Lippert, Freddy K; Torp-Pedersen, Christian; Christiansen, Christian F; Rasmussen, Bodil Steen

    2017-10-01

    The impact of bystander interventions on post-arrest hospital course is sparsely studied. We examined the association between bystander interventions and length of hospital stay and admission to intensive care unit (ICU) in one-day survivors after OHCA. This cohort study linked data of 4641 one-day OHCA survivors from 2001 to 2014 to data on hospital length of stay and ICU admission. We examined associations between bystander efforts and outcomes using regression, adjusted for age, sex, comorbidities, calendar year and witnessed status. We divided bystander efforts into three categories: 1. No bystander interventions; 2.Bystander CPR only; 3. Bystander defibrillation with or without bystander CPR. For patients surviving to hospital discharge, hospital length of stay was 20days for patients without bystander interventions, compared to 16 for bystander CPR, and 13 for bystander defibrillation. 82% of patients without bystander interventions were admitted to ICU compared to 77.2% for bystander CPR, and 61.2% for bystander defibrillation. In-hospital mortality was 60% in the first category compared to 40.5% and 21.7% in the two latter categories. In regression models, bystander CPR and bystander defibrillation were associated with a reduction of length of hospital stay of 21% (Estimate: 0.79 [95% CI: 0.72-0.86]) and 32% (Estimate: 0.68 [95% CI: 0.59-0.78]), respectively. Both bystander CPR (OR: 0.94 [95% CI: 0.91-0.97]) and bystander defibrillation (OR: 0.81 [0.76-0.85]), were associated with lower risk of ICU admission. Bystander interventions were associated with reduced hospital length of stay and ICU admission, suggesting that these efforts improve recovery in OHCA survivors. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The effect of muscle relaxant antagonismon on patients with residual paralysis in postanesthesia care unit%肌松拮抗对麻醉恢复室患者残余阻滞作用的影响

    Institute of Scientific and Technical Information of China (English)

    汪忠玉; 吴新海; 郑利民

    2014-01-01

    目的 探讨肌松拮抗药对麻醉恢复室患者残余阻滞作用的影响.方法 从入麻醉恢复室(PACU)患者中选出相似的患者进行配对,分为实验组(J组)和对照组(F组),每组26例,术后PACU内用四个成串刺激(TOF)监测肌松,TOF为4时J组给予新斯的明40 μg/kg、阿托品20 μg/kg;F组给予5ml生理盐水.按临床指征拔管,记录拔管时的TOF值、PaO2、PaCO2、离开PACU时SpO2、PACU停留时间以及是否出现呼吸抑制和副作用.结果 J组拔管时的TOF值(0.96 ±0.04)明显较F组(0.92±0.06)高(P<0.05),PACU停留时间[(26 ±5)min]也短于F组[(33±7)min](P <0.01).F组有2例出现呼吸抑制.拔管时的PaO2及PaCO2、拔管时间、离开PACU的SpO2两组差异无统计学意义(P>0.05).两组患者均未出现术后恶心呕吐(PONV)等副作用.结论 常规肌松拮抗使术后残余肌松作用风险降低,缩短PACU停留时间,且无PONV等副作用.%Objective To investigate the effects of muscle relaxant antagonism on patients with residual paralysis in postanesthesia care unit (PACU).Methods The similar patients who were daily accepted into PACU were chosen to make pairs,and were randomly divided into experimental (J; n =26) and control (F; n =26) groups.On arrival to the PACU,the train-of-four ratio (TO-Fr) was assessed using electromyography.When TOFr reached 4,Grour J was given with neostigmine 40 μg/kg and atropine 20 μg/kg; Group F was given with 5ml saline.Extubation was determined with standard clinical criteria.We recorded TOFr,PaO2,PaCO2at the time point of extubation,SpO2 at the time point of left the PACU,the stay time in PACU,the incidence of respiratory dysfunction,and the side effect.Results The TOFr at the time point of extubation in group J (0.96 ± 0.04) was significantly higher than group F (0.92 ±0.06) (P <0.05).The stay time in PACU in group J [(26 ±5)min] was significantly less than group F [(33 ±7) min] (P < 0.01).PaO2,PaCO2,extubation time,and SpO2 were

  4. Stochastic evolution of staying together.

    Science.gov (United States)

    Ghang, Whan; Nowak, Martin A

    2014-11-07

    Staying together means that replicating units do not separate after reproduction, but remain attached to each other or in close proximity. Staying together is a driving force for evolution of complexity, including the evolution of multi-cellularity and eusociality. We analyze the fixation probability of a mutant that has the ability to stay together. We assume that the size of the complex affects the reproductive rate of its units and the probability of staying together. We examine the combined effect of natural selection and random drift on the emergence of staying together in a finite sized population. The number of states in the underlying stochastic process is an exponential function of population size. We develop a framework for any intensity of selection and give closed form solutions for special cases. We derive general results for the limit of weak selection. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Role of the nurse in the short stay immunotherapy Unit during the administration of intravenous anda subcutaneous gammaglobulin

    Directory of Open Access Journals (Sweden)

    Rosales Sánchez Isis

    2014-07-01

    Full Text Available With the increasing development of medical specialties, an urgent necessity of parallel specialties in the laboratories and nursing fields becomes evident. Immunology is the field of science responsible for the study of defense responses developed by an individual in the face of aggression by microorganisms or foreign particles as well as those coming from the internal environment such as neoplastic cells.1 Immunology is considered as a young discipline with an spectacular development that took place in the second half of 20th century. From then till date, there have been many important spectacular advances in the area leading to its consolidation as an independent science separate from microbiology. As part of the Immunology Service at the Instituto Nacional de Pediatria (INP, the Short-Stay Immunotherapy Unity (SSI was established. This unity has been fundamental in ensuring adequate treatment for patients with primary immunodeficiency and autoim- mune in the long term. We highlight the roles of the nursing staff of SSI in the area of drug preparation and patient care.

  6. Incorporation of conjugated linoleic acid (CLA and α-linolenic acid (LNA in pacu fillets

    Directory of Open Access Journals (Sweden)

    Deoclécio José Barilli

    2014-03-01

    Full Text Available The objective of this study was to evaluate the incorporation of conjugated linoleic acid and α-linolenic acid in fillets of pacu fish raised in net cages and fed diets enriched with these acids. The fish were fed for 49 days, and at the end of this period the fatty acid content in the fillets was determined by gas chromatography. Concentrations of α-linolenic acid, eicosapentaenoic acid, and the total omega-3 (n-3 fatty acid in the fillets increased, improving the n-6/n-3 ratio. In addition, the incorporation of conjugated linoleic acid in the fish fillets proved well established. This study showed that the use of diets enriched with conjugated linoleic acid and α-linolenic acid results in the incorporation of these acids in the of pacu fish fillets, improving their nutritional quality.

  7. Disease resistance of pacu Piaractus mesopotamicus (Holmberg, 1887 fed with β-glucan

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    JD Biller-Takahashi

    Full Text Available Effects of β-glucan on innate immune responses and survival were studied in pacu experimentally infected with Aeromonas hydrophila. Fish fed diets containing 0, 0.1% and 1% β-glucan were injected with A. hydrophila. β-glucan enhanced fish survival in both treated groups (26.7% and 21.2% of the control, respectively. Leukocyte respiratory burst and alternative complement pathway activities were elevated after bacterial challenge regardless the β-glucan concentration. Lysozyme activity was higher after infection and showed a gradual increase as β-glucan concentration increased. A significant elevation in WBC count was observed either after bacterial challenge or by influence of β-glucan separately. The same response was observed in the number of thrombocytes, lymphocytes, eosinophils, LG-PAS positive cell and monocytes. It can be concluded that feeding pacu with β-glucan can increase protection against A. hydrophila, due to changes in non-specific immune responses.

  8. Controle biológico de Dolops carvalhoi (Crustacea: Branchiura) em juvenis de pacu (Piaractus mesopotamicus)

    OpenAIRE

    Genovez, Lara Wichr [UNESP; Pilarski, Fabiana; Sakabe, Roberson; do Amaral Marques, Mauricio Pires; Moraes, Flavio Ruas de [UNESP

    2008-01-01

    This work evaluated piaucu juveniles (Leporinus macrocephalus) efficiency on the control of Dolops carvalhoi in pacu (Piaractus mesopotamicus) under artificial infestation. 30 fish were equally distributed in six aquarium and acclimated for seven days. After this period the pacus were unnaturaly infested with 20 D. carvalhoi per fish to four days. on the fifth day, for aquaria were added with five uninfected piaucus each and the fish were checked eight times to evaluted the total number of pa...

  9. Seletividade alimentar de organismos-alimento por formas jovens de pacu Piaractus mesopotamicus (Holmberg, 1887 e curimba Prochilodus lineatus (Valenciennes, 1836 - DOI: 10.4025/actascibiolsci.v29i2.523 Selective feeding of food organisms by fish larvae of Piaractus mesopotamicus (Holmberg, 1887 and Prochilodus lineatus (Valenciennes, 1836 - DOI: 10.4025/actascibiolsci.v29i2.523

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    Carlos Eduardo Bento Fernandes

    2007-12-01

    Full Text Available Objetivou-se avaliar a seleção alimentar de organismos-alimento por formas jovens de pacu (Piaractus mesopotamicus e curimba (Prochilodus lineatus com diferentes idades (6, 12, 19 e 26 dias, na presença e ausência de Pistia stratiotes. Foram utilizados quatro tratamentos (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba e quatro repetições. A cada sete dias, foram coletadas 24 larvas de cada espécie de peixe dos tanques, sendo estas mantidas em jejum por 24 horas. Depois de distribuídas nos aquários com plâncton, as larvas permaneceram por três horas, sendo coletadas e fixadas para análise, juntamente com as amostras de água. Os tratos digestórios das larvas foram retirados e analisados sob microscópio óptico. Observaram-se diferenças estatísticas na seletividade alimentar de organismos planctônicos por larvas de mesma espécie, em diferentes idades e também entre larvas de espécies diferentes, com mesma idade, não diferindo quanto à presença ou ausência de P. stratiotes. As formas jovens de pacu e curimba selecionaram organismos similares aos seis dias de idade, passando por alterações até o 26º dia. À medida que se desenvolveram, as larvas de pacu passaram a selecionar cladóceros e ostrácodos e as de curimba, protozoários e algas.The objective was to evaluate the feeding selection of food organisms for two species of fish larvae (pacu and curimba at different ages (6, 12, 19 and 26 days after eclosion, in the presence or absence of Pistia stratiotes. Four treatments were used (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba and four replications. Every seven days, 24 fish larvae of each species were collected, and kept without food for 24 hours. After being distributed in the aquariums with plankton, the larvae stayed for three hours, and were collected and prepared for analysis, along with the water samples. The digestive tract of the fish larvae

  10. Rearing temperature induces changes in muscle growth and gene expression in juvenile pacu (Piaractus mesopotamicus).

    Science.gov (United States)

    Gutierrez de Paula, Tassiana; de Almeida, Fernanda Losi Alves; Carani, Fernanda Regina; Vechetti-Júnior, Ivan José; Padovani, Carlos Roberto; Salomão, Rondinelle Arthur Simões; Mareco, Edson Assunção; Dos Santos, Vander Bruno; Dal-Pai-Silva, Maeli

    2014-03-01

    Pacu (Piaractus mesopotamicus) is a fast-growing fish that is extensively used in Brazilian aquaculture programs and shows a wide range of thermal tolerance. Because temperature is an environmental factor that influences the growth rate of fish and is directly related to muscle plasticity and growth, we hypothesized that different rearing temperatures in juvenile pacu, which exhibits intense muscle growth by hyperplasia, can potentially alter the muscle growth patterns of this species. The aim of this study was to analyze the muscle growth characteristics together with the expression of the myogenic regulatory factors MyoD and myogenin and the growth factor myostatin in juvenile pacu that were submitted to different rearing temperatures. Juvenile fish (1.5 g weight) were distributed in tanks containing water and maintained at 24°C (G24), 28 °C (G28) and 32 °C (G32) (three replicates for each group) for 60 days. At days 30 and 60, the fish were anesthetized and euthanized, and muscle samples (n=12) were collected for morphological, morphometric and gene expression analyses. At day 30, the body weight and standard length were lower for G24 than for G28 and G32. Muscle fiber frequency in the 50 μm class was lower in G24. MyoD gene expression was higher in G24 compared with that in G28 and G32, and myogenin and myostatin mRNA levels were higher in G24 than G28. At day 60, the body weight and the standard length were higher in G32 but lower in G24. The frequency distribution of the muscle fibers was higher in G24, and that of the >50 μm class was lower in G24. MyoD mRNA levels were higher in G24 and G32, and myogenin mRNA levels were similar between G24 and G28 and between G24 and G32 but were higher in G28 compared to G32. The myostatin mRNA levels were similar between the studied temperatures. In light of our results, we conclude that low rearing temperature altered the expression of muscle growth-related genes and induced a delay in muscle growth in juvenile

  11. Elevation of a patient's trunk and legs does not influence length of stay in the post-anesthesia care unit

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    Otávio Omati

    Full Text Available CONTEXT: Patient recovery time after anesthesia depends on problem-oriented monitoring and individual assessment. OBJECTIVE: To investigate the influence of patient positioning on post-anesthesia recovery time. TYPE OF STUDY: Retrospective. SETTING: Post-anesthesia care unit, Hospital das Clínicas, São Paulo. METHODS: Data were obtained from patients recovering from anesthesia in a supine horizontal position or with their trunk and legs elevated at 30 degrees. Data were recorded every 30 minutes. The start time was considered to be the admission to the unit, and the final measurement was taken when the patient reached an Aldrete-Kroulik index of 10. The length of time until discharge was recorded. RESULTS: 442 patients recovering after general (n = 274 or regional anesthesia (n = 168 were assigned to be kept in a supine position or with their trunk and legs elevated. There was no difference in the medians for non-parametric results, between supine position (75 min, n = 229 and trunk and legs elevated (70 min, n = 213; p = 0.729. Patients recovered faster from regional anesthesia with trunk and legs elevated (70 min than in the supine position (84.5 min, although not significantly (p = 0.097. There was no difference between patients recovering from general anesthesia, no matter the positioning (70 min; p = 0.493. DISCUSSION: Elevated legs may supposedly improve venous return and cardiac output since spinal anesthesia blocks sympathetic system and considering leg-raising has been shown to improve cardiac output from hipovolemia. Our findings did not support this hypothesis. Some limitations included a retrospective collection of data that did not allow randomization for recovery position and the unregistered duration of the exposure to the anesthetic drugs. CONCLUSIONS: There was no difference in anesthesia recovery time in relation to positioning patients supinely or with trunk and legs elevated.

  12. The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients.

    Science.gov (United States)

    Piva, Simone; Dora, Giancarlo; Minelli, Cosetta; Michelini, Mariachiara; Turla, Fabio; Mazza, Stefania; D'Ottavi, Patrizia; Moreno-Duarte, Ingrid; Sottini, Caterina; Eikermann, Matthias; Latronico, Nicola

    2015-12-01

    We validated the Italian version of Surgical Optimal Mobility Score (SOMS) and evaluated its ability to predict intensive care unit (ICU) and hospital length of stay (LOS), and hospital mortality in a mixed population of ICU patients. We applied the Italian version of SOMS in a consecutive series of prospectively enrolled, adult ICU patients. Surgical Optimal Mobility Score level was assessed twice a day by ICU nurses and twice a week by an expert mobility team. Zero-truncated Poisson regression was used to identify predictors for ICU and hospital LOS, and logistic regression for hospital mortality. All models were adjusted for potential confounders. Of 98 patients recruited, 19 (19.4%) died in hospital, of whom 17 without and 2 with improved mobility level achieved during the ICU stay. SOMS improvement was independently associated with lower hospital mortality (odds ratio, 0.07; 95% confidence interval [CI], 0.01-0.42) but increased hospital LOS (odds ratio, 1.21; 95% CI: 1.10-1.33). A higher first-morning SOMS on ICU admission, indicating better mobility, was associated with lower ICU and hospital LOS (rate ratios, 0.89 [95% CI, 0.80-0.99] and 0.84 [95% CI, 0.79-0.89], respectively). The first-morning SOMS on ICU admission predicted ICU and hospital LOS in a mixed population of ICU patients. SOMS improvement was associated with reduced hospital mortality but increased hospital LOS, suggesting the need of optimizing hospital trajectories after ICU discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. An Official American Thoracic Society Systematic Review: The Effect of Nighttime Intensivist Staffing on Mortality and Length of Stay among Intensive Care Unit Patients.

    Science.gov (United States)

    Kerlin, Meeta Prasad; Adhikari, Neill K J; Rose, Louise; Wilcox, M Elizabeth; Bellamy, Cassandra J; Costa, Deena Kelly; Gershengorn, Hayley B; Halpern, Scott D; Kahn, Jeremy M; Lane-Fall, Meghan B; Wallace, David J; Weiss, Curtis H; Wunsch, Hannah; Cooke, Colin R

    2017-02-01

    Studies of nighttime intensivist staffing have yielded mixed results. To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models. Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95% confidence interval, 0.75-1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes. Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.

  14. Uso de saponina de quilaia (Quillaja saponaria Molina) em juvenis de pacu

    OpenAIRE

    Fernandes, Rosangela do Nascimento [UNESP

    2014-01-01

    The quillaja saponin (QS) is present in the bark of Chilean and Brazilian trees of the same family, Rosaceae and, it´s able to promote performance and the immune system of animals. Thus, this study evaluated the effect of consuming diets containing increasing levels of QS (0,0; 100,0; 200,0; 300,0; 400,0 mg kg-1) by pacu. Three distinct steps in different consumption diets periods compound by seven, 15, and 30 days. At each step, was used a total of 350 fish, totaling 1050 fishes. These fishe...

  15. Growth and structure of the digestive system of pacu larvae fed microencapsulated diet produced experimentally

    OpenAIRE

    Olívia Cristina Camilo Menossi; Rodrigo Takata; María Isabel Sánchez-Amaya; Thiago Mendes de Freitas; Manuel Yúfera; Maria Célia Portella

    2012-01-01

    Foram comparados os efeitos de diferentes dietas e da transição alimentar sobre o desempenho zootécnico e a morfologia do trato digestório de larvas de pacu alimentadas com duas dietas comerciais e uma dieta experimental microencapsulada produzida por gelificação interna. Larvas com quatro dias de vida receberam os seguintes protocolos alimentares: somente náuplios de artêmia em quantidades crescentes (controle positivo); larvas mantidas em jejum (controle negativo); três tipos de alimento fo...

  16. Plasma testosterone and 11-ketotestosterone levels of male pacu Piaractus mesopotamicus (Cypriniformes, Characidae

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    R. Gazola

    1997-12-01

    Full Text Available The levels of testosterone (T and 11-ketotestosterone (11-KT of the South American pacu Piaractus mesopotamicus were determined by radioimmunoassay during two stages of the reproductive cycle, i.e., resting and maturation, and the gonadosomatic index (GSI was calculated. The highest levels of T and 11-KT were reached during the maturation stage (T = 2400 ± 56 pg/ml; 11-KT = 2300 ± 60 pg/ml and lower levels were maintained during the resting period. The rise in androgen levels occurred with the appearance of spermatozoa in the maturation stage, when GSI was highest

  17. Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings

    Science.gov (United States)

    Salgado Yepez, Estuardo; Bovera, Maria M; Rosenthal, Victor D; González Flores, Hugo A; Pazmiño, Leonardo; Valencia, Francisco; Alquinga, Nelly; Ramirez, Vanessa; Jara, Edgar; Lascano, Miguel; Delgado, Veronica; Cevallos, Cristian; Santacruz, Gasdali; Pelaéz, Cristian; Zaruma, Celso; Barahona Pinto, Diego

    2017-01-01

    AIM To report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador. METHODS A device-associated healthcare-acquired infection (DA-HAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units (ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection (CLABSI) rate was 6.5 per 1000 central line (CL)-days, the ventilator-associated pneumonia (VAP) rate was 44.3 per 1000 mechanical ventilator (MV)-days, and the catheter-associated urinary tract infection (CAUTI) rate was 5.7 per 1000 urinary catheter (UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9 (CLABSI) and 5.3 (CAUTI)] and higher than NHSN rates [0.8 (CLABSI) and 1.3 (CAUTI)] - although device use ratios for CL and UC were higher than INICC and CDC/NSHN’s ratios. By contrast, despite the VAP rate was higher than INICC (16.5) and NHSN’s rates (1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates. PMID:28289522

  18. KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality.

    Science.gov (United States)

    Papadimitriou-Olivgeris, Matthaios; Marangos, Markos; Fligou, Fotini; Christofidou, Myrto; Sklavou, Christina; Vamvakopoulou, Sophia; Anastassiou, Evangelos D; Filos, Kriton S

    2013-10-01

    A prospective observational study of 226 intensive care unit (ICU) patients was conducted during a 25-month period. Rectal samples were taken at day 1, 4, and 7 and, afterwards, once weekly. Klebsiella pneumoniae was identified using standard techniques, whereas the presence of bla(KPC) gene was confirmed by PCR. During ICU stay, 72.6% of the patients were colonized with Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-Kp). Male gender, prior bed occupants, and patients in nearby beds colonized with KPC-Kp, tracheotomy, number of invasive catheters inserted, and number of antibiotics administered were the major risk factors for KPC-Kp colonization. ICU mortality (35.4%) was significantly related to Simplified Acute Physiology II score and respiratory insufficiency upon admission, cortisone administration, aminoglycoside administration, confirmed KPC-Kp infection, and severe sepsis or septic shock. The high prevalence of KPC-Kp enteric carriage in ICU patients and the significant mortality associated with KPC-Kp infection dictate the importance of early identification and isolation of such carriers.

  19. Performance and carcass traits in the diallel crossing of pacu and tambaqui

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    Rafael Vilhena Reis Neto

    2012-12-01

    Full Text Available With the purpose of evaluating the changes and the degree of heterosis on performance and carcass traits of fish from the diallel crossing between Pacu and Tambaqui, four genetic groups were generated through hormonal induction: pacu, tambaqui, tambacu and paqui. For 196 days, 400 juveniles of each genetic group were stocked in a pond divided into four parts of equal size, one for each group. At the end of this period, when the fish weighed on average 1024 g (±115.52 g, 20 specimens of each genetic group were sampled, weighed, measured: head length; standard length; body height; and width; and also processed resulting in following body yield: viscera; carcass; head; fillet; rib; residue and skin yields. There was positive heterosis for body weight, viscera and skin yield and head measures and negative heterosis for carcass and filet yield and body width, indicating that the hybrids have better performance on weight gain, but are inferior in relation to the carcass conformation.

  20. Hematology of juvenile pacu, Piaractus mesopotamicus (Holmberg, 1887 fed graded levels of mannan oligosaccharides (MOS

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    Ricardo Yuji Sado

    2014-03-01

    Full Text Available Intensification of aquaculture production systems exposes fish to numerous stressors, which may negatively affect their health. This study determined the effects of increasing levels of dietary mannan oligosaccharides (ActiveMOS®-Biorigin on biochemical and hematological parameters of juvenile pacu, Piaractus mesopotamicus. Fish (44.04 ± 5.27 g were randomly distributed into 24 tanks (500 L; 10 fishes per tank and fed during 63 days with a commercial diet supplemented with 0.0, 0.2, 0.4, 0.6, 0.8, 1.0, 1.5 and 2.0% MOS. Blood samples were collected at 42 and 63 trial. Red blood cell count (RBC and total plasmatic protein were affected by dietary MOS levels (P < 0.05. Fish fed 1.0% dietary MOS presented higher neutrophils numbers when compared to fish fed control diet and fish fed 1.5% MOS for 42 days presented significant higher granulocytic cell numbers. During trial fish presented increased (P < 0.05 hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and plasmatic glucose concentrations and decreased (P < 0.05 RBC, hemoglobin concentration, mean corpuscular hemoglobin concentration, white blood cell and differential leukocyte count. Dietary MOS levels did not present prebiotic effects for pacu and did not minimize stress effects on hematological and biochemical parameters for the species.

  1. Intra-hospital transfers to a higher level of care: contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS).

    Science.gov (United States)

    Escobar, Gabriel J; Greene, John D; Gardner, Marla N; Marelich, Gregory P; Quick, Bryon; Kipnis, Patricia

    2011-02-01

    Patients who experience intra-hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single-center studies or studies that employ ICU admissions as the denominator. To employ automated bed history data to examine outcomes of intra-hospital transfers using all hospital admissions as the denominator. Retrospective cohort study. A total of 19 acute care hospitals. A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008. Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre-existing illness burden; outcomes were: 1) occurrence of intra-hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS). A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers. Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Copyright © 2010 Society of Hospital Medicine.

  2. Predicting Length of Psychiatric Hospital Stay in Children and Adolescents.

    Science.gov (United States)

    Leininger, Michele; Stephenson, Laura A.

    Length of stay in psychiatric inpatient units has received increasing attention with the external pressures for treatment cost-effectiveness and evidence that longer hospital stays do not appear to have significant advantages over shorter hospital stays. This study examined the relationship between length of psychiatric hospital stay and…

  3. Pain-related stress during the Neonatal Intensive Care Unit stay and SLC6A4 methylation in very preterm infants

    Science.gov (United States)

    Provenzi, Livio; Fumagalli, Monica; Sirgiovanni, Ida; Giorda, Roberto; Pozzoli, Uberto; Morandi, Francesco; Beri, Silvana; Menozzi, Giorgia; Mosca, Fabio; Borgatti, Renato; Montirosso, Rosario

    2015-01-01

    Very preterm (VPT) infants need long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU) during which they are daily exposed to pain-related stress. Alterations of DNA methylation at the promoter region of the SLC6A4 have been associated with early adverse experiences in infants. The main aim of the present work was to investigate the association between level of exposure to pain-related stress during hospitalization and changes in SLC6A4 DNA methylation at NICU discharge in VPT infants. In order to exclude the potential effect of birth status (i.e., preterm vs. full-term birth) on SLC6A4 methylation, we preliminarily assessed SLC6A4 epigenetic differences between VPT and full-term (FT) infants at birth. Fifty-six VPT and thirty-two FT infants participated in the study. The level of exposure to pain-related stress was quantified on the basis of the amount of skin-breaking procedures to which they were exposed. VPT infants were divided in two sub-groups: low-pain exposure (LPE, N = 25) and high-pain exposure (HPE, N = 31). DNA methylation was evaluated at birth for both VPT and FT infants, assessing 20 CpG sites within the SLC6A4 promoter region. The same CpG sites were re-evaluated for variations in DNA methylation at NICU discharge in LPE and HPE VPT infants. No differences in SLC6A4 CpG sites' methylation emerged between FT and VPT infants at birth. Methylation at CpG sites 5 and 6 significantly increased from birth to NICU discharge only for HPE VPT infants. Findings show that preterm birth per se is not associated with epigenetic alterations of the SLC6A4, whereas higher levels of pain-related stress exposure during NICU stay might alter the transcriptional functionality of the serotonin transporter gene. PMID:25941480

  4. Performance and hematology of pacu fed diets supplemented with vitamins C and/or E Desempenho e hematologia do pacu alimentado com dietas suplementadas com vitaminas C e/ou E

    Directory of Open Access Journals (Sweden)

    Fabiana Garcia

    2011-06-01

    Full Text Available Pacu (Piaractus mesopotamicus Holmberg, 1887 is a valued Brazilian fish species for aquaculture. This is highly susceptible to disease, and feed supplementations for pacu can be a very important strategy to prevent disease incidence in fish farms. The aim of this study was to evaluate a strategic supplementation for pacu. Juvenile pacu (10.5 ± 1.2 g were fed diets containing three levels of vitamins C and/or E (0, 250, and 500 mg vitamin kg-1 diet. Fish were fed diets without supplementation for two months prior to the experiment. After that period, experimental feeding was initiated for two months. Growth and hematological evaluations were made on the thirtieth and sixtieth days of feeding. Pacu fed diet without supplementation of vitamins C and E during 120 days did not show clear typical signs of deficiency. Fish fed diet vitamins C and E free increased feed intake, but no improvement on growth performance was detected. Vitamin E proved essential for erythrocyte protection, so that the higher the level of this vitamin in diet, the smaller the number of erythroblasts. Supplementation with 500 mg of vitamin C and 250 mg of vitamin E for 60 days increased the production of monocytes, thrombocytes and special granulocytic cells in pacu.O pacu (Piaractus mesomotamicus Holmberg 1887 é uma espécie altamente valiosa para a aqüicultura brasileira. Entretanto, trata-se de uma das espécies mais susceptíveis a doenças. Por isso, a suplementação alimentar para o pacu pode representar importante estratégia de prevenção da incidência das enfermidades em pisciculturas. Pacus (10,5 ± 1,2 g foram alimentados com dietas contendo três níveis de vitamina C e/ou E (0, 250 e 500 mg vitamina kg-1 de dieta. Os peixes foram alimentados com dieta não purificada sem suplementação durante os primeiros 60 dias para reduzir as reservas teciduais das vitaminas. Após este período, os peixes foram alimentados com as dietas testadas durante 60 dias. As

  5. Effect of ractopamine on the chemical and physical characteristics of pacu(Piaractus mesopotamicus steaks

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    L.M.F.S. Oliveira

    2014-02-01

    Full Text Available The objective was to evaluate the use of ractopamine (RAC in the diet for pacu (Piaractus mesopotaminus in the finishing phase on some quality parameters of the fillets. Thirty-five animals weighing 0.868±0.168kg were distributed in a completely randomised design with five treatments (0.0 - control; 11.25, 22.50, 33.75 and 45 ppm of RAC and seven replicates with two fillets obtained from the same animal. The diets were isocaloric and isoprotein and experimental time was 90 days. RAC did not affect (P>0.05 the initial pH or ph after 24 hours of the fillets. Compared to the control, RAC increased (P<0.05 the moisture content of the fillets in natura and lipid oxidation of samples stored for 12 days in the refrigerator or freezer for 60 days. The RAC in 11.25 ppm reduced (P<0.05 the lipid content, while 45 ppm reduced (P<0.05 the crude protein in the fillets. Considering only RAC, there was a linear increase (P<0.05 in the lipid content (P<0.05 and a linear reduction in crude protein and weight loss after cooking the fillets. There was a quadratic effect (P<0.05 on the ash content, weight loss and lipid oxidation in fillets stored in the refrigerator or freezer. A RAC dose of 33.75 ppm resulted in a lower lipid oxidation index. In conclusion, ractopamine at 11.25 ppm is effective for reducing the fat content in fillets of pacu, although it increases the formation of peroxides in samples kept in the freezer for longer than 60 days. At 33.75 ppm, ractopamine is effective in reducing the effect of oxidation during storage in the refrigerator or freezer.

  6. Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study

    Science.gov (United States)

    Stefana, Alberto; Lavelli, Manuela

    2017-01-01

    Introduction The preterm infants' developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/father–infant interactions and the parents' ability to respond to the trauma of premature birth. In the case of premature birth, the father's ability to take an active part in the care of the infant from the start is essential. The parents' emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent–infant affective relationship and the parents' confidence in their ability to provide care for their baby. Methods and analysis This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants' hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-to-face interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions. Ethics and dissemination The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural

  7. Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study.

    Science.gov (United States)

    Stefana, Alberto; Lavelli, Manuela

    2017-02-02

    The preterm infants' developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/father-infant interactions and the parents' ability to respond to the trauma of premature birth. In the case of premature birth, the father's ability to take an active part in the care of the infant from the start is essential. The parents' emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent-infant affective relationship and the parents' confidence in their ability to provide care for their baby. This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother-infant and father-infant interaction in the NICU; (3) a semistructured interview with fathers during the infants' hospital stay; (4) 3-minute video recordings of mother-infant and father-infant face-to-face interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions. The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner

  8. Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals.

    Science.gov (United States)

    Cheng, Amy H Y; Barclay, Neil G; Abu-Laban, Riyad B

    2016-12-01

    Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design. Data were extracted from administrative databases. The post-OU cohort included all adults presenting 6 months after OU implementation. The pre-OU cohort included all adults presenting in the same 6-month period 1 year before OU implementation. There were 109,625 patient visits during the study period. Of the 56,832 visits during the post-OU period (27,512 to ED A and 29,318 to ED B), 1.9% were managed in the OU in ED A and 1.4% in ED B. Implementation was associated with an increase in the median ED LOS at ED A (179.0 min pre vs. 192.0 min post [+13.0 min]; p < 0.001; mean difference -12.5 min, 95% confidence interval [CI] -15.2 to -9.9 min), but no change at ED B (182.0 min pre vs. 182.0 min post; p = 0.55; mean difference +2.0 min, 95% CI -0.7 to +4.7 min). Implementation significantly decreased the hospital admission rate for ED A (17.8% pre to 17.0% post [-0.8%], 95% CI -0.18% to 0.15%; p < 0.05) and did not significantly change the hospital admission rate at ED B (18.9% pre to 18.3% post [-0.6%], 95% CI -1.19% to -0.09%; p = 0.09). A multi-diagnosis OU can reduce hospital admission rate in a site-specific manner. In contrast to previous studies, we did not find that an OU reduced ED LOS. Further research is needed to determine whether OUs can reduce ED overcrowding. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit.

    Science.gov (United States)

    Caine, J

    1991-01-01

    The purpose of this study was to examine the effects of music on selected stress behaviors, weight, caloric and formula intake, and length of hospital stay. Subjects were 52 preterm and low birth weight newborns in a newborn intensive care unit (NBICU) who were in stable condition and restricted to isolettes. Subjects in the experimental and control groups were matched for equivalency based on sex, birth weight, and diagnostic criticality. Eleven males and 15 females were assigned to the control group and received routine auditory stimulation. The experimental group of 11 males and 15 females received music stimulation, which consisted of approximately 60 minutes of tape recorded vocal music, including lullabies and children's music, and routine auditory stimulation. Thirty-minute segments of the recording were played alternatively with 30 minutes of routine auditory stimulation three times daily. Exposure to music stimulation occurred only during the infants' stay in the NBICU. Results suggest music stimulation may have significantly reduced initial weight loss, increased daily average weight, increased formula and caloric intake, significantly reduced length of the NBICU and total hospital stays, and significantly reduced the daily group mean of stress behaviors for the experimental group. Data analyses suggest the length of hospital stay may be correlated with the amount of stress experienced by the neonate and not with weight gains. Theoretical and practical aspects of these results are discussed.

  10. Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: A study protocol for a cluster randomised trial

    LENUS (Irish Health Repository)

    O'Shea, Eamon

    2011-02-14

    Abstract Background Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods\\/Design The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in relation to scale

  11. Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: A study protocol for a cluster randomised trial

    Directory of Open Access Journals (Sweden)

    Jordan Fionnuala

    2011-02-01

    Full Text Available Abstract Background Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods/Design The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in

  12. Gastrointestinal transit of extruded or pelletized diets in pacu fed distinct inclusion levels of lipid and carbohydrate

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    Claucia Aparecida Honorato

    2014-11-01

    Full Text Available The objective of this work was to evaluate the effect of pelletized or extruded diets, with different levels of carbohydrate and lipid, on the gastrointestinal transit time (GITT and its modulation in pacu (Piaractus mesopotamicus. One hundred and eighty pacu juveniles were fed with eight isonitrogenous diets containing two carbohydrate levels (40 and 50% and two lipid levels (4 and 8%. Four diets were pelletized and four were extruded. Carbohydrate and lipid experimental levels caused no changes to the bolus transit time. However, the bolus permanence time was related to diet processing. Fish fed pelletized diets exhibited the highest gastrointestinal transit time. Regression analysis of bolus behavior for pelletized and extruded diets with 4% lipid depicted different fits. GITT regression analysis of fish fed 8% lipid was fitted to a cubic equation and displayed adjustments of food permanence, with enhanced utilization of the diets, either with extruded or pelletized diets. GITT of fish fed extruded diets with 4% lipid was adjusted to a linear equation. The GITT of pacu depends on the diet processing and is affected by dietary levels of lipid and carbohydrate.

  13. Pacu fish (Cuvier, 1818 (Characiformes: Characidae landed in Porto Velho (Rondônia fish market from 1985 to 2004

    Directory of Open Access Journals (Sweden)

    Maria Alice Leite Lima

    2008-09-01

    Full Text Available This study evaluated various aspects of the profile of pacu (Mylossoma spp., Myleus spp., Metynnis spp. fish marketed on the Cai N’água floating platform of Porto Velho (RO from 1985 to 2004. Inter- and intra-annual variations in yield, variation in fish length and general characteristics of the fishing are reported. The annual pacu yield ranged from 33,000kg to 146,000kg (average = 86,585kg, representing from 6.6% to 20.45% of the total landings in the studied period. These variations followed the hydrologic cycle, and the greatest yields were recorded in the years following the highest water levels. The monthly production ranged from 0 to 42,366kg (average = 5,772kg and it was related to reproductive migration. The pacu presented variations in standard length from 14 to 20cm (18.72cm ± 3.69, mean ± sd. The fishing was based on the use of seines and gill nets and the main environments of capture were tributaries of the low Madeira River (Jamari, Oropiara, Machado and Novo Aripuanã. The CPUE calculated for 2003 to 2005 was 15kg*fisherman 1day-1 (sd = ±21. The results show that the category constituted during this period an important resource for local commercial exploitations, as verified in other regions of the Amazon.

  14. Metabolic effects of trichlorfon (Masoten®) on the neotropical freshwater fish pacu (Piaractus mesopotamicus).

    Science.gov (United States)

    Venturini, Francine P; Moraes, Fernanda D; Cortella, Lucas R X; Rossi, Priscila A; Cruz, Claudinei; Moraes, Gilberto

    2015-02-01

    Fish parasites are among the crucial limiting factors in aquaculture. The organophosphorous pesticide trichlorfon is widely used as an insecticide and against fish parasites worldwide. In this study, the effects of environmental trichlorfon on biochemical and physiological parameters were investigated in Piaractus mesopotamicus (pacu), a widely farmed fish in South America, through sublethal exposure (8 µg L(-1), 10 % of the LC50; 96 h) and recovery. The activity of brain acetylcholinesterase (AChE) was reduced after exposure (15.5 %) and remained decreased during the recovery (21.5 %). In white muscle, AChE activity decreased 31 % only after recovery. Alkaline phosphatase (ALP) and acid phosphatase (ACP) activities of the liver, muscle and plasma were steady during exposure. However, after the recovery period, ALP activity was increased in the liver and muscle and decreased in plasma, while ACP was increased in the liver and decreased in muscle. Intermediary metabolism was also affected by trichlorfon, depicting increase of energetic demand (hypoglycemia, neoglucogenesis and lipid catabolism), which remained even after recovery. These results indicate that P. mesopotamicus is adversely affected by sublethal concentrations of trichlorfon and are useful for assessing the impact as well as the pros and cons of its use in controlling fish parasites in aquaculture.

  15. Efeito da granulometria do milho no desempenho de juvenis de pacu, Piaractus mesopotamicus (Holmberg, 1887

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    M.F Polese

    2010-12-01

    Full Text Available Avaliou-se o efeito de diferentes granulometrias do milho da ração no desempenho de juvenis de pacu, Piaractus mesopotamicus. Foram utilizados 120 juvenis com peso inicial de 8,42±0,89, comprimento total de 7,03±0,20cm, comprimento padrão de 6,32±0,13cm e altura de 3,21±0,11cm, distribuídos em 20 aquários (300L, na densidade de seis peixes por unidade experimental (aquário, em delineamento inteiramente ao acaso, com cinco tratamentos constituídos por diferentes granulometrias - 850, 710, 500, 300, 150µm - do milho na composição da ração. Cada tratamento tinha quatro repetições. O tratamento que proporcionou melhor desempenho dos animais foi o com granulometria do milho de 150µm, destacando-se a conversão alimentar de 1,38, enquanto no tratamento com maior granulometria a conversão alimentar foi de 1,61. Assim, recomenda-se usar a granulometria de 150µm.

  16. 影响重度颅脑损伤患者ICU停留时间的相关因素分析%Influencing factors of the intensive care unit stay following severe craniocerebral trauma

    Institute of Scientific and Technical Information of China (English)

    华天凤; 孙昀; 杨旻; 曹立军; 尹路; 鹿中华; 郑瑶

    2011-01-01

    Objective To discuss the influencing factors of the intensive care unit stay following severe craniocerebral trauma. Methods A retrospective study was conducted in fifty-eight patients, who had suffered from severe craniocerebral injury and been hospitalized in intensive care unit from Oct.2009 to Dct.2010. The influencing factors including age, gender, Glasgow Coma Scale, the type of injury, the timing of operation, respiratory insufficiency, blood glucose after trauma were analyzed. Results The lower Glasgow Coma Scale, the more serious craniocerebral trauma with hyperglycemia and respiratory insufficiency led to the longer ICU stay. The timing of operation also affected ICU stay, but age and gender had no influence on ICU stay. Conclusion The extent and the type of trama, Glasgow Coma Scale, the timing of operation, respiratory insufficiency, blood glucose after trauma affect ICU stay directly.%目的 探讨影响重度颅脑损伤患者在ICU停留时间的相关因素.方法 收集入住ICU监护治疗的58例重度闭合性颅脑损伤患者临床资料,从年龄、性别、GCS评分、颅脑损伤类型、手术时机、呼吸功能不全、伤后血糖等方面综合分析多种因素与患者ICU停留时间的关系.结果 GCS评分越低、颅脑损伤类型越严重,合并伤后血糖增高以及呼吸功能不全的患者,ICU停留时间明显延长,并对疾病预后产生不利影响;同样,手术时机的把握对ICU停留时间也存在影响,并有统计学意义.年龄和性别对ICU停留时间无明显影响.结论 颅脑损伤的程度、类型、GCS评分、手术时机的选择以及合并伤后血糖增高以及呼吸功能不全,直接影响患者ICU停留时间.

  17. Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit

    Directory of Open Access Journals (Sweden)

    Ana Beatriz Francioso de Oliveira

    2010-09-01

    Full Text Available OBJETIVO: A unidade de terapia intensiva é sinônimo de gravidade e apresenta taxa de mortalidade entre 5,4% e 33%. Com o aperfeiçoamento de novas tecnologias, o paciente pode ser mantido por longo período nessa unidade, ocasionando altos custos financeiros, morais e psicológicos para todos os envolvidos. O objetivo do presente estudo foi avaliar os fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva adulto. MÉTODOS: Participaram deste estudo todos os pacientes admitidos consecutivamente na unidade de terapia intensiva de adultos, clínica/cirúrgica do Hospital das Clínicas da Universidade Estadual de Campinas, no período de seis meses. Foram coletados dados como: sexo, idade, diagnóstico, antecedentes pessoais, APACHE II, dias de ventilação mecânica invasiva, reintubação orotraqueal, traqueostomia, dias de internação na unidade de terapia intensiva, alta ou óbito na unidade de terapia intensiva. RESULTADOS: Foram incluídos no estudo 401 pacientes, sendo 59,6% homens e 40,4% mulheres, com idade média de 53,8±18,0 anos. A média de internação na unidade de terapia intensiva foi de 8,2±10,8 dias, com taxa de mortalidade de 13,46%. Dados significativos para mortalidade e tempo de internação prolongado em unidade de terapia intensiva (p11, traqueostomia e reintubação. CONCLUSÃO: APACHE >11, traqueostomia e reintubação estiveram associados, neste estudo, à maior taxa de mortalidade e tempo de permanência prolongado em unidade de terapia intensiva.OBJECTIVE: The intensive care unit is synonymous of high severity, and its mortality rates are between 5.4 and 33%. With the development of new technologies, a patient can be maintained for long time in the unit, causing high costs, psychological and moral for all involved. This study aimed to evaluate the risk factors for mortality and prolonged length of stay in an adult intensive care unit. METHODS: The study

  18. PHYSIOLOGICAL RESPONSES OF PACU (Piaractus mesopotamicus, FED CASSAVA (Manihot esculenta FOLIAGE IN DIETS RESPOSTAS FISIOLÓGICAS DO PACU (Piaractus mesopotamicus, ALIMENTADO COM RAMA DE MANDIOCA (Manihot esculenta NA RAÇÃO

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    João Teodoro Padua

    2009-07-01

    Full Text Available Brazil is the largest world producer of cassava. Leafs and stem of cassava can be a alternative source of protein for omnivorous fish. However, the potential use is limited by the presence of high level of cyanide acid. The present study evaluated physiological responses of juvenile pacu submitted to increasing levels of the final third of the cassava foliage meal in diets. A completely randomized design was used in factorial scheme 4x2, four levels, 0, 12, 24 and 36 % of cassava foliage meal (CFM, and 2 levels of crude protein (CP, 24 % and 30 %, with three replicates. Three hundred twelve fish (55.33±6.19 g were distributed into 24 ponds of 13 m2. Results indicated that the levels of CFM inclusion affected the hemoglobin values (P<0.01, as well as the CP level (P<0.05, with interaction of these factors (P<0.01. Significant interaction among the CFM levels and CP was also observed for hematocrit, plasma protein (P<0.01 and plasma lipid (P<0.05. In the 24 % CP level was observed higher values of Hb in control and 36 % of CFM (3.51 g/dl and 3.25 g/dl respectively while with 30 % CP the control diet and 36 % CFM presented the smallest values (3.29 g/dl and 2.78 g/dl respectively. The higher level of CFM tested, inside of any protein level, had low influence on the pacu metabolism.

    KEY WORDS: Cassava leaf and stem fish metabolism, pacu, P. Mesopotamicus.
    O Brasil é o maior produtor mundial de mandioca, disponibilizando a rama de mandioca como fonte alternativa na alimentação de peixes onívoros. No entanto, o potencial de uso da rama é limitado pela toxidez do ácido cianídrico. Objetivou-se avaliar a resposta fisiológica do pacu alimentado com níveis crescentes da rama de mandioca. Utilizou-se delineamento inteiramente casualizado, em fatorial 4x2, quatro níveis de rama de mandioca (RM (0%, 12%, 24% e 36% e dois níveis de proteína bruta (PB (24% e 30% com três repetições. Trezentos e doze peixes (55,33±6,19 g foram

  19. TOLERÂNCIA DE JUVENIS DE PACU PIARACTUS MESOPOTAMICUS À ÁGUA SALINIZADA

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    BARBOSA JÚNIOR, Sérgio Garcia

    2010-11-01

    Full Text Available The sodium chloride is a product commonly used in the rearing of freshwater fish in prophylaxis and treatment therapeutic. The objective of this work was to evaluate the survival and the time oftolerance of juvenile of pacu Piaractus mesopotamicus in different salinity of water: 0 (freshwater, 3, 6, 9, 12 and 15 ‰, with 3 replicates, during 20 days. The experiment was carried out in tanks containing 12 L of water in each, in systems of rested water with the daily change of 100 % of capacity. In the second experiment, thetolerance time was determinated at 10, 15, 20, 30, 40 and 50 ‰ of salinity during 15, 30 and 45 minutes. In the salinities of 30, 40 and 50 ‰, the tolerance time was also evaluated for the periods of 4, 8 and 12 minutes. There was no difference (p>0.05 among the averages of length and weight of the animals kept in salinities of 0 to 9‰.The total mortality (100% occurred at 15 and 12 ‰ after 6 and 24 hours of experiment, respectively. In the second experiment, to the animals kept at 30, 40 and 50 ‰, it was observed 66, 100 and 100% of mortality in periods of 15, 30 and 45 minutes of exhibition, respectively. But, the concentrations of 30, 40 and 50 ‰ for periods of 4, 8 and 12 minutes did not cause fish`s mortality, and 100% of animals survived after their transfer to freshwater.O cloreto de sódio é um produto comumente utilizado durante a criação de peixes de água doce em manejos profiláticos e terapêuticos. O objetivo do trabalho foi avaliar o desempenho e o tempo de tolerânciade juvenis de pacu P. mesopotamicus submetidos a diferentes salinidades da água: 0 (água doce, 3, 6, 9, 12, 15 ‰, com três repetições, durante 20 dias. O experimento foi realizado em unidades contendo 12 litros de água cada, em sistema de água parada e substituição diária de 100% do volume. Em outro experimento, determinou-se o tempo de tolerância dos juvenis em concentrações de 10, 15, 20, 30, 40 e 50 ‰, por per

  20. Histologia e ultraestrutura do rim e rim cefálico do pacu

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    Gerlane M. Costa

    2012-05-01

    Full Text Available O pacu, Piaractus mesopotamicus, é um teleósteo da Família Characidae, intensivamente cultivado no Brasil devido sua rusticidade, crescimento rápido e fácil adaptação. O conhecimento morfológico dos sistemas corpóreos, incluído órgãos linfóide, se faz necessário, para uma melhor produção no cultivo de peixes, fornecendo subsídios na manutenção dos estoques. O objetivo deste estudo foi descrever morfologicamente o rim e rim cefálico de Piaractus mesopotamicus, analisando os perfis celulares de cada órgão com o uso de microscopia de luz e microscopia eletrônica de transmissão. O resultado da análise macroscópica mostrou que a localização do rim e rim cefálico são as mesmas encontradas na maioria dos teleósteos. O rim apresentou uma forma em "H", onde a região média se expandia sobre a bexiga natatória. O rim cefálico se apresentou como uma dilatação na região cranial do rim, mostrando-se bem visível. Na microscopia eletrônica de transmissão também foram observadas similaridades ultraestruturais com outros teleósteos. Observando nossos resultados concluímos que histologicamente e ultraestruturalmente, os órgãos linfóides rim e rim cefálico de Piaractus mesopotamicus são similares aos de outros teleósteos.

  1. Fatores antinutricionais e coeficientes de digestibilidade aparente da proteína de produtos de soja para o pacu (Piaractus mesopotamicus = Anti-nutritional factors and protein apparent digestibility coefficients of soybeans sources to pacu (Piaractus mesopotamicus

    Directory of Open Access Journals (Sweden)

    Marcia Regina Stech

    2010-07-01

    Full Text Available Este estudo teve como objetivo determinar as atividades dos inibidores de tripsina, hemaglutinante e teores de taninos no farelo de soja e na soja crua e processada, e avaliar o coeficiente de digestibilidade aparente da fração proteica para juvenis de pacu. Oscoeficientes de digestibilidade aparente da proteína da soja crua, extrusada, tostada e macerada foram determinadas usando óxido de cromo (0,5% como marcador. Foi elaborada dieta de referência com 26% de proteína bruta e 4.352 kcal kg-1, e a cada alimento avaliado foram substituídas 30% da dieta-teste. As fezes foram coletadas por pressãoabdominal. Todos os produtos analisados apresentaram fatores antinutricionais, mas foi observada menor atividade de inibidor de tripsina no farelo de soja. Sojas que receberam tratamento térmico apresentaram os melhores coeficientes de digestibilidade e menoresvalores de atividade hemaglutinante do que a soja crua. Não foram observados efeitos dos inibidores de tripsina e taninos sobre o coeficiente de digestibilidade da proteína, mas foi observada relação negativa entre os teores de hemaglutinina com a digestibilidade daproteína bruta. Para a alimentação do pacu recomenda-se a utilização do farelo de soja e da soja processada por extrusão ou tostada.This study aimed to determine the activities of trypsin inhibitors, hemagglutinant and tannin levels in soybean meal and in raw andprocessed soy, as well evaluate the protein apparent digestibility coefficient for pacu juveniles. The apparent coefficients of raw, extruded, toasted and milled soy were determined using chromium oxide (0.5% as marker. A reference diet was created with 26% crude protein and 4,352 kcal kg-1, with each feed containing 30% of the test diet. Feces were collected by abdominal pressure. All analyzed products presented anti-nutritional factors, but the lowest trypsin inhibitoractivity was observed in soybean meal. Soy that received thermal treatment presented better

  2. Eficácia do fembendazole no controle de nematódeos de pacu Piaractus mesopotamicus (Holmberg, 1987) The efficiency of fembendazole in the control of nematodes in pacu Piaractus mesopotamicus (Holmberg, 1987)

    OpenAIRE

    Jorge Erick Garcia Parra; Deodoro Atlante Brandão; Paulo Sérgio Ceccarelli

    1997-01-01

    O presente trabalho foi realizado no Centro de Pesquisa e Treinamento em Aquicultura (CEPTA/1BAMA), município de Pirassununga, SP. Foram utilizados 60 pacus, dos viveiros da Estação de Piscicultura do CEPTA, com peso médio de 600g. Foi realizado um teste visando avaliar o efeito do Femben-dazote (adicionado no alimento em diferentes dosagens), sobre os nematódeos presentes no tubo intestinal do pacu, utilizando três tratamentos: Tl - grupo testemunha (ração sem Fembendazole), T2 - 20mg de Fem...

  3. Effects of re-stripping on the seminal characteristics of pacu (Piaractus mesopotamicus) during the breeding season.

    Science.gov (United States)

    Kuradomi, Rafael Y; De Souza, Thiago G; Foresti, Fausto; Schulz, Rüdiger W; Bogerd, Jan; Moreira, Renata G; Furlan, Luiz R; Almeida, Eduardo A; Maschio, Lucilene R; Batlouni, Sergio R

    2016-01-01

    Seminal characteristics in teleost fish with an annual reproductive period, such as pacu (Piaractus mesopotamicus), may vary during the breeding season. The sperm formed before the beginning of the spawning period may be stored for a long time, causing damage to the cells. Therefore, re-stripping may be an important way to eliminate the "old" and allow for the collection of "new" spermatozoids. In this study, we analyzed the seminal characteristics of hormonally induced pacu at the beginning, middle and end of the breeding season, and we analyzed samples from re-stripped males (stripped first at the beginning, re-stripped in the middle, and re-stripped again at the end of the season) during two breeding seasons. The sperm density, ionic composition, pH, and osmolality were similar among the groups. The semen volume, seminal plasma protein concentration and incidence of morphologically anomalous sperm increased over time. In addition, some parameters that are associated with good-quality semen decreased, such as sperm motility, viability and DNA integrity. Moreover, we observed a positive association among motility, viability and DNA integrity for sperm with elevated 11-ketotestosterone, but there was no such association for fshb or lhb mRNA levels in the pituitary. The semen that was obtained earlier (at the beginning) or from re-stripped males exhibited better characteristics than the other samples collected. In conclusion, collecting semen from pacu at the end of breeding season should be avoided; it is preferable to strip early and then re-strip later in the season, and this approach may be used for diverse aquaculture purposes.

  4. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States.

    Science.gov (United States)

    Bonis, Peter A; Pickens, Gary T; Rind, David M; Foster, David A

    2008-11-01

    Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes. We compared hospitals with online access to UpToDate with other acute care hospitals included in the Thomson 100 Top Hospitals Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume. Hospitals with access to UpToDate (n=424) were associated with significantly better performance than other hospitals in the Thomson database (n=3091) on risk-adjusted measures of patient safety (P=0.0163) and complications (P=0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, PUpToDate was used at each hospital. Mortality was not significantly different between UpToDate and non-UpToDate hospitals. The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes. An electronic clinical knowledge support system (UpToDate was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals.

  5. Crescimento e estruturas do sistema digestório de larvas de pacu alimentadas com dieta microencapsulada produzida experimentalmente Growth and structure of the digestive system of pacu larvae fed microencapsulated diet produced experimentally

    Directory of Open Access Journals (Sweden)

    Olívia Cristina Camilo Menossi

    2012-01-01

    Full Text Available Foram comparados os efeitos de diferentes dietas e da transição alimentar sobre o desempenho zootécnico e a morfologia do trato digestório de larvas de pacu alimentadas com duas dietas comerciais e uma dieta experimental microencapsulada produzida por gelificação interna. Larvas com quatro dias de vida receberam os seguintes protocolos alimentares: somente náuplios de artêmia em quantidades crescentes (controle positivo; larvas mantidas em jejum (controle negativo; três tipos de alimento formulado durante todo o experimento (dieta experimental microencapsulada, dieta comercial NRD1.2/2.0, Inve, USA, e dieta Poli-Peixe 450F, PoliNutri, Brasil; e três protocolos de transição alimentar com náuplios de artêmia durante os seis primeiros dias, seis dias de coalimentação, e somente as respectivas dietas formuladas após esse período. O experimento foi conduzido por 23 dias em delineamento inteiramente casualizado, com avaliações periódicas do crescimento e do sistema digestório. A taxa de sobrevivência foi determinada ao final do experimento. Os melhores desempenhos de crescimento e sobrevivência, assim como mais acelerada organogênese do sistema digestório, foram verificados entre os animais que receberam alimento vivo. As larvas que passaram pela transição alimentar apresentaram médias intermediárias de crescimento e sobrevivência e não diferiram entre si. Entre os grupos que receberam apenas dieta inerte, somente naquele alimentado com a dieta nacional houve sobrevivência até o final do experimento. Nenhuma das dietas formuladas é adequada para uso como alimento exclusivo para larvas de pacu. Na fase de transição alimentar, a dieta experimental microencapsulada proporciona resultados de sobrevivência e crescimento semelhantes aos obtidos com dietas comerciais.The effects of different diets and dietary transition on the performance and morphology of the digestive tract of pacu larvae fed two commercial formulated

  6. Estudo da vegetação relacionada com a alimentação do "Pacu" (Colossoma mitrei-Berg (1895)) no Pantanal Mato-Grossense

    OpenAIRE

    Paula, José Elias de; Morais Filho, Manoel Batista de; Bernardino,Geraldo; De Melo, José Sávio Colares; Ferrari, Valdir Aparecido

    1988-01-01

    Os 102 aparelhos digestivos analisados foram provenientes de espécimes capturados no Pantanal de Mato Grosso, nos municípios do Poconé e Barão de Melgaço. O estudo da vegetação aquática, ciliar e de áreas inundáveis foi conduzido nas áreas onde os espécimes de "pacu" foram capturados. Foram considerados também dados biométricos do "pacu", tais como: comprimento total do esôfago, do intestino e do estômago. _______________________________________________________________________________ ABSTRAC...

  7. Down Syndrome in Adults: Staying Healthy

    Science.gov (United States)

    ... Shortfall Questionnaire Home Prevention and Wellness Staying Healthy Down Syndrome in Adults: Staying Healthy Down Syndrome in Adults: Staying Healthy Family HealthPrevention and WellnessStaying ...

  8. Desova induzida de curimatã-pacu submetido a dois protocolos de hipofisação

    Directory of Open Access Journals (Sweden)

    José Cláudio Epaminondas dos Santos

    2013-08-01

    Full Text Available O objetivo deste trabalho foi comparar dois protocolos de hipofisação, na indução à desova de curimatã-pacu.Testou-se a aplicação de dose única ou duas doses de extrato bruto de hipófise de carpa-comum. Não houve diferença significativa entre os protocolos quanto às taxas de fêmeas que desovaram, fertilização e larvas deformadas. A aplicação de dose única resultou em valores de horas-graus até a extrusão dos ovócitos maiores do que em duas doses. A aplicação de uma única dose representou menor consumode água, energia e tempo. O protocolo da dose única pode ser utilizado como alternativa para a indução à desova de curimatã-pacu.

  9. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit

    NARCIS (Netherlands)

    J.A. Lipton (Jonathan); R. Barendse (Rj); R.T. van Domburg (Ron); A.F.L. Schinkel (Arend); H. Boersma (Eric); M.L. Simoons (Maarten); K.M. Akkerhuis (Martijn)

    2013-01-01

    textabstractAims: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. Methods: Observational study of patients admitted t

  10. Marry the Prince or Stay with Family--That Is the Question: A Perspective of Young Korean Immigrant Girls on Disney Marriages in the United States

    Science.gov (United States)

    Lee, Lena

    2009-01-01

    Although several studies have examined popular culture, the perspectives of young children from various cultures still have not been discussed at length in such studies. In order to listen to these children's voices, this paper focuses on young immigrant Korean girls in the United States. It particularly examines their interpretations of marriage…

  11. Theme: Staying Current--Horticulture.

    Science.gov (United States)

    Shry, Carroll L., Jr.; And Others

    1986-01-01

    This theme issue on staying current in horticulture includes articles on sex equity in horticulture, Future Farmers of America, career opportunities in horticulture, staying current with your school district's needs, staying current in horticulture instruction, staying current with landscape trade associations, emphasizing the basics in vocational…

  12. Staying Well at Work.

    Science.gov (United States)

    Blai, Boris, Jr.

    Employee wellness directly affects business/industry operations and costs. When employees are helped and encouraged to stay well, this people-positive policy results in triple benefits: reduced worker absenteeism, increased employee productivity, and lower company expenditures for health costs. Health care programs at the worksite offer these…

  13. Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: a study protocol for a cluster randomised trial.

    LENUS (Irish Health Repository)

    O'Shea, Eamon

    2011-02-01

    Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units.

  14. Formulation and Application of A Predetermined Discharge Criteria Using by Nurses in the Post-anesthesia Care Unit%麻醉恢复室患者«转运前护理观察指标»的制定及应用

    Institute of Scientific and Technical Information of China (English)

    丁红; 胡婉贞; 林海洁

    2014-01-01

    目的:探讨参考«患者离室标准»制定的«转运前护理观察指标»应用于全麻手术患者的效果.方法便利抽样选择2013年5-8月南方医院300例成年择期行全身麻醉的手术患者,按手术时间分成两组,对照组(control group)患者由麻醉恢复室(post-anesthesia care unit,PACU)医生在患者离室标准的基础上,根据个人经验观察后,进行 Steward 评分,之后通知护士转运;观察组(observation group)患者由PACU护士按照«转运前护理观察指标»的要求进行判断,满足条件后通知 PACU医生进行 Steward评分,之后遵医嘱转送.比较两组患者满足转送条件时间、实际转送时间、转送至病房后术后基本情况的差异.结果观察组患者PACU的满足转运条件时间和实际转运时间均明显短于对照组(均P<0.05);两组患者转送至病房后不良事件发生率差异无统计学意义(均P>0.05).结论麻醉护士执行预先制定的«转运前护理观察指标»,主动进行患者转运前病情观察,可明显缩短患者留置PACU时间,提高医疗和护理工作效率.%Objective To investigate the effects of a predetermined discharge criteria using by nurses on the patients during the awaken period of general anesthesia in the post-anesthesia care unit (PACU ). Methods By convenience sampling,300 adult patients were divided into two groups.In control group,all patients were evaluated by an anesthetist according to the discharge criteria.After assessing the patient and giving Steward score based on personal experience,then the anesthetist informs the nurse to discharge the patient.The patients in the observation group were evaluated by a PACU nurse using predetermined discharge criteria.While get a satisfied result,the nurse will report it to the anesthetist for Steward score assessing.The patients then were discharged according to the doctor’s advice.The time that discharge criteria were met,the actual discharge time

  15. Mentol e eugenol como substitutos da benzocaína na indução anestésica de juvenis de pacu = Menthol and eugenol as benzocaine substitutes in anesthetic induction of pacu juveniles

    Directory of Open Access Journals (Sweden)

    André Fernando Nascimento Gonçalves

    2008-07-01

    Full Text Available Objetivou-se verificar a eficiência de anestésicos naturais na indução à anestesia de juvenis de pacu. Foram avaliadas quatro concentrações de mentol (50, 100, 150 e 200 mg L-1, quatro de eugenol (10, 25, 50 e 100 mg L-1 e uma de benzocaína (100 mg L-1. Durante o procedimento de anestesia, foram monitorados e avaliados quatro estágios de sedação, da redução dos movimentos operculares até a perda total de reação à manipulação. Após o procedimento de biometria, foram avaliados o tempo de recuperação e a mortalidade até48h após anestesia. As concentrações de 100, 150 e 200 mg L-1 de mentol e as concentrações de 50 e 100 mg L-1 de eugenol apresentaram tempos de indução à anestesia e recuperação similares aos da benzocaína. Os resultados obtidos mostraram que o mentol e o eugenol são anestésicos eficientes para pacus em substituição à benzocaína, sugerindo a concentração de 100 mg L-1 de mentol e 50 mg L-1 de eugenol.This study aimed to verify the efficacy of natural anestheticinduction of pacu juveniles. Were evaluated four menthol (50, 100, 150 and 200 mg L-1, four eugenol (10, 25, 50 and 100 mg L-1 and one benzocaine (100 mg L-1 concentrations. During the anesthetic procedure, four sedative stages were monitored and evaluated until no reaction of the fish to handling was registered. After performingbiometric evaluation on the anesthetized fish, were recorded the recovery time and mortality rate up to 48 hours after the anesthetic experiments. Concentrations of 100, 150 and 200 mg L-1 of menthol, 50 and 100 mg L-1 of eugenol showed anesthetic induction timeand recovery time similar to that of benzocaine. The obtained results showed that menthol and eugenol are efficient anesthetics for pacu juveniles in substitution of benzocaine, suggesting the concentration of 100 mg L-1 of menthol and 50 mg L-1 of eugenol.

  16. Estudo da vegetação relacionada com a alimentação do "pacu" (Colossoma mitrei-Berg(1895 no Pantanal mato-grossense

    Directory of Open Access Journals (Sweden)

    José Elias de Paula

    1988-01-01

    Full Text Available Os 102 aparelhos digestivos analisados foram provenientes de espécimes capturados no Pantanal de Mato Grosso, nos municípios do Poconé e Barão de Melgaço. O estudo da vegetação aquática, ciliar e de áreas inundáveis foi conduzido nas áreas onde os espécimes de "pacu" foram capturados. Foram considerados também dados biométricos do "pacu", tais como: comprimento total do esôfago, do intestino e do estômago.This study is part of the "pacu" (Colossoma mitrei Berg 1895 project of biotecnology. The studies were conducted in areas of Pantanal, municipalities of Poconé and Barão de Melgaço (Mato Grosso, Brasil. In conjunction with the vegetation study, the stomach contents od 102 espécimes of "pacu" were analized. The results indicate that Colossoma mitrei's custom feeding is herbivorous.

  17. Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system.

    Science.gov (United States)

    Betten, Jan; Roness, Aleksander Kirkerud; Endreseth, Birger Henning; Trønnes, Håkon; Tyvold, Stig Sverre; Klepstad, Pål; Nordseth, Trond

    2016-04-01

    Admittance to a high dependency unit (HDU) is expensive. Patients who receive surgical treatment with 'low anterior resection of the rectum' (LAR) or 'abdominoperineal resection of the rectum' (APR) at our hospital are routinely treated in an HDU the first 16-24 h of the postoperative (PO) period. The aim of this study was to describe the extent of HDU-specific interventions given. We included patients treated with LAR or APR at the St. Olav University Hospital (Trondheim, Norway) over a 1-year period. Physiologic data and HDU-interventions recorded during the PO-period were obtained from the anesthesia information management system (AIMS). HDU-specific interventions were defined as the need for respiratory support, fluid replacement therapy >500 ml/h, vasoactive medications, or a need for high dose opioids (morphine >7.5 mg/h i.v.). Sixty-two patients were included. Most patients needed HDU-specific interventions during the first 6 h of the PO period. After this, one-third of the patients needed one or more of the HDU-specific interventions for shorter periods of time. Another one-third of the patients had a need for HDU-specific therapies for more than ten consecutive hours, primarily an infusion of nor-epinephrine. Most patients treated with LAR or APR was in need of an HDU-specific intervention during the first 6 h of the PO-period, with a marked decline after this time period. The applied methodology, using an AIMS, demonstrates that there is great variability in individual patients' postoperative needs after major surgery, and that these needs are dynamic in their nature.

  18. Aging and growth parameter from the Piaractus mesopotamicus (pacu from the Cuiabá river, Mato Grosso, Brazil

    Directory of Open Access Journals (Sweden)

    Angela M. Ambrosio

    2014-12-01

    Full Text Available This study has aims to determine the age and to estimate the growth parameters using scales of the species. Individuals of Piaractus mesopotamicus (Holmberg, 1887 used in this study were captured in the commercial fishery conducted in the region, along the year 2006. The model selected to express the growth of the species was the von Bertalanffy Sl= Sl∞*[1-exp-k(t-to]. To determine if scales are suitable for studying the growth of pacu, we analyzed the relation between standard length (Sl and the radius of the scales through linear regression. The period of annuli formation was determined analyzing the variations in the marginal increment and evaluating the consistency of the readings through the analysis of the coefficient of variations (CVs for the average standard lengths of each age (number of rings observed in the scales. The relationship between Ls of the fish and the radius of the scales showed that scales can be used to study the age and growth of P. mesopotamicus (R= 0.79. CVs were always below 20%, demonstrating the consistency of the readings. Annuli formation occurred in February, probably related to trophic migration that occurs in this month in the region. Equations that represents the growth in length obtained for P. mesopotamicus are Sl=50.00*[1-exp-0.18(t-(-3.00] for males and Sl=59.23*[1-exp-0.14(t-(-3.36] for females. The growth parameters obtained in this study were lower compared to other studies previously conducted for the same species and can related to overexploitation that species is submitted by fishing in the region. These values show also that females of pacu attain greater asymptotic length than males that growth faster.

  19. How to stay becoming

    DEFF Research Database (Denmark)

    Skrubbeltrang, Lotte Stausgaard; Nielsen, Jens Christian; Olesen, Jesper

    2016-01-01

    In this article we show how a hybridisation of elite sport and school in lower-secondary education in Denmark produces a particular kind of learning subject with dual tracks for development, and we ask what kind of actions the students apply in order to stay becoming along both tracks. We apply...... theoretical conceptions of ‘becoming’ inspired by Brembeck and Johansson that allow us to understand how the sports students live up to the code of conduct of the sports classes. The article is based on an ethnographic study carried out in four schools located in four regions of Denmark. We argue...

  20. The Factors that Affect Indian Migrants' Decision to Stay in or Counter Migrate from the United States: A Study with Special Reference to the Role of Tourism Related Imagery as a Determinant

    Directory of Open Access Journals (Sweden)

    Babu P. GEORGE

    2007-11-01

    Full Text Available In the light of the changing socio-economic realities of the presenttimes, this paper explores the complex dynamics underlying Indian immigrants' decision to continue to stay in the United States or to counter migrate back to India. In a reversal of fortunes, the specific set of conditions that once triggered a massive inflow of economic migrants from India to the US has been causing a counter migration to India. Based on a review of literature and an exploratory study involving focus groups the paper identifiessome of the major migration / counter migration related factors. Then, employing a survey, the relative importance of each of these factors is gauged for individuals associated with different professions. In addition, the study explores as a special case the role of tourism related images about the US being held by immigrants as determinants of their migration related decisions. Tourism images held by the migrants and the tourism opportunities provided by the US act more as hygiene factors than as motivators. In course of theexploration, a number of hypotheses are emerged that are of interest to future researchers. The study has got significant implications for migration / counter migration policy makers, industry practitioners, and the migrants themselves.

  1. How to stay becoming

    DEFF Research Database (Denmark)

    Skrubbeltrang, Lotte Stausgaard; Nielsen, Jens Christian; Olesen, Jesper

    2016-01-01

    that the hybrid obliges students to follow a narrow developmental track with an ambitious goal of performing in both sport and school, and that the hybrid is threatened when a sports student prioritises either sport or school while he/she is still enrolled in the class.......In this article we show how a hybridisation of elite sport and school in lower-secondary education in Denmark produces a particular kind of learning subject with dual tracks for development, and we ask what kind of actions the students apply in order to stay becoming along both tracks. We apply...... theoretical conceptions of ‘becoming’ inspired by Brembeck and Johansson that allow us to understand how the sports students live up to the code of conduct of the sports classes. The article is based on an ethnographic study carried out in four schools located in four regions of Denmark. We argue...

  2. 冠状动脉旁路移植术后ICU监护时间延长的危险因素%Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    袁忠祥; 刘健

    2011-01-01

    Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses for preoperative risk factors were performed. Prolonged length of ICU stay was defined as initial admission to ICU exceeding 72 h. Results The mean age of patients ( 322women and 996 men) was (67.4±9.4) years. Of 1318 patients undergoing isolated CABG from 1997 to 2009, 205 experienced prolonged length of ICU stay. The length of ICU stay was (40.1 ± 22.5 ) hours and ( 122.6 ± 48.7 ) hours separately.Overall in-hospital mortality was higher among these 205 patients ( 13.7% vs. 1.2%, P <0.05 ). The overall mortality was 3.1%. In univariate analyses, there were statistically significant differences with respect to the percentage of CPB, total bypass time, cross-clamp time, number of distal anastomoses, use of pressor agent, use of intro-aortic balloon pump,time of ventilation and hospital mortality. The significant risk factors were age, NYHA class Ⅲ/Ⅳ, left ventricular ejection fraction(LVEF) <0.40, renal failure, cerebrovascular and/or peripheral vascular disease, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, left main stenosi, three-vessels disease. The variables entered into the multivariate logistic regression were age, NYHA class Ⅲ/Ⅳ, LVEF <0.40, renal failure, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, three-vessels disease. According to the outcome of multivariate logistic regression, we can conclude the model of probability forecast and create a new variable named Pre. The area under ROC curve of the new variable Pre was larger than other variables. Conclusion The main risk factors of prolonged ICU

  3. Factors Associated with Intubation Time and ICU Stay After CABG

    Directory of Open Access Journals (Sweden)

    Suzanny Flegler

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass. METHODS: This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil. RESULTS: The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay. CONCLUSION: In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay.

  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...... with a stronger SOC experienced significantly less pain (P nurse anesthetists...

  5. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...

  6. 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...

  7. Feasibility of Nu-DESC in Screening Delirium of Elderly Patients in PACU%护理谵妄筛查量表在全麻苏醒期老年患者中的应用研究

    Institute of Scientific and Technical Information of China (English)

    丁红; 胡婉贞; 肖伦华; 陈寒霏; 姜玉梅; 张婷婷

    2016-01-01

    目的:观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。%Objective To evaluate the feasibility of Nu-DESC in screening delirium of elderly patients in PACU (post anesthesia care unit). Methods Elderly patients aged over 65 receiving selective non-cardiac surgery under general anesthesia and admitted in PACU were recruited and evaluated by CAM-ICU and Nu-DESC successively. With CAM-ICU serving as a standard, the sensitivity and specificity of Nu-DESC were assessed. Results A total of 303 patients were included in this research. According to the diagnosis of CAM-ICU, the incidence of delirium was 25.7% and area under the ROC curve of Nu-DESC 0.825. when threshold value reached 3, the sensitivity and specificity of Nu-DESC was 65.3% and 99.6% respectively and the kappa 0.707 (P<0.01). Conclusion Nu-DESC is a convenient and easy to master delirium detection scale. It could be used as an efficient method to screen

  8. Processamento da carne do pacu (Piaractus mesopotamicus cultivado em tanques-rede no reservatório de Itaipu = Processing of pacu (Piaractus mesopotamicus meat from net cage farming in the Itaipu reservoir

    Directory of Open Access Journals (Sweden)

    Robie Allan Bombardelli

    2007-10-01

    Full Text Available O trabalho objetivou avaliar as características morfométricas, bromatológicas e o rendimento de cortes da carne do pacu (Piaractus mesopotamicus, cultivados em tanquesrede. Utilizaram-se 45 animais, distribuídos em três tratamentos e 15 repetições cada uma.Os tratamentos constituíram-se de animais alimentados com ração extrusada comercial (REC, resíduos de vegetal cozido (RPV e resíduos cozidos de produção pesqueira (RPP. Realizaram-se as medidas individuais dos animais de comprimento-padrão (CP,comprimento total (CT, comprimento da cabeça (CC, altura da cabeça (AC, largura do tronco (LT, comprimento do tronco (CTR, altura do tronco (AT e, a partir delas, avaliaram-se as relações morfométricas de CC/CP, CC/AC, CP/CT, LT/CTR, LT/AT e AT/CTR. Avaliaram-se os rendimentos: carcaça (RCARC, tronco limpo (TL, musculaturadorsal (MD, filé (FL, costelas (COST, nadadeiras (NAD, gordura visceral (GVISC, pele com escamas (PELE, e os teores de umidade (UM, matéria mineral (MM, proteína bruta (PB e extrato etéreo (EE dos diferentes cortes. Observaram-se maiores resultados (pThis work was carried out to evalue the morphometric and chemical characteristics, as well as the meat cut yields from pacu (Piaractusmesopotamicus reared in net cages. Forty-five specimens were used, distributed in three treatments and 15 replications. The treatments consisted of animals fed with commercial extruded ration (CER, vegetal by-products (VBP and fishery by-products (FBP. Individual morphometric characteristics were measures in terms of standard length (SL, total length (TL, head length (HL head height (HH, body width (BW, body lenght (BL, body height (BH, to evaluate the morphometric ratio of HL/SL, HL/HH, SL/TL, BW/BL, BW/BH and BH/BL. Next, the carcass (CARC, clean body (CB, dorsal muscle (DM, fillet (FL, ribs (RIB, fin (FIN, visceral fat (VISCF, skin with scales (SKIN, as well as the levels of moisture (M, ash (ASH, crude protein (CPB and fat (FAT

  9. The surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K

    2017-01-01

    The immediate postoperative course in the post-anaesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the d...

  10. 安全护理在PACU 对全麻术后患者的应用

    Institute of Scientific and Technical Information of China (English)

    肖伦华; 张红姣; 朱文倩

    2012-01-01

    目的 探讨安全护理在全麻术后患者麻醉恢复室(PACU)中全身恢复和并发症中的应用与疗效.方法 将收入PACU的266例全麻术后,用Aldrete 麻醉后恢复评分法记录患者出室和入室时的评分,同时观察、记录患者在PACU期间的相关生命指证、留室时间和并发症的发生情况.结果 266例离开PACU时,患者神志清醒;肌力、肌张力、呼吸满意;咳嗽、吞咽等保护反射恢复,不用吸氧;SPO≥ 95%;血流动力学稳定.结论 麻醉医师和手术医师术前应对患者病情作全面评估,以确保围麻醉期的安全.PACU可为所有全麻术后患者的平顺恢复提供良2好的监测和处理,是保证患者完全恢复的重要单位.老年患者宜适当延长在PACU内的停留时间.安全护理在PACU对全麻术后患者的疗效显著,值得推广.

  11. Fontes e níveis de proteína bruta em dietas para alevinos de pacu (Piaractus mesopotamicus

    Directory of Open Access Journals (Sweden)

    Fernandes João Batista Kochenborger

    2000-01-01

    Full Text Available Foi conduzido um experimento, com 100 dias duração, utilizando-se 288 alevinos de pacu, distribuídos em 36 caixas de cimento amianto com volume de 100 litros, para avaliar a substituição da farinha de peixe por farelo de soja e os níveis protéicos nas dietas. Durante o período experimental, a temperatura média da água permaneceu em 28ºC e os demais parâmetros limnológicos (oxigênio dissolvido, pH, alcalinidade e condutividade apresentaram-se dentro dos níveis adequados para o desenvolvimento desta espécie. O delineamento experimental foi de blocos casualizados, em que foram avaliados nove tratamentos em esquema fatorial 3 x 3, três níveis de proteína bruta (22, 26 e 30% e três níveis de substituição da farinha de peixe pelo farelo de soja (0, 50 e 100%. O nível de 26% de proteína bruta foi mais adequado. A farinha de peixe pode ser substituída parcial ou totalmente pelo farelo de soja, sem influir no ganho de peso, na conversão alimentar, na taxa de crescimento específico e na taxa de eficiência protéica dos alevinos. A substituição das fontes protéicas também não influenciou a composição corporal dos peixes, a eficiência de retenção de nitrogênio, o nitrogênio corporal, a gordura corporal e o nitrogênio e a gordura no ganho de peso.

  12. Staying Active: Physical Activity and Exercise

    Science.gov (United States)

    ... Patients About ACOG Staying Active: Physical Activity and Exercise Home For Patients Search FAQs Staying Active: Physical ... 2016 PDF Format Staying Active: Physical Activity and Exercise Women's Health What are the benefits of physical ...

  13. Caracterização química da laranjinha-de-pacu (Pouteria Glomerata) (MIQ.) RADLQ.) e elaboração de sorvete

    OpenAIRE

    2015-01-01

    Frutos nativos podem ser utilizadas para o consumo in natura ou para a produção de doces, geleias, sucos, licores e sorvetes. Características químicas e nutricionais são ferramentas básicas para a formulação de novos produtos. A laranjinha-de-pacu contém vitaminas e minerais além de apresentar ácido tartárico, málico e pectina, sendo boa formadora de gel, favorecendo o preparo de geleias, sucos, doces e sorvetes. O presente estudo teve como objetivo caracterizar físico-quimicamente a laranjin...

  14. Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay%重症加强治疗病房清醒患者不良住院经历调查分析

    Institute of Scientific and Technical Information of China (English)

    马朋林; 王宇; 席修明; 林洪远; 许媛; 杜斌; 赵赫林; 张翔宇; 曾琳

    2008-01-01

    Objective To survey the incidences of psychological and physiological unpleasant experiences in conscious critically ill patients during their intensive care unit (ICU) stay, and investigate the inducing factors. Methods A two-month consecutive nationwide investigation was prospectively performed in 31 academic hospital ICUs. An in-person questionnaire interview to each conscious patient was performed by specific trained staff from RMC-ROMIT Healthcare Consulting Company within 2 days after the patient was transferred from ICU. Results Two hundred and thirty-four cases were interviewed in this survey. One hundred and sixty-three of the 234 patients (69.6%) appeared psychological unpleasant experience. The ratio of patients with physiological unpleasant experience was as high as 97.0%, and 74.8% of whom were with serious physiological unpleasant experiences. The incidence of serious physiological unpleasant experiences was markedly higher in patients with than without psychological unpleasant experience (46.5% vs. 86.50%). The difference was shown to be statistical significant (P<0.01). The percentage of patients complained of ICU noise and medical or nursing manipulations not tolerable was 65.8% and 74.8%,respectively. Compared with the tolerable cases, the incidences of psychological and physiological unpleasant experiences were significantly increased in those patients (P<0.05 or P<0.01). Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score was the independent high risk factor inducing psychological unpleasant experience through multiple factor analysis [odds ratio (OR)=1.070, 95% confidence interval (CI)=1.020-1.130, P<0.05]. Age was the high risk factor inducing physiological unpleasant experience (OR=0.936, 95%CI=0.879-0.998, P<0.05). In addition, adequate sedation significantly reduced the incidence of the psychological and physiological unpleasant experiences. Conclusion A high incidence of unpleasant experience is found in conscious

  15. Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2007

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Michael G. Finn

    2010-01-04

    Study of the stay rate in the United States of foreign nationals receiving their S/E doctorates from U.S. universities. This study has estimated stay rates in 2007 for persons receiving a doctorate one, two, five, and ten years previously. The two-year stay rate (for 2005 graduates) recovered from the decline experienced earlier in the decade. The five-year stay rate (for 2002 graduates) is lower; the ten-year stay rate (for 1997 graduates) reached a new high.

  16. Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone

    Science.gov (United States)

    Hiller, Kenneth N.; Altamirano, Alfonso V.; Cai, Chunyan; Tran, Stephanie F.; Williams, George W.

    2015-01-01

    Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure. PMID:26693222

  17. Evolutionary construction by staying together and coming together.

    Science.gov (United States)

    Tarnita, Corina E; Taubes, Clifford H; Nowak, Martin A

    2013-03-07

    The evolutionary trajectory of life on earth is one of increasing size and complexity. Yet the standard equations of evolutionary dynamics describe mutation and selection among similar organisms that compete on the same level of organization. Here we begin to outline a mathematical theory that might help to explore how evolution can be constructive, how natural selection can lead from lower to higher levels of organization. We distinguish two fundamental operations, which we call 'staying together' and 'coming together'. Staying together means that individuals form larger units by not separating after reproduction, while coming together means that independent individuals form aggregates. Staying together can lead to specialization and division of labor, but the developmental program must evolve in the basic unit. Coming together can be creative by combining units with different properties. Both operations have been identified in the context of multicellularity, but they have been treated very similarly. Here we point out that staying together and coming together can be found at every level of biological construction and moreover that they face different evolutionary problems. The distinction is particularly clear in the context of cooperation and defection. For staying together the stability of cooperation takes the form of a developmental error threshold, while coming together leads to evolutionary games and requires a mechanism for the evolution of cooperation. We use our models to discuss simple aspects of the evolution of protocells, eukarya, multi-cellularity and animal societies. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. On Staying with Our Students

    Science.gov (United States)

    Jennings, Marianne

    2009-01-01

    This paper describes the author's experience and strategy in teaching business law and ethics. Jennings shares how business scandals have changed her three decades of teaching and describes how she has found a way of connecting with students by introducing some cognitive dissonance that stays with them when they are asked to do something in their…

  19. On Staying with Our Students

    Science.gov (United States)

    Jennings, Marianne

    2009-01-01

    This paper describes the author's experience and strategy in teaching business law and ethics. Jennings shares how business scandals have changed her three decades of teaching and describes how she has found a way of connecting with students by introducing some cognitive dissonance that stays with them when they are asked to do something in their…

  20. Effectiveness of Advanced Stay Strong, Stay Healthy in Community Settings

    Directory of Open Access Journals (Sweden)

    Emily M. Crowe MS

    2015-07-01

    Full Text Available The goal of this research was to investigate the effectiveness of the 10-week, University of Missouri (MU Extension strength training program Advanced Stay Strong, Stay Healthy (ASSSH. It was hypothesized that the program can improve strength, balance, agility, and flexibility—all physical measures of falling among seniors. Matched pair t tests were used to compare differences in five physical measures of health, body composition, and percent body fat (%BF. Two-way ANOVA was conducted to examine the age effects on changes in physical health from the start and finish of the exercise program. Following programming, participants significantly improved strength, flexibility, and balance, and significantly reduced %BF (p < .05. Our data indicate that ASSSH can improve the physical health of senior citizens and can successfully be translated into community practice by MU Extension professionals.

  1. Effectiveness of Advanced Stay Strong, Stay Healthy in Community Settings

    Directory of Open Access Journals (Sweden)

    Emily M. Crowe MS

    2015-07-01

    Full Text Available The goal of this research was to investigate the effectiveness of the 10-week, University of Missouri (MU Extension strength training program Advanced Stay Strong, Stay Healthy (ASSSH. It was hypothesized that the program can improve strength, balance, agility, and flexibility—all physical measures of falling among seniors. Matched pair t tests were used to compare differences in five physical measures of health, body composition, and percent body fat (%BF. Two-way ANOVA was conducted to examine the age effects on changes in physical health from the start and finish of the exercise program. Following programming, participants significantly improved strength, flexibility, and balance, and significantly reduced %BF ( p < .05. Our data indicate that ASSSH can improve the physical health of senior citizens and can successfully be translated into community practice by MU Extension professionals.

  2. Ethnically Diverse Older Adults' Beliefs about Staying Mentally Sharp

    Science.gov (United States)

    Friedman, Daniela B.; Laditka, Sarah B.; Laditka, James N.; Wu, Bei; Liu, Rui; Price, Anna E.; Tseng, Winston; Corwin, Sara J.; Ivey, Susan L.; Hunter, Rebecca; Sharkey, Joseph R.

    2011-01-01

    This study examined diverse older adults' (n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos,…

  3. Staying Safe in the Water

    Centers for Disease Control (CDC) Podcasts

    2008-05-15

    In this podcast, Dr. Julie Gilchrist, a pediatrician and medical epidemiologist from CDC’s Injury Center, talks about staying safe in the water. Tips are for all audiences, with a focus on preventing drownings and keeping children safe in and around the pool, lake, or ocean.  Created: 5/15/2008 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 5/19/2008.

  4. Stay-Behind og Firmaet

    DEFF Research Database (Denmark)

    Heiberg, Morten Rievers

    En række hemmelige og illegale grupper, der havde deres udspring i de europæiske modstandsbevægelser, opbyggede i tiden efter 1945 et bevæbnet net, der gik under betegnelsen 'stay-behind'. Der var tale om enheder, som skulle være klar til at udføre militære operationer bag fjendens linjer i tilfæ...

  5. Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2011

    Energy Technology Data Exchange (ETDEWEB)

    Finn, Michael G. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

    2014-01-02

    This report provides estimates of stay rates for foreign students who received doctorates in science or engineering (S/E) from U.S. universities. For this paper, the stay rate represents the proportion of foreign doctorate recipients from U.S. universities who stayed in the United States after graduation for any reason and is always specific to a particular year. Each line in the tables that follow describes a different group of these degree recipients.

  6. Digestibilidade e tempo de trânsito gastrintestinal de dietas contendo níveis crescentes de fibra bruta para pacu - doi: 10.4025/actascianimsci.v32i2.8625 Digestibility and gastrointestinal transit time of diets with increasing dietary fiber levels to pacu - doi: 10.4025/actascianimsci.v32i2.8625

    Directory of Open Access Journals (Sweden)

    Thiago Matias Torres Nascimento

    2010-07-01

    Full Text Available O objetivo deste trabalho foi avaliar a digestibilidade e o tempo de trânsito gastrintestinal (TTGI de dietas contendo níveis crescentes de fibra bruta (FB para pacus. Para avaliar a digestibilidade foram utilizados 288 pacus, em delineamento inteiramente casualizado, alimentados em aquários e transferidos para coletores do tipo Guelf Modificado, utilizando-se o método de coleta parcial de fezes. As rações foram marcadas com 1% de óxido de crômio para a determinação da digestibilidade das dietas. No ensaio de TTGI, 288 pacus foram distribuídos em 24 aquários em delineamento inteiramente casualizado e alimentados com rações contendo 1% óxido de titânio ou crômio, que apresentam cores diferentes, verde ou branca, respectivamente. Por meio de massagem abdominal foi averiguada periodicamente a cor das fezes, e o TTGI foi estabelecido quando as fezes de todos os peixes apresentaram cor verde. Os coeficientes de digestibilidade aparente das dietas e o TTGI foram reduzidos com aumento do nível de FB nas dietas. Conclui-se que em dietas para pacus pode-se empregar até 9% de FB sem efeito negativo na digestibilidade da energia, proteína, matéria seca e estrato etéreo e sem alterar o TTGI.This work aimed to evaluate the effect of increasing dietary fiber levels on the digestibility and gastrointestinal transit time (GTT for pacu. The digestibility trial used 288 pacu in a completely randomized design, fed in aquaria and transferred to a modified Guelf-type feces collector, using the partial sampling method. The inert marker on the diets was chromic oxide (1% to establish the diet digestibility. In the GTT assay, 288 pacu were distributed in 24 aquaria in a completely randomized design. Fish were fed with two colored diets – green and white – and feces color was determined after abdominal pressure. The white and green diets used 1% of titanium and chromic oxides, respectively. Total GTT was determined when all fish showed green

  7. Fatores antinutricionais e coeficientes de digestibilidade aparente da proteína de produtos de soja para o pacu (Piaractus mesopotamicus - doi: 10.4025/actascianimsci.v32i3.5819 Anti-nutritional factors and protein apparent digestibility coefficients of soybeans sources to pacu (Piaractus mesopotamicus - doi: 10.4025/actascianimsci.v32i3.5819

    Directory of Open Access Journals (Sweden)

    Maria Regina Barbieri de Carvalho

    2010-09-01

    Full Text Available Este estudo teve como objetivo determinar as atividades dos inibidores de tripsina, hemaglutinante e teores de taninos no farelo de soja e na soja crua e processada, e avaliar o coeficiente de digestibilidade aparente da fração proteica para juvenis de pacu. Os coeficientes de digestibilidade aparente da proteína da soja crua, extrusada, tostada e macerada foram determinadas usando óxido de cromo (0,5% como marcador. Foi elaborada dieta de referência com 26% de proteína bruta e 4.352 kcal kg-1, e a cada alimento avaliado foram substituídas 30% da dieta-teste. As fezes foram coletadas por pressão abdominal. Todos os produtos analisados apresentaram fatores antinutricionais, mas foi observada menor atividade de inibidor de tripsina no farelo de soja. Sojas que receberam tratamento térmico apresentaram os melhores coeficientes de digestibilidade e menores valores de atividade hemaglutinante do que a soja crua. Não foram observados efeitos dos inibidores de tripsina e taninos sobre o coeficiente de digestibilidade da proteína, mas foi observada relação negativa entre os teores de hemaglutinina com a digestibilidade da proteína bruta. Para a alimentação do pacu recomenda-se a utilização do farelo de soja e da soja processada por extrusão ou tostada.This study aimed to determine the activities of trypsin inhibitors, hemagglutinant and tannin levels in soybean meal and in raw and processed soy, as well evaluate the protein apparent digestibility coefficient for pacu juveniles. The apparent coefficients of raw, extruded, toasted and milled soy were determined using chromium oxide (0.5% as marker. A reference diet was created with 26% crude protein and 4,352 kcal kg-1, with each feed containing 30% of the test diet. Feces were collected by abdominal pressure. All analyzed products presented anti-nutritional factors, but the lowest trypsin inhibitor activity was observed in soybean meal. Soy that received thermal treatment presented

  8. Desempenho produtivo, composição corporal e parâmetros fisiológicos de pacu alimentado com níveis crescentes de fibra Productive performance, body composition and physiological parameters of pacu fed increasing levels of fiber

    Directory of Open Access Journals (Sweden)

    Laurindo André Rodrigues

    2010-08-01

    Full Text Available O objetivo deste trabalho foi avaliar os efeitos de teores de fibra bruta na dieta sobre o desempenho produtivo, composição centesimal da carcaça e parâmetros fisiológicos de juvenis de pacu. O experimento teve duração de 84 dias, e foram utilizados 360 juvenis de pacu, com peso médio de 23,97±0,59 g, distribuídos aleatóriamente em 30 tanques com 180 L de água, em delineamento inteiramente casualizado, com seis tratamentos (5, 7, 9, 11, 13 e 15% de fibra bruta e cinco repetições. Dietas com altos teores de fibra (11, 13 e 15% resultaram em piores taxas de ganho de peso, conversão alimentar e crescimento específico, além de menor eficiência proteica e consumo de ração. A composição da carcaça dos animais foi alterada pelo aumento do teor de fibra das dietas. Os teores de proteína e cinza tiveram aumento com o incremento nos teores de fibra. O metabolismo foi alterado com o emprego de teores crescentes de fibra, o que resultou em pequena elevação do colesterol plasmático. Teores de fibra bruta de até 9% não tiveram efeitos negativos no metabolismo; entretanto, teores acima de 11% reduziram o crescimento dos peixes.The objective of this work was to evaluate the effects of dietary crude fiber contents on productive performance, carcass composition and physiological parameters of pacu juveniles. The experiment was carried out during 84 days, 360 pacu juveniles were used with mean weight 23.97±0.59 g, stocked in 30 tanks with 180 L of water, in a completely randomized design, with six treatments (5, 7, 9, 11, 13 and 15% crude fiber and five replicates. Diets with high fiber contents (11, 13 and 15% resulted in worse rates of weight gain, feed conversion, and specific growth, besides lower protein efficiency ratio and feed consumption. Carcass composition changed by increasing the contents of dietary fiber. Body contents of protein and ash increased along with the fiber levels. The metabolism changed with the use of

  9. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.

    Science.gov (United States)

    Weinger, Matthew B; Slagle, Jason M; Kuntz, Audrey H; Schildcrout, Jonathan S; Banerjee, Arna; Mercaldo, Nathaniel D; Bills, James L; Wallston, Kenneth A; Speroff, Theodore; Patterson, Emily S; France, Daniel J

    2015-10-01

    Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers. We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3. Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P 3 years later.

  10. A percepção do paciente sobre sua permanência na unidade de terapia intensiva The patients's perception during their stay in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Edinêis de Brito Guirardello

    1999-06-01

    Full Text Available Este estudo procura identificar a percepção do paciente sobre sua permanência na UTI. A amostra constituiu-se de10 pacientes, submetidos à cirurgia cardíaca e que receberam intervenção psicológica somente após a alta da UTI. Para a coleta e análise dos dados, utilizou-se uma abordagem qualitativa (análise de conteúdo. Os resultados sugerem que o paciente possue uma visão esteriotipada da UTI, vinculada à ideia de sofrimento e morte; o enfermeiro ocupa um importante papel nos momentos de fragilidade, dependência física e emocional; a dor, por seu caráter subjetivo, individual e emocional, é inevitável por estar relacionada aos procedimentos e, muitas vezes, associada ao sofrimento físico.The purpose of this study is to identify the patients's perception during their stay in the ICU. The sample was composed by ten patients, who had gone to cardiac surgery. They received psychological assistance only after their discharge from the ICU. The data was obtained throw a qualitative approach, using a content analysis. The results suggest that the patients have a. stereotyped view about the ICU, linked with the idea of suffering and death; the nurses play an important role during fragility moments, physical and emotional dependence; the pain, by its subjective nature, individually and emotionaly, is inevitable, because it is related to procedure and usually it is associated to physical suffering.

  11. La unidad de corta estancia de urgencias y la hospitalización a domicilio como alternativas a la hospitalización convencional The emergency department short stay unit and the hospital at home as alternatives to standard inpatient hospitalisation

    Directory of Open Access Journals (Sweden)

    G. Alonso

    2010-01-01

    Full Text Available La unidad de corta estancia de urgencias (UCEU es una unidad de soporte del servicio de urgencias y una alternativa clara a la hospitalización convencional de pacientes con requerimiento de atención urgente y que están afectados de algunas enfermedades crónicas reagudizadas (estacionales o no o de patologías de gravedad leve-moderada de corta evolución. La hospitalización a domicilio (HaD es una alternativa asistencial que permite realizar en el domicilio del enfermo los cuidados y tratamientos propios del hospital, con mayor comodidad e intimidad para éste, y el origen del paciente puede ser tanto la hospitalización convencional, como el servicio de urgencias o la UCEU. En ambas alternativas a la hospitalización convencional, es clave la selección adecuada de los pacientes, mediante criterios estrictos tanto clínicos como sociofamiliares. Su correcto uso asegura un significativo ahorro de estancias en las unidades de hospitalización convencional, una reducción de la estancia media en los servicios médicos y quirúrgicos hospitalarios y una menor presión de urgencias, ya que aumenta la disponibilidad de camas tanto para el ingreso programado como para el ingreso urgente en hospitalización convencional y mejora, por tanto, el drenaje del servicio de urgencias.The emergency short stay unit (ESSU is a support unit for the accident and emergency services and a clear alternative to the conventional hospitalisation of patients needing urgent care, who are affected by the re-aggravation of certain chronic diseases (whether seasonal o not or by moderate short-evolution pathologies. Hospitalisation at home is one alternative making it possible to undertake the care and treatment characteristic of a hospital in the home of the patient, with greater comfort and intimacy. The origin of the patient might be the conventional hospital, the emergency service or ESSU. A suitable selection of patients is essential in both alternatives to

  12. Why trains stay on tracks

    Science.gov (United States)

    Shayak, B.

    2017-03-01

    In this article, we give both qualitative and quantitative explanations of why a train stays on its track, in spite of perturbations that could cause it to derail. We show that train stability originates from the conical shape of the wheels, which gives rise to a restoring normal force in response to a lateral disturbance. We first demonstrate translational stabilization in a simple situation where the rails are assumed frictionless and the steering motion of the wheel is neglected. We then develop a more comprehensive model, taking friction and steering into account. We show that rolling friction couples the rotational motion to the translational motion, enhancing overall stability. Finally, we find approximate formulae for the parameters governing stability, and show good agreement with parameters of a real railway coach.

  13. Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2005

    Energy Technology Data Exchange (ETDEWEB)

    Mike Finn

    2008-02-01

    This is the latest in a series of studies conducted for the National Science Foundation to estimate the proportion of foreign science / engineering doctorate recipients from U.S. universities who stayed in the United States after graduation. Sixty-six percent of those who graduated in 2003 were still in the United States in 2005, a 5 percent decline since the last report. But the five-year stay rate continues to climb, now at 68 percent.

  14. [Length of stay in patients admitted for acute heart failure].

    Science.gov (United States)

    Martín-Sánchez, Francisco Javier; Carbajosa, Virginia; Llorens, Pere; Herrero, Pablo; Jacob, Javier; Miró, Òscar; Fernández, Cristina; Bueno, Héctor; Calvo, Elpidio; Ribera Casado, José Manuel

    2016-01-01

    To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001). A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  15. Mentol e eugenol como substitutos da benzocaína na indução anestésica de juvenis de pacu - DOI: 10.4025/actascianimsci.v30i3.1081 Eugenol and menthol as benzocaine substitutes in anaesthesic induction of pacu juveniles - DOI: 10.4025/actascianimsci.v30i3.1081

    Directory of Open Access Journals (Sweden)

    João Batista Kochenborger Fernandes

    2008-11-01

    Full Text Available Objetivou-se verificar a eficiência de anestésicos naturais na indução à anestesia de juvenis de pacu. Foram avaliadas quatro concentrações de mentol (50, 100, 150 e 200 mg L-1, quatro de eugenol (10, 25, 50 e 100 mg L-1 e uma de benzocaína (100 mg L-1. Durante o procedimento de anestesia, foram monitorados e avaliados quatro estágios de sedação, da redução dos movimentos operculares até a perda total de reação à manipulação. Após o procedimento de biometria, foram avaliados o tempo de recuperação e a mortalidade até 48h após anestesia. As concentrações de 100, 150 e 200 mg L-1 de mentol e as concentrações de 50 e 100 mg L-1 de eugenol apresentaram tempos de indução à anestesia e recuperação similares aos da benzocaína. Os resultados obtidos mostraram que o mentol e o eugenol são anestésicos eficientes para pacus em substituição à benzocaína, sugerindo a concentração de 100 mg L-1 de mentol e 50 mg L-1 de eugenol.Anaesthetics represents important tool for management procedures in aquaculture. This study aimed to verify the efficacy of natural anaesthesic induction of pacu juvenile. Were evaluated four menthol concentrations (50, 100, 150 and 200 mg L-1, four eugenol (10, 25, 50 and 100 mg L-1 and one of benzocaine (100 mg L-1. During the anaesthesic procedure were monitored and evaluated four sedative stages, until no reaction to handling. After biometric was evaluated recovery time and mortality 48 hours after anaesthesia. Concentrations 100, 150 and 200 mg L-1 of menthol, 50 and 100 mg L-1 of eugenol showed anaesthesic induction time and recovery time similar of benzocaine. The obtained results showed that menthol is an efficient anaesthesic for pacu juvenile in substitution of benzocaine, suggesting the concentration of 100 mg L-1 of menthol and 50 mg L-1 of eugenol.

  16. Suplementação de lisina e metionina em dietas com baixo nível protéico para o crescimento inicial do pacu, Piaractus mesopotamicus (Holmberg Lysine and methionine supplementation in diets with low protein level for the initial growth of pacu Piaractus mesopotamicus (Holmberg

    Directory of Open Access Journals (Sweden)

    Adriana Patrícia Muñoz-Ramírez

    2002-04-01

    Full Text Available O objetivo deste trabalho foi estudar os efeitos da suplementação de metionina ou lisina em dietas com baixo teor protéico para o crescimento do pacu Piaractus mesopotamicus (Holmberg (Characiformes, Characidae. Foram formuladas uma dieta basal com 22% de proteína bruta (PB, 4100kcal de energia bruta (EB/kg, 0,42% de metionina e 1,16% de lisina e outras 6 dietas, com a mesma formulação básica, suplementadas com 0,2, 0,4 ou 0,6% de metionina ou lisina. Uma 8ª dieta (controle continha 26% PB, 4100kcal EB/kg, 0,48% metionina e 1,43% de lisina. As dietas foram administradas à vontade a 144 alevinos com 14,98 ± 1,16g de peso médio inicial. As médias de ganho em peso, eficiência de retenção de energia bruta e dos consumos alimentares da dieta controle mostraram-se maiores (P The objective of this research was to study the effects of methionine or lysine supplementation in diets with low protein level for growth of pacu Piaractus mesopotamicus (Holmberg (Characiformes, Characidae. Diets were formulated as a basal diet presenting 22% crude protein (CP, 4100 kcal gross energy (GE/kg, 0.42% of methionine and 1.16% of lysine and other six diets, with the same basic formulation, supplemented with 0.2%, 0.4% or 0.6% methionine or lysine. An eighth diet (control contained 26% CP, 4100 kcal (GE/kg, 0.48% methionine and 1.43% of lysine. The diets were administered ad libitum to 144 fingerlings with initial medium weight of 14.98 ± 1.16 g. Averages weight gain, gross energy efficiency retention and feed intake for the control treatment were significantly higher (P < 0.05 than those of smaller protein level diets. Averages protein retention efficiency were only higher (P < 0.01 in the diets supplemented with lysine, showing the advantages of lysine supplementation in diets with low crude protein level. A higher growth of pacu was confirmed with diets containing 26% of CP.

  17. ‘You can't stay away from your family’: a qualitative study of the ongoing ties and future plans of South African health workers in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Katherine Taylor

    2015-03-01

    Full Text Available Background: Migration of African-trained health workers to countries with higher health care worker densities adds to the severe shortage of health personnel in many African countries. Policy initiatives to reduce migration levels are informed by many studies exploring the reasons for the original decision to migrate. In contrast, there is little evidence to inform policies designed to facilitate health workers returning home or providing other forms of support to the health system of their home country. Objective: This study explores the links that South African-trained health workers who now live and work in the United Kingdom maintain with their country of training and what their future migration plans may be. Design: Semi-structured interviews were conducted with South African trained health workers who are now living in the United Kingdom. Data extracts from the interviews relating to current links with South Africa and future migration plans were studied. Results: All 16 participants reported strong ongoing ties with South Africa, particularly through active communication with family and friends, both face-to-face and remotely. Being South African was a significant part of their personal identity, and many made frequent visits to South Africa. These visits sometimes incorporated professional activities such as medical work, teaching, and charitable or business ventures in South Africa. The presence and location of family and spouse were of principal importance in helping South African-trained health care workers decide whether to return permanently to work in South Africa. Professional aspirations and sense of duty were also important motivators to both returning and to being involved in initiatives remotely from the United Kingdom. Conclusions: The main barrier to returning home was usually the development of stronger family ties in the United Kingdom than in South Africa. The issues that prompted the original migration decision, such as

  18. Development of Intention to Stay Model for Temporary Nursing Staff in RS UNAIR

    Directory of Open Access Journals (Sweden)

    Ike Nesdia Rahmawati

    2016-09-01

    Full Text Available Introduction: Intention to stay of nurses is important to reduce turnover rate and to improve the stability of hospital. Quality of nursing work life (QNWL has been found to influence intention to stay. However, reliable information of this effect is limited. The purpose of this study was to develop the model of intention to stay for temporary nursing staff in RS UNAIR. Method: Anexplanative cross-sectional survey design was used in this study. Data were collected by using questionnaire among 32 nurses working at different units in this hospital through simple random sampling and analyzed by partial least square (PLS. Result: QNWL affected job satisfaction but did not affect commitment. Commitment was significantly affected by job satisfaction. There was effect of job satisfaction on intention to stay. Commitment also significantly affected intention to stay Discussion: QNWL is a predictor of intention to stay trough job satisfaction and commitment. It is recommended that more focused interventions on QNWL, job satisfaction, and commitment developments may improve intention to stay. Recruitment of non-nursing staff to carry out billing and administrative tasks is urgently needed. Suggestions for further research is to analyze the effect of empowerment, remuneration, and career ladder on nurses’ intention to stay. Keywords: intention to stay, quality of nursing work life, job satisfaction, commitment.

  19. Ingestão de ração e comportamento de larvas de pacu em resposta a estímulos químicos e visuais Diet ingestion rate and pacu larvae behavior in response to chemical and visual stimuli

    Directory of Open Access Journals (Sweden)

    Marcelo Borges Tesser

    2006-10-01

    Full Text Available Este estudo foi realizado com o objetivo de comparar a influência dos estímulos visual e/ou químico de náuplios de Artemia e de dieta microencapsulada sobre a taxa de ingestão da dieta microencapusulada por larvas de pacu Piaractus mesopotamicus. Utilizou-se um esquema fatorial 7 x 4 (estímulos e idades com duas repetições. Verificou-se efeito da idade das larvas e dos estímulos, mas não houve efeito para a interação idade ´ estímulos. O estímulo químico da Artemia e ambos os estímulos da Artemia resultaram em maior taxa de ingestão de dieta inerte. Resultado intermediário foi obtido com o estímulo visual da dieta microencapsulada. O estímulo químico, em comparação ao estímulo visual da Artemia, resultou em maiores taxas de ingestão da dieta. Com o aumento da idade, houve incremento na taxa de ingestão. Os estímulos visual e químico dos náuplios e o estímulo visual da ração aumentaram a ingestão de dieta inerte por larvas de pacu. Náuplios de Artemia devem ser oferecidos antes do fornecimento da dieta inerte, pois podem auxiliar no processo de transição alimentar. Os resultados deste trabalho apontaram novas possibilidades de estudos com larvas de peixes neotropicais visando a substituição precoce do alimento vivo para o inerte.The effect of visual, chemical and the combination of both stimuli from Artemia nauplii and from microencapsulated diet on dry diet ingestion by pacu Piaractus mesopotamicus larvae was evaluated in this research. The experiment was analyzed as a 7 x 4 factorial arrangement (seven stimuli and four ages with two replicates. It was observed effect of larvae age and stimuli, but no interaction (age ´ stimuli was observed. The chemical effect from Artemia and both effects from Artemia resulted in higher ingestion rates. An intermediary result was obtained with visual effect from microencapsulated diet. The chemical stimulus from Artemia resulted in higher ingestion rates than that

  20. Atrazine levels in the Jaboticabal water stream (São Paulo State, Brazil) and its toxicological effects on the pacu fish Piaractus mesopotamicus.

    Science.gov (United States)

    Santos, Edson Aparecido dos; Cruz, Claudinei da; Carraschi, Silvia Patrícia; Marques Silva, José Roberto; Grossi Botelho, Rafael; Velini, Edivaldo Domingues; Pitelli, Robinson Antonio

    2015-03-01

    The aim of this study was to determine the environmental concentration of atrazine (ATZ) in five streams located in the north of São Paulo state (Brazil) and evaluate its toxicological impact on young specimens of the pacu fish Piaractus mesopotamicus. Samples of water were collected on three occasions between 2010 and 2011, corresponding to periods signifying the beginning, middle, and end of rain season. ATZ levels were estimated by a high-performance liquid chromatography coupled with a mass spectrometry (HPLC-MS/MS) triple quadrupole. Later, the quotient of environmental risk (QR) was determined based on the medium lethal concentration (LC50 48 h), non-observable effect concentration (NOEC), and the estimated environmental concentration (EEC) of ATZ detected in the environment. Histological changes in gills and liver were also studied, along with the brain activity of the enzyme acetylcholinesterase (AChE). The highest concentration of ATZ measured was 10.4 μg L(-1). The ATZ LC50 (48 h) for young P. mesopotamicus was 24.46 mg L(-1) and the QR was classified as "safe". Although the QR indicated that ATZ could be safe for the tested species, it caused many histological alterations in the liver and gills of the exposed specimens, and an increase in the AChE levels.

  1. Métodos de coleta de fezes e determinação dos coeficientes de digestibilidade da fração protéica e da energia de alimentos para o pacu, Piaractus mesopotamicus (Holmberg, 1887 Fecal collection methods and determination of crude protein and of gross energy digestibility coefficients of feedstuffs for pacu, Piaractus mesopotamicus (Holmberg, 1887

    Directory of Open Access Journals (Sweden)

    Eduardo Gianini Abimorad

    2004-10-01

    Full Text Available Para melhorar a alimentação do pacu (Piaracatus mesopotamicus, é necessário conhecer o nível de aproveitamento dos ingredientes utilizados em suas dietas. Neste trabalho, inicialmente, foram analisados quatro métodos de coleta de fezes, em função da precisão e da versatilidade (dissecação, extrusão, Guelph e Guelph modificado, e o tempo entre as coletas de fezes nos sistemas de Guelph, por intermédio do coeficiente de digestibilidade da proteína bruta de uma dieta-referência para o pacu. Não houve diferença entre os métodos de coleta de fezes; já os intervalos de tempo das coletas apresentaram diferenças, podendo interferir nos resultados de digestibilidade da proteína. Em uma segunda etapa, para determinação dos coeficientes de digestibilidade da proteína e da energia de cinco concentrados protéicos de origem animal, cinco de origem vegetal e quatro energéticos, foram utilizadas rações elaboradas com 69,5% de uma dieta-referência, 30% do ingrediente teste e 0,5% de Cr2O3, utilizando o método de extrusão manual para a coleta de fezes. Os valores de digestibilidade da proteína da maioria dos alimentos apresentaram-se altos e não variaram estatisticamente, de 93,89 a 75,73% para o farelo de trigo e a farinha de penas, respectivamente. Entretanto, a farinha de sangue e a levedura apresentaram valores de digestibilidade da fração protéica significativamente inferiores (57,72 e 68,86%, respectivamente. Os coeficientes de digestibilidade da energia dos alimentos variaram consideravelmente, apresentando altos valores (acima de 90% para o sorgo, o farelo de arroz e as sojas crua e tostada, e baixos valores (menores que 70% para as farinhas de vísceras e de sangue, os farelos de soja e de algodão e a levedura. Quanto aos métodos de coleta de fezes, conclui-se que qualquer um pode ser adotado para a determinação de digestibilidade, desde que sejam rigorosamente aplicados. De maneira geral, a maioria dos

  2. Optimal Damping of Stays in Cable-Stayed Bridges for In-Plane Vibrations

    DEFF Research Database (Denmark)

    Jensen, C.N.; Nielsen, S.R.K.; Sørensen, John Dalsgaard

    2002-01-01

    Significant vibrations have been reported in stays of recently constructed cable stayed bridges. The vibrations appear as in-plane vibrations that may be caused by rain–wind- induced aeroelastic interaction or by resonance excitation of the cables from the motion of the pylons. The stays of moder...

  3. Stay vane and wicket gate relationship study

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2005-01-19

    This report evaluates potential environmental and performance gains that can be achieved in a Kaplan turbine through non-structural modifications to stay vane and wicket gate assemblies. This summary is based primarily on data and conclusions drawn from models and studies of Lower Granite Dam. Based on this investigation, the study recommends (1) a proof of concept at Lower Granite Dam to establish predicted improvements for the existing turbine and to further refine the stay vane wicket gate designs for fish passage; and (2) consideration of the stay vane wicket gate systems in any future turbine rehabilitation studies.

  4. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit? Colecistectomía laparoscópica en el tratamiento de la litiasis biliar: ¿cirugía mayor ambulatoria o corta estancia?

    Directory of Open Access Journals (Sweden)

    A. Martínez Vieira

    2004-07-01

    Full Text Available Objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Results: group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017, inability to tolerate oral diet (p = 0.002, and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003. Conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.Objetivo: analizar los factores clínicos y quirúrgicos que en una serie de pacientes sometidos a colecistectomía laparoscópica ambulatoria influyeron en la decisión del momento del alta y cuál fue la aceptación de los pacientes al alta. Pacientes y método: en este estudio fueron incluidos 81 pacientes consecutivos procedentes de la lista de espera quirúrgica en quienes se realizó una colecistectomía laparoscópica electiva a lo largo del año 2002. Es un estudio retrospectivo y comparativo que incluye dos grupos de pacientes: los del grupo A fueron dados de alta entre 24 a 48 horas tras la intervención; los del grupo B lo fueron en menos de 24 horas. Analizamos las caracter

  5. Vivências e perspectivas maternas na internação do filho prematuro em Unidade de Tratamento Intensivo Neonatal Experiencias y perspectivas maternas en la internación del niño prematuro en unidad de terapia intensiva neonatal Mothers' experiences and perspectives regarding their premature infant's stay at the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Bárbara Bertolossi Marta de Araújo

    2010-12-01

    espacio de convivencias, intercambio de experiencias y apoyo mutuo en la larga y difícil permanencia hospitalaria.The purpose of this study was to learn the reason why mothers remain at the hospital throughout the stay of their premature infant at the Neonatal Intensive Care Unit. The study was performed with twelve mothers to premature newborns at a municipal maternity hospital in Rio de Janeiro, in 2007. The methodological support used in the study was the Sociological Phenomenology of Alfred Schütz. The phenomenological interview was used to capture the mothers' discourse, whose intentional action was unveiled through the following categories: Taking care of the child - dealing with the challenge of having a small baby; Staying near the premature child - the mother's presence helps the child's recovery to be faster; Reciprocal help among mothers - reinforcing hope every day. Rooming-in care stands out as an innovative and relevant initiative during the hospital stay of preterm infants, and it is considered an environment for living together, sharing experiences, and giving mutual support throughout the long and difficult stay at the hospital.

  6. Staying Socially Active Nourishes the Aging Brain

    Science.gov (United States)

    ... fullstory_163679.html Staying Socially Active Nourishes the Aging Brain Researchers suggest making friends of all ages ... and Human Services. More Health News on: Healthy Aging Recent Health News Related MedlinePlus Health Topics Healthy ...

  7. Having Twins? How to Stay Healthy

    Science.gov (United States)

    ... Listen Español Text Size Email Print Share Having Twins? How to Stay Healthy Page Content Article Body ... the eyes of obstetricians. Many would call a twin pregnancy a high-risk pregnancy , but don’t ...

  8. Senior Living: Staying Positive and Moving Forward

    Science.gov (United States)

    ... Past Issues Feature: Senior Living Staying Positive and Moving Forward Past Issues / Summer 2009 Table of Contents ... page please turn Javascript on. For Juanita Kuhn, moving to an independent living facility is just the ...

  9. A simple method for the determination of fluoroquinolone residues in tilapia (Oreochromis niloticus) and pacu (Piaractus mesopotamicus) employing LC-MS/MS QToF.

    Science.gov (United States)

    Quesada, Silvia Pilco; Paschoal, Jonas Augusto Rizzato; Reyes, Felix Guillermo

    2013-01-01

    The use of antimicrobials in livestock production is a powerful resource applied throughout the world to guarantee high yield and control bacterial diseases in aquaculture. However, residues of these substances in animal products represent a potential risk to consumer health when residue levels are above the established maximum residue limits (MRLs). Fluoroquinolones (FQs) are antimicrobials commonly used worldwide in aquaculture. The aim of this work was to develop and validate a simple analytical method for the simultaneous determination of norfloxacin, danofloxacin, enrofloxacin and ciprofloxacin levels in tilapia (Oreochromis niloticus) and pacu (Piaractus mesopotamicus) fillets using liquid chromatography-tandem mass spectrometry (LC-MS/MS) quadrupole time of flight (QToF). The FQs were extracted from the fillets with 1% acetic acid-methanol and 1% acetic acid-acetonitrile solutions using ultrasonic assistance. The clean-up was performed with hexane. Chromatographic separation was conducted in an XTerra RP18 column (2.1 × 150 mm, 5 µm) at 25 °C with a flow of 0.2 mL min⁻¹. The mobile phase consisted of 0.1% aqueous formic acid and acetonitrile, with gradient elution. The validation parameters for all FQs were linearity (>0.99), intra-day precision (CV of 1%-9%), inter-day precision (CV of 3%-17%), decision limit (63-126 ng g⁻¹), detection capability (76 -152 ng g⁻¹) and accuracy (90%-111%). The limit of quantification was lower than the MRL for each FQ, indicating that the method is suitable for the determination of the FQ levels in the fish fillets. The mass analyser of the QToF type was able to confirm the identities of the FQs with an error of the accuracy of the mass (reasons m/z) of less than 10 ppm.

  10. [Use of valproic acid in long stay units of psychiatry].

    Science.gov (United States)

    Martínez-Lazcano, M Teresa; Esplá-González, Sara; Herraiz-Robles, Paola; Hernández-Pérez, Pilar; Chillerón-Cuenca, Raquel; Pol-Yanguas, Emilio

    2015-03-01

    Objetivo: El ácido valproico es utilizado frecuentemente en psiquiatría para tratar la esquizofrenia y otras afecciones fuera de indicación de ficha técnica (“off-label”). A pesar de ello, su efectividad no ha sido suficientemente demostrada y su uso no está exento de efectos adversos. El presente estudio tiene como objetivo principal conocer la frecuencia de uso de ácido valproico tanto en las indicaciones recogidas en ficha técnica, como su utilización “off-label” en pacientes psiquiátricos. Método: Se diseñó un estudio transversal el 7 de julio de 2014 con una muestra de 167 pacientes residentes en un centro psiquiátrico. Se analizaron las siguientes variables: datos demográficos, tratamiento con ácido valproico y pauta posológica, tratamiento farmacológico asociado, monitorización de los parámetros de seguridad, interacciones y concentraciones de ácido valproico. Resultados: El ácido valproico se prescribió en 1 de cada 3 pacientes del centro. Se utilizó según las indicaciones aprobadas en ficha técnica en 8 (15%) de los 53 pacientes analizados: 5 (9%) de ellos con trastorno bipolar y 3 (6%) diagnosticados de epilepsia. Otros 5 pacientes (9%) se incluyeron en la indicación extendida de trastorno esquizoafectivo. El 76% (40) de los pacientes evaluados tenían prescrito ácido valproico fuera de indicación. La media de dosis de ácido valproico fue de 1,26 Dosis Diarias Definidas/paciente/día. Se encontró una media de 6 fármacos asociados al ácido valproico. El 18% de los pacientes presentó trombocitopenia. Conclusiones: El ácido valproico se utiliza frecuentemente en pacientes psiquiátricos fuera de indicación. Debería valorarse el beneficio-riesgo en esta población.

  11. Use of valproic acid in long stay units of psychiatry

    Directory of Open Access Journals (Sweden)

    Mª Teresa Martínez-Lazcano

    2015-01-01

    Full Text Available Objective: Valproic acid is often used in psychiatry to treat schizophrenia and other conditions outside of indication (“off-label”. However, its effectiveness has not been sufficiently demonstrated and its use is not exempt of adverse effects. This study’s main objective is to determine the frequency of use of valproic acid in approved indications and the “off-label” use in psychiatric patients. Methods: A cross-sectional study on July 7, 2014 with a sample of 167 patients residents in a psychiatric center was designed. Demographics, valproic acid treatment, posology and associated drug treatment, monitoring safety parameters, interactions and valproic acid concentrations. Results: Valproic acid is prescribed in 1 of 3 patients of the center. It was used in the approved indications in 8 (15% of the 53 patients analyzed: 5 (9% of them with bipolar disorder and 3 (6% diagnosed with epilepsy. Other 5 patients (9% were included in the extended schizoaffective disorder indication. 76% (40 of the evaluated patients were prescribed valproic acid off-label. The mean dose of valproic acid was 1.26 Defined Daily Dose / patient / day. An average of 6 drugs associated with valproic acid was found. 18% of patients had thrombocytopenia. Conclusions: Valproic acid is often used off-label in psychiatric patients. It should be assessed the benefit-risk in this population

  12. An analysis of relevant factors on Postanesthetic Care Unit%影响PACU运转的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    张秦; 洪毅

    2013-01-01

    目的探讨影响麻醉后恢复室(PACU)运转的相关因素,合理分配人力资源,减少 PACU并发症的发生。方法选择2011年11月-2012年11月入PACU的8046例患者,记录在PACU中的带管时间、留观时间和并发症的发生情况。结果8046例中普外科患者最多(26.5%),其次为妇科(19.2%)、耳鼻喉科(17.8%);并发症总的发生率为14.3%,其中发生率最高的为高血压(7.6%);平均带管时间为(28.9±26.5)min,平均留观时间为(81.8±33.2)min。胸外科带管时间最长,为(39.0±35.2)min,留观时间最长,为(98.1±40.3)min,其次是神经外科。年龄≥70岁患者留观时间最长,为(108.5±43.4)min。结论年龄≥70岁患者、胸科和神经外科、高血压等并发症是影响PACU周转的重要因素。%Objective This paper aims to explore the related factors affecting the operation of PACU for a better distribution of manpower resources and less incidence of PACU complications.Methods CAPU pa-tients from 2011.9 to 2012.9 were observed to record their time with tracheal tube,staying time in PACU and the incidence of complications in PACU.Results Within 12 months,there were 8046 patients entering the PACU,and among them the patients with general surgery(26.5%)gynecology(19.2%)and otorhino-laryngology(17.8%)ranked high;The total incidence of complications was 14.3%,with hypertention the highest(7.6%);The time with tracheal tube was(28.9±26.5)min on average,the average whole time in PACU was(81.8±33.2)min.The time with tracheal tube in thoracic surgery was the longest(39.0±35.1) min,the whole time in PACU was(98.1±40.3)min,the next was the neurosurgery.Patients aged 70+have the longest time with tracheal tube,about(108.5 ± 43.4)min.Conclusion Patients aged 70+, thoracic surgery,neurosurgery and complications such as hypertention are the important factors affecting PACU turnover.

  13. United Mitochondrial Disease Foundation

    Science.gov (United States)

    ... Other Ways to Give Matching Gifts Donate Your Car Online Options United Way Close About UMDF Our ... Rights Reserved | UMDF Donor Privacy Policy Facebook Twitter Google+ Youtube Vimeo Instagram Email STAY UPDATED! Join the ...

  14. Análise da degradação de dieta microencapsulada por larvas de pacu (Piaractus mesopotamicus, Holmberg, 1887 através de microscopia eletrônica de varredura - DOI: 10.4025/actascianimsci.v25i1.2088 Degradation analysis of microencapsulated diet in pacu (Piaractus mesopotamicus Holmberg, 1887 larvae intestine through scanning electron microscopy (SEM - DOI: 10.4025/actascianimsci.v25i1.2088

    Directory of Open Access Journals (Sweden)

    Maria Célia Portella

    2003-04-01

    Full Text Available Este trabalho teve como objetivo analisar o grau de degradabilidade de dietas microencapsuladas por larvas de pacu (Piaractus mesopotamicus, através da microscopia eletrônica de varredura. Os seguintes tratamentos alimentares foram testados: AMD - larvas alimentadas por 6 dias, com náuplios de Artemia, com transição brusca para dieta microencapsulada; C6MD - alimentação inicial com Artemia por 6 dias, 6 dias de co-alimentação e o restante do tempo (8 dias somente com dieta microencapsulada; e C9MD - idêntico ao tratamento anterior, porém, com 9 dias de co-alimentação. O conteúdo presente no trato digestório das larvas foi coletado e processado para análise em microscópio eletrônico de varredura. Os grânulos provenientes das larvas do tratamento de transição brusca (AMD possuíam poucas áreas de degradação, semelhantes às dietas secas. Já as dietas coletadas das larvas durante o período de co-alimentação possuíam uma maior área degradada. Os resultados sugerem uma influência dos náuplios de Artemia sobre a degradação das dietas microencapsuladas.This research analyzed the microencapsulated diet degradation in pacu (Piaractus mesopotamicus larvae intestine. The pacu larvae received the following feeding treatments: AMD- larvae fed initially Artemia nauplii for six days, followed by microencapsulated diet; C6MD- larvae fed initially Artemia for six days, followed by six days of co-feeding and the rest of the experiment (8 days with microencapsulated diet; C9MD- larvae fed initially Artemia for six days, followed by nine days of co-feeding and the rest of the experiment (5 days with microencapsulated diet. The pacu digestive tract contents were removed, processed and analyzed under scanning electronic microscopy. Diets from AMD larvae treatment showed few degradation areas, when compared to original dry diets. On the other hand, diets removed during co-feeding period showed the highest degradation areas. The

  15. Influência da adição de iodeto de potássio e citrato de sódio na qualidade do sêmen de pacu (Piaractus mesopotamicus - Holmberg, 1887 The effects of potassium iodide and sodium citrate on semen quality of pacu (Piaractus mesopotamicus

    Directory of Open Access Journals (Sweden)

    Alexandre Nízio Maria

    2004-02-01

    Full Text Available Atualmente, tem-se dado maior atenção ao desenvolvimento de tecnologias para estocagem de sêmen de peixes em curto prazo, por dias ou semanas, utilizando diluentes de sêmen que não ativem a motilidade espermática. Essa técnica é indicada em piscicultura para facilitar a reprodução artificial ou aumentar sua eficiência. Conduziu-se este trabalho com o objetivo de verificar o efeito do diluidor BTS (Beltsville Thawing Solution - MINITUB® na qualidade do sêmen de pacu, após a coleta, enriquecido com iodeto de potássio e com citrato de sódio. Foram utilizados seis reprodutores de pacu (Piaractus mesopotamicus submetidos à indução hormonal e liberação dos gametas, manualmente. O sêmen coletado de cada macho foi dividido em três frações, as quais receberam diluição (1:3 com o diluidor 1 (BTS 5% + iodeto de potássio 0,16%, diluidor 2 (BTS 5% + citrato de sódio 1,28% e uma fração não diluída (controle. A ativação espermática foi realizada com água destilada, e, a seguir, foram avaliadas as taxas e duração da motilidade espermática, cujos valores médios respectivos foram de 95,00 ± 3,16% e 486,83 ± 314,55 segundos para o sêmen in natura, 80,00 ± 9,49% e 221,50 ± 207,89 segundos para o sêmen com o diluidor 1 e 80,00 ± 11,40% e 320,66 ± 181,14 segundos para o sêmen no diluidor 2. Em seguida, foram coletadas amostras para a avaliação da concentração espermática, que obteve um valor médio de 13,89 ± 1,26 x 10(9/mL. Pelas análises estatísticas, verificou-se que não houve diferença significativa na duração da motilidade (P>0,05 entre o sêmen “in natura” e os diluidores 1 e 2. A motilidade espermática foi estatisticamente melhor (PCurrently, it has been given a special attention to developing technologies for short-term storage of fish semen, for a few days to weeks, using extenders of semen that do not activate the sperm motility. The short-term storage technique is indicated for fish culture

  16. Parallel monostrand stay cable bending fatigue

    DEFF Research Database (Denmark)

    Winkler, Jan Pawel

    of damage and replacement of bridge stay cables due to wind and traffic-induced fatigue. The understanding of fatigue mechanisms in most steel structures is well established. However, in the case of cables composed of steel strands, many important aspects related with bending fatigue remain to be clarified......This dissertation investigates the bending fatigue response of high-strength steel monostrands and multistrand stay cables to cyclic transverse deformations. Increasing bridge stock numbers and a push for longer cable-supported span lengths have led to an increased number of reported incidents...... associated with variable loading, and different testing procedures. As most of the contemporary stay cables are comprised of a number of individual highstrength steel monostrands, the research study started with an extensive experimental work on the fatigue response of a single monostrand to cyclic flexural...

  17. Proteína e energia na alimentação de pacus criados em tanques-rede Protein and energy on food of pacu fish raised in cages

    Directory of Open Access Journals (Sweden)

    Arcangelo Augusto Signor

    2010-11-01

    Full Text Available O objetivo neste trabalho foi avaliar o desempenho de pacus (Piaractus mesopotamicus criados em tanques-rede e alimentados com dietas contendo níveis de proteína bruta (PB e energia digestível (ED. Foram utilizados 3.960 peixes com 293,38 ± 5,67 g de peso inicial, distribuídos em 18 tanques-rede de 5 m³, com 220 peixes por unidade experimental (44 peixes/m³, em esquema fatorial 3 × 2, composto de três níveis de proteína bruta (25, 30 e 35% e dois de energia digestível (3.250 e 3.500 kcal/kg. O arraçoamento foi realizado quatro vezes ao dia (às 9 h, 11h30min, 14 h e 17 h até a saciedade aparente dos animais. Não foram observadas diferenças no ganho de peso, na taxa de sobrevivência, na conversão alimentar aparente nem na taxa de crescimento específico. No entanto, houve diferença na deposição de gordura visceral, que foi maior nos animais alimentados com as rações de maior nível energético. Também não foi observada influência dos níveis de proteína e energia da dieta nos teores de umidade, proteína bruta, matéria mineral e lipídio dos filés. Rações contendo 25% de proteína bruta e 3.250 kcal/kg de energia digestível promovem melhores resultados de desempenho.The aim of this study was to evaluate the performance of pacu (Piaractus mesopotamicus raised in cages and fed diets containing levels of crude protein (CP and digestible energy (DE. It was used 3.960 fish with an average initial weight of 293.38 ± 5.67 g, distributed in 18 net-ponds with 5 m³, with 220 fish per experimental unit (44 fish/m³ in a 3 × 2 factorial scheme composed of three levels of crude protein (25, 30 and 35% and two levels of digestible energy (3,250 and 3,500 kcal/kg. Feeding was performed four times a day (9:00 a.m., 11:30 a.m., 2:00 p.m. and 5:00 p.m. until apparent satiety of the animals. No differences were observed for weight gain, survival rate, apparent feed conversion and specific growing rate. Nevertheless, there was a

  18. Managing Postoperative Analgesic Failure: Tramadol Versus Morphine for Refractory Pain in the Post-Operative Recovery Unit.

    Science.gov (United States)

    Byrne, Kelly; Nolan, Aoife; Barnard, John; Tozer, Megan; Harris, David; Sleigh, Jamie

    2017-02-01

    This study aimed to discover whether co-analgesia with tramadol or additional morphine was more effective for patients who still had severe pain despite being given 10 mg intravenous morphine in the post-anesthesia care unit (PACU). All eligible patients were consented and recruited to the trial pre-operatively, but only a small subgroup – whose pain was not successfully controlled (pain score 6/10 or more) after receiving 10 mg of morphine in the PACU—were then randomized to enter the trial and receive, in a double blinded fashion, the analgesic study drug; which consisted of either a further 10 mg of morphine, or 100 mg of tramadol, titrated intravenously to control their pain. The groups were compared as to: the time to readiness for discharge, the patient’s pain scores over time, and the presence of side effects. There was no statistically significant difference in any of the outcomes measured. The time to readiness for discharge from PACU was 119 minutes in the morphine group and 120 minutes in the tramadol group. However in approximately half the cases who entered the trial (i.e., where pain had not been controlled with the pre-enrollment baseline 10 mg of morphine in PACU) neither a further 10 mg of morphine nor 100 mg of tramadol effectively relieved the patient’s pain. We found no difference between additional morphine and co-analgesia with tramadol in this study. Patients who don’t respond to reasonable doses of opioids in PACU are very likely to be unresponsive to further opioids, and other non-opioid analgesic techniques (such as regional anesthesia) should be considered early in this group of patients.

  19. Stay Safe and Healthy This Winter!

    Centers for Disease Control (CDC) Podcasts

    2010-11-23

    In this podcast for kids, the Kidtastics offer some simple ways to stay safe and healthy during the winter holiday season.  Created: 11/23/2010 by CDC Office of Women’s Health.   Date Released: 11/23/2010.

  20. History of cable-stayed bridges

    DEFF Research Database (Denmark)

    Gimsing, Niels Jørgen

    1999-01-01

    The principle of supporting a bridge deck by inclined tension members leading to towers on either side of the span has been known for centuries. However, the real development of cable-stayed bridges did not begin before the 1950s. Since then the free span has been increased from 183 m in the Strö...

  1. Staying in "the stream of life"

    DEFF Research Database (Denmark)

    Rasmussen, Birgitte; Delmar, Charlotte; Dolmer, Ilone

    2009-01-01

    Staying in the stream of life is about being the author of one's own meaningful life. It takes into account life phenomena embodied in the maintenance aspect of health care; dignity in relation to identity and integrity; and an understanding of the dialectical relation between frailty and strength....

  2. Avaliação do crescimento e do custo da alimentação do pacu (Piaractus mesopotamicus Holmberg, 1887 submetido a ciclos alternados de restrição alimentar e realimentação Evaluation of the growth and feeding costs of pacu (Piaractus mesopotamicus submitted to alternate cycles of feeding restriction and refeeding

    Directory of Open Access Journals (Sweden)

    Valéria Leão Souza

    2003-02-01

    Full Text Available Avaliaram-se os efeitos da utilização de ciclos alternados de restrição alimentar e realimentação no crescimento do pacu, durante o período de engorda, e a viabilidade desta prática na produção comercial da espécie. Juvenis foram distribuídos em três tanques e submetidos a diferentes manejos alimentares, constituindo os tratamentos: A (alimentado ad libitum, B (restrição alimentar de 4 semanas, realimentado por 9 semanas e C (6 semanas de restrição alimentar, realimentado por 7 semanas, em um total de 13 semanas por ciclo (4 ciclos experimentais. No final de cada ciclo alimentar, 20 peixes de cada tratamento foram amostrados e os dados biométricos registrados. Os valores obtidos para peso, comprimento total e fator de condição (K foram submetidos a ANOVA e as médias comparadas pelo teste de Duncan. Os resultados mostraram que o tratamento C é o mais indicado somente para outono/inverno, promovendo maior crescimento, menor custo com ração, baixa conversão alimentar e maior receita líquida parcial. Entretanto, durante as estações mais quentes do ano (primavera/verão outros programas de alimentação devem ser testados, utilizando-se períodos mais curtos de restrição alimentar. Quando se tratou da produção anual, o tratamento A respondeu melhor em termos de biomassa produzida, apesar do maior gasto com alimentação, visto que, com o aumento da temperatura, o crescimento dos peixes dos demais tratamentos ficou prejudicado.The present study evaluated the effects of alternating food restriction and refeeding cycles on the growth of pacu, during the growout phase and the viability of this practice in the commercial production of the species. Juvenile fish were distributed in 3 tanks and submitted to different feeding strategies: group A (fed ad libitum daily, B (food restricted to 4 weeks and refed for 9 weeks and C (food restricted to 6 weeks and refed for 7 weeks totalizing 13 weeks per cycle (4 experimental cycles

  3. Processamento da carne do pacu (Piaractus mesopotamicus cultivado em tanques-rede no reservatório de Itaipu - DOI: 10.4025/actascianimsci.v29i4.1018 Processing of pacu (Piaractus mesopotamicus meat from net cage farming in the Itaipu reservoir - DOI: 10.4025/actascianimsci.v29i4.1018

    Directory of Open Access Journals (Sweden)

    Beatriz Cristina Bencke

    2008-03-01

    Full Text Available O trabalho objetivou avaliar as características morfométricas, bromatológicas e o rendimento de cortes da carne do pacu (Piaractus mesopotamicus, cultivados em tanques-rede. Utilizaram-se 45 animais, distribuídos em três tratamentos e 15 repetições cada uma. Os tratamentos constituíram-se de animais alimentados com ração extrusada comercial (REC, resíduos de vegetal cozido (RPV e resíduos cozidos de produção pesqueira (RPP. Realizaram-se as medidas individuais dos animais de comprimento-padrão (CP, comprimento total (CT, comprimento da cabeça (CC, altura da cabeça (AC, largura do tronco (LT, comprimento do tronco (CTR, altura do tronco (AT e, a partir delas, avaliaram-se as relações morfométricas de CC/CP, CC/AC, CP/CT, LT/CTR, LT/AT e AT/CTR. Avaliaram-se os rendimentos: carcaça (RCARC, tronco limpo (TL, musculatura dorsal (MD, filé (FL, costelas (COST, nadadeiras (NAD, gordura visceral (GVISC, pele com escamas (PELE, e os teores de umidade (UM, matéria mineral (MM, proteína bruta (PB e extrato etéreo (EE dos diferentes cortes. Observaram-se maiores resultados (p This work was carried out to evalue the morphometric and chemical characteristics, as well as the meat cut yields from pacu (Piaractus mesopotamicus reared in net cages. Forty-five specimens were used, distributed in three treatments and 15 replications. The treatments consisted of animals fed with commercial extruded ration (CER, vegetal by-products (VBP and fishery by-products (FBP. Individual morphometric characteristics were measures in terms of standard length (SL, total length (TL, head length (HL head height (HH, body width (BW, body lenght (BL, body height (BH, to evaluate the morphometric ratio of HL/SL, HL/HH, SL/TL, BW/BL, BW/BH and BH/BL. Next, the carcass (CARC, clean body (CB, dorsal muscle (DM, fillet (FL, ribs (RIB, fin (FIN, visceral fat (VISCF, skin with scales (SKIN, as well as the levels of moisture (M, ash (ASH, crude protein (CPB and fat

  4. A New Multiconstraint Method for Determining the Optimal Cable Stresses in Cable-Stayed Bridges

    Directory of Open Access Journals (Sweden)

    B. Asgari

    2014-01-01

    Full Text Available Cable-stayed bridges are one of the most popular types of long-span bridges. The structural behaviour of cable-stayed bridges is sensitive to the load distribution between the girder, pylons, and cables. The determination of pretensioning cable stresses is critical in the cable-stayed bridge design procedure. By finding the optimum stresses in cables, the load and moment distribution of the bridge can be improved. In recent years, different research works have studied iterative and modern methods to find optimum stresses of cables. However, most of the proposed methods have limitations in optimising the structural performance of cable-stayed bridges. This paper presents a multiconstraint optimisation method to specify the optimum cable forces in cable-stayed bridges. The proposed optimisation method produces less bending moments and stresses in the bridge members and requires shorter simulation time than other proposed methods. The results of comparative study show that the proposed method is more successful in restricting the deck and pylon displacements and providing uniform deck moment distribution than unit load method (ULM. The final design of cable-stayed bridges can be optimised considerably through proposed multiconstraint optimisation method.

  5. A new multiconstraint method for determining the optimal cable stresses in cable-stayed bridges.

    Science.gov (United States)

    Asgari, B; Osman, S A; Adnan, A

    2014-01-01

    Cable-stayed bridges are one of the most popular types of long-span bridges. The structural behaviour of cable-stayed bridges is sensitive to the load distribution between the girder, pylons, and cables. The determination of pretensioning cable stresses is critical in the cable-stayed bridge design procedure. By finding the optimum stresses in cables, the load and moment distribution of the bridge can be improved. In recent years, different research works have studied iterative and modern methods to find optimum stresses of cables. However, most of the proposed methods have limitations in optimising the structural performance of cable-stayed bridges. This paper presents a multiconstraint optimisation method to specify the optimum cable forces in cable-stayed bridges. The proposed optimisation method produces less bending moments and stresses in the bridge members and requires shorter simulation time than other proposed methods. The results of comparative study show that the proposed method is more successful in restricting the deck and pylon displacements and providing uniform deck moment distribution than unit load method (ULM). The final design of cable-stayed bridges can be optimised considerably through proposed multiconstraint optimisation method.

  6. Influência de diferentes aglutinantes na digestibilidade aparente da matéria seca e da proteína, no pacu (Piaractus mesopotamicus arraçoado com rações elaboradas com ou sem vapor Influence of different binders in the apparent digestibility of dry matter and protein in pacu (Piaractus mesopotamicus fed with ration processed with or without steam

    Directory of Open Access Journals (Sweden)

    Maria Angélica Rosa Ribeiro

    1999-07-01

    Full Text Available O trabalho foi realizado no Centro Nacional de Pesquisa de Peixes Tropicais - Cepta, com o objetivo de determinar a influência de vários aglutinantes: carboximetilcelulose, polimetilcarbamida, amido de mandioca, alginato de sódio, polivinilpirrolidona e goma guar, bem como a técnica de processamento, com ou sem vapor, na digestibilidade aparente das frações matéria seca e proteína bruta. Os resultados obtidos demonstraram que a técnica de processamento a que se submete a mistura, durante a confecção de ração para peixes, influencia o coeficiente de digestibilidade aparente das frações matéria seca e proteína bruta, em pacus. Quando da confecção de rações para peixes, houver a necessidade de utilizar-se de aglutinantes, a fim de obter pelletes mais estáveis, recomenda-se, para os equipamentos dotados de câmara de acondicionamento com adição de vapor, a polivinilpirrolidona, e para os sem a adição de vapor, a goma guar.This work was carried out at National Research of Tropical Fishes - Cepta, with the objective to determine the influence of different dietary binders with their respective concentrations: sodium alginate, guar gum, polymethylolcarbamide, polyvinylpyrrolidone, carboxymethylcellulose, cassava starch, and the manufacturing process with or without steam, in the apparent digestibility of protein and dry matter. The results obtained showed that the manufacturing technique during the fish ration process, influences the apparent digestibility coefficient of dry matter and protein in pacu. When binders are required to obtain more stable diet pellets, polyvinylpyrrolidone for equipments with steam addition chambers and guar gum for equipment without steam are recommended.

  7. Engineering diagnostics for vortex-induced stay vanes cracks in a Francis turbine

    Science.gov (United States)

    D'Agostini Neto, Alexandre; Gissoni, Humberto, Dr.; Gonçalves, Manuel, Dr.; Cardoso, Rogério; Jung, Alexander, Dr.; Meneghini, Julio, Prof.

    2016-11-01

    Despite the fact that vortex-induced vibration (VIV) in hydraulic turbines components (especially in stay vanes) is a well-known phenomenon, it still remains challenging for operation and maintenance teams in several power plants around the world. Since the first publication of a similar problem in 1967, literature shows that at least 27 other turbines witnessed strong stay vane vibrations associated with vortex shedding. Recurrent stay vane cracks in a 250 MW Francis turbine in Brazil motivated an engineering study involving prototype measurements, structural and Computational Fluid Dynamics (CFD) analysis in order to determine a proper geometry modification that could eliminate the periodic vortex wake generated at the stay vanes trailing edge. First cracks appeared in 1978 just after the machine was put into operation. A study published in 1982 associated these cracks with dynamic excitations caused by the water flow at high flow conditions. New stay vane profiles were proposed and executed as well as improved welding recommendations. Cracks however, continued to appear requiring welding repairs roughly every two years. Although Voith Hydro was not the original equipment manufacturer for these units, the necessary information was available to study the issue and propose and execute new stay vane profiles. This paper details the approach taken for the study. First, indirect vibration measurements were used to determine vibration frequencies to help to characterize the affected mode shapes. These results were compared to finite element (FE) calculations. Strain gage measurements performed afterwards confirmed the conclusions of this analysis. Next, transient CFD calculations were run to reproduce the measured phenomenon and to serve as a basis for a new stay vane geometry. This modification was then implemented in the actual turbine stay vanes. A new set of indirect vibration measurements indicated the effectiveness of the proposed solution. Final confirmation

  8. Staying thermal with Hartree ensemble approximations

    Energy Technology Data Exchange (ETDEWEB)

    Salle, Mischa E-mail: msalle@science.uva.nl; Smit, Jan E-mail: jsmit@science.uva.nl; Vink, Jeroen C. E-mail: jcvink@science.uva.nl

    2002-03-25

    We study thermal behavior of a recently introduced Hartree ensemble approximation, which allows for non-perturbative inhomogeneous field configurations as well as for approximate thermalization, in the phi (cursive,open) Greek{sup 4} model in 1+1 dimensions. Using ensembles with a free field thermal distribution as out-of-equilibrium initial conditions we determine thermalization time scales. The time scale for which the system stays in approximate quantum thermal equilibrium is an indication of the time scales for which the approximation method stays reasonable. This time scale turns out to be two orders of magnitude larger than the time scale for thermalization, in the range of couplings and temperatures studied. We also discuss simplifications of our method which are numerically more efficient and make a comparison with classical dynamics.

  9. Hospital stay for healthy term newborn infants.

    Science.gov (United States)

    Benitz, William E

    2015-05-01

    The hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of problems and to ensure that the mother is sufficiently recovered and prepared to care for herself and her newborn at home. The length of stay should be based on the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the newborn, the ability and confidence of the mother to care for herself and her newborn, the adequacy of support systems at home, and access to appropriate follow-up care in a medical home. Input from the mother and her obstetrical care provider should be considered before a decision to discharge a newborn is made, and all efforts should be made to keep a mother and her newborn together to ensure simultaneous discharge. Copyright © 2015 by the American Academy of Pediatrics.

  10. 29 CFR 500.269 - Stay pending decision of the Secretary.

    Science.gov (United States)

    2010-07-01

    ... REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Modification Or Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The... Administrative Law Judge's Decision and Order in a United States District Court and the Secretary issues a...

  11. Is duration of postoperative fasting associated with infection and prolonged length of stay in surgical patients?

    OpenAIRE

    Assis, Michelli Cristina Silva de; Carla Rosane de Moraes SILVEIRA; Beghetto, Mariur Gomes; Mello, Elza Daniel de

    2014-01-01

    Objective: Verify whether the postoperative fasting period increases the risk for infection and prolonged length of stay. Methods: Prospective cohort study. Elective surgery patients were included. Excluded: those with no conditions for nutritional assessment, admitted in minimal care units, as well as with

  12. Evaluation of a pediatric hospitalist service: impact on length of stay and hospital charges.

    Science.gov (United States)

    Bellet, P S; Whitaker, R C

    2000-03-01

    Inpatient medical services supervised by pediatric hospitalist physicians are a new development in academic medical centers in the United States. In a large pediatric teaching hospital, we compared length of stay, readmission rates, and hospital charges for children admitted to medical services with and without a hospitalist system of care. This retrospective observational study compared a baseline year of a traditional ward service (TS) with a subsequent year of a new hospitalist system of care called the Generalist Inpatient Service (GIS). Data were obtained from the hospital's clinical, demographic, and financial databases and from selected record review. All hospitalizations were at least 24 hours long and did not involve a stay in an intensive care unit. The average length of stay was longer for the 627 TS hospitalizations than for the 813 GIS hospitalizations (2.7 +/- 2.0 vs 2.4 +/- 1.7 days). Total hospital charges were significantly lower on the GIS ($3002 +/- $2160 vs $2720 +/- $1933) because of lower room and respiratory therapy charges. Three readmissions to the TS and 8 to the GIS occurred within 24 hours of hospital discharge and were, therefore, considered potentially preventable by a longer initial hospital stay. In a large pediatric teaching hospital, a system of inpatient care provided by hospitalists can reduce length of stay. This model has the potential to control hospital charges in a period of increasing health care costs.

  13. History of cable-stayed bridges

    DEFF Research Database (Denmark)

    Gimsing, Niels Jørgen

    1999-01-01

    The principle of supporting a bridge deck by inclined tension members leading to towers on either side of the span has been known for centuries. However, the real development of cable-stayed bridges did not begin before the 1950s. Since then the free span has been increased from 183 m...... in the Strömsund Bridge (from 1955) to 890 m in the Tatara Bridge (from 1999)....

  14. Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution Internação breve em unidade de emergência psiquiátrica pode prevenir permanência prolongada em instituições psiquiátricas

    Directory of Open Access Journals (Sweden)

    Régis Eric Maia Barros

    2010-06-01

    Full Text Available OBJECTIVE: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds, a psychiatric hospital (80 and of an emergency psychiatry unit (6. METHOD: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. RESULTS: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergency psychiatry unit increased. CONCLUSION: The increase in the number of psychiatric admissions in 2004 could be attributed to a lack of new community-based services available in the area beginning in 1998. Changes in the health care network did affect the emergency psychiatric service and the limitations of the community-based network could influence the rate of psychiatric admissions.OBJETIVO: Caracterizar e comparar internações psiquiátricas agudas em alas psiquiátricas no hospital geral (22 leitos, hospital psiquiátrico (80 e emergência psiquiátrica (6. MÉTODO: Foram analisadas todas as internações agudas entre 1998 e 2004 na região do estudo, com razões e proporções de variáveis demográficas, diagnósticas e das hospitalizações. RESULTADOS: Das 11.208 internações, 47,8% foram no hospital psiquiátrico e 14,1% no hospital geral. A emergência psiquiátrica realizou 38,1% das internações no período, com grande variabilidade da taxa de ocupa

  15. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital

    Science.gov (United States)

    Harde, Minal; Bhadade, Rakesh; Iyer, Hemlata; Jatale, Amol; Tiwatne, Sagar

    2016-01-01

    Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h) postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24), of them 7% (14) were from PACU and 5% (10) were from ward (P = 0.5285). Positive skin swab culture was 38% (150), of them 20% (80) were from PACU and 18% (70) were from ward (P = 0.3526). The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053–0.2289). The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary. PMID:27076712

  16. Application of nursing flowchart in the post-anesthesia care unit%麻醉恢复室入室护理流程的应用

    Institute of Scientific and Technical Information of China (English)

    丁红; 张红姣; 肖攀; 何利君

    2014-01-01

    Objective To investigate effect of applying nursing flowchart in the post-anesthesia care unit(PACU).Method The nursing flowchart in PACU are as follous,including a ventilator connection,monitoring instrument connection,handover of pipeline and skin and training for PACU nurses.Results After application of the nursing flowchart,the nursing time for postoperative patients was reduced from 7.0 min to 4.0 min.No nursing risks and adverse events occurred.Conclusion Application of nursing flowchart in PACU can improve the quality of nursing and enhance patients safety.%目的:探讨麻醉恢复室(post-anesthesia care unit,PACU)入室护理流程的临床实践效果。方法建立PACU入室护理流程,内容包括连接呼吸机、连接监护仪、管道交接、皮肤交接等流程和对PACU护士进行培训、考核。结果流程应用前,术后患者入室护理时间从7.0 min降至流程应用后4.0 min,无1例发生护理风险及不良事件。结论 PACU入室护理流程的应用提高了护理质量,加强了患者安全。

  17. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2016-01-01

    Full Text Available Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24, of them 7% (14 were from PACU and 5% (10 were from ward (P = 0.5285. Positive skin swab culture was 38% (150, of them 20% (80 were from PACU and 18% (70 were from ward (P = 0.3526. The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053–0.2289. The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary.

  18. Parâmetros zootécnicos e perfil de ácidos graxos de juvenis de pacu (Piaractus mesopotamicus) alimentados com dietas contendo sesamina e ácido alfa-lipoico

    OpenAIRE

    Adja Cristina Lira de Medeiros

    2017-01-01

    O objetivo deste trabalho foi avaliar os efeitos de dois modificadores metabólicos, a sesamina, presente no óleo de gergelim, e ácido alfa-lipoico (na forma pura), sobre desempenho zootécnico, perfil de ácidos graxos, composição química dos filés de pacus e alterações histológicas no fígado. Foram utilizados 480 juvenis de pacu (3,35±0,78 g), distribuídos em 24 caixas de polietileno com volume de 50 litros, sendo estocados 20 peixes em cada unidade. Durante o período experimental de 90 dias, ...

  19. 40 CFR 124.16 - Stays of contested permit conditions.

    Science.gov (United States)

    2010-07-01

    ...) Uncontested conditions which are not severable from those contested shall be stayed together with the... shall be granted based on the staying of any State-issued permit except at the discretion of the...

  20. Parametrically excited oscillation of stay cable and its control in cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    孙炳楠; 汪至刚; 高赞明; 倪一清

    2003-01-01

    This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.

  1. Parametrically excited oscillation of stay cable and its control in cable-stayed bridges"

    Institute of Scientific and Technical Information of China (English)

    孙炳楠; 汪至刚; 高赞明; 倪一清

    2003-01-01

    This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.

  2. 16 CFR 460.24 - Stayed or invalid parts.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Stayed or invalid parts. 460.24 Section 460.24 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES LABELING AND ADVERTISING OF HOME INSULATION § 460.24 Stayed or invalid parts. If any part of this regulation is stayed or...

  3. 46 CFR 59.10-25 - Stayed areas.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Stayed areas. 59.10-25 Section 59.10-25 Shipping COAST... areas. Welding repairs are permitted in staybolted areas or areas adequately stayed by other means so... located entirely within staybolted areas and shall not pass through the outer row of stays....

  4. 42 CFR 456.436 - Continued stay review process.

    Science.gov (United States)

    2010-10-01

    ... mentally retarded, the recipient's qualified mental retardation professional, within 1 working day of its... 42 Public Health 4 2010-10-01 2010-10-01 false Continued stay review process. 456.436 Section 456... Ur Plan: Review of Need for Continued Stay § 456.436 Continued stay review process. The UR plan must...

  5. 17 CFR 201.401 - Consideration of stays.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Consideration of stays. 201... PRACTICE Rules of Practice Appeal to the Commission and Commission Review § 201.401 Consideration of stays... consideration. Where the action complained of has already taken effect and the motion for stay is filed...

  6. The Stay/Switch Model of Concurrent Choice

    Science.gov (United States)

    MacDonall, James S.

    2009-01-01

    This experiment compared descriptions of concurrent choice by the stay/switch model, which says choice is a function of the reinforcers obtained for staying at and for switching from each alternative, and the generalized matching law, which says choice is a function of the total reinforcers obtained at each alternative. For the stay/switch model…

  7. A família na unidade de internação hospitalar: entre o informal e o instituído La familia en la unidad de internamiento hospitalario: entre lo informal y lo instituido Families in the overnight stay unit of the hospital: between informal and instituted

    Directory of Open Access Journals (Sweden)

    Marisa Monticelli

    2007-09-01

    comparative approach, as well as two already concluded ethnographies, to achieve its objective of identifying how families perceive their insertion into the overnight stay unit in a hospital and how they are perceived by the health care team, considering the rules and regulations of the institutional culture. The results obtained show that teams and families get closer or more distant depending on whether there's agreement or disagreement regarding the hospital's governing rules. Although families, in many situations, subject themselves to the regulations imposed by the hospital and the health care team, they also use individual and collective resistances in order to confront the regulatory mechanisms. The results contribute to increase the comprehension of this theme, both for the health care team and for the practice of family nursing, especially in the sense of recognizing the family as an active, responsible, and co-participatory unit within intra-hospital care.

  8. Paid sick days and stay-at-home behavior for influenza

    Science.gov (United States)

    Piper, Kaitlin; Youk, Ada; James, A. Everette

    2017-01-01

    Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees’ decisions to stay home from work for their own or a child’s illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee’s own or a child’s illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee’s own illness/injury, ILI, or influenza, and for a child’s illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee’s own or a child’s illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child’s illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and

  9. Comparison of length of stay and outcomes of patients with positive versus negative blood culture results.

    Science.gov (United States)

    Armstrong-Briley, Danielle; Hozhabri, Neda S T; Armstrong, Kris; Puthottile, Jason; Benavides, Raul; Beal, Stacy

    2015-01-01

    In the United States, sepsis is the leading cause of death in critically ill patients. The fatality rate for severe sepsis is about 40%, and treatment costs over $16 billion annually. It is critical to identify and treat the source of sepsis. While there are varying guidelines determining when to draw blood for culture, at Baylor University Medical Center at Dallas, blood cultures are ordered for patients with new onset of fever, immunosuppression, or a suspicion of an underlying infectious etiology. We conducted a retrospective study of patients who had blood cultures after hospital admission or in the emergency department in December 2013. We compared length of stay and outcomes of patients with positive versus negative blood cultures. There was no significant difference for length of stay or outcomes among patients with positive and negative blood cultures. For patients admitted from the emergency department, there was a longer length of stay for patients with positive cultures; however, the overall prognosis was not worse.

  10. Functional Improvement Among Short-Stay Nursing Home Residents in the MDS 3.0

    Science.gov (United States)

    Wysocki, Andrea; Thomas, Kali S.; Mor, Vincent

    2015-01-01

    Objectives To examine the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0. Design Retrospective analysis of MDS admission and discharge assessments. Setting Nursing homes from July 1, 2011, to June 30, 2012. Participants New nursing home residents admitted from acute hospitals with corresponding admission and discharge assessments between July 1, 2011, and June 30, 2012, who had a length of stay of 100 days or less. Measurements ADL self-performance items, including bed mobility, transfer, walking in room, walking in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, and personal hygiene, at admission and discharge. Results The ADL self-performance items are complete at both admission and discharge, with less than 1% missing for any item. More than 60% of residents improved over the course of their post-acute stay. New short-stay nursing home residents with conditions such as cognitive impairment, delirium, dementia, heart failure, and stroke showed less improvement in ADL performance during their stay. Conclusion The discharge assessment data in the MDS 3.0 provide new information to researchers and providers to examine and track ADL performance. Nursing homes can identify and track patients who require more intensive therapies or targeted interventions to achieve functional improvement during their stay. Future research can examine facility-level measures to better understand how ADL improvement varies across facilities. PMID:25659622

  11. Who Stays? Who Leaves? An Examination of Sex Differences in Staying and Leaving.

    Science.gov (United States)

    Poole, Millicent E.; Low, B. C.

    The purpose of this study was to examine the major determinants of the "staying" and "leaving" process for samples of Melbourne (Australia) male and female adolescents. Sixty attitudinal statements were obtained from 796 adolescents and factor analysed. The subset of independent variables, together with a set of personality and…

  12. Histologia da pele do pacu (Piaractus mesopotamicus e testes de resistência do couro - DOI: 10.4025/actascianimsci.v25i1.2071 Histology of skin of Piaractus mesopotamicus and leather resistance tests - DOI: 10.4025/actascianimsci.v25i1.2071

    Directory of Open Access Journals (Sweden)

    Petra Maria Wagner

    2003-04-01

    Full Text Available Este trabalho analisou a morfologia da pele do pacu, Piaractus mesopotamicus (Holmberg, 1887, e, após curtimento, a resistência do couro. Observou-se que a derme apresenta uma camada superficial com fibras finas, juntas e entrelaçadas, sem diferenciação quanto à disposição das mesmas e uma camada profunda, com fibras mais finas e espaçadas; e à medida que se distanciam da epiderme, os feixes de fibras tornam-se mais espessos, juntos e entrelaçados. A resistência à tração foi significativamente menor no sentido longitudinal (5,93 N/mm2 comparada ao transversal (13,81 N/mm2 em relação ao comprimento do corpo. O valor de alongamento até a ruptura foi superior (p0,05 para rasgamento progressivo. A resistência do couro à tração e alongamento foi superior no sentido transversal ao comprimento do corpo do peixe e não houve diferença para o rasgamento progressivo entre os cortes analisados (transversal e longitudinal. Sendo assim, a média da tração foi 9,87 N/mm2 e 64,59% de elongação, estando dentro dos padrões exigidos para ser utilizado na confecção de vestuário.This work study the histology of skin of Piaractus mesopotamicus (Holmberg, 1887, and after tanning, the leather resistance. Dermis showed a superficial layer with thin, united and interlaced fibers and a inner layer with thinner and spacer fibers. When this layer keeped away from epidermis, the sheaf fibers became thicker, uniter and interlacer. The resistance to tension of body length was significatively inferior in longitudinal sense (5.93 N/mm when compared with transversal sense (13.81 N/mm. The extension value until the rupture was superior (P0.05 to progressive tearing. The leather resistance to tension and extension was higher in transversal sense to body lenght of fish and there wasn’t difference to progressive tearing between the section analysed. Thus, the tension was 9.87 N/mm and 64.59% of elongation that are inside the standard require to

  13. Coiling vs. clipping. Hospital stay and procedure time in intracranial aneurysm treatment

    Energy Technology Data Exchange (ETDEWEB)

    Brunken, Martin; Kehler, U. [Abt. fuer Neurochirurgie, Asklepios-Klinik Altona (Germany); Fiehler, J. [Neuroradiology, Universitaetskrankenhaus Hamburg-Eppendorf (Germany); Leppien, A.; Eckert, B. [Fachbereich Neuroradiologie, Asklepios-Klinik Altona (Germany)

    2009-10-15

    Purpose: evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. Materials and methods: retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. Results: clinical admission grade (rupt. A: Hunt and Hess grade 1-3: clip: 73% coil: 72%) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1/13.8% coil: 45.5/10.3% non-rupt. A: 88.2/0% coil: 88.5/1.3%) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p < 0.01; non-rupt. A: coil: 164 min, clip: 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6d, p < 0.01; non-rupt. A: coil: 1.5d; clip: 2d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4d; clip: 26.8 d, p < 0.01; non-rupt. A: coil: 9.2d; clip: 17.5d; p = 0.01). The discharge to home ratio did not differ (rupt. A: clip: 31.6% coil: 29.7% nonrupt. A: clip: 74.5% coil: 80.5%). Conclusion: in a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy. (orig.)

  14. NONLINEAR TRANSIENT RESPONSE OF STAY CABLE WITH VISCOELASTICITY DAMPER IN CABLE-STAYED BRIDGE

    Institute of Scientific and Technical Information of China (English)

    陈水生; 孙炳楠; 冯义卿

    2004-01-01

    Taking the bending stiffness,static sag,and geometric non-linearity into consideration,the space nonlinear vibration partial differential equations were derived.The partical differential equations were discretized in space by finite center difference approximation,then the nonlinear ordinal differential equations were obtained.A hybrid method involving the combination of the Newmark method and the pseudo-force strategy was proposed to analyze the nonlinear transient response of the inclined cable-dampers system subjected to arbitrary dynamic loading.As an example,two typical stay cables were calculated by the present method.The results reveal both the validity and the deficiency of the viscoelasticity damper for vibration control of stay cables.The efficiency and accuracy of the proposed method is also verified by comparing the results with those obtained by using Runge-Kutta direct integration technique.A new time history analysis method is provided for the research on the stay cable vibration control.

  15. Prolonged length of hospital stay in Denmark after nephrectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Christensen, Tom; Petri, Anette Lykke

    2012-01-01

    Implementation of the principles of a fast-track surgical programme resulted in a decrease in the length of hospital stay after open nephrectomies. The aim of this study was to describe the regional distribution of nephrectomies, postoperative hospital stay and mortality.......Implementation of the principles of a fast-track surgical programme resulted in a decrease in the length of hospital stay after open nephrectomies. The aim of this study was to describe the regional distribution of nephrectomies, postoperative hospital stay and mortality....

  16. The Effects of Cannabis on Inpatient Agitation, Aggression, and Length of Stay.

    Science.gov (United States)

    Johnson, Joseph M; Wu, Chris Y; Winder, Gerald Scott; Casher, Michael I; Marshall, Vincent D; Bostwick, Jolene R

    2016-01-01

    This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay. Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (N = 201) were retrospectively identified, and those with positive results of urine drug screen for cannabis on admission were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics. Positive urine drug screen results for cannabis was correlated with young (p = .001) males (p = .003) with bipolar disorder (p = .009) exhibiting active manic symptoms (p = .003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = .008), agitation triggering adapted PANSS-EC nursing assessments (p = .029), and oral medications as needed (p = .002) for agitation. Cannabis use, as defined by positive urine drug screen results, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder

  17. Evolution of staying together in the context of diffusible public goods.

    Science.gov (United States)

    Olejarz, Jason W; Nowak, Martin A

    2014-11-07

    We study the coevolution of staying together and cooperation. Staying together means that replicating units do not separate after reproduction, but remain in proximity. For example, following cell division the two daughter cells may not fully separate but stay attached to each other. Repeated cell division thereby can lead to a simple multi-cellular complex. We assume that cooperators generate a diffusible public good, which can be absorbed by any cell in the system. The production of the public good entails a cost, while the absorption leads to a benefit. Defectors produce no public good. Defectors have a selective advantage unless a mechanism for evolution of cooperation is at work. Here we explore the idea that the public good produced by a cooperating cell is absorbed by cells of the same complex with a probability that depends on the size of the complex. Larger complexes are better at absorbing the public goods produced by their own individuals. We derive analytical conditions for the evolution of staying together, thereby studying the coevolution of clustering and cooperation. If cooperators and defectors differ in their intrinsic efficiency to absorb the public good, then we find multiple stable equilibria and the possibility for coexistence between cooperators and defectors. Finally we study the implications of disadvantages that might arise if complexes become too large.

  18. The implementation of an Intensive Care Information System allows shortening the ICU length of stay.

    Science.gov (United States)

    Levesque, Eric; Hoti, Emir; Azoulay, Daniel; Ichai, Philippe; Samuel, Didier; Saliba, Faouzi

    2015-04-01

    Intensive care information systems (ICIS) implemented in intensive care unit (ICU) were shown to improve patient safety, reduce medical errors and increase the time devolved by medical/nursing staff to patients care. Data on the real impact of ICIS on patient outcome are scarce. This study aimed to evaluate the effects of ICIS on the outcome of critically-ill patients. From January 2004 to August 2006, 1,397 patients admitted to our ICU were enrolled in this observational study. This period was divided in two phases: before the implementation of ICIS (BEFORE) and after implementation of ICIS (AFTER). We compared standard ICU patient's outcomes: mortality, length of stay in ICU, hospital stay, and the re-admission rate depending upon BEFORE and AFTER. Although patients admitted AFTER were more severely ill than those of BEFORE (SAPS II: 32.1±17.5 vs. 30.5±18.5, p=0.014, respectively), their ICU length of stay was significantly shorter (8.4±15.2 vs. 6.8±12.9 days; p=0.048) while the re-admission rate and mortality rate were similar (4.4 vs. 4.2%; p=0.86, and 9.6 vs 11.2% p=0.35, respectively) in patients admitted AFTER. We observed that the implementation of ICIS allowed shortening of ICU length of stay without altering other patient outcomes.

  19. New-Onset Depression Following Hip Fracture Is Associated With Increased Length of Stay in Hospital and Rehabilitation Centers

    Directory of Open Access Journals (Sweden)

    Anna C. Phillips

    2015-05-01

    Full Text Available This article examines the coincident effects of new-onset depression post hip fracture on length of hospital stay, readmission rates, and incidence of infections in older adults. Participants were 101 hip fracture patients aged 60+ years; 38 developed depressive symptoms following their fracture. Infection rates, readmissions to hospital and rehabilitation units, and length of hospital stay were assessed over the 6 months post hip fracture from hospital and general practitioner notes. Patients who developed depression by Week 6 post fracture were likely to spend more time in hospital/rehabilitation wards (p = .02 and more likely to be discharged to a rehabilitation unit (p < .05. There were no group differences in readmissions or infection rates. New-onset depression coincident with hip fracture in older adults is associated with longer hospital ward stays and greater need for rehabilitation.

  20. Prolonged length of hospital stay in Denmark after nephrectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Christensen, Tom; Petri, Anette Lykke

    2012-01-01

    INTRODUCTION: Implementation of the principles of a fast-track surgical programme resulted in a decrease in the length of hospital stay after open nephrectomies. The aim of this study was to describe the regional distribution of nephrectomies, postoperative hospital stay and mortality. MATERIAL...

  1. 12 CFR 308.540 - Stay pending appeal.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Stay pending appeal. 308.540 Section 308.540 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE RULES OF PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.540 Stay pending appeal. (a) An...

  2. Cholecystectomy During the Weekend Increases Patients' Length of Hospital Stay

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2016-01-01

    30 days between week time and weekend time. A longer postoperative length of stay was observed for patients operated on Fridays and Saturdays even though surgical complication rates were alike between weekdays. Patients with acute cholecystitis had a longer length of stay on Saturdays. CONCLUSION: We...

  3. 49 CFR 1018.96 - Stay of offset.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Stay of offset. 1018.96 Section 1018.96... OF TRANSPORTATION GENERAL RULES AND REGULATIONS DEBT COLLECTION Tax Refund Offset § 1018.96 Stay of offset. If the debtor timely notifies the Board that the debtor is exercising the right described...

  4. 24 CFR 17.107 - Stay of offset.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Stay of offset. 17.107 Section 17... ADMINISTRATIVE CLAIMS Procedures for the Collection of Claims by the Government Administrative Offset Provisions § 17.107 Stay of offset. If the debtor timely notifies the Secretary that he or she is exercising...

  5. 40 CFR 13.40 - Stay of offset.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Stay of offset. 13.40 Section 13.40 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referral of Debts to IRS for Tax Refund Offset § 13.40 Stay of offset. If the debtor timely notifies the EPA that...

  6. 49 CFR 89.47 - Stay of offset.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Stay of offset. 89.47 Section 89.47 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT Referral of Debts to IRS for Tax Refund Offset § 89.47 Stay of offset. If the debtor timely notifies the...

  7. 24 CFR 17.156 - Stay of offset.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Stay of offset. 17.156 Section 17.156 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development... Payment Offset Provisions and Administrative Wage Garnishment § 17.156 Stay of offset. If the...

  8. HOW COFFEE COMPANIES CAN STAY COMPETITIVE

    Directory of Open Access Journals (Sweden)

    RALUCA DANIELA RIZEA

    2014-04-01

    Full Text Available The coffee shop industry in the U.S. includes 20,000 stores with combined annual revenue of about $11 billion. Major companies include Starbucks, Dunkin’ Donuts, Caribou, Coffee Bean and Tea Leaf, and Diedrich (Gloria Jean’s. The industry is highly concentrated at the top and fragmented at the bottom: the top 50 companies have over 70 percent of industry sales. Coffee is one of the world’s largest commodities. The top green coffee producing countries are Brazil, Colombia, and Vietnam. Many grower countries are small, poor developing nations that depend on coffee to sustain local economies. The U.S. is the world’s largest importer of green coffee beans and the largest consumer of coffee. The main objective of this study is to investigate the competitive strategies that U.S. coffee franchise companies adopt considering customers’ expectations and industry best practices. In order to achieve this objective, a best practice benchmarking analysis was performed taking into account the top U.S. coffee companies This analysis showed that product and service innovation are necessary in order to stay competitive in the market and attract new or to keep existing customers successfully. Many customers focus on the special atmosphere each store has and which is characterized by the location, music, interior design, seating or whether internet access is provided. Particularly for specialty coffee shops it is important not to sell only the beverage but the whole experience. Coffee shops have to establish a unique image that prevents customers from buying products from another shop or use home-brewing systems which are also on the rise in American households. In addressing the increased level of competition, every company’s focus should be on differentiating from the rest of the market in every possible business segment (products, atmosphere, location, image etc..

  9. HOW COFFEE COMPANIES CAN STAY COMPETITIVE

    Directory of Open Access Journals (Sweden)

    RALUCA DANIELA RIZEA

    2014-04-01

    Full Text Available The coffee shop industry in the U.S. includes 20,000 stores with combined annual revenue of about $11 billion. Major companies include Starbucks, Dunkin’ Donuts, Caribou, Coffee Bean and Tea Leaf, and Diedrich (Gloria Jean’s. The industry is highly concentrated at the top and fragmented at the bottom: the top 50 companies have over 70 percent of industry sales. Coffee is one of the world’s largest commodities. The top green coffee producing countries are Brazil, Colombia, and Vietnam. Many grower countries are small, poor developing nations that depend on coffee to sustain local economies. The U.S. is the world’s largest importer of green coffee beans and the largest consumer of coffee. The main objective of this study is to investigate the competitive strategies that U.S. coffee franchise companies adopt considering customers’ expectations and industry best practices. In order to achieve this objective, a best practice benchmarking analysis was performed taking into account the top U.S. coffee companies This analysis showed that product and service innovation are necessary in order to stay competitive in the market and attract new or to keep existing customers successfully. Many customers focus on the special atmosphere each store has and which is characterized by the location, music, interior design, seating or whether internet access is provided. Particularly for specialty coffee shops it is important not to sell only the beverage but the whole experience. Coffee shops have to establish a unique image that prevents customers from buying products from another shop or use home-brewing systems which are also on the rise in American households. In addressing the increased level of competition, every company’s focus should be on differentiating from the rest of the market in every possible business segment (products, atmosphere, location, image etc..

  10. Marginal revenue and length of stay in inpatient psychiatry.

    Science.gov (United States)

    Pletscher, Mark

    2016-09-01

    This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated to assess variations in policy effects over length of stay. Among patients whose costs are fully reimbursed by the mixed scheme, the model demonstrates a significant effect of marginal revenue on length of stay. No significant policy effects are found among patients for whom only health insurance rates are delivered as mixed tariffs and government contributions are made retrospectively. The results indicate that marginal revenue can affect length of stay in inpatient psychiatry facilities, but that the reduction in marginal revenue must be sufficiently large.

  11. Professional values, job satisfaction, career development, and intent to stay.

    Science.gov (United States)

    Yarbrough, Susan; Martin, Pam; Alfred, Danita; McNeill, Charleen

    2017-09-01

    Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse-an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.

  12. Parenting from Prison: Staying Connected while Apart

    Science.gov (United States)

    Tomlin, Angela; Pickholtz, Naomi; Green, Allison; Rumble, Patricia

    2012-01-01

    The United States has more people in prison than any other country, and more than half of those incarcerated are parents. This article reviews the challenges to parenting while in prison and considers how parental attachment experiences and difficult life trajectories have an impact on parent-child relationships. The authors provide examples of…

  13. Impact on patient outcome of emergency department length of stay prior to ICU admission.

    Science.gov (United States)

    García-Gigorro, R; de la Cruz Vigo, F; Andrés-Esteban, E M; Chacón-Alves, S; Morales Varas, G; Sánchez-Izquierdo, J A; Montejo González, J C

    2017-05-01

    The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department. A single-center ambispective cohort study was carried out. A general ICU and Emergency Care Department (ED) of a single University Hospital. We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period. Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h. Demographic, diagnostic, length of stay and mortality data were compared among the groups. Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay. A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. Multimedia campaign on a shoestring: promoting 'Stay Active - Stay Independent' among seniors.

    Science.gov (United States)

    John-Leader, Franklin; Van Beurden, Eric; Barnett, Lisa; Hughes, Karen; Newman, Beth; Sternberg, Jason; Dietrich, Uta

    2008-04-01

    This paper describes a multimedia campaign implemented in rural New South Wales on a budget smaller than that typical of many published campaigns. The 'To Be Young at Heart - Stay Active Stay Independent' (SASI) campaign was one arm of a multi-strategic program to reduce falls among seniors by promoting physical activity. This 18-month campaign used social marketing techniques. Central to this campaign was strong formative research, significant use of corporate, community and media partnerships and a detailed, strategic distribution plan. Campaign reach was evaluated by a community intercept survey. A variety of high-quality information, education and communication (IEC) resources were developed. Overall, the campaign cost was calculated at USD 191,000. The actual cost of USD 42,000 (excluding staff time) was used to generate almost double this amount in sponsorship (USD 82,000). In the mid-campaign reach survey, 36% recognised the campaign and attributed this to television (58%), newspaper (33%), poster (13%) and bus-back advertising (8%). Of these respondents, 21% reported seeking information about physical activity, 33% reported increased intention to be more active, and 22% reported becoming more active as a result of the campaign. It is possible to develop and deliver a well-designed, multi-media campaign on a limited budget by using sound formative research and engaging community and corporate partners to generate sponsorship. An effective distribution strategy is crucial and may require additional partnerships at State or national level.

  15. 危重孕产妇住重症监护病房时间延长的危险因素分析——北京市3家医院5年回顾性研究%Analysis of risk factors of prolonged intensive care unit stay of critically ill obstetric patients: a 5-year retrospective review in 3 hospitals in Beijing

    Institute of Scientific and Technical Information of China (English)

    林英; 朱曦; 刘飞; 赵扬玉; 杜俊; 么改琦; 李文雄; 贾晓君

    2011-01-01

    独立危险因素.结论 危重孕产妇ICU住院时间延长的发生率较高.临床上可以根据危险因素预测危重孕产妇ICU住院时间延长,加强规律产前检查、避免产科及内科严重并发症;发病后尽快转入ICU并在ICU内加强各器官功能支持可能有助于缩短ICU住院时间.%Objective To identify the risk factors of prolonged intensive care unit (ICU) stay of critically ill obstetric patients. Methods A retrospective analysis of cases of critically ill obstetric patients admitted to the ICUs of Peking University Third Hospital, Capital Medical University Affiliated Beijing Chaoyang Hospital, and PLA 306 Hospital from January 1st 2006 to December 31st 2010 was made. Data included demographics, causes of critical illness or complications that prompted ICU admission, the acute physiology and chronic health evaluation Ⅰ (APACHE Ⅱ ) scores, the time intervals between onset of acute symptoms and ICU admission, laboratory test results, treatment measures, length of ICU stay and the final maternal mortality. Data were used to identify univariate and multivariate predictors for prolonged ICU stay.Results During the 5-year period there were 207 obstetric patients[mean age (31. 74±2.32) years old,mean gestational age (34. 86±4. 72) weeks]were transferred to the ICU for critical care (42 ICU admissions per 10 000 deliveries), and among them 4 women died (mortality rate 1.93%). The pathogenesis of the cases could be divided into direct obstetric pathologies (n= 138) and indirect or coincidental pathologies (n= 69).The most common obstetric causes of admission were massive postpartum haemorrhage (n= 42, 20. 29%)and pregnancy-associated hypertension (n= 36, 17.39%), followed by acute fatty liver of pregnancy (AFLP,n= 27, 13.04%), obstetric disseminated intravascular coagulation (DIC, n= 23, 11.11%). The most common non-obstetric causes of admission were acute heart failure (n= 26, 12. 56%) and acute respiratory failure (n = 22, 10. 63 %), followed by

  16. "Why we stay": immigrants' motivations for remaining in communities impacted by anti-immigration policy.

    Science.gov (United States)

    Valdez, Carmen R; Lewis Valentine, Jessa; Padilla, Brian

    2013-07-01

    Although restrictive immigration policy is intended to reduce incentives for unauthorized immigrants to remain in the United States, many immigrants remain in their U.S. community despite the anti-immigration climate surrounding them. This study explores motivations shaping immigrants' intentions to stay in Arizona after passage of Senate Bill 1070 in 2010, one of the most restrictive immigration policies in recent decades. We conducted three focus groups in a large metropolitan city in Arizona with Mexican immigrant parents (N = 25). Themes emerging from the focus groups described multiple and interlocking personal, family and community, and contemporary sociopolitical motivations to stay in their community, and suggest that some important motivating factors have evolved as a result of immigrants' changing environment. Implications for research and social policy reform are discussed.

  17. Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

    Science.gov (United States)

    Maan, Zeshaan N; Frew, Quentin; Din, Asmat H; Unluer, Zeynep; Smailes, Sarah; Philp, Bruce; El-Muttardi, Naguib; Dziewulski, Peter

    2014-12-01

    Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.

  18. Aterações químicas e microbiológicas em PACU (piaractus mesopotamicus armazenado sob refrigeração a 5°c

    Directory of Open Access Journals (Sweden)

    Mauro F.F. Leitão

    1997-08-01

    Full Text Available A pesquisa foi conduzida com o objetivo de analisar a vida útil e o processo de deterioração do pacu (Piaractus mesopotanicus armazenado sob refrigeração em temperatura inadequada (5°C. Amostras do pescado, imediatamente após a captura, foram armazenadas a 5°C e analisadas nos intervalos de 0-7-14 e 21 dias, com relação a características sensoriais e de natureza química (bases nitrogenadas voláteis - BNV, nitrogênio não protéico - NNP, aminoácidos livres totais, histidina livre e histamina e microbiológicos (contagem padrão, produtores de histamina em ágar Niven, contagem de microrganismos gelatinase e H2S positivos, nas temperaturas de 35°C, 20° e 5°C. Os resultados obtidos confirmaram que, a exemplo de outros peixes fluviais de regiões tropicais, o pacu revelou-se bastante resistente ao armazenamento, somente evidenciando uma alteração marcante após 14 dias de estocagem. Assim mesmo, a rejeição do pescado foi baseada principalmente em características sensoriais (odor, aspecto, textura uma vez que com relação aos índices químicos (BNV e mesmo microbiológicos, não se caracterizava uma situação definitiva de deterioração e rejeição. Observou-se, também, que o processo de deterioração pareceu concentrar-se principalmente no muco superficial, sendo que as características químicas do tecido muscular não evidenciaram alterações marcantes, mesmo após 21 dias de armazenamento. A presença de histamina não foi positivada nas amostras e os níveis de histidina livre, embora relativamente elevadas, não sugerem maiores riscos desta espécie de peixe como eventual veículo de intoxicação por histamina. No entanto, bactérias his+ foram isoladas das amostras iniciais, entre elas cepas de Plesiomonas shigelloides e Vibrio fluvialis. A microbiota contaminante natural foi reduzida, predominando microrganismos mesófilos/psicrotrófilos, com baixas contagens iniciais a 5°C. Ao longo do armazenamento a 5

  19. Modelling length of hospital stay in motor victims

    Directory of Open Access Journals (Sweden)

    Mercedes Ayuso-Gutiérrez

    2015-03-01

    Full Text Available Objective. To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. Materials and methods. In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. Results. Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. Conclusions. Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

  20. Trends In Complicated Newborn Hospital Stays and Costs..

    Data.gov (United States)

    U.S. Department of Health & Human Services — The article, Trends In Complicated Newborn Hospital Stays and Costs, 2002-2009, Implications For the Future, published in Volume 4, Issue 4 of Medicare and Medicaid...

  1. Modeling of cable vibration effects of cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The analysis of dynamic responses of cable-stayed bridges subjected to wind and earthquake loads generallyconsiders only the motions of the bridge deck and pylons. The influence of the stay cable vibration on the responses of the bridgeis either ignored or considered by approximate procedures. The transverse vibration of the stay cables, which can be significant insome cases, are usually neglected in previous research. In the present study, a new three-node cable element has been developed tomodel the transverse motions of the cables. The interactions between the cable behavior and the other parts of the bridgesuperstructure are considered by the concept of dynamic stiffness. The nonlinear effect of the cable caused by its self-weight isincluded in the formulation. Numerical examples are presented to demonstrate the accuracy and efficiency of the proposed model.The impact of cable vibration behavior on the dynamic characteristics of cable-stayed bridges is discussed.

  2. Long stay patients in a psychiatric hospital in Lagos, Nigeria

    African Journals Online (AJOL)

    hospital, with a prolonged stay, by being brought to the centre by government ... study center; or, in the alternative provision of mid–way facilities for their rehabilitation. Key Words: ... residency and occupational therapy in place.18. Subjects ...

  3. Trends In Complicated Newborn Hospital Stays and Costs..

    Data.gov (United States)

    U.S. Department of Health & Human Services — The article, Trends In Complicated Newborn Hospital Stays and Costs, 2002-2009, Implications For the Future, published in Volume 4, Issue 4 of Medicare and Medicaid...

  4. Fitness: Stay Safe during Hot-Weather Exercise

    Science.gov (United States)

    Healthy Lifestyle Fitness Stay safe during hot-weather exercise by drinking enough fluids, wearing proper clothing and timing your ... 06, 2017 Original article: http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048167 . Mayo Clinic Footer ...

  5. CMS proposes to OK one-midnight inpatient stays.

    Science.gov (United States)

    2015-09-01

    The Centers for Medicare & Medicaid Services (CMS) has proposed that stays shorter than two midnights be reimbursed as inpatient stays if the documentation in the medical record supports it. CMS made the proposal in the Outpatient Prospective Payment System proposed rule for 2016 and left the policy unchanged for stays of two midnights or longer. CMS also announced that the two Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs), Livanta and KEPRO, will take over the responsibility of Probe and Educate and will review cases for medical necessity when patient stays are one midnight or less, referring hospitals with high denial rates to the Recovery Auditors. Case managers should continue to assist physicians in determining patient status and to make sure that the documentation is complete, accurate, and specifies the severity of illness.

  6. Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

    DEFF Research Database (Denmark)

    Burgdorf, Stefan K; Rosenberg, Jacob

    2012-01-01

    in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we aimed to reduce hospitalisation without increasing cost in nursing staff per hospital bed. Length of stay......Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks...... during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation), but without changing nurse staffing or principles for peri- or postoperative...

  7. Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay.

    Science.gov (United States)

    Pintado, M C; Villa, P; Luján, J; Trascasa, M; Molina, R; González-García, N; de Pablo, R

    2016-01-01

    To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. A prospective observational study was carried out. A Spanish medical-surgical ICU. Patients over 75 years of age admitted to the ICU. ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  8. Geoportal "READY:Prepare, Prevent, Stay Informed"

    Science.gov (United States)

    Sole, Aurelia; Albano, Raffaele; Giuzio, Luciana; Manfreda, Salvatore; Maggio, Massimo; Presta, Aldo; Albano, Giovanni

    2014-05-01

    Information, communication, and training at all levels of a hydrogeological risk prevention culture is useful and necessary to develop the awareness among the people; this awareness can only lead to the correct application of the rules and correct behaviours that reduce the risk. A territorial system is more vulnerable to a calamitous event if there is little risk knowledge, in terms of knowledge of phenomenology of the event itself, of its own way to manifest and of the actions needed to mitigate their harmful effects. So, the Geoportal "READY: Prepare, Prevent, Stay Informed," developed by the School of Engineering at the University of Basilicata in collaboration with Paesit srl and Wat-TUBE, a spin-off of University of Basilicata, aims to inform people in an easy and correct way. This can improve the knowledge of the territory in order to promote the consciousness and awareness of the risks affecting the territory, in geo-localized form, even through using the memory of past disasters and precise directions on what to do for a tangible reduction of the risk. The Geoportal stores and dynamically integrates a series of layers that, individually, have a lower utility, but integrated into the web-based platform represent, for the prevention of the risks of the citizens, the anatomy for medicine. In fact, it makes the data not only available but concretely accessible. It is created on the "MapServer" platform, an open source web mapping suggested by the European Directives in the field of geographic database publication, and covers the Italian territory. It is designed to increase the knowledge of the areas at potential flood and landslide risk, delineated by the Authorities in the "P.A.I. (Piano di Assetto Idrogeologico"), and the elements which could possibly be involved in potential events with a particular attention to the critical infrastructures, such as bridges, railways and so on, and relevant structures, such as schools and hospitals. It permits the

  9. Could Staying Human in Medical Training Help Make Medicine Humane? Review of Allan D. Peterkin, Staying Human During Residency Training

    Directory of Open Access Journals (Sweden)

    Ballesteros, Fabián

    2013-10-01

    Full Text Available Staying Human During Residency Training. How to survive and Thrive after Medical School, Dr. Allan D. Peterkin provides guidance and tools to medical residents, with a common thread the wellbeing of the person in each resident, essential to staying humane during the demanding training called residency. This review focuses on ethics, as presented in the author’s discourse, in a chapter specifically dealing with clinical ethics.

  10. Inpatient hospital complications and lengths of stay: a short report

    Directory of Open Access Journals (Sweden)

    Johnson Pamela E

    2011-05-01

    Full Text Available Abstract Background Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area. Findings This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York. It employed the Potentially Preventable Complications (PPC software developed by 3M™ Health Information Services to identify lengths of stay for patients with and without urinary tract infection and pneumonia. The patient populations included individuals assigned to the same All Patients Refined Diagnosis Related Groups and severity of illness. The comparisons involved two nine month periods in 2008 and 2009. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of urinary tract infection stayed a mean of 8.9 - 11.9 days or 161 - 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 - 2,427 additional patient days. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of pneumonia stayed a mean of 13.0 - 16.3 days or 232 - 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 - 3,456 additional patient days. Similar differences were generated for median lengths of stay. Conclusions The differences in hospital stays for patients in the same APR DRGs and severity of illness with and without urinary tract infection and pneumonia in the Syracuse hospitals were substantial. The additional utilization for these complications was valued at between $2,000,000 - $3,000,000 for a

  11. Comportamento alimentar de alevinos de pacu (Piaractus mesopotamicus, Holmberg, 1887 por meio das observações do tempo de retorno do apetite e do tempo de saciação dos peixes em duas temperaturas - DOI: 10.4025/actascianimsci.v26i3.1802 The feed behavior of pacu figerling (Piaractus mesopotamicus, Holmberg, 1887, based on appetite revival and satiation of fish at two cultivate temperature - DOI: 10.4025/actascianimsci.v26i3.1802

    Directory of Open Access Journals (Sweden)

    Dalton José Carneiro

    2004-04-01

    Full Text Available O presente trabalho teve como por objetivo avaliar os efeitos da temperatura de cultivo na ingestão de alimentos pelo pacu (Piaractus mesopotamicus, de forma a caracterizar o comportamento alimentar por meio das observações do tempo de retorno do apetite e do tempo de saciação. Foram utilizados 96 juvenis de pacu com peso aproximado de 160g, alojados em aquários de 150 litros, com fluxo de água contínuo. Utilizou-se ração extrusada comercial, contendo 28% de proteína bruta, e as temperaturas de cultivo analisadas foram 23°C e 27°C. Para o ensaio do tempo de retorno do apetite (TRA, no tempo considerado zero, para cada uma das parcelas, os peixes de todas as repetições foram alimentados. A realimentação ocorreu em um aquário de cada vez, em intervalos de 60 minutos. Dessa forma, os peixes do aquário um receberam a quantidade determinada de ração uma hora após o arraçoamento inicial. Os do aquário dois receberam a ração 2 horas após o arraçoamento inicial, e assim sucessivamente para os aquários de um mesmo tratamento, com a finalidade de se obter uma curva de consumo durante 24 horas. Para consumo alimentar e tempo de saciação, os peixes foram alimentados, repetidas vezes, até que a procura pelo alimento terminasse, em cada uma das 6 observações, em cada aquário. O tempo foi marcado desde o início da alimentação até que não houvesse mais procura pelo alimento por nenhum dos peixes que constituíam uma parcela. O tempo de saciação (TS foi calculado em cada repetição por meio da média dos tempos de procura pelo alimento, determinado em todas as observações. Os delineamentos experimentais utilizados foram em blocos casualizados ou inteiramente casualizados de acordo com as características de cada ensaio. Observou-se que os peixes alimentavam-se melhor e mais avidamente à tarde (6,53g e 3,97g para o período da tarde e da manhã, respectivamente, embora o tempo para a ingestão da ração tenha sido

  12. Factors affecting ED length-of-stay in surgical critical care patients.

    Science.gov (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J

    1995-09-01

    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  13. Physical therapy services utilization and length of stay for obese patients following traumatic leg fracture.

    Science.gov (United States)

    Slayton, Stephanie; Williams, D S Blaise; Newman, Glen

    2012-01-01

    Obesity is an increasing epidemic that can complicate the treatment of simple injuries and can increase health care costs. The purpose of the present study was to determine whether obesity is a factor in the utilization of inpatient physical therapy services and length of stay following a traumatic lower leg fracture. A retrospective study of patients admitted to the hospital in 2005 and 2006 with a primary discharge diagnosis of lower leg or ankle fracture was conducted. Inclusion criteria were age > or = 18 years, only 1 involved lower extremity, and nonweight-bearing on the affected extremity per physician orders. Patients were excluded from the study if they had a fibular fracture only, pathological fractures, multiple trauma, severe cardiac or vascular comorbidities, or cognitive impairments. Data were compiled into 3 categories on the basis of body mass index (BMI): 35. Physical therapy services were measured in 15-minute units of time. These data were analyzed by within-group and between-group comparisons and with regression analysis. A total of 181 patients with a primary discharge diagnosis of distal lower extremity or ankle fracture were included in the study. Patients with a BMI >35 used more physical therapy services (mean services, 9.8 units) than did patients with a BMI of 30-35 (mean services, 6.2 units) or a BMI 35. Factors other than BMI may be associated with length of stay and physical therapy use and may confound the association. Previous studies have shown that there is an increase in health care utilization among the bariatric population. The present study demonstrates similar findings for physical therapy services. Increased length of stay and physical therapy utilization among the bariatric population also result in increased staff utilization and equipment costs.

  14. Inspection method of cable-stayed bridge using magnetic flux leakage detection: principle, sensor design, and signal processing

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Fengyu; Wang, Xingsong [Southeast University, Nanjing (China); Wu, Hongtao [Nanjing University of Aeronautics and Astronautics, Nanjing (China)

    2012-03-15

    A nondestructive testing technique based on magnetic flux leakage is presented to inspect automatically the stay cables with large diameters of a cable-stayed bridge. Using the proposed inspection method, an online nondestructive testing (NDT) modular sensor is developed. The wreath-like sensor is composed of several sensor units that embrace the cable at equal angles. Each sensor unit consists of two permanent magnets and a hall sensor to detect the magnetic flux density. The modular sensor can be installed conveniently on cables with various diameters by increasing the number of sensor units and adjusting the relative distances between adjacent sensor units. Results of the experiments performed on a man-made cable with faults prove that the proposed sensor can inspect the status signals of the inner wires of the cables. To filter the interfering signals, three processing algorithms are discussed, including the moving average method, improved detrending algorithm, and signal processing based on a digital filter. Results show that the developed NDT sensor carried by a cable inspection robot can move along the cable and monitor the state of the stay cables.

  15. Distinguishing movement from stays during continual GPS tracking

    DEFF Research Database (Denmark)

    Jensen, Anders Sorgenfri; Bro, Peter; Harder, Henrik

    a relatively high amount of immobility compared to movement. Attempting to analyse how this setup of respondents use the city becomes problematic when the gathered geodata consists of both the 1-2 hours each respondent spend on travelling through the city, and the remaining 22 hours of the day which...... the respondent would spend stationary at certain locations important to the respondent such as school, home address, work address etc. It would be much more convenient if the geodata could be divided into two datasets consisting of movement and stays respectively, so stay-related analyses such as pinpointing...... popular city squares wouldn't be affected by noise from movement data. This paper aims to describe the technique developed by Diverse Urban Spaces to counteract the above mentioned inconvenience by splitting the dataset into movement and stays. The paper will explain how the technique was commenced, how...

  16. BMI AND LENGTH OF HOSPITAL STAY IN LAPAROSCOPIC CHOLECYTECTOMY

    Directory of Open Access Journals (Sweden)

    Vinod Kumar

    2015-12-01

    Full Text Available Gallbladder disease is one of the most common causes of hospital admission in middle-aged women in developed countries. Body Mass Index (BMI is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness. Postoperative length of stay (POLOS was defined as the time from operative end to discharge from the hospital. Although increased Body Mass Index (BMI is well recognized as a risk factor for gallstones and subsequent cholecystectomy, there is little information on what direct impact underweight, overweight and obesity have on the length of hospital stay for gallbladder disease. Aim of this study was to find out effect of BMI on length of hospital stay .This retrospective study of 55 patients was conducted over 3months in the department of general surgery, Father Muller Medical College Hospital (FMMCH Mangalore, India, and BMI appeared to contribute to a decreased POLOS.

  17. Seismic Passive Control of Cable-Stayed Bridges

    Directory of Open Access Journals (Sweden)

    Hosam-Eddin M. Ali

    1995-01-01

    Full Text Available A three-dimensional modeling procedure is proposed for cable-stayed bridges with rubber, steel, and lead energy dissipation devices. The passive control technique is investigated by considering the response of bridge models with and without energy dissipation devices. The impact of various design parameters on the seismic response of current and future bridge designs is studied. Appropriate locations and properties of the passive devices can achieve better performance for cable-stayed bridges by balancing the significant reduction in earthquake-induced forces against tolerable displacements. Proper design of passive systems can help provide solutions for retro-fitting some existing bridges.

  18. Aerodynamic stability of cable-stayed bridges under erection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin-jun; SUN Bing-nan; XIANG Hai-fan

    2005-01-01

    In this work, nonlinear multimode aerodynamic analysis of the Jingsha Bridge under erection over the Yangtze River is conducted, and the evolutions of structural dynamic characteristics and the aerodynamic stability with erection are numerically generated. Instead of the simplified method, nonlinear multimode aerodynamic analysis is suggested to predict the aerodynamic stability of cable-stayed bridges under erection. The analysis showed that the aerodynamic stability maximizes at the relatively early stages, and decreases as the erection proceeds. The removal of the temporary piers in side spans and linking of the main girder to the anchor piers have important influence on the dynamic characteristics and aerodynamic stability of cable-stayed bridges under erection.

  19. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  20. Forecasting Length of Stay in Child Residential Treatment

    Science.gov (United States)

    Hussey, David L.; Guo, Shenyang

    2005-01-01

    A sample of 126 consecutively admitted residential treatment children (mean age = 9.86, SD=1.84; 70.6% male; 42.1% African American; 50% Caucasian) were studied over a five-year period to identify predictors of length-of-stay. Cox regression was the primary statistical method used to analyze psychiatric and behavioral rating data for children…

  1. Gotta Have It! Pepsi Challenges Students to Stay in School.

    Science.gov (United States)

    Punsalan, Carla M.

    1993-01-01

    A program sponsored by Pepsi-Cola Company is designed to provide students in inner-city school districts with reasons for staying in school. Incentives for students include scholarship credit of $250 for each semester in which they maintain a C average; mentor-teachers receive $1,000 for continuing education, classroom enhancement, or the…

  2. Residents' Coping Strategies in an Extended-Stay Hotel Home

    Science.gov (United States)

    Lewinson, Terri

    2010-01-01

    Some families live in extended-stay hotels as a solution after housing displacement. This temporary accommodation provides a furnished home environment with resources such as a kitchenette, bed, heating/air conditioning, and room services with one payment that can be made weekly or monthly without a credit check or rent deposit. Despite these…

  3. Probabilistic Approach to Fatigue Assessment for Stay Cables

    DEFF Research Database (Denmark)

    Baussaron, Julien; Sørensen, John Dalsgaard; Toft, Henrik Stensgaard

    2013-01-01

    Many parameters used for predicting times to failure of structure due to fatigue are uncertain and their variations have a big influence on the real lifetime. This paper focus on a global methodology to take main sources of variability in fatigue prediction for stay cables into account. The first...

  4. Halloween: Have Fun and Stay Safe and Healthy!

    Centers for Disease Control (CDC) Podcasts

    2010-10-25

    Halloween is a fun time for kids, but it's no fun if you get sick or hurt. In this podcast for kids, the Kidtastics offer some simple ways to stay safe and healthy on Halloween.  Created: 10/25/2010 by CDC Office of Women’s Health.   Date Released: 10/25/2010.

  5. 42 CFR 456.233 - Initial continued stay review date.

    Science.gov (United States)

    2010-10-01

    ... assigns the initial continued stay review date within 1 working day after the mental hospital is notified... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... must provide that— (a) When a recipient is admitted to the mental hospital under admission...

  6. Residents' Coping Strategies in an Extended-Stay Hotel Home

    Science.gov (United States)

    Lewinson, Terri

    2010-01-01

    Some families live in extended-stay hotels as a solution after housing displacement. This temporary accommodation provides a furnished home environment with resources such as a kitchenette, bed, heating/air conditioning, and room services with one payment that can be made weekly or monthly without a credit check or rent deposit. Despite these…

  7. Predicting stay/leave behavior among volleyball referees

    NARCIS (Netherlands)

    Van Yperen, N.W.

    1998-01-01

    This study aimed to predict stay/leave behavior among volleyball referees. The predictor variables reflect commitment aspects from the literature: attraction, perceived lack of alternatives, personal investments, and feelings of obligation to remain. Intent to quit was assumed to mediate the link

  8. Visas for entry and stays in the Host States

    CERN Multimedia

    DG Unit

    2010-01-01

    1. What is a visa? A visa is an administrative document authorising nationals of countries subject to the visa requirement to transit, enter and stay in a foreign country. The numerous types of visa include in particular: a) Short-stay visas (the Schengen C-type visa), which allows their holders to enter and reside in the Schengen Area1) for a continuous or a non-continuous period not exceeding 3 months within any six-month period with effect from initial entry into the Schengen Area; b) Long-stay visas (D-type visa or national visa for the purposes of taking up employment), which are required for stays of over three months, allowing the holder to obtain a legitimation document (titre de séjour) from the Host States: A “carte de légitimation” issued by the Swiss Federal Department of Foreign Affairs; A “titre de séjour spécial” issued by the French Ministry of Foreign and European Affairs. Since 5 April 2010...

  9. Should I Stay or Should I Go? Maximizers versus Satisficers

    Science.gov (United States)

    Buri, John R.; Gunty, Amy; King, Stephanie L.

    2008-01-01

    In the present study, university students were presented a scenario in which a married couple was struggling in their marriage. These students were asked how likely it is that they would stay in a difficult marriage like the one described in the scenario. Each student also completed Schwartz's (2004) Maximization Scale. High scorers on this scale…

  10. Gotta Have It! Pepsi Challenges Students to Stay in School.

    Science.gov (United States)

    Punsalan, Carla M.

    1993-01-01

    A program sponsored by Pepsi-Cola Company is designed to provide students in inner-city school districts with reasons for staying in school. Incentives for students include scholarship credit of $250 for each semester in which they maintain a C average; mentor-teachers receive $1,000 for continuing education, classroom enhancement, or the…

  11. Predicting stay/leave behavior among volleyball referees

    NARCIS (Netherlands)

    Van Yperen, N.W.

    1998-01-01

    This study aimed to predict stay/leave behavior among volleyball referees. The predictor variables reflect commitment aspects from the literature: attraction, perceived lack of alternatives, personal investments, and feelings of obligation to remain. Intent to quit was assumed to mediate the link be

  12. 41 CFR 105-70.041 - Stay pending appeal.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Stay pending appeal. 105-70.041 Section 105-70.041 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  13. 29 CFR 2200.63 - Stay of proceedings.

    Science.gov (United States)

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION RULES OF PROCEDURE... period requested or for such period as is deemed appropriate. (c) Periodic reports required. The parties in a stayed proceeding shall be required to submit periodic reports on such terms and conditions...

  14. Probabilistic FE analysis of a cable stayed composite bridge

    NARCIS (Netherlands)

    Boer, A. de; Waarts, P.H.

    1999-01-01

    This paper describes the design of a new cable stayed composite bridge near Kampen in the Netherlands. In the design process, the safety of bridges is insured by means of partial safety factors for both strength and load parameters. As a result it is generally accepted that the structure as a whole

  15. Staying Safe in Your Home During a Hurricane

    Centers for Disease Control (CDC) Podcasts

    2006-08-10

    If you are not ordered to evacuate, and you stay in your home through a hurricane, there are things you can do to protect yourself and your family.  Created: 8/10/2006 by Emergency Communications System.   Date Released: 8/13/2008.

  16. Primum nocere: medical brain drain and the duty to stay

    NARCIS (Netherlands)

    Ferracioli, L.; de Lora, P.

    2015-01-01

    In this essay, we focus on the moral justification of a highly controversial measure to redress medical brain drain: the duty to stay. We argue that the moral justification for this duty lies primarily in the fact that medical students impose high risks on their fellow citizens while receiving their

  17. Factors Predicting Staying in School to Eat Lunch

    Science.gov (United States)

    Beaulieu, Dominique; Godin, Gaston

    2011-01-01

    Purpose: Easy access to fast-food restaurants in the immediate environment of a high school is such that a high proportion of students do not remain in school for lunch. Hence, the probability that they will eat a healthy meal is reduced. The aim of this study is to identify the behavioral determinants of "staying in school to eat lunch" among…

  18. Predictors for length of hospital stay after inguinal hernia surgery

    Science.gov (United States)

    Aldoescu, S; Patrascu, T; Brezean, I

    2015-01-01

    Aim: identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery. Method: 257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay. Results: out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology. Conclusions: the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources. PMID:26351540

  19. 5 CFR 185.141 - Stay pending appeal.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Stay pending appeal. 185.141 Section 185.141 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD... disposition of a motion for reconsideration or of an appeal to the authority head. (b) No administrative...

  20. Stay tuned: what is special about not shifting attention?

    Directory of Open Access Journals (Sweden)

    Durk Talsma

    Full Text Available BACKGROUND: When studying attentional orienting processes, brain activity elicited by symbolic cue is usually compared to a neutral condition in which no information is provided about the upcoming target location. It is generally assumed that when a neutral cue is provided, participants do not shift their attention. The present study sought to validate this assumption. We further investigated whether anticipated task demands had an impact on brain activity related to processing symbolic cues. METHODOLOGY/PRINCIPAL FINDINGS: Two experiments were conducted, during which event-related potentials were elicited by symbolic cues that instructed participants to shift their attention to a particular location on a computer screen. In Experiment 1, attention shift-inducing cues were compared to non-informative cues, while in both conditions participants were required to detect target stimuli that were subsequently presented at peripheral locations. In Experiment 2, a non-ambiguous "stay-central" cue that explicitly required participants not to shift their attention was used instead. In the latter case, target stimuli that followed a stay-central cue were also presented at a central location. Both experiments revealed enlarged early latency contralateral ERP components to shift-inducing cues compared to those elicited by either non-informative (exp. 1 or stay-central cues (exp. 2. In addition, cueing effects were modulated by the anticipated difficulty of the upcoming target, particularly so in Experiment 2. A positive difference, predominantly over the posterior contralateral scalp areas, could be observed for stay-central cues, especially for those predicting that the upcoming target would be easy. This effect was not present for non-informative cues. CONCLUSIONS/SIGNIFICANCE: We interpret our result in terms of a more rapid engagement of attention occurring in the presence of a more predictive instruction (i.e. stay-central easy target. Our results

  1. 'Imported risk' or 'health transition'? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany - analysis of microcensus data

    Directory of Open Access Journals (Sweden)

    Spallek Jacob

    2010-06-01

    Full Text Available Abstract Background It can be assumed that resettlers (ethnic German immigrants from the Former Soviet Union show similar smoking patterns as persons in their countries of origin at the time of migration. We analysed how the smoking prevalence among resettlers differs from that among the general population of Germany and whether the prevalence differs between groups with increasing duration of stay. Methods To estimate the smoking prevalence we used the scientific-use-file (n = 477,239 of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse resettlers and the comparison group (population of Germany without resettlers by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total persons were identified as resettlers. Results Female resettlers with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%. In contrast, the smoking prevalence among male resettlers with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%. Except for female resettlers with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level. Conclusions This is the first study estimating the smoking prevalence among resettlers by duration of stay. The results support the hypothesis that resettlers brought different smoking habits from their countries of origin shortly after

  2. Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia

    Science.gov (United States)

    Ali Hassan, Hossam Ibrahim Eldesuky

    2015-01-01

    Background: There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges. Aim of the Study: The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness. Patients and Methods: Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA. Results: Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P 0.05. Group L patients did not stay in PACU, and all patients bypassed it P anesthesia than bupivacaine spinal with shorter time

  3. Evaluation of reasons for staying and waiting for more than 24 hours in the emergency ward of Imam Hossein hospital

    Directory of Open Access Journals (Sweden)

    Hossein Alimohammadi

    2015-06-01

    Full Text Available Objective: Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward. Methods: In the present 2-month cross-sectional study, patients referring to the emergency ward of Imam Hossein hospital were assessed. The patients’ demographic data, including age, the presenting symptoms and signs, reasons for delays, and the final outcome in relation to the location of hospitalization and discharge information were recorded. Data were reported as frequencies and percentages. The results were reported as means and standard deviations using SPSS version 20. Results: Of 10087 patients admitted into the emergency ward during a 2-month period, 75 patients (0.7% needed to stay and wait for more than 24 hours. The mean ± standard deviation of the patients’ ages was 62.5 ± 20.2 years, with 60% of the patients being over 60 years of age. The most common reason for overcrowding in the emergency ward was a lack of empty beds, with the need for ICU beds as the most important reason for bed deficiency in 59% of the cases. Nervous system problems were the most common reasons for referring to the emergency unit (41% in patients under study. Finally, 81% of the patients were hospitalized, 10% died, 7% were discharged based on personal request and 1.3% were transferred to another hospital. Conclusion: The prevalence of patients staying and waiting in the emergency ward for more than 24 hours was 0.7%. Lack of empty ICU beds was the most important reason for such delays; however, paraclinical problems had no role in these delays which were associated with the death of 10% of patients

  4. Eight ways to stay healthy after cancer: an evidence-based message.

    Science.gov (United States)

    Wolin, Kathleen Y; Dart, Hank; Colditz, Graham A

    2013-05-01

    Since 1999, in conjunction with the internationally known and award-winning Your Disease Risk ( yourdiseaserisk.org ) risk assessment tool, the "Eight Ways to Stay Healthy and Prevent Cancer" message campaign has provided an evidence-based, but user-friendly, approach to cancer prevention. The scientific evidence behind the campaign is robust and while not a complete list, provides a great deal of benefit in the reduction of cancer risk. With 12 million cancer survivors in the United States, there is a need for a parallel set of recommendations that oncologists and primary care providers may routinely use for individuals following a cancer diagnosis focused on improving the quantity and quality of life after diagnosis. With increasing survival rates and many cancer survivors dying from noncancer causes, survivorship care necessarily focuses on more than just risk of cancer recurrence and cancer-related mortality. To provide a foundation for living a healthy life after a cancer diagnosis, we developed a set of evidence-based health messages for cancer survivors. "Cancer Survivors' Eight Ways to Stay Healthy After Cancer," published by the Siteman Cancer Center at Washington University School of Medicine and Barnes Jewish Hospital, documents both the evidence supporting the recommendations as well as tips for implementing them. The one-line summary messages are: (1) don't smoke, (2) avoid secondhand smoke, (3) exercise regularly, (4) avoid weight gain, (5) eat a healthy diet, (6) drink alcohol in moderation, if at all, (7) stay connected with friends, family, and other survivors, (8) get screening tests and go to your regular checkups. The cancer survivors' eight ways are the foundation for an evidence-based health promotion program for survivors.

  5. Stay Alive--Simulation for Situational Safety Awareness

    Science.gov (United States)

    Ruder, Michelle

    2008-01-01

    STAY ALIVE is an idea for a safety awareness simulation prototype, powered by gaming technology, that would make safety training enlightening, engaging and fun. Recalling initial instructions and using situational awareness principles, participants would escape a fire by choosing the appropriate door. Escape times would be measured while stressors increased. This presentation describes how STAY ALIVE utilizes first person point of view (PoV), a generic scenario, immersion- and presence-enhancing design, and ease of distribution to provide more people opportunity to realize, review, analyze and practice effective awareness behaviors. The goals for this prototype include facilitating interest in first-person PoV safety training and eliciting further suggestions on prevention technologies.

  6. Thermal Effect of the Cable-Stayed Bridge Tower

    Institute of Scientific and Technical Information of China (English)

    Zhang Hai-long; Li Jun; Liu Chang-guo; Jiang Tian-hua; Wei jun

    2003-01-01

    This paper studies the thermal effect of the cable-stayed bridge tower based on full time accurate measurement and finite element analysis on Xiantao Hanjiang River Highway Bridge. The measured results and the displacement variation of top tower show that the tower rotates periodically when it is exposed in sunshine. But the tower column will not decline when there is no sunshine. In spite of in winter or in summer, the period when the tower column changed smallest is from 0∶00 am to 5∶00 am. The time period when the tower column has maximum deviation lags behind the time when the tower column has maximum temperature difference, and this phenomenon is obvious in winter. The conclusions also have directive value in predicting the tower deformations and their directions in construction control of cable-stayed bridge, and in verifying the finite element program.

  7. "Should I Stay or Should I Go? - The Emigrating Immigrants"

    DEFF Research Database (Denmark)

    Rezaei, Shahamak; Goli, Marco

    2011-01-01

    in keeping those immigrants who contribute to the development of the universal welfare state, while reducing the burden of the others. Thus, the controversial question arises: whom among the immigrants from non-western countries will chose to stay in their new country and who will emigrate again......? The following is an empirical clarification of this issue, the state of the art and the attitudes and future trends, based on two sets of comprehensive quantitative data collection....

  8. Systemic Lidocaine Shortens Length of Hospital Stay After Colorectal Surgery

    Science.gov (United States)

    Herroeder, Susanne; Pecher, Sabine; Schönherr, Marianne E.; Kaulitz, Grit; Hahnenkamp, Klaus; Friess, Helmut; Böttiger, Bernd W.; Bauer, Harry; Dijkgraaf, ↶oMarcel G. W.; Durieux, Marcel E.; Hollmann, Markus W.

    2007-01-01

    Objective: To characterize the beneficial effects of perioperative systemic lidocaine on length of hospital stay, gastrointestinal motility, and the inflammatory response after colorectal surgery. Summary Background Data: Surgery-induced stimulation of the inflammatory response plays a major role in the development of several postoperative disorders. Local anesthetics possess anti-inflammatory activity and are thought to positively affect patients' outcome after surgery. This double-blinded, randomized, and placebo-controlled trial aimed to evaluate beneficial effects of systemic lidocaine and to provide insights into underlying mechanisms. Methods: Sixty patients undergoing colorectal surgery, not willing or unable to receive an epidural catheter, were randomly assigned to lidocaine or placebo treatment. Before induction of general anesthesia, an intravenous lidocaine bolus (1.5 mg/kg) was administered followed by a continuous lidocaine infusion (2 mg/min) until 4 hours postoperatively. Length of hospital stay, gastrointestinal motility, and pain scores were recorded and plasma levels or expression of pro- and anti-inflammatory mediators determined. Results: Lidocaine significantly accelerated return of bowel function and shortened length of hospital stay by one day. No difference could be observed in daily pain ratings. Elevated plasma levels of IL-6, IL-8, complement C3a, and IL-1ra as well as expression of CD11b, l- and P-selectin, and platelet-leukocyte aggregates were significantly attenuated by systemic lidocaine. Conclusions: Perioperative intravenous lidocaine not only improved gastrointestinal motility but also shortened length of hospital stay significantly. Anti-inflammatory activity modulating the surgery-induced stress response may be one potential mechanism. Systemic lidocaine may thus provide a convenient and inexpensive approach to improve outcome for patients not suitable for epidural anesthesia. PMID:17667496

  9. Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study

    Science.gov (United States)

    Qin, Li; Bierlein, Maggie; Choi, Jennie E S; Lin, Zhenqiu; Desai, Nihar R; Spatz, Erica S; Krumholz, Harlan M; Venkatesh, Arjun K

    2017-01-01

    Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (Pobservation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to

  10. Nurse managers' role in older nurses' intention to stay.

    Science.gov (United States)

    Armstrong-Stassen, Marjorie; Freeman, Michelle; Cameron, Sheila; Rajacic, Dale

    2015-01-01

    The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses' intentions to stay with their hospitals. Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. The cross-sectional research design does not allow determination of causality. It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

  11. Prospect theory and the decision to move or stay.

    Science.gov (United States)

    Clark, William A V; Lisowski, William

    2017-09-05

    Migration has always involved stress and risk. More risk-averse households are less likely to move, while less risk-averse households will seek out opportunities and migrate. We investigate how the theoretical contributions of prospect theory, and specifically the endowment effect, can provide new understanding about decisions whether to migrate or not. We test the hypothesis that risk aversion extends the length of stay in the dwelling and, by extension, in the local labor and housing markets. How long people remain in place is a function, we hypothesize, of their independently self-assessed propensity to take risks, after controlling for a range of demographic and socioeconomic characteristics. We use the theoretical insights of prospect theory and the endowment effect (the notion of the "use value" differing from the "exchange value") to explain the likelihood of staying after controlling for life-course events. The results confirm the explanatory power of self-assessed risk in the decision to migrate or stay and, equally important, confirm the role of the endowment effect.

  12. Nonlinear Dynamic Reliability of Coupled Stay Cables and Bridge Tower

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Nonlinear vibration can cause serious problems in long span cable-stayed bridges. When the internal resonance threshold is reached between the excitation frequency and natural frequency,large amplitudes occur in the cable. Based on the current situation of lacking corresponding constraint criteria, a model was presented for analyzing the dynamic reliability of coupling oscillation between the cable and tower in a cable-stayed bridge. First of all, in the case of cable sag, the d'Alembert principle is applied to studying the nonlinear dynamic behavior of the structure, and resonance failure interval of parametric oscillation is calculated accordingly. Then the dynamic reliability model is set up using the JC method. An application of this model has been developed for the preliminary design of one cable-stayed bridge located on Hai River in Tianjin, and time histories analysis as well as reliability indexes have been obtained. When frequency ratio between the cable and tower is approaching 1∶2, the reliability index is 0.98, indicating high failure probability. And this is consistent with theoretical derivation and experimental results in reference. This model, which is capable of computing the reliability index of resonance failure, provides theoretical basis for the establishment of corresponding rule.

  13. Optimization technique of the stay of person in the middle-altitude conditions

    Directory of Open Access Journals (Sweden)

    Borisenko O.V.

    2013-12-01

    Full Text Available The objective: In order to improve exercise capacity in the middle-altitude conditions a technique of urgent adaptation with use of the compact device has been developed. Material and Methods. The study included two groups of people involved in mountain tourism, on the move and stay in the midlands, which used (experimental group and didn't use (control group the developed technique. Considering the specificity of observations directly on the mountain route, the compact equipment and functional studies (pulse oximetry, spirometry, peak flow, the dynamic measurement of pulse and blood pressure with the calculation of double product index were used to monitor the experiment. Results. During the experiment changes of the data characterizing positive development of the functioning of human cardiore-spiratory system during the physical activities in the conditions of middle mountains were recorded (peak expiratory flow rate (from 512,86 to 592,86 I / min, t = 2,25, or by 115,6% in the experimental group and double product index (from 95,66 to 127,09 units., t = 2,41, or by 132,9% in the experimental group. Conclusion. Thus, the offered device and its technique compose an effective scheme of preliminary preparation of cardiorespiratory system to stay in the middle-altitude condition and can be recommended for use in need short-term adaptation.

  14. Strategies that assist children with communicative disability during hospital stay: Parents' perceptions and ideas.

    Science.gov (United States)

    Thunberg, Gunilla; Buchholz, Margret; Nilsson, Stefan

    2016-06-01

    There is a lack of research on the use of augmentative and alternative communication (AAC) in paediatric care, despite the fact that most children in need of AAC frequently need to visit hospitals and sometimes have to stay for long periods. The aim of this study was to investigate parents' experiences of the hospital visits with their children with communicative disabilities and to collect their ideas about how to optimize communication in this situation. Ten parents who had children with communicative disability took part in three focus group interviews. The analysis had a retrospective qualitative content theory. In the qualitative content analysis of the focus group interviews, 4 categories and 17 subcategories were identified. Overall, the results highlighted the importance of enabling direct communication between the child and the staff during the hospital stay. Parents of children with communication difficulties highlighted the importance of listening to their children and understanding their needs during hospital care and that hospital staff are in need of more knowledge in communicative disability and AAC to accomplish this. Training programmes for health-care professionals should be established to facilitate these requirements and connect to the United Nations conventions. Hospitals should provide and use AAC/communicative support.

  15. [Schizophrenic patients' length of stay: clinical factors of variability and consequences].

    Science.gov (United States)

    Capdevielle, D; Ritchie, K; Villebrun, D; Boulenger, J-P

    2009-02-01

    Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect and sense of self. The clinical picture is further complicated by the multiple secondary consequences of the disorder; notably disrupted education, unemployment, impoverished social relationships, isolation, legal difficulties, family stress and substance abuse. Not surprisingly, the disorder is also associated with suicidal behaviour. The management of schizophrenia is thus extremely difficult with high rates of relapse, treatment refusal and poor treatment outcome. In Europe and the United States there has been a general trend towards decreasing the former long duration of hospital care in favour of short-term pharmacological stabilization in the hospital setting, followed by longer multidisciplinary follow-up within the community. This change reflects, on the one hand, the evolution in aetiological conceptions towards a predominantly neurobiological model of the disorder, with complex social consequences and also social and economic constraints. The clinical consequences of these changes were not, however, evaluated prior to the implementation of these changes. Several studies have shown a clear relationship between reductions in duration of stay and increases in readmission rates and suggest that the development of community services may not in fact significantly improve clinical outcome, and may also possibly increase relapse rates due to the instability of the clinical condition at first discharge. There has been some unsettling evidence to suggest that shortening hospital stays may not be a general panacea. Authors reported in 1999 that deinstitutionalization policies in Denmark had led to premature discharge and subsequently a 100% increase in suicide, a doubling of the rates of criminal acts committed by psychotic patients, and increases of 80 to 100% in acute admission rates. A large follow

  16. Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants.

    Science.gov (United States)

    Rangey, Priya Singh; Sheth, Megha

    2014-01-01

    Background. Massage therapy (MT) and kangaroo mother care (KMC) are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT) infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age Limitation. Long term follow-up was not taken.

  17. Aerodynamic stability of cable-stayed-suspension hybrid bridges

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin-jun; SUN Bing-nan

    2005-01-01

    Three-dimensional nonlinear aerodynamic stability analysis was applied to study the aerodynamic stability of a cable-stayed-suspension (CSS) hybrid bridge with main span of 1400 meters, and the effects of some design parameters (such as the cable sag, length of suspension portion, cable plane arrangement, subsidiary piers in side spans, the deck form, etc.) on the aerodynamic stability of the bridge are analytically investigated. The key design parameters, which significantly influence the aerodynamic stability of CSS hybrid bridges, are pointed out, and based on the wind stability the favorable structural system of CSS hybrid bridges is discussed.

  18. Extended-stay rounds can help move patients along.

    Science.gov (United States)

    2014-08-01

    Weekly extended stay rounds help move along patients who have issues and barriers to a timely discharge, experts say. They recommend: Hold them at the same time and place each week and schedule an hour to an hour and a half for each meeting. Include the physician advisor for case management, a financial counselor, and representatives from case management, social work, therapy, nutrition, pharmacy, wound care, and other departments providing services to patients. Talk about the barriers and issues impeding discharge and brainstorm on solutions.

  19. Service Members' Experiences in Staying Connected With Family While Deployed.

    Science.gov (United States)

    Durham, Susan W

    2015-01-01

    The purpose of this study was to describe the communication issues experienced by service members staying connected with families while deployed. Qualitative design guided data collection using interviews with 20 key informants who had been deployed in Iraq or Afghanistan. Inductive content analysis and NVivo software enabled data analysis. From the data, 5 main themes emerged: Creating Normalcy Through Connecting With Others; Understanding the Spoken and Unspoken; Connecting and Disconnecting; Changing Sense of Self; and Sustaining a Common Bond. A collective understanding of common communication challenges emerged that had an impact on service member/family relationships, mission focus, and safety.

  20. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia

    DEFF Research Database (Denmark)

    Lunn, T H; Kristensen, B B; Gaarn-Larsen, L;

    2012-01-01

    patients operated with primary unilateral total hip or knee arthroplasty (THA or TKA) under spinal anaesthesia were included in this hypothesis-generating, prospective, observational cohort study during a 4-month period. Surgical technique, analgesia, and perioperative care were standardized. Well...

  1. [Prevalence of malnutrition in a mid-long term stay unit].

    Science.gov (United States)

    Argente Pla, María; García Malpartida, Katherine; León De Zayas, Beatriz; Martín Sanchis, Silvia; Micó García, Andrea; Del Olmo García, Maria Isabel; Moral Moral, Pedro; Moreno Muñoz, Iván; Beseler Soto, Rosario; Ramos Prol, Agustín; Merino Torres, Juan Francisco

    2014-10-06

    Introducción: La desnutrición es un problema de salud frecuente, especialmente en el ámbito hospitalario donde se asocia con estancias más prolongadas y mayor tasa de morbi-mortalidad. Por otro lado, los avances científicos actuales y la mayor expectativa de vida, han producido un aumento progresivo de unidades de media y larga estancia (UMLE). Objetivos: Determinar la prevalencia de desnutrición en una UMLE mediante el uso del MNA y la VGS, así como analizar los factores/características clínicas asociadas a la misma y sus repercusiones. Métodos: Estudio transversal, descriptivo de una cohorte formada por 201 pacientes ingresados en la UMLE de un Hospital universitario de forma consecutiva durante 12 meses. Se recogieron variables clínicas, antropométricas, bioquímicas e historia nutricional, así como escala de comorbilidad de Charlson, escala cognitiva de Pfeiffer, escala funcional de Barthel y presencia de edemas, ascitis y úlceras por presión. El estado nutricional fue evaluado en las primeras 24-72 horas de ingreso mediante el MNA y la VGS. La presencia de disfagia se evaluó mediante el cuestionario EAT-10 y el MECV-V. Resultados: La prevalencia global de desnutrición fue del 76,6%, siendo la desnutrición mixta grave la más prevalente (20.4%). Los pacientes desnutridos tenían más edad (p=0,002), mayor grado de dependencia (p.

  2. Why the United States will stay engaged in Afghanistan and Pakistan beyond 2017

    DEFF Research Database (Denmark)

    Jakobsen, Peter Viggo

    consensus is the key to sustain the US engagement in Afghanistan beyond 2017, and why a successful strategic narrative is required to create it. It provides an analytic framework specifying the requirements for success that a strategic narrative must meet in order to convince its intended audience. Part two...... proof to Congress and the American people that his strategy was working. Part three discusses the implications of these findings for sustaining the American engagement in Afghanistan beyond 2017. They suggest it possible to do so provided that the US President can craft a new strategic narrative...

  3. Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair.

    Science.gov (United States)

    Beg, Kisha A; Haq, Anwarul; Amanullah, Muneer; Laique, Sobia N; Sadqani, Saleem; Aslam, Nadeem; Rehmat, Amina Wali; Hasan, Babar S

    2015-01-01

    After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively. Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (>2 days). Odds ratios were calculated, and regression was performed. Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O(2) saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%). Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support. © 2015 Wiley Periodicals, Inc.

  4. Staying safe from hepatitis C: engaging with multiple priorities.

    Science.gov (United States)

    Harris, Magdalena; Treloar, Carla; Maher, Lisa

    2012-01-01

    Hepatitis C virus (HCV) infection is a significant global public health problem. In developed countries, 90% of new infections occur among people who inject drugs (PWID), with seroprevalence increasing rapidly among new injectors. Staying Safe is an international, qualitative, social research project, the aim of which is to draw on the experiences of long-term PWID to inform a new generation of HCV prevention strategies. The Sydney project team employed life history interviews and computer-generated timelines to elicit detailed data about unexposed participants' (n =13) injecting practices, circumstances, and social networks over time. The motivations and strategies that enabled participants to avoid risk situations, and which might have helped them to "stay safe," appeared not to be directly related to harm-reduction messages or HCV avoidance. These included the ability and inclination to maintain social and structural resources, to mainly inject alone, to manage withdrawal, and to avoid injecting-related scars. These findings point to the multiple priorities that facilitate viral avoidance among PWID and the potential efficacy of nonspecific HCV harm-reduction interventions for HCV prevention.

  5. Study on vulnerability assessment of cable-stayed bridges

    Science.gov (United States)

    Chang, C. C.; Yan, D.

    2006-03-01

    A structure is vulnerable if any small damage will trigger disproportionately large consequences, even leads to a cascade of failure events and progressive collapse. The structural vulnerability performance depends upon the properties, locations of damaged components and the way they are connected to the rest of the structure. In this paper, progressive failure analysis method is utilized for the vulnerability study of cable-stayed bridges. The goal of it is to identify various failure scenarios initiated from the sudden damage of some bridge components. Based on the analysis results, assuming that the behaviors of damaged components can be modeled using plastic hinges, the hybrid element model is introduced to derived the modified stiffness matrix considering both of the effects of bending moments and shear forces. Furthermore, the vulnerability index in terms of the nodal stiffness degradation can be analytically quantified, which could be regarded as an index to determine the bridge failure consequences, so that the vulnerability distribution graph for the whole bridge can be sketched to evaluate the bridge performances from vulnerability viewpoints. This quantitative approach is applicable for structural evaluation under unforeseen attack and illustrated on a typical long-span cable-stayed bridge.

  6. Modal analysis of cable-stayed UHPC bridge

    Directory of Open Access Journals (Sweden)

    Tej Petr

    2017-01-01

    Full Text Available This paper deals with the dynamic analysis of cable-stayed UHPC bridge over the Vltava river near town Melnik in Czech Republic, Europe. Bridge serves for pedestrians and cyclists. This work aims to familiarize the reader with dynamic calculations carried out and the results obtained, describing the dynamic properties of proposed bridge. The construction of bridge is designed as a cable-stayed structure with prestressed bridge deck consisting of prefabricated UHPC panels and reversed “V” shaped steel pylon with height of approximately 40 meters. The deck is anchored using 24 steel hangers in one row in a steel pylon - 17 ropes in the main span and 7 cables on the other side. Range of the main span is 99.18 meters and the secondary span is 31.9 m. Deck width is 4.5 meters with 3.0 meters passing space. The bridge is designed for the possibility of passage of vehicles weighting up to 3.5 tonnes. Deck panels are made of UHPC with reinforcement. At the edge of the bridge on the side of the shorter span the bridge deck is firmly connected with abutment and on the other deck it is stored using a pair of sliding bearings.

  7. Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants

    Directory of Open Access Journals (Sweden)

    Priya Singh Rangey

    2014-01-01

    Full Text Available Background. Massage therapy (MT and kangaroo mother care (KMC are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age < 37 weeks and birth weight < 2500 g were included. Those on ventilators and with congenital, orthopedic, or genetic abnormality were excluded. Outcome measures, body weight and length of hospital stay, were taken before intervention day 1 and after intervention day 5. Level of significance was 5%. Result. Data was analyzed using SPSS16. Both MT and KMC were found to be effective in improving body weight (P = 0.001, P = 0.001. Both were found to be equally effective for improving body weight (P = 0.328 and reducing length of hospital stay (P = 0.868. Conclusion. MT and KMC were found to be equally effective in improving body weight and reducing length of hospital stay. Limitation. Long term follow-up was not taken.

  8. Inappropriate Hospital Utilization for Long-stay Patients in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Herng-Chia Chiu

    2003-05-01

    Full Text Available This study examined the inappropriate utilization of hospital services under the National Health Insurance (NHI program. The study population consisted of long-stay inpatients who stayed longer than 30 days in acute care hospitals located in southern Taiwan. The study hospitals included four medical centers, six regional hospitals, and 21 district general hospitals. The survey of patients was conducted in January and May of 1996 using the Acute Care Hospital Long-stay Questionnaire developed by the research team. Excluding subjects with missing values and abnormal length of stay, 536 long-stay patients were included in the analysis. Among these, 196 patients (36.6% were classified as having an inappropriate stay, while 340 patients (63.4% had an appropriate stay. Of the long-stay patients in medical centers, 32.2% were inappropriate stays; this figure was 45.4% for regional hospitals and 43.3% for district general hospitals. There were significantly higher proportions of inappropriate long-stay patients in regional and district general hospitals than in medical centers. In conclusion, this study confirms the existence of inappropriate hospital bed days, which may be due to patient characteristics, hospital factors, and NHI payment schemes. If the NHI program can provide incentives to long-stay patients who no longer need acute care to move, patients' utilization behaviors might change and hospital discharge plans could be modified for more efficient utilization of hospital beds.

  9. Long-Term Persistency of Abnormal Heart Rate Variability following Long NICU Stay and Surgery at Birth

    Directory of Open Access Journals (Sweden)

    Mélanie Morin

    2014-01-01

    Full Text Available Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either preterm or full-term who were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°C water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Full-term subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life.

  10. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study

    Directory of Open Access Journals (Sweden)

    Pizzolorusso Gianfranco

    2011-06-01

    Full Text Available Abstract Background Organizational improvement of neonatal intensive care units requires strict monitoring of preterm infants, including routine assessment of physiological functions of the gastrointestinal system and optimized procedures for the definition of appropriate discharge timing. Methods We conducted a prospective study on the effect of osteopathic manipulative treatment in a cohort of N = 350 consecutive premature infants admitted to a neonatal intensive care unit without any major complication between 2005 and 2008. In addition to ordinary care, N = 162 subjects received osteopathic treatment. Endpoints of the study were differences between study and control groups in terms of excessive length of stay and gastrointestinal symptoms, defined as the upper quartiles in the distribution of the overall population. Statistical analysis was based on crude and adjusted odds ratios from multivariate logistic regression. Results Baseline characteristics were evenly distributed across treated/control groups, except for the rate of infants unable to be oral fed at admission, significantly higher among those undergoing osteopathic care (p = .03. Osteopathic treatment was significantly associated with a reduced risk of an average daily occurrence of gut symptoms per subject above .44 (OR = 0.45; 0.26-0.74. Gestational age lower or equal to 32 weeks, birth weight lower or equal to 1700 grams and no milk consumption at admission were associated with higher rates of length of stay in the unit of at least 28 days, while osteopathic treatment significantly reduced such risk (OR = 0.22;0.09-0.51. Conclusions In a population of premature infants, osteopathic manipulative treatment showed to reduce a high occurrence of gastrointestinal symptoms and an excessive length of stay in the NICU. Randomized control studies are needed to generalize these results to a broad population of high risk newborns.

  11. Home Stay Accommodation for Tourism Development in East Coast Economic Region

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    Md. Anowar Hossain Bhuiyan

    2012-01-01

    Full Text Available Problem statement: Home stay program provided tourists multi ethnic life condition with cultural experiences and economic well beings for the local people. Malaysian home stay program differed from the other commercial home stay in the world. Home stay accommodation can create a scope to the local communities for active participation in tourism activities. Home stay accommodation might be a potential economic activity in the East Coast Economic Region (ECER. The study examined the potentialities of home stay accommodation for tourism development in ECER. The aim of the study was to analyze the overall situations of home stay accommodation in ECER from the perception of operators. Approach: The data of this study perceived from both the primary and secondary sources. A structured questionnaire had been used for data collection. In 2006, home stay accommodation was remaining 31 villages and in the year 2008 it spreads in 38 villages of ECER. Within this period, there were 482 and 648 home stay operators in this region. The necessary requirements for home stay operations are located; basic facilities; hygiene; safety and security. Results: There were some potentialities are remaining in ECER for establishing home stay in this region. These were low charging, hospitality, motivation for young generation, women entrepreneurship, profitable investment, easy access and satisfactory income. Some initiatives such as government support, capacity building, develop facilities, appropriate act, Community involvement, loan facilities and infrastructure development might be taken for the home stay accommodations in ECER. Conclusion: Research initiatives, various services for customer satisfaction, sustainable marketing and proper policy in management had been considered for home stay development in ECER. Home stay accommodations would be ensured the economic advancement in this region as well as sustainable regional development.

  12. Prognostic value of severity by various visceral proteins in critically ill patients with SIRS during 7 days of stay.

    Science.gov (United States)

    Bouharras-El Idrissi, Hicham; Molina-López, Jorge; Herrera-Quintana, Lourdes; Domínguez-García, Álvaro; Lobo-Támer, Gabriela; Pérez-Moreno, Irene; Pérez-de la Cruz, Antonio; Planells-Del Pozo, Elena

    2016-11-29

    Critically ill patients typically develop a catabolic stress state as a result of a systemic inflammatory response (SIRS) that alters clinical-nutritional biomarkers, increasing energy demands and nutritional requirements. To evaluate the status of albumin, prealbumin and transferrin in critically ill patients and the association between these clinical-nutritional parameters with the severity during a seven day stay in intensive care unit (ICU). Multicenter, prospective, observational and analytical follow-up study. A total of 115 subjects in critical condition were included in this study. Clinical and nutritional parameters and severity were monitored at admission and at the seventh day of the ICU stay. A significant decrease in APACHE II and SOFA (p < 0.05) throughout the evolution of critically ill patients in ICU. In general, patients showed an alteration of most of the parameters analyzed. The status of albumin, prealbumin and transferrin were below reference levels both at admission and the 7th day in ICU. A high percentage of patients presented an unbalanced status of albumin (71.3%), prealbumin (84.3%) and transferrin (69.0%). At admission, 27% to 47% of patients with altered protein parameters had APACHE II above 18. The number of patients with altered protein parameters and APACHE II below 18 were significantly higher than severe ones throughout the ICU stay (p < 0.01). Regarding the multivariate analysis, low prealbumin status was the best predictor of severity critical (p < 0.05) both at admission and 7th day of the ICU stay. The results of the present study support the idea of including low prealbumin status as a severity predictor in APACHE II scale, due to the association found between severity and poor status of prealbumin.

  13. Impact of positive fluid balance on mortality and length of stay in septic shock patients

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    Wachiraporn Koonrangsesomboon

    2015-01-01

    Full Text Available Background: Fluid management is important in critically patients. The aim of this study was to determine the relationship between fluid balance and adverse outcomes of septic shock. Methods: A retrospective study was conducted in the medical Intensive Care Unit (ICU of a tertiary university hospital in Thailand, over a 7-year period. Results: A total of 1048 patients with an ICU mortality rate of 47% were enrolled. The median cumulative fluid intake at 24, 48, and 72 h from septic shock onset were 4.2, 7.7, and 10.5 L, respectively. Nonsurvivors had a significantly higher median cumulative fluid intake at 24, 48, and 72 h (4.6 vs. 3.9 L, 8.2 vs. 7.1 L, and 11.4 vs. 9.9 L, respectively, P < 0.001 for all. Nonsurvivors also had a significantly higher cumulative and mean fluid balance within 72 h (5.4 vs. 4.4 L and 2.8 vs. 1.6 L, P < 0.001 for both. In multivariate logistic regression analysis, mean fluid balance quartile within 72 h, was independently associated with an increase in ICU and hospital mortality. Quartile 3 and 4 have statistically significant increases in mortality compared with quartile 1 (odds ratio [95% confidence interval] 3.04 [1.9-4.48] and 4.16 [2.49-6.95] for ICU mortality and 2.75 [1.74-4.36] and 3.16 [1.87-5.35] for hospital mortality, respectively, P < 0.001 for all. In addition, the higher amount of mean fluid balance was associated with prolonged ICU stays. Conclusions: Positive fluid balance over 3 days is associated with increased ICU and hospital mortality along with prolonged ICU stays in septic shock patients.

  14. Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

    Science.gov (United States)

    Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

    The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

  15. Nonlinear dynamic response of stay cables under axial harmonic excitation

    Institute of Scientific and Technical Information of China (English)

    Xu XIE; He ZHAN; Zhi-cheng ZHANG

    2008-01-01

    This paper proposes a new numerical simulation method for analyzing the parametric vibration of stay cables based on the theory of nonlinear dynamic response of structures under the asynchronous support excitation.The effects of important parameters related to parametric vibration of cables,I.e., characteristics of structure,excitation frequency,excitation amplitude,damping effect of the air and the viscous damping coefficient of the cables,were investigated by using the proposed method for the cables with significant length difference as examples.The analysis results show that nonlinear finite element method is a powerful technique in analyzing the parametric vibration of cables,the behavior of parametric vibration of the two cables with different Irvine parameters has similar properties,the amplitudes of parametric vibration of cables are related to the frequency and amplitude of harmonic support excitations and the effect of distributed viscous damping on parametric vibration of the cables is very small.

  16. Physical restraint use and older patients' length of hospital stay.

    Science.gov (United States)

    Bai, Xue; Kwok, Timothy C Y; Ip, Isaac N; Woo, Jean; Chui, Maria Y P; Ho, Florence K Y

    2014-01-01

    In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.

  17. A simplified fragility analysis of fan type cable stayed bridges

    Institute of Scientific and Technical Information of China (English)

    R. A. Khan; T. K. Datta; S. Ahmad

    2005-01-01

    A simplified fragility analysis of fan type cable stayed bridges using Probabilistic Risk Analysis (PRA)procedure is presented for determining their failure probability under random ground motion. Seismic input to the bridge support is considered to be a risk consistent response spectrum which is obtained from a separate analysis. For the response analysis, the bridge deck is modeled as a beam supported on springs at different points. The stiffnesses of the springs are determined by a separate 2D static analysis of cable-tower-deck system. The analysis provides a coupled stiffness matrix for the spring system. A continuum method of analysis using dynamic stiffness is used to determine the dynamic properties of the bridges .The response of the bridge deck is obtained by the response spectrum method of analysis as applied to multidegree of freedom system which duly takes into account the quasi - static component of bridge deck vibration. The fragility analysis includes uncertainties arising due to the variation in ground motion, material property, modeling, method of analysis,ductility factor and damage concentration effect. Probability of failure of the bridge deck is determined by the First Order Second Moment (FOSM) method of reliability. A three span double plane symmetrical fan type cable stayed bridge of total span 689 m, is used as an illustrative example. The fragility curves for the bridge deck failure are obtained under a number of parametric variations. Some of the important conclusions of the study indicate that (i) not only vertical component but also the horizontal component of ground motion has considerable effect on the probability of failure; (ii) ground motion with no time lag between support excitations provides a smaller probability of failure as compared to ground motion with very large time lag between support excitation; and (iii) probability of failure may considerably increase for soft soil condition.

  18. Staying Home While Studying Abroad: Anti-Imperial Praxis for Globalizing Feminist Visions

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    Shireen Roshanravan

    2012-05-01

    Full Text Available This paper hinges on the recognition that when study-abroad opportunities are presented and perceived as a means of access to global perspectives on women and gender, they reduce the problem of US-centrism in Women's Studies to a geographic rather than an epistemic limitation. According to this logic, physical travel away from the United States can serve as an effective method for overcoming US-centrism and attending to the "global," a curricular strategy that Chandra Mohanty and M. Jacqui Alexander call "the cartographic rule of the transnational as always 'elsewhere'" (Mohanty and Alexander 2010, 33. This cartographic rule reinforces hegemonic representations of the United States as a unified "modern" white/Anglo nation against which the culturally Other terrain of the "global" becomes understandable. As such, the study-abroad approach to internationalizing US Women's Studies relies on the re-erasure of US Women of Color genealogies and epistemologies that disrupt the white/Anglo cultural assumptions grounding the field's central category of "woman/women." If challenging US-centrism in US Women's Studies is meant to dismantle the white/Anglo monocultural perspective of US imperialism, I argue that the geographic travel imperative of "study abroad" must be tempered by a re-inhabitation of the field through the radical genealogies and epistemologies of US Women of Color, a strategy I call the anti-imperial feminist praxis of "staying home."

  19. Patient origin is associated with duration of endotracheal intubation and PICU length of stay for children with status asthmaticus.

    Science.gov (United States)

    Shibata, Shinpei; Khemani, Robinder G; Markovitz, Barry

    2014-01-01

    To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). Retrospective cohort study using the Virtual PICU Performance System database (VPS, LLC) of children with status asthmaticus admitted to a participating PICU between December 2003 and September 2006. The primary outcome measure was intubation prior to intensive care unit (ICU) admission. Secondary outcomes included length of intubation and medical length of stay. Thirty-five PICUs in the United States. Children who were intubated and mechanically ventilated during their ICU stay for asthma and were admitted from an ER. A total of 4051 patients with status asthmaticus were identified. Intubation data were available from 35 of the 53 centers. Of all, 187 children were intubated for asthma, of which 157 were admitted from an ER and had complete data. Of all, 85 patients were from community hospital ERs and 72 were from the institution's own ER. In all, 115 (73%) patients were intubated prior to ICU admission and 42 (27%) patients were intubated after PICU admission. Of patients who received mechanical ventilation for status asthmaticus and were intubated prior to PICU admission, a greater proportion were intubated at community hospital ERs than in the institutions' own ERs. Eighty-five percent of the patients from community hospital ERs were intubated prior to PICU admission as opposed to 60% from institution's own ERs (P = .0004). However, median duration of intubation and PICU stay from community hospital ERs was significantly shorter than from the hospitals' own ERs (25 vs 42 hours P = .011; 57 vs 98 hours P = .0013, respectively). Logistic regression analysis revealed that after controlling for the effects of age, race, gender, and a revised version of the Paediatric Index of Mortality score of patients who were admitted for status asthmaticus and required mechanical

  20. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay.

    Science.gov (United States)

    Robinson, Bryce R H; Mueller, Eric W; Henson, Kathyrn; Branson, Richard D; Barsoum, Samuel; Tsuei, Betty J

    2008-09-01

    Analgesics and sedatives are required to maintain a calm and comfortable mechanically ventilated injured patient. Continuous sedative infusions have been shown to lengthen mechanical ventilation and hospital length of stay. Daily interruption of sedative infusions may reduce both of these variables. Implementation of an Analgesia-Delirium-Sedation (ADS) Protocol using objective assessments with a goal of maintaining an awake and comfortable patient may obviate the need for daily interruption of infusions in critically ill trauma patients. We examined the effects of such a protocol on ventilator duration, intensive care unit (ICU) length of stay, hospital slength of stay, and medication requirements. A multidisciplinary team designed the protocol. Objective measures of pain (visual/objective pain assessment scale-VAS/OPAS), agitation (Richmond Agitation-Sedation Scale-RASS), and delirium [Confusion Assessment Method {CAM-ICU}] were used. Medications were titrated to a RASS of -1 to +1 and VAS/OPAS CAM-ICU positive patients. Retrospective review of the local Project IMPACT database for a 6-month period in 2004 was compared with the same seasonal period in 2006 in which the ADS protocol was used. All mechanically ventilated trauma patients receiving infusions of narcotic, propofol, or benzodiazepine were included. Age, APACHE II score, Injury Severity Score, ventilator days, ventilator-free days at day 28, ICU length of stay, and hospital length of stay are reported as median values (interquartile range). Medication usage is reported as mean values (+/-SD). Differences in data were analyzed using Wilcoxon's rank-sum test or t test, as appropriate. Gender, mortality, and mechanism of injury were analyzed using chi analysis. A total of 143 patients were included. Patients who died during their hospitalization were excluded except in the analysis of ventilator-free days at day 28. After exclusions, 61 patients were in the control group and 58 in the protocol group. The

  1. Determinants of Length of Stay in Surgical Ward after Coronary Bypass Surgery: Glycosylated Hemoglobin as a Predictor in All Patients, Diabetic or Non-Diabetic

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    Mahdi Najafi

    2015-10-01

    Full Text Available Background: Reports on the determinants of morbidity in coronary artery bypass graft surgery (CABG have focused on outcome measures such as length of postoperative stay in the Intensive Care Unit (ICU. We proposed that major comorbidities in the ICU hampered the prognostic effect of other weaker but important preventable risk factors with effect on patients’ length of hospitalization. So we aimed at evaluating postoperative length of stay in the ICU and surgical ward separately.Methods: We studied isolated CABG candidates who were not dialysis dependent. Preoperative, operative, and postoperative variables as well as all classic risk factors of coronary artery disease were recorded. Using multivariate analysis, we determined the independent predictors of length of stay in the ICU and in the surgical ward.Results: Independent predictors of extended length of stay in the surgical ward ( > 3 days were a history of peripheral vascular disease, total administered insulin during a 24-hour period after surgery, glycosylated hemoglobin (HbA1c, last fasting blood sugar of the patients before surgery, and inotropic usage after cardiopulmonary bypass. The area under the Receiver Operating Characteristic Curve (AUC was found to be 0.71 and Hosmer-Lemeshow (HL goodness of fit statistic p value was 0.88. Independent predictors of extended length of stay in the ICU ( > 48 hours were surgeon category, New York Heart Association functional class, intra-aortic balloon pump, postoperative arrhythmias, total administered insulin during a 24-hour period after surgery, and mean base excess of the first 6 postoperative hours (AUC = 0.70, HL p value = 0.94 .Conclusion: This study revealed that the indices of glycemic control were the most important predictors of length of stay in the ward after cardiac surgery in all patients, diabetic or non-diabetic. However, because HbA1c level did not change under the influence of perioperative events, it could be deemed a

  2. The Role of Home Stay for Ecotourism Development in East Coast Economic Region

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    Md. Anowar H. Bhuiyan

    2011-01-01

    Full Text Available Problem statement: This study provided a brief discussion of home stay for ecotourism development in ECER. Home stay is a potential economic activity in tourism sector. The East Coast Economic Region (ECER has numerous ecotourism resources including hills, mountains, lakes, waterways, state and national parks, recreational forest parks and forest reserves. Home stay should emphasize on the cultural practices as well as to create a genuine interest and commitment among the local people in the region. This study focused the potentialities of home stay for ecotourism development in ECER. The study also discussed the short comings and necessary actions for developing home stay activities in this region. Approach: The data for analysis was perceived from the secondary sources. The significant manipulations for acquired data were home stay accommodation on ECER. Results: There are some potential factors were remaining in the ECER for establishing home stays-ecotourism resources and biodiversity, infrastructure development, integrated approach, present the cultural performance, limited environmental and social impact, commercial interest and investment and opportunities for local entrepreneurs. Weaknesses also remain in ECER for home stays development, these are low standard of accommodation, unacceptable bathroom and toilet facilities, identity for each Home stay, lack of hospitality experience, marketing problem and lack of campaign. There are some challenges such as brand image issues, meeting international standards, training facilities, marketing and promotion, poverty alleviation must be consider for home stay development in ECER. Conclusion: The study revealed that home stays operation could be create alternative accommodation opportunities in ECER. With proper planning and implementation, operational regulation and management, appropriate development and financial allocation in home stay operation would be ensuring sustainable ecotourism

  3. The long-term outcomes and unmet needs of a cohort of former long-stay patients in Melbourne, Australia.

    Science.gov (United States)

    Chopra, Prem; Herrman, Helen E

    2011-10-01

    Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent's Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients.

  4. The United States and VIetnam: 1787 - 1941

    Science.gov (United States)

    1990-01-01

    almost totally unproductive ceremony and haggling with the Cochinchinese authorities. During his stay there, White developed an appreciation of the...British and French involvement with the warring sides in the United States and with French adventures in Mexico , not with events in far-off

  5. Beverage can stay-tabs: still a source for inadvertently ingested foreign bodies in children

    Energy Technology Data Exchange (ETDEWEB)

    Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); University of Cincinnati, College of Medicine, Departments of Radiology and Pediatrics, Cincinnati, OH (United States)

    2010-09-15

    In the 1970s in part to avoid inadvertent ingestion, the beverage-can industry changed can construction from pull-tabs to the stay-tabs (remain attached to can after opening) used today. Our purpose is to identify the number of inadvertent ingestions of beverage-can stay-tabs by children recognized at our institution. The medical information system of a children's hospital was searched with key terms to identify cases in which a witnessed or self-reported inadvertent ingestion of a beverage-can stay-tab resulted in a radiograph to rule out presence of a foreign body. Demographics, identification of stay-tab on radiographs, associated abnormalities, and patient management were reviewed. Nineteen cases of stay-tab ingestion were identified over 16 years. Mean age of ingesters was 8.5 years with the majority being teenagers and 15 (79%) >5 years of age. The stay-tab could be seen radiographically only in 4 (21%) cases - all with the stay-tab identified in the stomach. The identification of 19 children who inadvertently ingested beverage-can stay-tabs at a single children's hospital suggests that such ingestions still occur. Radiologists should be aware that stay-tabs are radiographically visible in the minority (21%) of cases. (orig.)

  6. Family Dynamics of the Stay-at-Home Father and Working Mother Relationship.

    Science.gov (United States)

    Rushing, Cassie; Powell, Lisa

    2015-09-01

    A phenomenological qualitative study was utilized to explore family dynamics in stay-at-home father and working mother households. A total of 20 working mothers were asked to describe family interactions and daily routines with regard to their stay-at-home father and working mother dynamic. All participants were married, heterosexual women with biological children ages 1 to 4 and who worked outside the home and the father stayed home as primary caretaker and did not contribute financially. The study indicated that the family dynamic of a working mother and stay-at-home father provided a positive parent-child relationship, enhanced parenting cohesion, and enhanced quality time.

  7. Length of Stay and Tourism Facility Assessment: The Viewpoint of Malaysian Tourists at Langkawi

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    Jaafar Mastura

    2014-01-01

    Full Text Available This investigation employed partial least square analysis to scrutinize factors influencing the social perceptions of Malaysian tourists of tourism facilities at an island tourism destination. It focuses on the effect of one particular socio-demographic variable, length of stay, on consumer satisfaction. Data was collected from a major tourism destination at Langkawi, Malaysia. The results indicate that length of stay has an effect on tourists’ social perceptions and contributes to their dissatisfaction with the destination. Tourists who stayed more than 10 days were less satisfaction than those who stayed for less than 10 days. The implications of this finding and recommendations for further study are discussed as well.

  8. Appropriateness of admission and stay in obstetrics wards: a new tool assessing unnecessary days of hospital care

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    Giuseppina Poppa

    2009-12-01

    Full Text Available

    Introduction: The Appropriateness Evaluation Protocol (AEP is a widely used assessment tool that identifies and measures the inappropriateness variables of hospital healthcare related to unjustified admission and/or length of stay, however it does not apply specifically to gynaecology or obstetrics wards. Objectives of the study: The main objectives of the present study were to develop a new tool for the evaluation of the appropriateness of admission and hospital stay in obstetric settings; as well as to analyze the main determinants of inappropriate admission and days of hospital stay within all the units of the Pediatric Hospital “Regina Margherita” and the Obstetrics and Gynaecology Teaching Hospital “S.Anna” in Turin.

    Methods: A multidisciplinary team of reviewers, composed of gynaecologists, paediatricians and obstetricians, was established and the appropriateness evaluation criteria, the operational handbook and the plan were all defined. Data were collected during the period between September and December 2005 and then put in an ad hoc database. Data analysis and evaluation were performed by univariate analysis (chisquare test and multivariate analysis using a multiple logistic regression model. The level of significance was set at p<0.05.

    Results: Out of 734 clinical records, 598 were considered for the study. The prevalence of inappropriateness of admission was 3.34%. The total number of examined days was 2888, 801 of which (27.74% were considered to be inappropriate. The variables “place of residence” (÷²=6.272; p=0.0435 and “type of admission” (÷²=14.223; p<0.001 were significantly associated with the inappropriateness of the admission. Between the 2nd and the 8th day of hospital stay the percentage of inappropriate days exponentially increased (up to 56%. With regards to the quality of the clinical records almost all of them were characterized by

  9. Comparison of the Results of Cox Proportional Hazards Model and Parametric Models in the Study of Length of Stay in A Tertiary Teaching Hospital in Tehran, Iran

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    Ali Zare

    2011-10-01

    Full Text Available Survival analysis is a set of methods used for analysis of the data which exist until the occurrence of an event. This study aimed to compare the results of the use of the semi-parametric Cox model with parametric models to determine the factors influencing the length of stay of patients in the inpatient units of Women Hospital in Tehran, Iran. In this historical cohort study all 3421 charts of the patients admitted to Obstetrics, Surgery and Oncology units in 2008 were reviewed and the required patient data such as medical insurance coverage types, admission months, days and times, inpatient units, final diagnoses, the number of diagnostic tests, admission types were collected. The patient length of stay in hospitals leading to recoverys was considered as a survival variable. To compare the semi-parametric Cox model and parametric (including exponential, Weibull, Gompertz, log-normal, log-logistic and gamma models and find the best model fitted to studied data, Akaike's Information Criterion (AIC and Cox-Snell residual were used. P<0.05 was considered as statistically significant. AIC and Cox-Snell residual graph showed that the gamma model had the lowest AIC (4288.598 and the closest graph to the bisector. The results of the gamma model showed that factors affecting the patient length of stay were admission day, inpatient unit, related physician specialty, emergent admission, final diagnosis and the number of laboratory tests, radiographies and sonographies (P<0.05. The results showed that the gamma model provided a better fit to the studied data than the Cox proportional hazards model. Therefore, it is better for researchers of healthcare field to consider this model in their researches about the patient length of stay (LOS if the assumption of proportional hazards is not fulfilled.

  10. Caráter stay-green e produtividade de grãos em trigo Stay-green trait and wheat grain yield

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    José Antonio Gonzales da Silva

    2008-01-01

    Full Text Available O caráter stay-green é um dos fatores que poderá auxiliar o melhorista na obtenção de plantas mais produtivas, devido à permanência verde por um período mais prolongado favorecendo o enchimento de grãos. Desta forma, o objetivo do trabalho foi o de avaliar o desempenho de diferentes constituições genéticas de trigo com e sem a presença do caráter stay-green e verificar se a expressão de alelos que intensificam a coloração verde por um período mais prolongado, os quais auxiliam no incremento da produtividade de grãos. O trabalho foi desenvolvido em campo experimental com delineamento de blocos casualizados com três repetições, em dois anos de cultivo. A presença de constituições genéticas superiores facilita os benefícios expressos pelo caráter stay-green na produtividade de grãos. O caráter stay-green proporciona estabilidade na produtividade de grãos sob efeito de diferentes ambientes.The stay-green trait is one of the factors that can aid the breeder in obtaining higher yielding plants due to a delay in leaf senescence, favouring grain filling. The objective of this study was to evaluate the performance of different wheat lines with and without the stay-green trait and investigate if longer green period; foster an increment of grain yield. The field experiment was conducted in randomized complete block design with three replications in two crop years. Genetically superior lines facilitate the benefits of the stay-green trait for grain yield. The stay-green trait promotes yield stability under different environments.

  11. Get noticed and stay relevant to web users!

    Directory of Open Access Journals (Sweden)

    Tania Grove

    2004-12-01

    Full Text Available The study is based on the question why people visit some websites numerous times and other web sites only once. The problem for companies that decide to make use of the web as a marketing tool is not just how to get connected to the web, but getting noticed and staying relevant to its clients and potential clients. The main objective of this study was thus to investigate what influence people to return to a web site and what are their requirements from web sites. These answers will show how companies can ensure that people notice their websites, how they can be influenced to connect to their web sites and how these companies can retain the people connecting to their web sites as customers with diverse needs. This information will enable companies to develop and customise applicable strategies for their web sites to satisfy the needs of their target markets. The analysis of the responses showed that most of the respondents are not using the web to purchase items; that customer preferences vary and that the web is more effective than traditional media on certain variables.

  12. Factors affecting length of stay following colonic resection.

    Science.gov (United States)

    Schmelzer, Thomas M; Mostafa, Gamal; Lincourt, Amy E; Camp, Steven M; Kercher, Kent W; Kuwada, Timothy S; Heniford, B Todd

    2008-05-15

    In-hospital length of stay (LOS) has become a valuable measure of outcomes following any operation, which also directly impacts cost. The aim of this study was to identify the factors that affect LOS after colonic resection. A retrospective analysis was performed of adult patients who underwent colonic resection over an 8-y period at a tertiary institution. Data collected included demographics, American Society of Anesthesiologists (ASA) score, preoperative comorbidities and medications, operative management, postoperative morbidity and mortality, and LOS. Statistical analysis included descriptive statistics and multiple logistic regression to identify variables predictive of prolonged LOS. A total of 899 consecutive patients were identified. One hundred eighty-seven resections were performed urgently, and 712 were elective. Two-hundred forty-five cases were performed laparoscopically. Complications occurred in 205 cases (23%), and there were 32 deaths (4%). The median LOS was 7 d. Logistic analysis showed 15 variables to be predictive of prolonged LOS. These included advanced age, warfarin sodium use, ASA score >or=3, alcoholism, chronic obstructive pulmonary disease, end-stage renal disease, illicit drug use, total colectomy (versus segmental), open resections (versus laparoscopic), and postoperative complications. In addition, the presence of at least one postoperative complication was predictive of prolonged LOS (P = 0.0002, OR 2.4 95% CI 1.5-3.8). ASA score and the incidence of postoperative complications are the only significant categories of variables that predict prolonged LOS after colectomy. Laparoscopic approach and the extent of the resection are predictive as well.

  13. Re-Educating Jet-Engine-Researchers to Stay Relevant

    Science.gov (United States)

    Gal-Or, Benjamin

    2016-06-01

    To stay relevantly supported, jet-engine researchers, designers and operators should follow changing uses of small and large jet engines, especially those anticipated to be used by/in the next generation, JET-ENGINE-STEERED ("JES") fleets of jet drones but fewer, JES-Stealth-Fighter/Strike Aircraft. In addition, some diminishing returns from isolated, non-integrating, jet-engine component studies, vs. relevant, supersonic, shock waves control in fluidic-JES-side-effects on compressor stall dynamics within Integrated Propulsion Flight Control ("IPFC"), and/or mechanical JES, constitute key relevant methods that currently move to China, India, South Korea and Japan. The central roles of the jet engine as primary or backup flight controller also constitute key relevant issues, especially under post stall conditions involving induced engine-stress while participating in crash prevention or minimal path-time maneuvers to target. And when proper instructors are absent, self-study of the JES-STVS REVOLUTION is an updating must, where STVS stands for wing-engine-airframe-integrated, embedded stealthy-jet-engine-inlets, restructured engines inside Stealth, Tailless, canard-less, Thrust Vectoring IFPC Systems. Anti-terror and Airliners Super-Flight-Safety are anticipated to overcome US legislation red-tape that obstructs JES-add-on-emergency-kits-use.

  14. Length of stay in surgical patients: nutritional predictive parameters revisited.

    Science.gov (United States)

    Almeida, Ana Isabel; Correia, Marta; Camilo, Maria; Ravasco, Paula

    2013-01-28

    Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentiles v. the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (PMAC) or a mid-arm muscle circumference (MAMA) under the 15th and the 50th percentile, which was considered indicative of undernutrition, did predict longer LOS (PMAC+MAMA (n 158, 53 %) had longer LOS than patients with a TSF+MAC+MAMA positive variation (11 (8-15) v. 8 (7-12) d, PMAC and MAMA measurements and their classification according to the 50th percentile threshold seem reliable undernutrition indicators.

  15. Does Limiting Oral Contrast Decrease Emergency Department Length of Stay?

    Directory of Open Access Journals (Sweden)

    Erik Barton

    2012-12-01

    Full Text Available Introduction: The purpose of this study was to examine the impact on emergency department (EDlength of stay (LOS of a new protocol for intravenous (IV-contrast only abdominal/pelvic computedtomography (ABCT compared to historical controls.Methods: This was a retrospective case-controlled study performed at a single academic medicalcenter. Patients ≥ 18 undergoing ABCT imaging for non-traumatic abdominal pain were included inthe study. We compared ED LOS between historical controls undergoing ABCT imaging with PO/IVcontrast and study patients undergoing an IV-contrast-only protocol. Imaging indications were thesame for both groups and included patients with clinical suspicion for appendicitis, diverticulitis, smallbowel obstruction, or perforation. We identified all patients from the hospital’s electronic storehouse(imaging code, ordering department, imaging times, and we abstracted ED LOS and dispositionfrom electronic medical records.Results: Two hundred and eleven patients who underwent PO/IV ABCT prep were compared to 184patients undergoing IV-contrast only ABCT prep. ED LOS was shorter for patients imaged with theIV-contrast only protocol (4:35 hrs vs. 6:39 hrs, p < 0.0001.Conclusion: Implementation of an IV-contrast only ABCT prep for select ED patients presentingfor evaluation of acute abdominal pain significantly decreased ED LOS.

  16. Damage Detection for Long-Span Cable-Stayed Bridge

    Institute of Scientific and Technical Information of China (English)

    Zhao Ling; Li Aiqun; Miao Changqing; Wang Yonglan

    2006-01-01

    Based on the updated finite-element model of a cable-stayed bridge, this study investigates the technique of identifying damage existing in cable or girder by means of numerical simulation. The modal analysis is performed to identify the changes in modal frequencies and curvatures caused by damage, and the static analysis is executed to detect the influence of damage on cable force. The results indicate a relatively significant decrease in frequencies of lower vertical bending modes due to the damage in cable and little change of frequencies due to damage in girder. Different sensitivities to the location of damaged cable are observed from the frequency changes of different bending modes, which can be used to initially locate the damaged cable. The damage in either cable or girder can be further localized by the most significant change in curvature of girder. The damage occurred in a cable produces a remarkable change in force of nearby cables, whereas the damage in girder brings little change of cable forces. In addition, a pragmatic approach for localizing the damage in girder or cable is proposed based on a comprehensive utilization of the changes in frequency of vertical bending modes, modal curvature of girder, and force in cables.

  17. Staying theoretically sensitive when conducting grounded theory research.

    Science.gov (United States)

    Reay, Gudrun; Bouchal, Shelley Raffin; A Rankin, James

    2016-09-01

    Background Grounded theory (GT) is founded on the premise that underlying social patterns can be discovered and conceptualised into theories. The method and need for theoretical sensitivity are best understood in the historical context in which GT was developed. Theoretical sensitivity entails entering the field with no preconceptions, so as to remain open to the data and the emerging theory. Investigators also read literature from other fields to understand various ways to construct theories. Aim To explore the concept of theoretical sensitivity from a classical GT perspective, and discuss the ontological and epistemological foundations of GT. Discussion Difficulties in remaining theoretically sensitive throughout research are discussed and illustrated with examples. Emergence - the idea that theory and substance will emerge from the process of comparing data - and staying open to the data are emphasised. Conclusion Understanding theoretical sensitivity as an underlying guiding principle of GT helps the researcher make sense of important concepts, such as delaying the literature review, emergence and the constant comparative method (simultaneous collection, coding and analysis of data). Implications for practice Theoretical sensitivity and adherence to the GT research method allow researchers to discover theories that can bridge the gap between theory and practice.

  18. 9136例PACU患者术后并发症的发生原因及分析%Causes of Postoperative Complications of 9 136 Patients in the Post-anaesthesia Care Unit

    Institute of Scientific and Technical Information of China (English)

    兰培丽; 裴凌

    2011-01-01

    Objective To analyze the causes and incidences of complications in the post-anaesthesia care unit (PACU) and their correlations to the preventive treatments. Methods From January 2007 to December 2009,9 136 patients were selected to observe variable complications and their incidences as well as the treatments and prognoses. The causes were analyzed so as to estimate the correlation to the prophylactic factors. Results The incidences of different complications were variable. The total incidence was 9.8%(307/9,136).The retention time in PACU ranged from 15 minutes to 7 hours. Most of the patients went to ward or ICU safely after tracheal extubation while part of them went to ICU with endotracheal tube. The most common complications were hypertention,arrythmia,hypotention,postoperative nausea and vomitting( PONV ), restlessness,low degree of blood oxygen saturation, respiratory inhibition and abnormal body temperature (hyperthermia or hypothermia). Conclusion Senile (over 80 years old),ASA graded Ⅰ to Ⅲ ,preoperative coexisted dieases,poor preoperative estimation caused by man-made factors,thrombolysis in the bedridden patients,obesity,overdose or unindividualization of anesthetics in induction and maintainance period,alveolar hypoventilation and hypothermia were correlated to the retention time in PACU and complications in recovery period. It's very important to emphasize the preoperative visiting and assessment,strengthen intraoperative management,and improve postoperative monitoring and treatnent in PACU.%目的 分析麻醉后恢复室(PACU)患者术后并发症的发生原因及预防处理措施的相关性,进一步明确PACU的重要意义.方法 选择2007年1月至2009年12月PACU患者9 136例,观察各种并发症的发生率及其处理和预后,分析原因并探讨其与预防因素的相关性.结果 9 136例PACU患者中发生术后并发症者895例(9.8%.PACU停留时间为15 min~7 h不等.大部分患者清醒并达到气管拔管指征后

  19. 78 FR 10554 - Interim Final Determination To Stay and Defer Sanctions, Sacramento Metropolitan Air Quality...

    Science.gov (United States)

    2013-02-14

    ... AGENCY 40 CFR Part 52 Interim Final Determination To Stay and Defer Sanctions, Sacramento Metropolitan Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION: Interim final rule. SUMMARY: EPA is making an interim final determination to stay the imposition of offset...

  20. 78 FR 53038 - Interim Final Determination to Stay and Defer Sanctions; California; San Joaquin Valley

    Science.gov (United States)

    2013-08-28

    ... AGENCY 40 CFR Part 52 Interim Final Determination to Stay and Defer Sanctions; California; San Joaquin Valley AGENCY: U.S. Environmental Protection Agency (EPA). ACTION: Interim final rule. SUMMARY: EPA is making an interim final determination to stay the imposition of offset sanctions and to defer...

  1. Research on Collapse Process of Cable-Stayed Bridges under Strong Seismic Excitations

    Directory of Open Access Journals (Sweden)

    Xuewei Wang

    2017-01-01

    Full Text Available In order to present the collapse process and failure mechanism of long-span cable-stayed bridges under strong seismic excitations, a rail-cum-road steel truss cable-stayed bridge was selected as engineering background, the collapse failure numerical model of the cable-stayed bridge was established based on the explicit dynamic finite element method (FEM, and the whole collapse process of the cable-stayed bridge was analyzed and studied with three different seismic waves acted in the horizontal longitudinal direction, respectively. It can be found from the numerical simulation analysis that the whole collapse failure process and failure modes of the cable-stayed bridge under three different seismic waves are similar. Furthermore, the piers and the main pylons are critical components contributing to the collapse of the cable-stayed bridge structure. However, the cables and the main girder are damaged owing to the failure of piers and main pylons during the whole structure collapse process, so the failure of cable and main girder components is not the main reason for the collapse of cable-stayed bridge. The analysis results can provide theoretical basis for collapse resistance design and the determination of critical damage components of long-span highway and railway cable-stayed bridges in the research of seismic vulnerability analysis.

  2. Length of stay in asylum centres and mental health in asylum seekers

    DEFF Research Database (Denmark)

    Hallas, Peter; Hansen, Anne R; Staehr, Mia A

    2007-01-01

    BACKGROUND: The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic...

  3. Staying at work with chronic nonspecific musculoskeletal pain : a qualitative study of workers' experiences

    NARCIS (Netherlands)

    de Vries, Haitze J.; Brouwer, Sandra; Groothoff, Johan W.; Geertzen, Jan H. B.; Reneman, Michiel F.

    2011-01-01

    Background: Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study

  4. Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy

    Science.gov (United States)

    Ko-iam, Wasana; Sandhu, Trichak; Paiboonworachat, Sahattaya; Pongchairerks, Paisal; Chotirosniramit, Anon; Chotirosniramit, Narain; Chandacham, Kamtone; Jirapongcharoenlap, Tidarat

    2017-01-01

    Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors. PMID:28239497

  5. 49 CFR 40.393 - How long does a PIE stay in effect?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false How long does a PIE stay in effect? 40.393 Section... WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.393 How long does a PIE stay in effect? (a) In the NOPE (see § 40.375(b)(5)), the initiating official proposes the duration of the...

  6. Excess length of stay and economic consequences of adverse events in Dutch hospital patients.

    NARCIS (Netherlands)

    Hoogervorst-Schilp, J.; Langelaan, M.; Spreeuwenberg, P.; Bruijne, M.C. de; Wagner, C.

    2015-01-01

    Background: To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Methods: Data of a large retrospective patient recor

  7. Preliminary design and parametric study of 1400 m partially earth-anchored cable-stayed bridge

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    The preliminary design and parametric study of 1400 m partially earth-anchored cable-stayed bridge are described. Static per-formance of this new type of bridge is discussed. Compared with fully self-anchored cable-stayed bridge, its advantages in fin-ished state are summarized. Based on numerical calculation, effects of several structural parameters on static performance are presented.

  8. Optimization of Dead Load State in Earth-Anchored Cable-Stayed Bridges

    Institute of Scientific and Technical Information of China (English)

    Bin Sun∗; Rucheng Xiao

    2015-01-01

    In order to determine the reasonable completed dead load state in earth⁃anchored cable⁃stayed bridges, a practical method is proposed. The method is based on the rigidly supported continuous beam method and the feasible zone method, emphasizing on the mutual effect between the self⁃anchored structural parts and the earth⁃anchored ones. Three cable⁃stayed bridge models are designed with the main spans of 1 400 m, including a partially earth⁃anchored cable⁃stayed bridge, a cable⁃stayed⁃suspension bridge and a fully self⁃anchored cable⁃stayed bridge, in which the C50 concrete and Q345 steel are adopted. The partially earth⁃anchored cable⁃stayed bridge and the cable⁃stayed⁃suspension bridge secure lower compressive force in the girder than the fully self⁃anchored cable⁃stayed bridge by 25 percent at least. The same is for the material consumption of the whole bridge. Furthermore, the anchor volume is more than 20% lower in the partially earth⁃anchored cable⁃stayed bridge than that in the cable⁃stayed⁃suspension bridge. Consequently, the practical span of cable⁃stayed bridges can be accordingly extended.

  9. How can you resist? Executive control helps romantically involved individuals to stay faithful

    NARCIS (Netherlands)

    Pronk, T.M.; Karremans, J.C.T.M.; Wigboldus, D.H.J.

    2011-01-01

    In the present research, we examined why some people have more difficulty than others in staying faithful to their romantic partners. Three studies supported our main prediction that executive control is associated with romantically involved individuals' ability to stay faithful. Study 1 showed that

  10. Predictors of length of hospital stay after acute myocardial infarction in Japan.

    Science.gov (United States)

    Kinjo, Kunihiro; Sato, Hiroshi; Nakatani, Daisaku; Mizuno, Hiroya; Shimizu, Masahiko; Hishida, Eiji; Ezumi, Akira; Hoshida, Shiro; Koretsune, Yukihiro; Hori, Masatsugu

    2004-09-01

    In Western countries, the length of hospital stay after acute myocardial infarction (AMI) has decreased dramatically during the past 3 decades and is now approximately 1 week. However, epidemiological data concerning the length of hospital stay, its predictors and trends based on a large-scale sample are still limited in Japan. The study group comprised 4,113 surviving AMI patients who were enrolled in the Osaka Acute Coronary Insufficiency Study from April 1998 to March 2003. The mean length of hospital stay was 31.2 days. Clinical factors (patient characteristics, severity of infarction, therapy, and in-hospital complications) only explained 26% of the variation in hospital stay. The mean hospital stay was significantly longer in 1998 than in 2002. In 2002, occupational status and admission to a high-volume hospital were independent predictors of a shorter hospital stay, but this association was not observed in 1998. The hospital stay is still extremely long in Japan and clinical factors do not provide an explanation. The findings of the present study suggest that the hospital stay could be reduced in some patients with AMI, but randomized studies are needed to examine the feasibility of early discharge.

  11. Variation in duration of hospital stay between hospitals and between doctors within hospitals

    NARCIS (Netherlands)

    Westert, Gert P.; Nieboer, Anna P.; Groenewegen, Peter P.

    1993-01-01

    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign

  12. Variation in duration in hospital stay between hospitals and between doctors within hospitals.

    NARCIS (Netherlands)

    Westert, G.P.; Nieboer, A.P.; Groenewegen, P.P.

    1993-01-01

    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign

  13. VARIATION IN DURATION OF HOSPITAL STAY BETWEEN HOSPITALS AND BETWEEN DOCTORS WITHIN HOSPITALS

    NARCIS (Netherlands)

    WESTERT, GP; NIEBOER, AP; GROENEWEGEN, PP

    1993-01-01

    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign

  14. 75 FR 68305 - Proposed Rule Staying Numeric Limitation for the Construction and Development Point Source Category

    Science.gov (United States)

    2010-11-05

    ... regulated by this action, you should carefully examine the applicability criteria in 40 CFR 450.10 (74 FR... AGENCY 40 CFR Part 450 Proposed Rule Staying Numeric Limitation for the Construction and Development... is proposing to stay the numeric effluent limitation of 280 NTU and associated...

  15. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Pei-Fang (Jennifer Tsai

    2016-01-01

    Full Text Available For hospitals’ admission management, the ability to predict length of stay (LOS as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS, heart failure (HF, and acute myocardial infarction (AMI in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed.

  16. [A study on tuberculosis cases among over-staying foreigners].

    Science.gov (United States)

    Yamamura, J; Sawada, T

    2000-02-01

    An analysis was made on eighty-four cases of tuberculosis (TB) among over-staying foreigners during the past 9 years at Minatomachi Medical Center. All of them did not enroll in any health insurance system because they were illegal immigrants. Most of them were in their twenties and thirties. The ratio of male to female was four to one. By ethnic origin, the proportion was highest among Filipinos (30%), followed by Koreans (23%), Pakistanis (13%) and Indians (7%). Half of them had been in Japan for more than two years. Most patients sought care due to symptoms rather than as a result of the efforts of public health centers to screen foreigners. The proportion of extrapulmonary TB among all types of TB was 35% overall. Compared with pulmonary TB cases, patient's as well as doctor's delay was more marked among extrapulmonary TB cases. Forty cases were treated at Minatomachi Medical Center and forty-four cases were referred to another hospitals. The default rate including repatriation was as high as 41%, and the reasons for this high defaulting rate were as follows: 1. Language barrier, 2. Worry for loosing work during treatment, 3. Worry for high medical costs because of no coverage by a health insurance scheme, 4. Lack of information on medical systems and TB, 5. Worry for forced repatriation by the immigration office. In addition, some cases were not followed up due to unkind behaviour of attending physicians. The following measures are needed to prevent the epidemic of tuberculosis among overstaying foreigners and our societies. a) To provide free medical check-ups b) To provide easy access to medical facilities c) To utilize the tuberculosis prevention law d) To follow up patient thoroughly and strictly e) To explain TB in their mother languages f) To change the immigration law and its system g) To make liaison with other organizations such as medical facilities and NGOs, including foreign ones, and exchange informations h) To build good human relations with

  17. Lead--the toxic metal to stay with human.

    Science.gov (United States)

    Srianujata, S

    1998-07-01

    Lead has been known to be toxic to most living things at high dose. It is found naturally in earth and present in almost all parts of the environment, such as foods, air, water, dust, soil, paint, and tissues of living organisms including human. This metal is being used in various aspects including the manufacturing of storage batteries, production of chemicals, paints and gasoline additives. It is also used to make various metal products, e.g. sheet lead, solder, and pipes. Human exposure to lead is mainly from foods and other environments. However, it is expected that exposure to environmental lead is normally excessive and produces toxic effects. The well-known and excessive environmental exposures are air of industrial and heavy traffic areas. Use of leaded gasoline has caused the main lead pollution for years in almost every big city. Therefore, city inhabitants normally exposed to lead much more than those who live in the rural area. The most vulnerable groups at risk to lead exposure are fetuses and preschool age children. Young children in the 2-3 year-old age may be the most at risk for exposure to contaminated soil. Adults are affected when exposure is excessive in the working place and causing lead poisoning. Toxicities are mainly on heme biosynthesis, neurological effects including encepharopathy, peripheral neuropathy, and most importantly on I.Q. deficits. It also affects renal tissues to produce acute and chronic nephropathy and elevated blood pressure. There are studies of lead exposure of various means and the effects on human health, both in children and adults. Lead in environment and human exposure are expected to stay with us for long to come, due the still required lead use in many fields, particularly the use of lead in storage batteries and others. The magnitude of exposure will depend solely on the control of use by not allowing the contamination of lead in our environment to be excessive.

  18. Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

    Energy Technology Data Exchange (ETDEWEB)

    Weerasooriya, H.R. [Royal Perth Hospital, WA (Australia); Harris, A.H. [Monash Univ., Clayton, VIC (Australia); Davis, M.J.E. [Western Australia Univ., Nedlands, WA (Australia)

    1996-04-01

    It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative. The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety. This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent impatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing. The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation. 16 refs., 2 tabs.

  19. Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach.

    Science.gov (United States)

    Leung, K M; Elashoff, R M; Rees, K S; Hasan, M M; Legorreta, A P

    1998-03-01

    The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay. California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals. Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix. Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach.

  20. Research development of digital maintenance and management system for long-span cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    REN Yuan; HUANG Qiao; SUN Yong-ming

    2009-01-01

    Digital cable-stayed bridge maintenance and management system (DCBMS) was developed for the need of maintenance and management of long-span cable-stayed bridges. In this paper, the major functions and theoretical application of eight modules were systematically stated with the background of Harbin Songhua River cable-stayed bridge, which include data management module, inspection and measurement module, assessment module, finite element analysis module, disease diagnosis and prediction module, maintenance module, query module and help module. By analyzing and calculating the data from manual inspection database, basic database and health monitoring subsystem, DCBMS can accomplish the functions like life prediction, disease diagnosis, comprehensive assessment, maintenance and management of bridges. Therefore, the maintenance and management of long-span cable-stayed bridges can be made digital, professional and scientific. By running this system, a real-time and specific technical guidance can be provided for the maintainers and managers of longspan cable-stayed bridges.

  1. Sustainable Systems for exploration, stays with increased duration in LEO and Earth application -an overview about life support activities

    Science.gov (United States)

    Slenzka, Klaus; Duenne, Matthias

    Solar system exploration with extended stays in totally closed habitats far away from Earth as well as longer stays in LEO requires intensive preparatory activities. Activities supporting life in a more or less close meaning are essential in this context -on a scientific as well as on a technical level. These needed activities are supporting life by e.g.: i) increasing knowledge about the impact of single and combined effects of different exploration related environmental conditions (e. g. microgravity, radiation, reduced pressure and temperature, lunar soil etc.) on biological systems. This is needed to enable safe life of humans itself as well as safe operating of required bioregenerative life support systems. Thus, different human cell types as well as representatives of bioregenerative life support system protagonists (algae, bacteria as well as higher organisms) needs to be addressed. ii) provision of required consumables (oxygen, food, energy equivalents etc.) on site, mainly via bioregenerative life support systems, Bio-ISRU-units etc. Preparation is needed on a scientific as well as technological level. iii) ensuring reduced negative effects on humans (and partially also equipment), which could be caused by living in a closed habitat in general (and thus being not space related per se): E. g. detection systems for the quality of water and air, antimicrobial and selfhealing as well as anti-icing materials without dangerous hazard substances, psychological health enhancing components etc. Referring payloads for above mentioned investigations (scientific evaluation and technology demonstration) must be developed. Extended stays and extended closure in habitats without the possibility of material transport into and out of the system are leading to the necessity of more autonomous technologies and sustainable processes. Latter one will rely mainly on biological processes and structures, which increases additionally the necessity of an intensive scientific and

  2. Stay in Motion (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2017-03-09

    Regular physical activity can help relieve the pain and discomfort of arthritis, but many believe that activity will make their pain worse. Arthritis is one of the most common diseases in the United States. In this podcast, Dr. Charles Helmick discusses arthritis.  Created: 3/9/2017 by MMWR.   Date Released: 3/9/2017.

  3. Differential effect of whole-ear shading after heading on the physiology, biochemistry and yield index of stay-green and non-stay-green wheat genotypes.

    Science.gov (United States)

    Li, Qing; Zhong, Shengfu; Sun, Sifan; Fatima, Syeda Akash; Zhang, Min; Chen, Wanquan; Huang, Qianglan; Tang, Shengwen; Luo, Peigao

    2017-01-01

    Two winter wheat cultivars (the functional stay-green CN12 and non-stay-green CN19) were used to investigate the effects of ear-shading on grain yield and to elucidate the differential mechanisms of different cultivars. The photosynthetic parameters, chlorophyll fluorescence, antioxidant enzyme activities, and chlorophyll contents were measured 0, 15 and 30 days after heading (DAH) under both shaded and non-shaded conditions. The final grain-yield index was also measured. Shading had a smaller effect on the net photosynthetic rate (Pn), intercellular CO2 concentration (Ci), stomatal conductance (Gs), maximal photochemical efficiency of PSII (Fv/Fm) and coefficient of non-photochemical fluorescence quenching (qN) but a greater effect on both superoxide dismutase (SOD) and catalase (CAT) activities in CN12 than it did in CN19. Shading slightly altered the timeframe of leaf senescence in CN12 and may have accelerated leaf senescence in CN19. Moreover, shading had only a small effect on the weight of grains per spike (WGS) in CN12 compared with CN19, mainly resulting from the number of grains per spike (NGS) rather than the 1000-grain weight (SGW). In conclusion, the flag leaves of functional stay-green wheat could serve as potential "buffers" and/or "compensators" for ear photosynthesis, which is actively regulated by the antioxidant enzyme system and prevents yield loss. Thus, a functional stay-green genotype could be more tolerant to environmental stress than a non-stay-green genotype.

  4. Factors influencing hospital high length of stay outliers.

    Science.gov (United States)

    Freitas, Alberto; Silva-Costa, Tiago; Lopes, Fernando; Garcia-Lema, Isabel; Teixeira-Pinto, Armando; Brazdil, Pavel; Costa-Pereira, Altamiro

    2012-08-20

    The study of length of stay (LOS) outliers is important for the management and financing of hospitals. Our aim was to study variables associated with high LOS outliers and their evolution over time. We used hospital administrative data from inpatient episodes in public acute care hospitals in the Portuguese National Health Service (NHS), with discharges between years 2000 and 2009, together with some hospital characteristics. The dependent variable, LOS outliers, was calculated for each diagnosis related group (DRG) using a trim point defined for each year by the geometric mean plus two standard deviations. Hospitals were classified on the basis of administrative, economic and teaching characteristics. We also studied the influence of comorbidities and readmissions. Logistic regression models, including a multivariable logistic regression, were used in the analysis. All the logistic regressions were fitted using generalized estimating equations (GEE). In near nine million inpatient episodes analysed we found a proportion of 3.9% high LOS outliers, accounting for 19.2% of total inpatient days. The number of hospital patient discharges increased between years 2000 and 2005 and slightly decreased after that. The proportion of outliers ranged between the lowest value of 3.6% (in years 2001 and 2002) and the highest value of 4.3% in 2009. Teaching hospitals with over 1,000 beds have significantly more outliers than other hospitals, even after adjustment to readmissions and several patient characteristics. In the last years both average LOS and high LOS outliers are increasing in Portuguese NHS hospitals. As high LOS outliers represent an important proportion in the total inpatient days, this should be seen as an important alert for the management of hospitals and for national health policies. As expected, age, type of admission, and hospital type were significantly associated with high LOS outliers. The proportion of high outliers does not seem to be related to their

  5. Evaluation of reliability, availability, maintainability and safety requirements for manned space vehicles with extended on-orbit stay time

    Science.gov (United States)

    Carlier, S.; Coindoz, M.; Deneuville, L.; Garbellini, L.; Altavilla, A.

    1996-01-01

    The recent manned space transportation vehicles studies performed by ESA and European Industry, investigate the possibility of extended on-orbit stay time. From the RAMS (Reliability, Availability, Maintainability, Safety) point of view, these vehicles will have to meet, in addition to the multi-phase mission safety and reliability constraints, stringent on-orbit availability levels which will be among the most important design and operations drivers. The objective of the paper is to derive the lessons learnt from the Assured Crew Return Vehicle (ACRV) feasibility phase study, in terms of RAMS requirements specification. The paper briefly assesses the deterministic RAMS requirements derived from ESA and NASA applicable standards and focuses on the probabilistic requirements which were the subject of numerous interpretations. Different approaches are presented together with their impacts on the design (maintainability, testability, on-orbit replaceable units concept,…) and on the operations (check-out frequency, logistics,…). The main uncertainties are also assessed. In conclusion, recommendations are made for the specification of RAMS requirements for manned space vehicles with extended on-orbit stay time.

  6. Leadership practices and staff nurses' intent to stay: a systematic review.

    Science.gov (United States)

    Cowden, Tracy; Cummings, Greta; Profetto-McGrath, Joanne

    2011-05-01

    The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers' leadership practices and staff nurses' intent to stay in their current position. The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses' intent to stay is fundamental to retaining nurses in the workforce. Published English language articles on leadership practices and staff nurses' intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Relational leadership practices influence staff nurses' intentions to remain in their current position. This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses' intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  7. Conflict management style of Jordanian nurse managers and its relationship to staff nurses' intent to stay.

    Science.gov (United States)

    Al-Hamdan, Zaid; Nussera, Hayat; Masa'deh, Rami

    2016-03-01

    To explore the relationship between conflict management styles used by nurse managers and intent to stay of staff nurses. Nursing shortages require managers to focus on the retention of staff nurses. Understanding the relationship between conflict management styles of nurse managers and intent to stay of staff nurses is one strategy to retain nurses in the workforce. A cross-sectional descriptive quantitative study was carried out in Jordan. The Rahim organization conflict inventory II (ROCI II) was completed by 42 nurse managers and the intent to stay scale was completed by 320 staff nurses from four hospitals in Jordan. The anova analysis was carried out. An integrative style was the first choice for nurse managers and the last choice was a dominating style. The overall level of intent to stay for nurses was moderate. Nurses tend to keep their current job for 2-3 years. There was a negative relationship between the dominating style as a conflict management style and the intent to stay for nurses. The findings of the present study support the claim that leadership practices affect the staff nurses' intent to stay and the quality of care. Nurse managers can improve the intent to stay for staff nurses if they use the appropriate conflict management styles. © 2015 John Wiley & Sons Ltd.

  8. Static and Dynamic Characteristics of a Long-Span Cable-Stayed Bridge with CFRP Cables

    Directory of Open Access Journals (Sweden)

    Xu Xie

    2014-06-01

    Full Text Available In this study, the scope of CFRP cables in cable-stayed bridges is studied by establishing a numerical model of a 1400-m span of the same. The mechanical properties and characteristics of CFRP stay cables and of a cable-stayed bridge with CFRP cables are here subjected to comprehensive analysis. The anomalies in the damping properties of free vibration, nonlinear parametric vibration and wind fluctuating vibration between steel cables and CFRP cables are determined. The structural stiffness, wind resistance and traffic vibration of the cable-stayed bridge with CFRP cables are also analyzed. It was found that the static performances of a cable-stayed bridge with CFRP cables and steel cables are basically the same. The natural frequencies of CFRP cables do not coincide with the major natural frequencies of the cable-stayed bridge, so the likelihood of CFRP cable-bridge coupling vibration is minuscule. For CFRP cables, the response amplitudes of both parametric vibration and wind fluctuating vibration are smaller than those of steel cables. It can be concluded from the research that the use of CFRP cables does not change the dynamic characteristics of the vehicle-bridge coupling vibration. Therefore, they can be used in long-span cable-stayed bridges with an excellent mechanical performance.

  9. Reducing liver transplant length of stay: a Lean Six Sigma approach.

    Science.gov (United States)

    Toledo, Alexander H; Carroll, Tracy; Arnold, Emily; Tulu, Zeynep; Caffey, Tom; Kearns, Lauren E; Gerber, David A

    2013-12-01

    Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. To decrease our length of stay for liver transplant by using Lean Six Sigma methods. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. Multiple interventions, including a clinical pathway and enhanced communication, were implemented. Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.

  10. Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences

    Directory of Open Access Journals (Sweden)

    Geertzen Jan HB

    2011-06-01

    Full Text Available Abstract Background Many people with chronic nonspecific musculoskeletal pain (CMP have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators and how they manage to maintain working (success factors. Methods A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" Results A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. Conclusions Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at

  11. Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences.

    Science.gov (United States)

    de Vries, Haitze J; Brouwer, Sandra; Groothoff, Johan W; Geertzen, Jan H B; Reneman, Michiel F

    2011-06-03

    Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors). A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

  12. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

    Directory of Open Access Journals (Sweden)

    Daniel Martinez-Ramirez

    Full Text Available Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.A significant effect for dopaminergic administration (p<0.01 on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4. Contraindicated dopamine blocking agents were administered in 23% (71/339 of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4, p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1 compared to those who did not (M=5.9 days, SD=6.8. Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

  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

    To quantify the variability in risk-adjusted mortality and length of stay of Veterans Affairs intensive care units using a computer-based severity of illness measure. Retrospective cohort study. A stratified random sample of 34 intensive care units in 17 Veterans Affairs hospitals. A consecutive sample of 29,377 first intensive care unit admissions from February 1996 through July 1997. Standardized mortality ratio (observed/expected deaths) and observed minus expected length of stay (OMELOS) with 95% confidence intervals were estimated for each unit using a hierarchical logistic (standardized mortality ratio) or linear (OMELOS) regression model with Markov Chain Monte Carlo simulation. We adjusted for patient characteristics including age, admission diagnosis, comorbid disease, physiology at admission (from laboratory data), and transfer status. Mortality across the intensive care units for the 12,088 surgical and 17,289 medical cases averaged 11% (range, 2-30%). Length of stay in the intensive care units averaged 4.0 days (range, mean unit length of stay 3.0-5.9). Standardized mortality ratio of the intensive care units varied from 0.62 to 1.27; the standardized mortality ratio and 95% confidence interval were units and >1.0 for seven intensive care units. OMELOS of the intensive care units ranged from -0.89 to 1.34 days. In a random slope hierarchical model, variation in standardized mortality ratio among intensive care units was similar across the range of severity, whereas variation in length of stay increased with severity. Standardized mortality ratio was not associated with OMELOS (Pearson's r = .13). We identified intensive care units whose indicators for mortality and length of stay differ substantially using a conservative statistical approach with a severity adjustment model based on data available in computerized clinical databases. Computerized risk adjustment employing routinely available data may facilitate research on the utility of intensive care

  14. Routine Multimodal Antiemesis Including Low-Dose Perphenazine in an Ambulatory Surgery Unit of a University Hospital: A 10-Year History

    Directory of Open Access Journals (Sweden)

    Brian A. Williams

    2007-01-01

    Full Text Available For 10 years, we have used intravenous and oral perphenazine as part of a multimodal antiemetic prophylaxis care plan for at least 10,000 outpatients. We have never encountered an adverse event, to our knowledge, when the intravenous dose was less than or equal to 2 mg, or when the single preoperative oral dose did not exceed 8 mg (with no repeated dosing. As a single-dose component of multimodal antiemetic prophylaxis therapy, we believe that this track record of anecdotal safety in adults who meet certain criteria (age 14–70, no less than 45 kg, no history of extrapyramidal reactions or of Parkinson disease, and no Class III antidysrhythmic coadministered for coexisting disease constitutes a sufficient patient safety basis for formal prospective study. We believe that future perphenazine studies should include routine coadministration with prospectively established multimodal antiemetics (i.e., dexamethasone and a 5-HT3 antagonist. In settings where droperidol is still routinely used and deemed acceptable by local scientific ethics committees, we believe that oral perphenazine 8 mg should be compared head to head with droperidol 0.625–1.25 mg in patients receiving coadministered dexamethasone and 5-HT3 antagonists in order to determine differences in synergistic efficacy, if any. Similar trials should be performed, individually evaluating cyclizine, transdermal scopolamine, and aprepitant in combination with coadministered dexamethasone and a 5-HT3 antagonist. Such studies should also quantify efficacy in preventing nausea and vomiting after discharge home, and also quantify the extent to which the prophylaxis plans reduce postanesthesia care unit (PACU requirements (i.e., increase PACU bypass, reduce the need for any nursing interventions for postoperative nausea and/or vomiting (PONV, and influence the extent to which any variable costs of postoperative nursing care are reduced.

  15. Investigation of Tension Forces in A Stay Cable System of A Road Bridge Using Vibration Methods

    Directory of Open Access Journals (Sweden)

    Hawryszków Paweł

    2015-01-01

    Full Text Available In the article author presents method of investigation of tension forces in stay cable systems using dynamical methods. Research was carried out during stay cable system installation on WN-24 viaduct near Poznań, that is way it was possible to compare tension forces indicated directly by devices using for tensioning of cable-stayed bridges with results achieved indirectly by means of dynamical methods. Discussion of results was presented. Advantages of dynamical methods and possible fields of application was described. This method, which has been rarely used before, may occur interesting alternative in diagnostics of bridges in comparison to traditional methods.

  16. Nonlinear Analysis of Cable Vibration of a Multispan Cable-Stayed Bridge under Transverse Excitation

    OpenAIRE

    Kun Lin; Dujian Zou; Minghai Wei

    2014-01-01

    The nonlinear vibrations of cable in a multispan cable-stayed bridge subjected to transverse excitation are investigated. The MECS (multielements cable system) model, where multielements per cable stay are used, is built up and used to analyze the model properties of the multispan cable-stayed bridges. Then, a simplified two-degrees-of-freedom (2-DOFs) model, where the tower or the deck is reduced to a beam, is proposed to analyze the nonlinear dynamic behaviors of the beam and cable. The res...

  17. Limit span of self-anchored cable-stayed suspension cooperation system bridge based on strength

    Institute of Scientific and Technical Information of China (English)

    Zhe ZHANG; Huili WANG; Sifeng QIN; Xiaomeng GE

    2009-01-01

    The limit span of self-anchored cable-stayed suspension bridge is deduced. The relations among the geometrical parameters, loads and material characteristics are also analyzed. Based on the material strength and commonly used materials, the limit spans of self-anchored cable-stayed suspension bridges with concrete girder or steel girder under vertical static load are discussed in detail.The corresponding upper limit spans and the effect of the factors on the span are given. The results indicate that increasing rise-span ratio, height-span ratio and cable-stayed segment length or reducing the second dead load could increase the cooperation system span.

  18. Research of 1770 MPa galvanized steel wire for stay cable of domestic bridges

    Institute of Scientific and Technical Information of China (English)

    Ding Feng; Sang Chunming; Zhou Daiyi; Bai Bingdong

    2009-01-01

    This paper focuses on introducing the manufacture technology of 1 770 MPa galvanized steel wires for stay cables applied to domestic bridges. During the development practices of high strength galvanized wire for stay cables used in Sutong Bridge, Baosteel has established three key technologies based on research of manufacture technology and technical innovation. The three key technologies are: "Double Tensioning + limiter die" process, "dominant process + fine adjustment" in integrated optimization technology and "three-level control" in hot dip galvanization. With these key technologies, Baosteet has produced 1 770 MPa galvanized wires for stay cable, which has high tensile strength, low relaxation and good torsion performances.

  19. Why Nicaraguan Peasants Stay in Agricultural Production Cooperatives

    Directory of Open Access Journals (Sweden)

    Ruerd Ruben

    2005-04-01

    Full Text Available Despite the official support for parcellation of  agricultural production cooperatives created under  the Sandinista land reform in Nicaragua, a substantial number of peasants have decided to continue membership. Although theory suggests that  individual farms are more productive and more  efficient, Nicaraguan cooperatives did not fully  split up. We aim to identify the factors that govern  the choice of Nicaraguan peasants between staying in a cooperative and exiting to start a privately  owned farm. We used sample data from 475 landed households in four agroecological macroregions to compare resources, incomes and productivity of peasants continuing in production  cooperatives, former members of cooperatives  who became independent farmers, and peasants who had always been engaged in independent  farming. Low capital endowments of the new  independent farmers adversely affect their standard of living. Better access to non-farm income encourages peasants to remain in the cooperative  where they are less exposed to risk. Uncertainty associated with land ownership and difficulties  with resolution of cooperative debt play a dominant role in keeping Nicaraguan peasants in cooperatives. Cooperative members still maintain a  high degree of coordination of activities in order  to capture the benefits of rural development programmes.   Resumen:  Porqué los campesinos nicaragüenses permanecen en las cooperativas agrícolas  de producción A pesar del apoyo oficial para la parcelación de  las cooperativas agrícolas de producción creadas  durante la reforma agraria Sandinista en Nicaragua, un número significativo de campesinos decidieron continuar con su membresía. Mientras la  teoría sugiere que fincas individuales son más  productivas y más eficientes, las cooperativas nicaragüenses no fueron completamente seccionadas en fincas individuales. Nuestro objetivo es  identificar los factores que rigen la decisión de

  20. Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia

    DEFF Research Database (Denmark)

    Conner, J Michael; Aviles-Robles, Martha J; Asdahl, Peter H;

    2016-01-01

    . The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had...... in Mexico City, and assess the association between malnourishment and length of hospital stay. METHODS: Individuals eligible for this study were paediatric cancer patients (aged Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure...... of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-scorehospital stay. RESULTS: Our study...

  1. Research on Construction Monitoring Techniques for Cable Replacement of the Cable-Stayed Bridge

    Directory of Open Access Journals (Sweden)

    Dai Pu

    2013-09-01

    Full Text Available Due to various reasons, some cable-stayed bridges require the replacement of part or all stay cables after operating for a period of time. In this study, based on some engineering practices of stay cable replacement, the condition of bridge structure before replacement is analyzed with Finite Element Analysis method for plane member system. The theoretical calculations, cable force measurement, replacement methods and process monitoring for cable replacement are introduced to find out the key technical problems. From the specified bridge monitoring practices, we suggest monitoring cable tension and the main beam alignment during the process of cable replacement, to make sure the cable-stayed bridge reaches its design conditions.

  2. If You Can't Stay Off Social Media, Maybe It's in Your Genes

    Science.gov (United States)

    Skip navigation U.S. National Library of Medicine Menu ... You Can't Stay Off Social Media, Maybe It's in Your Genes Findings put 'the consumer in the driver's seat,' researcher says To use the sharing ...

  3. Aerostatic Stability of Long-Span Cable-Stayed Bridges: Parametric Study

    Institute of Scientific and Technical Information of China (English)

    程进; 江见鲸; 肖汝诚; 项海帆

    2003-01-01

    The increasing span of cable-stayed bridges has focused more attention on the aerostatic stability of the design and construction of such bridges. This paper presents a new method to analyze the nonlinear aerostatic stability of cable-stayed bridges including all three components of the wind load and the geometric nonlinearity. The analysis was used to investigate the effects of the wind angle of incidence, the wind load of individual bridge elements, the sagging of cable elements, the changes of tower height and the changes of side span length on the aerostatic stability of cable-stayed bridges. The results show that the wind angle of incidence and the wind loads on the cables have an important effect on the aerostatic stability of cable-stayed bridges.

  4. Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark

    DEFF Research Database (Denmark)

    Hallas, Peter; Hansen, Anne R; Staehr, Mia A

    2007-01-01

    The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group...... of asylum seekers to study if the incidence of mental disorders increased with length of stay....

  5. Barriers and facilitators to staying in work after stroke: insight from an online forum

    OpenAIRE

    Balasooriya-Smeekens, Chantal; Bateman, Andrew; Mant, Jonathan; De Simoni, Anna

    2016-01-01

    This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by BMJ Publishing. Objective: To explore barriers and facilitators to staying in work following stroke. Design: Qualitative analysis of posts regarding staying in work following stroke using the archives of an online forum for stroke survivors. Participants: 60 stroke survivors (29M, 23F, 8 not stated; mean age at stroke 44y) who have returned to work, identified using ter...

  6. Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care

    DEFF Research Database (Denmark)

    Kaltoft, B; Gögenur, I; Rosenberg, J

    2011-01-01

    The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities.......The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities....

  7. Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care

    DEFF Research Database (Denmark)

    Kaltoft, B; Gögenur, I; Rosenberg, J

    2011-01-01

    The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities.......The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities....

  8. The FOUR score predicts mortality, endotracheal intubation and ICU length of stay after traumatic brain injury.

    Science.gov (United States)

    Okasha, Ahmed Said; Fayed, Akram Muhammad; Saleh, Ahmad Sabry

    2014-12-01

    The Glasgow Coma Scale (GCS) is the most widely accepted scale for assessing levels of consciousness, clinical status, as well as prognosis of traumatic brain injury (TBI) patients. The Full Outline of UnResponsiveness (FOUR) score is a new coma scale developed addressing the limitations of the GCS. The aim of this prospective cohort study was to compare the performance of the FOUR score vs. the GCS in predicting TBI outcomes. From April to July 2011, 60 consecutive adult patients with TBI admitted to the Alexandria Main University Hospital intensive care units (ICU) were enrolled in the study. GCS and FOUR score were documented on arrival to emergency room. Outcomes were in-hospital mortality, unfavorable outcome [Glasgow outcome scale extended (GOSE) 1-4], endotracheal intubation, and ICU length of stay (LOS). Fifteen (25 %) patients died and 35 (58 %) had unfavorable outcome. When predicting mortality, the FOUR score showed significantly higher area under receiver operating characteristic curve (AUC) than the GCS score (0.850 vs. 0.796, p = 0.025). The FOUR score and the GCS score were not different in predicting unfavorable outcome (AUC 0.813 vs. 0.779, p = 0.136) and endotracheal intubation (AUC 0.961 vs. 0.982, p = 0.06). Both scores were good predictors of ICU LOS (r (2) = 0.40 [FOUR score] vs. 0.41 [GCS score]). The FOUR score was superior to the GCS in predicting in-hospital mortality in TBI patients. There was no difference between both scores in predicting unfavorable outcome, endotracheal intubation, and ICU LOS.

  9. Time Series Analysis of Emergency Department Length of Stay per 8-Hour Shift

    Directory of Open Access Journals (Sweden)

    Niels K. Rathlev, MD

    2012-05-01

    Full Text Available Introduction: The mean emergency department (ED length of stay (LOS is considered a measure ofcrowding. This paper measures the association between LOS and factors that potentially contribute toLOS measured over consecutive shifts in the ED: shift 1 (7:00 AM to 3:00 PM, shift 2 (3:00 PM to 11:00PM, and shift 3 (11:00 PM to 7:00 AM.Methods: Setting: University, inner-city teaching hospital. Patients: 91,643 adult ED patients betweenOctober 12, 2005 and April 30, 2007. Design: For each shift, we measured the numbers of (1 EDnurses on duty, (2 discharges, (3 discharges on the previous shift, (4 resuscitation cases, (5admissions, (6 intensive care unit (ICU admissions, and (7 LOS on the previous shift. For each 24-hour period, we measured the (1 number of elective surgical admissions and (2 hospital occupancy.We used autoregressive integrated moving average time series analysis to retrospectively measurethe association between LOS and the covariates.Results: For all 3 shifts, LOS in minutes increased by 1.08 (95% confidence interval 0.68, 1.50 forevery additional 1% increase in hospital occupancy. For every additional admission from the ED, LOSin minutes increased by 3.88 (2.81, 4.95 on shift 1, 2.88 (1.54, 3.14 on shift 2, and 4.91 (2.29, 7.53 onshift 3. LOS in minutes increased 14.27 (2.01, 26.52 when 3 or more patients were admitted to the ICUon shift 1. The numbers of nurses, ED discharges on the previous shift, resuscitation cases, andelective surgical admissions were not associated with LOS on any shift.Conclusion: Key factors associated with LOS include hospital occupancy and the number of hospitaladmissions that originate in the ED. This particularly applies to ED patients who are admitted to theICU.

  10. The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses.

    Science.gov (United States)

    Abualrub, Raeda F; Gharaibeh, Huda F; Bashayreh, Alaa Eddin I

    2012-01-01

    The purpose of the present study is to examine the relationships among safety climate, teamwork, and intent to stay at work as perceived by Jordanian hospital nurses. A descriptive correlational design was used to investigate these relationships among a convenience sample of 381 hospital nurses. Data were collected through a self-administered questionnaire that included the Safety Climate and Teamwork Scale and the McCain's Intent to Stay Scale. Descriptive statistics, Pearson correlation, analysis of variance, and hierarchical regression analysis were used to analyze the data. The findings showed (a) a strong positive correlation between safety climate and teamwork; and (b) moderate positive correlations between safety climate and intent to stay at work, and between teamwork and intent to stay at work. Moreover, the overall model of hierarchical regression showed that 45% of the variation in the level of intent to stay at work was explained by background variables, leadership styles, decision-making styles, and safety climate. The findings emphasized the positive effect of safety climate and teamwork on the level of nurses' intent to stay. Nurse administrators should design and implement strategies that create a culture of safety climate and teamwork in their organizations. © 2012 Wiley Periodicals, Inc.

  11. The stay/switch model describes choice among magnitudes of reinforcers.

    Science.gov (United States)

    MacDonall, James S

    2008-06-01

    The stay/switch model is an alternative to the generalized matching law for describing choice in concurrent procedures. The purpose of the present experiment was to extend this model to choice among magnitudes of reinforcers. Rats were exposed to conditions in which the magnitude of reinforcers (number of food pellets) varied for staying at alternative 1, switching from alternative 1, staying at alternative 2 and switching from alternative 2. A changeover delay was not used. The results showed that the stay/switch model provided a good account of the data overall, and deviations from fits of the generalized matching law to response allocation data were in the direction predicted by the stay/switch model. In addition, comparisons among specific conditions suggested that varying the ratio of obtained reinforcers, as in the generalized matching law, was not necessary to change the response and time allocations. Other comparisons suggested that varying the ratio of obtained reinforcers was not sufficient to change response allocation. Taken together these results provide additional support for the stay/switch model of concurrent choice.

  12. Staying competitive with advanced technologies for closed loop supervisory control

    Energy Technology Data Exchange (ETDEWEB)

    Radl, B.J.; Roland, W.B. [Pegasus Technologies Corp., Painesville, OH (United States); Kish, B. [Penn Power, New Castle, PA (United States)

    1996-05-01

    The following paper discusses the experience gained from installing a neural network-based supervisory control system for selected combustion parameters at Penn Power`s New Castle station. The primary goal of the program was to reduce NO{sub x} emissions, while maintaining or improving unit heat rate. The advanced technologies used to implement supervisory control include: Neural Networks, Genetic Algorithms, Pattern Recognition and Data Visualization. The program was jointly funded by Ohio Edison, U.S. Department of Energy (DOE), Environmental Protection Agency (EPA) and Pegasus Technologies Corporation, under a National Industrial Competitiveness through Energy, Environment and Economics (NICE) grant program. The system is installed on a 1950s vintage Babcock & Wilcox front-fired (four levels) drum unit with a gross generation capacity of 146 MW The program linked a Unix workstation, where the supervisory control system resides, with a Network 90 Digital Control System (DCS). The system uses a neural network-based nonlinear model of the combustion process to interactively adjust setpoints and bias settings in the DCS. The system performs many {open_quotes}what if{close_quotes} simulations to optimize setpoints for the current operating conditions. The neural network model is updated periodically, learning from the most recent data. New setpoints are generated accordingly and downloaded into the DCS. Setpoint and bias adjustments are constrained within the original control system limits. Conditioning algorithms were developed to handle the inherently {open_quote}noisy{close_quote} input data and to provide stable output recommendations. Test results and parameters used for combustion optimization are summarized in this paper.

  13. Differential effect of whole-ear shading after heading on the physiology, biochemistry and yield index of stay-green and non-stay-green wheat genotypes

    Science.gov (United States)

    Sun, Sifan; Fatima, Syeda Akash; Zhang, Min; Chen, Wanquan; Huang, Qianglan; Tang, Shengwen; Luo, Peigao

    2017-01-01

    Two winter wheat cultivars (the functional stay-green CN12 and non-stay-green CN19) were used to investigate the effects of ear-shading on grain yield and to elucidate the differential mechanisms of different cultivars. The photosynthetic parameters, chlorophyll fluorescence, antioxidant enzyme activities, and chlorophyll contents were measured 0, 15 and 30 days after heading (DAH) under both shaded and non-shaded conditions. The final grain-yield index was also measured. Shading had a smaller effect on the net photosynthetic rate (Pn), intercellular CO2 concentration (Ci), stomatal conductance (Gs), maximal photochemical efficiency of PSII (Fv/Fm) and coefficient of non-photochemical fluorescence quenching (qN) but a greater effect on both superoxide dismutase (SOD) and catalase (CAT) activities in CN12 than it did in CN19. Shading slightly altered the timeframe of leaf senescence in CN12 and may have accelerated leaf senescence in CN19. Moreover, shading had only a small effect on the weight of grains per spike (WGS) in CN12 compared with CN19, mainly resulting from the number of grains per spike (NGS) rather than the 1000-grain weight (SGW). In conclusion, the flag leaves of functional stay-green wheat could serve as potential “buffers” and/or “compensators” for ear photosynthesis, which is actively regulated by the antioxidant enzyme system and prevents yield loss. Thus, a functional stay-green genotype could be more tolerant to environmental stress than a non-stay-green genotype. PMID:28158297

  14. Randomized trial of a patient-centered hospital unit.

    Science.gov (United States)

    Martin, D P; Diehr, P; Conrad, D A; Davis, J H; Leickly, R; Perrin, E B

    1998-06-01

    Patient-centered hospital units have grown out of the national trend to greater consumerism, but few of these units have been evaluated rigorously. We used a randomized controlled trial to compare patient outcomes on the Planetree Model Hospital Unit with other medical-surgical units in the hospital. Planetree patients were significantly more satisfied than controls with their hospital stay, the unit's environment and nursing care, but did not differ in ratings of physician care. Planetree patients reported more involvement in their care while hospitalized and higher satisfaction with the education they received. There were few differences between Planetree and controls in health behaviors. While Planetree patients reported better mental health status and role functioning after discharge, their health status was similar to controls after 3 to 6 months. There were no differences in length of stay and charges for the index hospitalization, readmissions or outpatient care during the following year.

  15. Roy in the postanesthesia care unit.

    Science.gov (United States)

    Jackson, D A

    1990-06-01

    The adaptation model developed by Sister Callista Roy, RN, PhD, was used as the organizing framework for developing a preoperative assessment tool for PACU nurses. The purpose of preoperative assessment of a surgical patient by a PACU nurse is to determine the patient's location on the health-illness continuum. This is done by analyzing data regarding the patient's biopsychosocial needs, evaluating the data, and determining from that information what problems need intervention. Roy's theory advocates assessing the patient's biopsychosocial needs using four different adaptive modes: self-concept, physiological function, role function, and interdependence (level I assessment). After completing the PACU preoperative assessment tool, each mode in level I assessment is identified as either positive (adaptive) or negative (maladaptive) depending on the patient's behavior identified by the tool. If a maladaptive behavior is identified during the preoperative assessment, a level II assessment is made to collect data regarding focal, contextual, and residual stimuli. A nursing diagnosis, expected outcomes, nursing interventions, and evaluation are listed on the patient care plan based on the data obtained from the assessment.

  16. Full On-Device Stay Points Detection in Smartphones for Location-Based Mobile Applications

    Directory of Open Access Journals (Sweden)

    Rafael Pérez-Torres

    2016-10-01

    Full Text Available The tracking of frequently visited places, also known as stay points, is a critical feature in location-aware mobile applications as a way to adapt the information and services provided to smartphones users according to their moving patterns. Location based applications usually employ the GPS receiver along with Wi-Fi hot-spots and cellular cell tower mechanisms for estimating user location. Typically, fine-grained GPS location data are collected by the smartphone and transferred to dedicated servers for trajectory analysis and stay points detection. Such Mobile Cloud Computing approach has been successfully employed for extending smartphone’s battery lifetime by exchanging computation costs, assuming that on-device stay points detection is prohibitive. In this article, we propose and validate the feasibility of having an alternative event-driven mechanism for stay points detection that is executed fully on-device, and that provides higher energy savings by avoiding communication costs. Our solution is encapsulated in a sensing middleware for Android smartphones, where a stream of GPS location updates is collected in the background, supporting duty cycling schemes, and incrementally analyzed following an event-driven paradigm for stay points detection. To evaluate the performance of the proposed middleware, real world experiments were conducted under different stress levels, validating its power efficiency when compared against a Mobile Cloud Computing oriented solution.

  17. Full On-Device Stay Points Detection in Smartphones for Location-Based Mobile Applications

    Science.gov (United States)

    Pérez-Torres, Rafael; Torres-Huitzil, César; Galeana-Zapién, Hiram

    2016-01-01

    The tracking of frequently visited places, also known as stay points, is a critical feature in location-aware mobile applications as a way to adapt the information and services provided to smartphones users according to their moving patterns. Location based applications usually employ the GPS receiver along with Wi-Fi hot-spots and cellular cell tower mechanisms for estimating user location. Typically, fine-grained GPS location data are collected by the smartphone and transferred to dedicated servers for trajectory analysis and stay points detection. Such Mobile Cloud Computing approach has been successfully employed for extending smartphone’s battery lifetime by exchanging computation costs, assuming that on-device stay points detection is prohibitive. In this article, we propose and validate the feasibility of having an alternative event-driven mechanism for stay points detection that is executed fully on-device, and that provides higher energy savings by avoiding communication costs. Our solution is encapsulated in a sensing middleware for Android smartphones, where a stream of GPS location updates is collected in the background, supporting duty cycling schemes, and incrementally analyzed following an event-driven paradigm for stay points detection. To evaluate the performance of the proposed middleware, real world experiments were conducted under different stress levels, validating its power efficiency when compared against a Mobile Cloud Computing oriented solution. PMID:27754388

  18. Leadership behaviours, organizational culture and intention to stay amongst Jordanian nurses.

    Science.gov (United States)

    AbuAlRub, R F; Nasrallah, M A

    2017-03-15

    To investigate the impact of leadership behaviours of nurse managers and organizational culture on Jordanian nurses' intention to stay at work in public, private and university hospitals. Leadership behaviours of nurses and organizational culture are considered important factors in enhancing retention of nurses. A correlational design was used in the study. A sample of 285 Jordanian nurses was conveniently selected to complete a self-administered questionnaire that consisted of three measures; Kouzes and Posner's Leadership Practise Inventory, Professional Organizational Culture questionnaire and McCain's Intent to Stay Scale. Nurse managers' leadership behaviours and organizational culture were positively associated with the level of intention to stay at work. The study variables explained almost 43% of the variance in nurses' intention to stay at work. The limitation of the study was the use of convenience sampling method. The results asserted that transformational leadership styles of nurse managers enhance positive hospitals' culture as well as the intention of nurses to stay at work. Nurse executives should promote leadership behaviours of nurse managers through training. The regulatory bodies of nursing profession in collaboration with nurse educators and administrators should help in developing competencies for nurse managers that are based on transformational leadership and incorporate such competencies in nursing education programs as well as continuous education programs. © 2017 International Council of Nurses.

  19. Celiac disease and alcohol use disorders: increased length of hospital stay, overexpenditures and attributable mortality

    Directory of Open Access Journals (Sweden)

    Miguel Gili

    2013-10-01

    Full Text Available Background and objectives: alcohol use disorders are associated with a greater incidence of certain comorbidities in patients with celiac disease. Currently there is no available information about the impact that these disorders may have on length of hospital stays, overexpenditures during hospital stays, and excess mortality in these patients. Methods: a case-control study was conducted with a selection of patients 18 years and older hospitalized during 2008-2010 in 87 hospitals in Spain. Estimations of excess length of stays, costs, and attributable mortality were calculated using a multivariate analysis of covariance, which included age, gender, hospital group, alcohol use disorders, tobacco related disease and 30 other comorbidities. Results: patients who had both celiac disease and alcohol use disorders had an increased length of hospital stay, an average of 3.1 days longer in women, and 1.7 days longer in men. Excess costs per stay ranged from 838.7 euros in female patients, to 389.1 euros in male patients. Excess attributable mortality was 15.1% in women, 12.2% in men. Conclusions: apart from a gluten-free diet and other medical measures, the prevention of alcohol abuse is indicated in these patients. Patients hospitalized who present these disorders should receive specialized attention after leaving the hospital. Early detection and treatment should be used to prevent the appearance of organic lesions and should not be solely focused on male patients.

  20. Aerodynamic problems of cable-stayed bridges spanning over one thousand meters

    Institute of Scientific and Technical Information of China (English)

    Chen Airong; Ma Rujin; Wang Dalei

    2009-01-01

    Tbe elongating of cable-stayed bridge brings a series of aerodynamic problems. First of all, geometric nonlin-ear effect of extreme long cable is much more significant for cable-stayed bridge spanning over one thousand meters. Lat-eral static wind load will generate additional displacement of long cables, which causes the decrease of supporting rigidi-ty of the whole bridge and the change of dynamic properties. Wind load, being the controlling load in the design of ca-hie-stayed bridge, is a critical problem and needs to be solved. Meanwhile, research on suitable system between pylon and deck indicates fixed-fixed connection system is an effective way for improvement performance of cable-stayed bridges under longitudinal wind load. In order to obtain aerodynamic parameters of cable-stayed bridge spanning over one thou-sand meters, identification method for flutter derivatives of full bridge aero-elastic model is developed in this paper. Furthermore, vortex induced vibration and Reynolds number effect are detailed discussed.

  1. Damage identification of a large-span concrete cable-stayed bridge based on genetic algorithm

    Institute of Scientific and Technical Information of China (English)

    ZHU Jinsong; XIAO Rucheng

    2007-01-01

    The global stability of a structure, the stiffness of its main girder and concrete tower, and the variation of the forces of its stay cables are key issues to the safety assessment of an in-service cable-stayed bridge. The efficiency and ratio- nality of local elaborate non-damage-identification could be enhanced by the primary damage identification of cable- stayed bridges on the basis of periodic detection of the cable force and strain monitor in key sections of the main girder. The genetic algorithms of damage identification for cable- stayed bridges were investigated in this paper on the basis of the monitor data of the cable force and strain in a key section of the main girder. A damage detection program for complex civil structure was generated to implement the identification of damage location and extent. The deterioration of the struc- ture was calculated according to the variation of monitor data. It is demonstrated that the results of damage identification from the parametric finite element method are accurate. The method had been verified using a long-span concrete cable- stayed bridge in Ningbo, which has been in use for the past four years.

  2. Study of the aerostatic and aerodynamic stability of super long-span cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    Zhang Xinjun; Sun Hailing

    2014-01-01

    With the increase of span length,the bridge tends to be more flexible,and the wind stability be-comes an important problem for the design and construction of super long-span cable-stayed bridges. By taking a super long-span cable-stayed bridge with a main span of 1 400 m as example,the aerostatic and aerodynamic stability of the bridge are investigated by three-dimensional nonlinear aerostatic and aerodynamic stability analy-sis,and the results are compared with those of a suspension bridge with a main span of 1 385 m,and from the aspect of wind stability,the feasibility of using cable-stayed bridge in super long-span bridge with a main span above 1 000 m is discussed. In addition,the influences of design parameters including the depth and width of the girder,the tower structure,the tower height-to-span ratio,the side-to-main span ratio,the auxiliary piers in the side span and the anchorage system of stay cables,etc on the aerostatic and aerodynamic stability of su-per long-span cable-stayed bridges are investigated numerically;the key design parameters are pointed out,and also their reasonable values are proposed.

  3. The determinants of visitor length of stay at the Kruger National Park

    Directory of Open Access Journals (Sweden)

    Martinette Kruger

    2014-06-01

    Full Text Available This study analysed the determinants of tourists’ length of stay at one of South Africa’s oldest and largest national parks, the Kruger National Park. It took the different regions of this Park into account and analysed visitors to the northern and southern regions separately to distinguish the different determinants of length of stay. The results showed clear differences between the determinants of length of stay for the two regions, indicating that for a destination with the size and scope of the Kruger Park, a regional approach should be followed to improve management and encourage visitors to stay longer.Conservation implications: The northern and southern regions of the Kruger National Park differ significantly in terms of ecosystems, rainfall, climate and wildlife. From a tourism perspective, these regions should be managed separately taking the distinct differences of the two regions into consideration. Different variables influence visitors’ length of stay in these two regions. Conservation practitioners can use the results of this study to manage visitors to these areas.

  4. Efeito de três diferentes fontes de extrato de pituitárias na indução gonadal em machos e fêmeas de pacu (Piaractus mesopotamicus - DOI: 10.4025/actascianimsci.v27i4.1146 Effects of three different sources of pituitary extract on gonadal inducer in male and female pacu (Piaractus mesopotamicus - DOI: 10.4025/actascianimsci.v27i4.1146

    Directory of Open Access Journals (Sweden)

    Jayme Aparecido Povh

    2005-03-01

    Full Text Available Machos e fêmeas de (Piaractus mesopotamicus foram induzidas com extrato de hipófise de frango de corte (BCPE, coelho (RPE e de carpa (CPE. Os parâmetros vigor espermático, motilidade progressiva, taxa de fertilização e eclosão de acordo com a origem do sêmen, não apresentou diferença (p > 0,05 entre os tratamentos. O tratamento com BCPE produziu o menor volume de sêmen (p 0,05 para o taxa de espermatozóides com anormalidades nos tratamentos, mas as patologias secundárias foram elevadas (p P. mesopotamicusMale and female pacus (Piaractus mesopotamicus were induced with broiler chicken (BCPE, rabbit (RPE, and carp (CPE pituitary extracts. The parameters for spermatic vigor, progressive motility, fertilization and hatching rate, according to semen origin, did not show any differences among the treatments (p > 0.05. RPE produced the lowest (p 0.05 in the total rate of abnormal spermatozoa among the treatments, but the secondary pathologies were higher (p 0.05 between BCPE and CPE were found for accumulated thermal unit, number of oocytes/spawning grams, fertilization and hatchery rates according to treatment origin. The result indicates that BCPE use is recommended for gonadal induction of P. mesopotamicus

  5. Progress in Research onSTAY-GREEN Genes in Plants%植物滞绿基因STAY-GREEN的研究进展

    Institute of Scientific and Technical Information of China (English)

    孙佩光; 吴琼; 徐碧玉; 常胜合; 苗红霞; 金志强

    2015-01-01

    滞绿基因STAY-GREEN (SGR)是绿色器官衰老/成熟的关键调控因子,通过系统进化分析将其分为SGR和SGR-LIKE (SGRL)两大亚家族。在不同物种中SGR和SGRL基因的序列特征、表达模式及功能均存在一定差异,且同源基因之间的功能也不尽一致。本文概述了近年来国内外SGR/SGRL基因的最新研究进展,主要包括SGR/SGRL基因的染色体定位、分类和表达模式及可能具有的功能等。%STAY-GREEN (SGR) genes are key regulatory factors involved in senescence and ripening process in plant green organs. Based on phylogenetic analysis,STAY-GREEN genes were divided into two groups,SGR andSGR-LIKE (SGRL) subfamilies. However, there are some differences betweenSGR andSGRL in sequence features, expression patterns and functional characters among different plant species, while the functions for SGR/SGRL homolog genes are not the same. In this article, we summarize the research progress inSGR/SGRL genes in recent years including the chromosome location, classiifcation and expression, and possible functions ofSGR/SGRL genes.

  6. The Effects of Hospital Length of Stay on Readmissions for Children With Newly Diagnosed Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Wedekind, Mary F; Dennis, Robyn; Sturm, Mollie; Koch, Terah; Stanek, Joseph; O'Brien, Sarah H

    2016-07-01

    Although regimens for induction therapy in children with acute lymphoblastic leukemia (ALL) are similar across the United States, typical practice with regard to inpatient length of stay (LOS) varies by institution. US children's hospitals were categorized by typical induction LOS; and readmissions, pediatric intensive care unit (PICU) admissions, and average adjusted charges were compared for the first 30 days from initial admission. Using Pediatric Health Information System data, we extracted ALL induction admissions from 2007 to 2013. We categorized hospitals into 3 categories based on median LOS: short (≤7 d), medium (8 to 15 d), or long (≥16 d). Median LOS varied from 5 to 31 days across hospitals. Thirty-day median inpatient costs per patient ranged from $32 K for short LOS, $40 K for medium LOS, and $47 K for long LOS. Compared with short LOS hospitals (n=14), medium LOS (n=8) and long LOS hospitals (n=8) had lower odds of PICU readmissions (odds ratio [OR], 0.68; P=0.0124 and OR, 0.31; P7 days have fewer PICU readmissions but substantial increase in total induction inpatient costs.

  7. Summarizing the Methods of Determination of Rational Completion Status of Cable-Stayed Bridges

    Institute of Scientific and Technical Information of China (English)

    Yang Jun; Shen Chengwu; Sheng Jun

    2006-01-01

    Cable-stayed bridge is a high-order hyperstatic structure. The size of cable force affects the stress of the structure greatly. The key problem to determine the rational completion status of cable-stayed bridges is how to control cable force on completion status. Surrounding this problem, domestic and foreign experts and scholars have done a lot of favorable work and obtained much achievement. On the basis of comprehensive reading domestic and foreign relative documentation, the author of this article classifies rationally the current researching achievement, comments and compares advantages and disadvantages of each method and lists two synthetic methods' detail steps and puts forward the researching emphasis of the field will deflect to synthesis several methods to determine the rational completion status of cable-stayed bridges.

  8. Application of Gliding Scaffold System In Cable-Stayed Bridge Construction

    Institute of Scientific and Technical Information of China (English)

    YU Bao-chu; ZHANG Zhe; Chang Fu-ping

    2005-01-01

    Gonghe bridge is a double level cable-stayed concrete bridge with a single-cable-plane of single cable tower. Its span is 114+120 m and a whole length of 236 m. The gliding scaffold equipment is used for the first time in the long span cable-stayed bridge construction to reduce the construction time limit. In the process of construction, to make sure a safe connection among concrete objects with different ages, the single-supporting and single-suspension system is adopted before the concrete pouring. While the double-supporting and single-suspension system is applied after concrete pouring. These construction systems with gliding scaffold equipment are first introduced in long span cable-stayed bridge and presented in detail[1]. The practice shows that these gliding scaffold systems have many advantages over the traditional ones.

  9. How Does Mentoring Contribute to Gen Y Employees’ Intention to Stay? An Indian Perspective

    Science.gov (United States)

    Naim, Mohammad Faraz; Lenka, Usha

    2017-01-01

    The present study is aimed at investigating the impact of mentoring on intention to stay of Gen Y employees working in Indian IT industry. Also, the mediating roles of perceived organization support and affective commitment are examined. Primary data were collected from a sample of 314 Gen Y employees (born between 1980-2000) from IT industry in Delhi, NCR India. Data analysis was carried out using AMOS and SPSS to test sequential mediation. Findings reveal that mentoring has a direct influence on intention to stay of Gen Y employees and perceived organization support and affective commitment sequentially mediate the relationship between the two. This study contributes to the literature on mentoring, perceived organization support, affective commitment, and intention to stay. PMID:28580029

  10. Structural and biochemical mechanism responsible for the stay-green phenotype in common wheat

    Institute of Scientific and Technical Information of China (English)

    LUO Peigao; REN Zhenglong; WU Xianhua; ZHANG Huaiyu; ZHANG Huaiqiong; FENG Juan

    2006-01-01

    In order to increase the supply of assimilated carbon to grain, a new stay-green wheat cultivar, Chuannong17 (CN17), with delayed leaf senescence, carrying wheat-rye 1RS.1BL translocated chromosome was developed. CN17 exhibited distinct differences in net photosynthetic rate (Pn),chlorophyll (ChI) content, malondialdehyde (MDA)content, activity of both superoxide dismutase (SOD)and catalase (CAT) during the grain filling stage, and flag leaf senescence compared with the control. The new cultivar maintained longer and higher photosynthetic competence compared with the control, and this aspect correlated with the difference in chloroplast development. Moreover, the stay-green phenotype of CN17 was also observed under natural growth conditions. Consequently, the coordination of the physiological, biochemical, and structural aspects in the stay-green cultivar produced higher seed weights and per-plant yield compared with the control cultivar.

  11. Case Study on 4000 m-span Cable-stayed Suspension Bridge

    Directory of Open Access Journals (Sweden)

    Haijun Wang

    2014-04-01

    Full Text Available This study describes the case studies for a cable-stayed suspension bridges proposed over the Tsugaru Strait, Japan. Center Bridge is designed as a compound bridge of suspension bridges and cable-stayed bridges with 4000 m super-long-span. Case studies about the effects of cable-stayed bridge length, the design of sub-cable, height and stiffness of main tower, type of foundation and length of side span on displacement were carried out. With appropriate design of above parameters, the compound bridge can reduce horizontal displacement of main tower and vertical deflection in the central portion and enhance resistance to partial loading. The study reports the results based on these case studies.

  12. Seismic performance evaluation for super-long span cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    Ye Aijun; Wu Shouchang

    2009-01-01

    Based on the capacity/demand (C/D) analysis of bridge components, and life cycle and performance based seismic design principles, a practical approach is developed for the seismic performance evaluation of super-long span cable-stayed bridges. According to the approach, the seismic performance evaluation of the Sutong Bridge, which is a cable-stayed bridge with a main span of 1 088 m, is completed, and the practicality of the approach is validated. The earthquake resistance level for super-long span cable-stayed bridges is discussed, including the earthquake level, its corresponding structural performance and check indices. And a set of formula for capacity/demand ratio calculation of bridge components is proposed.

  13. Closure technique for the hybrid girder cable stayed bridge of Edong Bridge

    Institute of Scientific and Technical Information of China (English)

    Liu Minghu; Tan Hao; Xu GuoPing; Zhao Canhui

    2012-01-01

    Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long span hybrid girder cable stayed bridge are studied. After theoretical analysis, numerical evaluation and practical test, the loading assistant closure method is employed in Edong Yangtze River Bridge. The loading assistant closure method, with better thermal adaptability and less influence on bridge line and the forced status, can meet the requirements of the unstressed state control method. Based on the mentioned advantages, the loading assistant closure method is applicable to long span hybrid girder cable stayed bridges. The conclusion can provide a reference for the further design of the similar brid~es.

  14. Staying in the Hood: Black Lesbian and Transgender Women and Identity Management in North Philadelphia.

    Science.gov (United States)

    Brooks, Siobhan

    2016-12-01

    The concept Don't Ask, Don't Tell regarding Black LGBT sexuality in Black communities has been an acceptable form of identity management for Black LGBT people. In other words, Black LGBT people are accepted as long as they are not vocal about their sexuality. However, this is changing with the issue of gay marriage, which is creating a space where Black LGBT people are more open about their gender identity and sexuality in heterosexual Black spaces. This new form of openness allows Black LGBT people to "stay in" their communities, as opposed to coming out. In this article I examine how Black LGBT women in North Philadelphia stay in their communities: being politically active regarding LGBT issues, disengaging from LGBT issues, passing, and educating straight Black people about issues affecting the Black LGBT community. I conclude with implications of staying in and intersectionality among Black heterosexual and LGBT women fighting for social change.

  15. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU

  16. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien...

  17. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU s

  18. Challenges Faced by Korean Transnational Students in the United States

    Science.gov (United States)

    Jung, Adrian; Nam, Sang; Han, Shini

    2015-01-01

    The purpose of this study was to help parents, educators, and policymakers understand how to help transnational children adjust to their psychological challenges at school in the United States. A total of 109 Korean transnational adolescents aged 11 to 19 participated in this study. They had been staying in the country alone or with one of their…

  19. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  20. The effect of hospital occupancy on emergency department length of stay and patient disposition.

    Science.gov (United States)

    Forster, Alan J; Stiell, Ian; Wells, George; Lee, Alexander J; van Walraven, Carl

    2003-02-01

    Emergency department (ED) overcrowding is a common problem. Despite a widespread belief that low hospital bed availability contributes to ED overcrowding, there are few data demonstrating this effect. To identify the effect of hospital occupancy on ED length of stay for admitted patients and patient disposition. This was an observational study design using administrative data at a 500-bed acute care teaching hospital. All patients presenting to the ED between April 1993 and June 1999 were included in the study. The predictor variable was daily hospital occupancy. Outcome measures included daily ED length of stay for admitted patients, daily consultation rate, and daily admission rate. The models controlled for the average daily age of ED patients and the average daily "arrival density" index, which adjusts for patient volume and clustering of patient arrivals. The average hospital occupancy was 89.7%. On average 155 patients visited the ED daily; 21% were referred to hospital physicians and 19% were admitted. The median ED length of stay for admitted patients was 5 hours 54 minutes (interquartile range 5 hr 12 min to 6 hr 42 min). Daily ED length of stay for admitted patients increased 18 minutes (95% CI = 12 to 24) when there was an absolute increase in occupancy of 10%. The ED length of stay appeared to increase extensively when hospital occupancy exceeded a threshold of 90%. Consultation and admission rates were not influenced by hospital occupancy. Increased hospital occupancy is strongly associated with ED length of stay for admitted patients. Increasing hospital bed availability might reduce ED overcrowding.

  1. What happens to patients when they fracture their hip during a skilled nursing facility stay?

    Science.gov (United States)

    Leland, Natalie E.; Gozalo, Pedro; Bynum, Julie; Mor, Vincent; Christian, Thomas J.; Teno, Joan M.

    2015-01-01

    Objectives To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home (NH) receiving skilled nursing facility (SNF) services. Design Observational study. Participants Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during a SNF stay. Measurements Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community < 30 days), successful community discharge (in the community ≥30 days), death, and institutionalization. Results Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to a SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained less than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care. Conclusion SNF care aims to maximize the short-stay patient’s independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient’s plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed healthcare decisions. PMID:25944177

  2. The relationship between language proficiency and surgical length of stay following cardiac bypass surgery.

    Science.gov (United States)

    Tang, Erin W; Go, Jeremy; Kwok, Andrea; Leung, Bonnie; Lauck, Sandra; Wong, Sabrina T; Taipale, Priscilla G; Ratner, Pamela A

    2016-10-01

    Anglophone nurses face the challenge of communicating health information to patients who do not speak or understand English. Limited English-proficient patients are at higher risk of misinterpreting health information teaching. Successful recovery after coronary artery bypass graft surgery requires patients' engagement with healthcare professionals and active participation in therapies and related undertakings. Determination of whether limited English-proficient patients undergoing coronary artery bypass graft surgery recover at the same pace as the general population is of interest. This study examined whether limited English-proficient patients had prolonged post-operative length of stay following coronary artery bypass graft surgery. The patients' length of stay with regard to a clinical pathway target was also examined. A retrospective medical record review of all patients undergoing isolated coronary artery bypass graft surgery in a 2-year period was conducted. A screening tool was developed to identify limited English-proficient patients through examination of their medical records. A total of 691 of 712 (97.1%) patients met the inclusion criteria; 103 (14.9%) patients were identified as limited English-proficient. The post-operative median length of stay of limited English-proficient patients was 7 days compared with 6 days for the English-proficient patients (p = 0.007). Limited English-proficient patients had higher infection rates (29.1%) vs. English-proficient patients (16.7%) (odds ratio = 2.05 (95% confidence intervals 1.27-3.30)). Post-operative infection was the strongest predictor of length of stay and fully mediated the relationship between language proficiency and length of stay. When compared with English-proficient patients, limited English-proficient patients had greater infection rates, which were associated with longer length of stay. These findings warrant examination of the mechanisms through which post-operative infections are acquired by

  3. Win-stay-lose-learn promotes cooperation in the prisoner's dilemma game with voluntary participation.

    Science.gov (United States)

    Chu, Chen; Liu, Jinzhuo; Shen, Chen; Jin, Jiahua; Shi, Lei

    2017-01-01

    Voluntary participation, demonstrated to be a simple yet effective mechanism to promote persistent cooperative behavior, has been extensively studied. It has also been verified that the aspiration-based win-stay-lose-learn strategy updating rule promotes the evolution of cooperation. Inspired by this well-known fact, we combine the Win-Stay-Lose-Learn updating rule with voluntary participation: Players maintain their strategies when they are satisfied, or players attempt to imitate the strategy of one randomly chosen neighbor. We find that this mechanism maintains persistent cooperative behavior, even further promotes the evolution of cooperation under certain conditions.

  4. An invariance principle for random walk bridges conditioned to stay positive

    CERN Document Server

    Caravenna, Francesco

    2012-01-01

    We prove an invariance principle for the bridge of a random walk conditioned to stay positive, when the random walk is in the domain of attraction of a stable law, both in the discrete and in the absolutely continuous setting. This includes as a special case the convergence under diffusive rescaling of random walk excursions toward the normalized Brownian excursion, for zero mean, finite variance random walks. The proof exploits a suitable absolute continuity relation together with some local asymptotic estimates for random walks conditioned to stay positive, recently obtained by Vatutin and Wachtel [38] and Doney [21]. We review and extend these relations to the absolutely continuous setting.

  5. Impact of long-stay beds on the performance of a tertiary hospital in emergencies

    Directory of Open Access Journals (Sweden)

    Antonio Pazin-Filho

    2015-01-01

    Full Text Available ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9, for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%], 1 (n = 31 [56.5%] and ≥ 2 (n = 19 [17.5%] – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4. The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0% and 60 (75.0% days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

  6. Impact of long-stay beds on the performance of a tertiary hospital in emergencies.

    Science.gov (United States)

    Pazin-Filho, Antonio; de Almeida, Edna; Cirilo, Leni Peres; Lourençato, Frederica Montanari; Baptista, Lisandra Maria; Pintyá, José Paulo; Capeli, Ronaldo Dias; Silva, Sonia Maria Pirani Felix da; Wolf, Claudia Maria; Dinardi, Marcelo Marcos; Scarpelini, Sandro; Damasceno, Maria Cecília

    2015-01-01

    To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index - 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) - the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

  7. Observation-status patients in children's hospitals with and without dedicated observation units in 2011.

    Science.gov (United States)

    Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S

    2015-06-01

    Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P observation-status stays without impacting other hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.

  8. It’s the Strategic Narrative Stupid! How the United States May Overcome the Challenge of Continued Engagement in Afghanistan Beyond 2017

    DEFF Research Database (Denmark)

    Jakobsen, Peter Viggo

    2017-01-01

    This chapter argues that US staying power in Afghanistan primarily will be determined by the ability of the US President to craft a strategic narrative that can convince most members of Congress that it is necessary to stay engaged, that it is the right thing to do, and that the United States, Af...

  9. Variação da radiação solar no estado do Amapá: estudo de caso em Macapá, Pacuí, Serra do Navio e Oiapoque no período de 2006 a 2008 Variation of the solar radiation over the Amapa state: a case study on Macapa, Pacui, Serra do Navio and Oiapoque during the period from 2006 to 2008

    Directory of Open Access Journals (Sweden)

    Derivan Dutra Marques

    2012-07-01

    Full Text Available O objetivo do estudo foi estimar o potencial de energia solar a partir da variação da radiação solar global (RSG, no Estado do Amapá no período de 2006 a 2008. Foram utilizadas séries históricas temporais de RSG de quatro estações meteorológicas automáticas (PCD's distribuídas numa área central do Estado. Os resultados indicaram que a distribuição da RSG anual apresentou valor máximo da ordem de 4900 Wh.m-2.dia-1 sobre a estação de Macapá, devido a sua proximidade com a linha do equador. Em Serra do Navio, Pacuí e Oiapoque foram observados valores entre 4000, 4400 e 3800 Wh.m-2.dia-1, respectivamente. Conclui-se que as localidades estudadas do Amapá apresentam significativo potencial para aproveitamento fotovoltaico durante todo o ano. Este potencial sugere uma viabilidade estratégica de instalação de sistemas fotovoltaicos, tanto em sistemas urbanos consolidados quanto em comunidades remotas para geração de energia elétrica.The objective of this study was to estimate the potential of solar energy through the variation of the global solar radiation (GSR in the State of Amapá during two season's cycle (2006 to 2008. GSR historical time series were used from four collection data platforms (PCD's distributed in a central area of the state. The results indicated that the distribution of RSG showed annual peak of about 4900Wh.m-2.day-1 on the Macapá station, due to its proximity to the equator line. At Serra do Navio, Pacuí and Oiapoque cities the values observed were 4000, 4400 and 3800Wh.m-2.day-1, respectively. We conclude that the studied sites in Amapá State have significant potential for photovoltaic use during a complete annual cycle. The potential for generating electricity proved to be attractive, both for use in traditional urban systems and in isolated systems in remote communities.

  10. 成年患者神经外科手术麻醉恢复期恶心呕吐的情况分析%Incidence of postoperative nausea and vomiting following neurosurgical procedures in postanesthesia care unit

    Institute of Scientific and Technical Information of China (English)

    王会文; 侯春梅; 张雪梅; 韩如泉

    2012-01-01

    目的 通过回顾性分析,探讨不同神经外科手术成年患者麻醉恢复期恶心呕吐的发生情况.方法 2009年5月至2011年3月麻醉恢复室( PACU)收治的神经外科术后成年患者5 078例,按肿瘤部位和手术种类分组.观察并记录患者恶心呕吐的发生情况.结果 5 078例患者中,发生术后恶心呕吐798例,发生率为15.7%.其中颅咽管瘤组占28.4%(25/88)、脑室肿瘤组26.7%(35/131)、后颅窝肿瘤组24.2%(157/650)、脑血管病组20.8% (87/418)、幕上肿瘤组19.3%(297/1535)、癫痫组15.8%(16/101)、经蝶窦垂体瘤组8.9% (88/991)、脊髓肿瘤组8.4%(52/619)及其他手术组7.5%(41/545).结论 神经外科不同部位手术患者术后恶心呕吐的发生情况不同,需针对不同的病种严密观察及时处理.%Objective To study the incidence of postoperative nausea and vomiting(PONV) after different neurosurgical procedures in the postanesthesia care unit (PACU).Methods 5 078 adult patients who had undergone neurosurgical procedures enrolled into PACU were divided nine groups.The incidence of PONV were recorded and treated.Results The overall incidence of PONV following neurosurgical procedures was 15.7%.The incidence of PONV in patients undergoing craniopharyngioma、ventricular tumor、infratentorial craniotomy、intracranial aneurysm and arteriovenous malformation、supratentorial tumor、epilepsy、transsphenoidal surgery of pituitary tumor、spinal cord tumor and others was 28.4% 、26.7%、24.2% 、20.8%、19.3%、15.8%、8.9%、8.4% and 7.5%,respectively.Conclusions The overall incidence of PONV in PACU following neurosurgical procedures is approximately 16%.The incidence of PONV following neurusurgical procedures is different and craniopharyngioma、ventricular tumor and posterior fossa tumor are high risk factors for PONV.Strategies for the prevention of PONV following neurusurgical procedures are required.

  11. Implementing a Nurse Manager Profile to Improve Unit Performance.

    Science.gov (United States)

    Krugman, Mary E; Sanders, Carolyn L

    2016-06-01

    Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

  12. Nurse characteristics, leadership, safety climate, emotional labour and intention to stay for nurses: a structural equation modelling approach.

    Science.gov (United States)

    Liang, Hui-Yu; Tang, Fu-In; Wang, Tze-Fang; Lin, Kai-Ching; Yu, Shu

    2016-12-01

    The aim of this study was to propose a theoretical model and apply it to examine the structural relationships among nurse characteristics, leadership characteristics, safety climate, emotional labour and intention to stay for hospital nurses. Global nursing shortages negatively affect the quality of care. The shortages can be reduced by retaining nurses. Few studies have independently examined the relationships among leadership, safety climate, emotional labour and nurses' intention to stay; more comprehensive theoretical foundations for examining nurses' intention to stay and its related factors are lacking. Cross-sectional. A purposive sample of 414 full-time nurses was recruited from two regional hospitals in Taiwan. A structured questionnaire was used to collect data from November 2013-June 2014. Structural equation modelling was employed to test the theoretical models of the relationships among the constructs. Our data supported the theoretical model. Intention to stay was positively correlated with age and the safety climate, whereas working hours per week and emotional labour were negatively correlated. The nursing position and transformational leadership indirectly affected intention to stay; this effect was mediated separately by emotional labour and the safety climate. Our data supported the model fit. Our findings provide practical implications for healthcare organizations and administrators to increase nurses' intent to stay. Strategies including a safer climate, appropriate working hours and lower emotional labour can directly increase nurses' intent to stay. Transformational leadership did not directly influence nurses' intention to stay; however, it reduced emotional labour, thereby increasing intention to stay. © 2016 John Wiley & Sons Ltd.

  13. Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

    Science.gov (United States)

    2015-10-01

    conferences such as American Thoracic Society (2016 or 17), Critical Care Medicine (2017), International Society for Burn Injuries (2016) or the American Burn...findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or...to Report.” What was the impact on society beyond science and technology? “Nothing to Report.” “Nothing to Report.” Page 7 of 22 5

  14. Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

    Science.gov (United States)

    2016-10-01

    underlying aberrant wound healing and scarring, and their reversal by propranolol, will lay the foundation to develop additional anti-scarring therapies ...Herndon) 01/01/12-12/31/16 0.60 cal mths Shriners Hospitals for Children $120,614 "Mechanisms of Improved Wound Healing & Protein Metabolism of...Insulin & Metformin" Goal: To understand the mechanisms by which insulin and metformin can improve wound healing and protein metabolism. Aims: 1

  15. Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units

    Directory of Open Access Journals (Sweden)

    A. Różańska

    2015-06-01

    Conclusions: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

  16. Student-Led Services in a Hospital Aged Care Temporary Stay Unit: Sustaining Student Placement Capacity and Physiotherapy Service Provisions

    Science.gov (United States)

    Nicole, Madelyn; Fairbrother, Michele; Nagarajan, Srivalli Vilapakkam; Blackford, Julia; Sheepway, Lyndal; Penman, Merrolee; McAllister, Lindy

    2015-01-01

    Through a collaborative university-hospital partnership, a student-led service model (SLS-model) was implemented to increase student placement capacity within a physiotherapy department of a 150 bed Sydney hospital. This study investigates the perceived barriers and enablers to increasing student placement capacity through student-led services…

  17. 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...

  18. 8 CFR 241.21 - Stay of deportation of excluded alien.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Stay of deportation of excluded alien. 241.21 Section 241.21 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS APPREHENSION AND DETENTION OF ALIENS ORDERED REMOVED Deportation of Excluded Aliens (for Hearings Commenced...

  19. Hosting providers' liability: Cour de cassation puts an end to the notice and stay down rule

    NARCIS (Netherlands)

    Jasserand, C.

    2013-01-01

    In applying the rules on hosting providers' liability, French lower courts have shifted from a notice and take down rule (provided by Article 14 of the E-Commerce Directive and Article 6 of the French implementing law) to a notice and stay down rule (created by the judges). This interpretation was c

  20. Changes in mitochondrial homeostasis and redox status in astronauts following long stays in space

    DEFF Research Database (Denmark)

    Indo, Hiroko P; Majima, Hideyuki J; Terada, Masahiro

    2016-01-01

    The effects of long-term exposure to extreme space conditions on astronauts were investigated by analyzing hair samples from ten astronauts who had spent six months on the International Space Station (ISS). Two samples were collected before, during and after their stays in the ISS; hereafter...

  1. Comparison of various procedures for progressive collapse analysis of cable-stayed bridges

    Institute of Scientific and Technical Information of China (English)

    Jian-guo CAI; Yi-xiang XU; Li-ping ZHUANG; Jian FENG; Jin ZHANG

    2012-01-01

    Alternate path (AP) method is the most widely used method for the progressive collapse analysis,and its application in frame structures has been well proved.However,the application of AP method for other structures,especially for cable-stayed structures,should be further developed.The four analytical procedures,i.e.,linear static,nonlinear static,linear dynamic,and nonlinear dynamic were firstly improved by taking into account the initial state.Then a cable-stayed structure was studied using the four improved methods.Furthermore,the losses of both one cable and two cables were discussed.The results show that for static and dynamic analyses of the cable-stayed bridges,there is large difference between the results obtained from simulations starting with either a deformed or a nondeformed configuration at the time of cable loss.The static results are conservative in the vicinity of the ruptured cable,but the dynamic effect of the cable loss in the area farther away from the loss-cable cannot be considered.Moreover,the dynamic amplification factor of 2.0 is found to be a good estimate for static analysis procedures,since linear static and linear dynamic procedures yield approximately the same maximum vertical deflection.The results of the comprehensive evaluation of the cable failure show that the tread of the progressive failure of the cable-stayed bridges decreases when the location of the failed cables is closer to the pylon.

  2. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation.

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.J.; Keller, B.P.; Ramshorst, B. van

    2009-01-01

    AIM AND OBJECTIVE: The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. BACKGROUND: Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of

  3. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation.

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.J.; Keller, B.P.; Ramshorst, B. van

    2009-01-01

    AIM AND OBJECTIVE: The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. BACKGROUND: Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of pressur

  4. Factors That Influence Stay Intention of Thai International Students Following Completion of Degrees in China

    Science.gov (United States)

    Lin, Yi; Kingminghae, Worapinya

    2017-01-01

    Based on data recently collected in China, this study examined factors influencing Thai international students' stay/leave intentions after completion of degrees in Chinese universities. Paying attention to the concrete situations and lived experiences of international students in a more integrated Asia-Pacific region, we found that…

  5. The Struggle of Staying with Toxic Emotions when all you want to do is Leave

    DEFF Research Database (Denmark)

    Svalgaard, Lotte

    2015-01-01

    Much has been debated about the importance of negative capability for managers as well as employees in meeting with organisational turbulence and demands. Negative capability is defined as the ability to stay with disturbing and toxic emotions, tolerate anxiety, fear, not-knowing and uncertainty...

  6. Hydrocephalus during rehabilitation following severe TBI. Relation to recovery, outcome, and length of stay

    DEFF Research Database (Denmark)

    Linnemann, Mia; Tibæk, Maiken; Kammersgaard, Lars Peter

    2014-01-01

    ), level of consciousness, injury severity (ISS), and admission FIM™), and PTH were related to recovery (discharge FIM™), outcome (GOS), and length of rehabilitation stay. RESULTS: Patients with PTH were older, brain injury more severe, and acute treatment was longer. At discharge they had more disability...

  7. Study on the Mechanical Properties of Stay Cable HDPE Sheathing Fatigue in Dynamic Bridge Environments

    Directory of Open Access Journals (Sweden)

    Danhui Dan

    2015-08-01

    Full Text Available As the main force-bearing component of a cable-stayed bridge, a durable stay cable is paramount to the safety and durability of the entire bridge. High-density polyethylene (HDPE sheathing is the main protective component of a stay cable and is the key to insuring cable durability. To address the issue of HDPE sheathing fracture on service, strain level data for in-service, HDPE bridge cable sheathing was used in this study as the basis for HDPE material aging and fatigue testing. A fatigue yield phenomenon with a yield platform on the hysteresis curve of the fatigue cycles is observed by the fatigue test. The parameters to describe this phenomenon are proposed and defined in this paper. A preliminary examination of the relationship between these parameters and the factors, such as the number of cycles, the strain amplitude, and strain rate, are presented. Based on the results obtained, it is suggested that the condition of fatigue yield of HDPE sheathing be defined as the fatigue durability limit state for the purposes of durability design, assessment, and protection of cable-stayed bridges.

  8. 22 CFR 35.40 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... finding that continuation of the administrative process described in this part with respect to a claim or... statement, the authority head shall stay the process immediately. The authority head may order the process resumed only upon receipt of the written authorization of the Attorney General....

  9. 45 CFR 79.40 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-10-01

    ... such claim or statement, the authority head shall stay the process immediately. The authority head may order the process resumed only upon receipt of the written authorization of the Attorney General. ... written finding that continuation of the administrative process described in this part with respect to...

  10. 22 CFR 224.40 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... related to such claim or statement, the A.I.D. Administrator shall stay the process immediately. The A.I.D. Administrator may order the process resumed only upon receipt of the written authorization of the Attorney.... Administrator a written finding that continuation of the administrative process described in this part...

  11. 14 CFR 1264.139 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... General transmits to the authority head a written finding that continuation of the administrative process... criminal or civil action related to such claim or statement, the authority head shall stay the process immediately. If the process is before the presiding officer, the authority head shall promptly transmit...

  12. 28 CFR 71.40 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... finding that continuation of the administrative process described in this part with respect to a claim or... statement, the authority head shall stay the process immediately. The authority head may order the process resumed only upon receipt of the written authorization of the Assistant Attorney General who ordered...

  13. GPS for structural health monitoring: A case study on the Basarab overpass cable-stayed bridge

    NARCIS (Netherlands)

    Lepadatu, L.; Tiberius, C.C.J.M.

    2014-01-01

    The Basarab cable-stayed bridge is a newly built structure in Bucharest, Romania, which was inaugurated in June 2011. Before the oficial opening, in order to assure its qualification for trafic, it had to pass several loading tests with convoys of trucks and trams. For this, besides a priori evaluat

  14. Multiobjective Optimal Control of Longitudinal Seismic Response of a Multitower Cable-Stayed Bridge

    Directory of Open Access Journals (Sweden)

    Geng Fangfang

    2016-01-01

    Full Text Available The dynamic behavior of a multitower cable-stayed bridge with the application of partially longitudinal constraint system using viscous fluid dampers under real earthquake ground motions is presented. The study is based on the dynamic finite element model of the Jiashao Bridge, a six-tower cable-stayed bridge in China. The prime aim of the study is to investigate the effectiveness of viscous fluid dampers on the longitudinal seismic responses of the bridge and put forth a multiobjective optimization design method to determine the optimized parameters of the viscous fluid dampers. The results of the investigations show that the control objective of the multitower cable-stayed bridge with the partially longitudinal constraint system is to yield maximum reductions in the base forces of bridge towers longitudinally restricted with the bridge deck, with slight increases in the base forces of bridge towers longitudinally unrestricted with the bridge deck. To this end, a multiobjective optimization design method that uses a nondominating sort genetic algorithm II (NSGA-II is used to optimize parameters of the viscous fluid dampers. The effectiveness of the proposed optimization design method is demonstrated for the multitower cable-stayed bridge with the partially longitudinal constraint system, which reveals that a design engineer can choose a set of proper parameters of the viscous fluid dampers from Pareto optimal fronts that can satisfy the desired performance requirements.

  15. Factors promoting staying at work in people with chronic nonspecific musculoskeletal pain : a systematic review

    NARCIS (Netherlands)

    de Vries, H.J.; Reneman, M.F.; Groothoff, J.W.; Geertzen, J.H.B.; Brouwer, S.

    2012-01-01

    Purpose: To identify determinants for staying at work (SAW) in workers with chronic musculoskeletal pain (CMP). Method: A systematic review of factors that promote SAW in workers with CMP. We searched the databases of PubMed, EMBASE, PsycInfo, CINAHL and the Cochrane Library. We included studies

  16. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Science.gov (United States)

    2010-10-01

    ... outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day...

  17. To Stay or Leave: Factors That Impact Undergraduate Women's Persistence in Science Majors

    Science.gov (United States)

    Gayles, Joy Gaston; Ampaw, Frim

    2016-01-01

    This study examined factors that influenced undergraduates' decision to enter, leave, or stay within science majors. In addition, we sought to understand if such decisions differed by gender and type of science major. Using Beginning Postsecondary Students (BPS) longitudinal survey data, we found that women were less likely to select a science…

  18. Using the pallet costing system to determine costs and stay competitive in the pallet industry

    Science.gov (United States)

    A. Jefferson Jr. Palmer; Bruce G. Hansen; Bruce G. Hansen

    2002-01-01

    In order to stay competitive and keep production costs at a minimum, wood pallet manufacturers must plan, monitor, and control their various production activities. Cost information on pallet manufacturing operations, must be gathered and analyzed so that the plant manager can determine whether certain activities are efficient and profitable. The Pallet Costing System (...

  19. 78 FR 46255 - Handling of Animals; Contingency Plans; Stay of Regulations

    Science.gov (United States)

    2013-07-31

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service 9 CFR Part 2 RIN 0579-AC69 Handling of Animals; Contingency Plans; Stay of Regulations AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Final rule...

  20. Staying at work with chronic musculoskeletal pain: A new reference for pain rehabilitation

    NARCIS (Netherlands)

    de Vries, Haitze; Brouwer, Sandra; Groothoff, J.W.; Geertzen, J.H.B.; Reneman, M.F.

    2011-01-01

    Background and Aims: Chronic nonspecific musculoskeletal pain (CMP) results often in work disability and sick-leave, confronting employers, insurance companies, and society with considerable costs. However, a substantial amount of workers stay at work despite CMP. It is currently unknown on which fa

  1. Stay Awake Behind the Wheel (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2016-11-10

    Being a safe driver requires complete focus on the road and the cars around you. This podcast discusses the importance of staying awake while driving.  Created: 11/10/2016 by MMWR.   Date Released: 11/10/2016.

  2. Stay for the Children? Husband Violence, Marital Stability, and Children's Behavior Problems

    Science.gov (United States)

    Emery, Clifton R.

    2009-01-01

    Much research has argued for the existence of a marriage benefit to men, women, and children. Although the commonly suggested current response to a husband's violence has been for the couple to separate, traditionally women were often told to "stay for the children." This paper uses the Project on Human Development in Chicago…

  3. Nonlinear Analysis of Cable Vibration of a Multispan Cable-Stayed Bridge under Transverse Excitation

    Directory of Open Access Journals (Sweden)

    Kun Lin

    2014-01-01

    Full Text Available The nonlinear vibrations of cable in a multispan cable-stayed bridge subjected to transverse excitation are investigated. The MECS (multielements cable system model, where multielements per cable stay are used, is built up and used to analyze the model properties of the multispan cable-stayed bridges. Then, a simplified two-degrees-of-freedom (2-DOFs model, where the tower or the deck is reduced to a beam, is proposed to analyze the nonlinear dynamic behaviors of the beam and cable. The results of MECS model analysis show that the main tower in the multispan cable-stayed bridge is prone to the transverse vibration, and the local vibration of cables only has a little impact on the frequency values of the global modes. The results of simplified model analysis show that the energy can be transformed between the modes of the beam and cable when the nature frequencies of them are very close. On the other hand, with the transverse excitation changing, the cable can exhibit richer quasi-periodic or chaotic motions due to the nonlinear terms caused by the coupled mode between the beam and cable.

  4. To Stay or Leave: Factors That Impact Undergraduate Women's Persistence in Science Majors

    Science.gov (United States)

    Gayles, Joy Gaston; Ampaw, Frim

    2016-01-01

    This study examined factors that influenced undergraduates' decision to enter, leave, or stay within science majors. In addition, we sought to understand if such decisions differed by gender and type of science major. Using Beginning Postsecondary Students (BPS) longitudinal survey data, we found that women were less likely to select a science…

  5. [Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay].

    Science.gov (United States)

    Lezana Pérez, María Ángeles; Carreño Villarreal, Guillermo; Lora Cumplido, Paola; Alvarez Obregón, Raúl

    2013-01-01

    To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST). A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients). The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  6. 41 CFR 105-70.040 - Stays ordered by the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services Administration 70-IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 105-70.040... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Stays ordered by...

  7. Compressive sampling based approach for identification of moving loads distribution on cable-stayed bridges

    Science.gov (United States)

    Bao, Yuequan; Li, Hui; Zhang, Fujian; Ou, Jinping

    2013-04-01

    A moving loads distribution identification method for cable-stayed bridges based on compressive sampling (CS) technique is proposed. CS is a technique for obtaining sparse signal representations to underdetermined linear measurement equations. In this paper, CS is employed to localize moving loads of cable-stayed bridges by limit cable force measurements. First, a vehicle-bridge model for cable-stayed bridges is presented. Then the relationship between the cable force and moving loads is constructed based on the influence lines. With the hypothesis of sparsity distribution of vehicles on bridge deck (which is practical for long-span bridges), the moving loads are identified by minimizing the `l2-norm of the difference between the observed and simulated cable forces caused by moving vehicles penalized by the `l1-norm' of the moving load vector. The resultant minimization problem is convex and can be solved efficiently. A numerical example of a real cable-stayed bridge is carried out to verify the proposed method. The robustness and accuracy of the identification approach with limit cable force measurement for multi-vehicle spatial localization are validated.

  8. Technology for long cable erection of a thousand-meter scale cable-stayed bridge

    Institute of Scientific and Technical Information of China (English)

    Rao Huarong; Deng Huibin

    2009-01-01

    In the background of the construction of Sutong Yangtze River Bridge (short as Sutong Bridge), the cable construction method and techniques of a thousand-meter scale cable-stayed bridge are introduced. Some key construction techniques, such as outspreading cable on deck, installing cable at pylon, pulling and fixing cable at the attachment with decks and cable PE sheath protection are discussed.

  9. Life Changes, Connection Stays: Photo Sharing and Social Connectedness for People with Special Needs

    NARCIS (Netherlands)

    Van Dijk, B.; Dadlani, P.; Van Halteren, A.T.; Biemans, M.

    2011-01-01

    We study the effects of digital photo sharing on social connectedness of people with special needs. We target people dealing with a transition in life that forced them to live away from their family and friends. Our study included four people with spinal-cord injury staying in a rehabilitation centr

  10. Changes in mitochondrial homeostasis and redox status in astronauts following long stays in space

    DEFF Research Database (Denmark)

    Indo, Hiroko P; Majima, Hideyuki J; Terada, Masahiro

    2016-01-01

    The effects of long-term exposure to extreme space conditions on astronauts were investigated by analyzing hair samples from ten astronauts who had spent six months on the International Space Station (ISS). Two samples were collected before, during and after their stays in the ISS; hereafter...

  11. [Effects of IT usage on the nursing-care stress of stay-at-home caregivers].

    Science.gov (United States)

    Kubota, Masakazu; Kinoshita, Ayae

    2008-12-01

    We examined the effects of blog post on the stress reduction of stay-at-home care givers who posted their nursing-care blog on the Internet. Fourteen bloggers filled out the attached questionnaires. In the examination of questionnaires about intercommunication among the care givers, we suggest that IT literacy is found to be useful for reducing the burden of nursing care.

  12. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures.

    Science.gov (United States)

    Gili-Miner, M; López-Méndez, J; Vilches-Arenas, A; Ramírez-Ramírez, G; Franco-Fernández, D; Sala-Turrens, J; Béjar-Prado, L

    2016-10-22

    The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Is the length of stay in hospital correlated with patient satisfaction?

    NARCIS (Netherlands)

    Borghans, I.; Kleefstra, S.M.; Kool, R.B.; Westert, G.P.

    2012-01-01

    OBJECTIVE: To investigate the correlation between length of stay (LOS) and patient satisfaction on the level of hospital wards. The underlying hypothesis is that good quality of care leads both to shorter LOS and to patients that are more satisfied. DESIGN: We used standardized LOS and standardized

  14. From Long-Stay Hospitals to Community Care: Reconstructing the Narratives of People with Learning Disabilities

    Science.gov (United States)

    Leaning, Brian; Adderley, Hope

    2016-01-01

    Raymond, a 62 year old gentleman diagnosed with severe and profound learning disabilities, autistic spectrum disorder and severe challenging behaviour, who had lived in long stay campus-based hospital accommodation for 46 years was supported to move to a community project developed to support people to live in their own bespoke flat. This…

  15. 78 FR 894 - Interim Final Determination To Stay Sanctions, Imperial County Air Pollution Control District

    Science.gov (United States)

    2013-01-07

    ... AGENCY 40 CFR Part 52 Interim Final Determination To Stay Sanctions, Imperial County Air Pollution... of revisions to the Imperial County Air Pollution Control District (ICAPCD) portion of the California... such as unpaved roads and disturbed soils in open and agricultural areas in Imperial County....

  16. Advice to stay active or structured exercise in the management of sciatica

    DEFF Research Database (Denmark)

    Fernandez, Matt; Hartvigsen, Jan; Ferreira, Manuela L

    2015-01-01

    STUDY DESIGN: A systematic review and meta-analysis. OBJECTIVE: To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica. SUMMARY OF BACKGROUND DATA: Conservative management of sciatica usually includes inte...

  17. Treating Long-Stay Patients in Acute Hospital Beds: An Economic Diagnosis.

    Science.gov (United States)

    Hochstein, Alan

    1985-01-01

    A study of 105 medical files from three Montreal hospitals suggests that long-stay patients are inactive users of many hospital services; estimated reduction in cost per day for these patients due to their earlier discharge is only about 24-30 percent of the hospital's per diem.

  18. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

    Science.gov (United States)

    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  19. Determinants in Adolescence of Stroke-Related Hospital Stay Duration in Men: A National Cohort Study.

    Science.gov (United States)

    Bergh, Cecilia; Udumyan, Ruzan; Appelros, Peter; Fall, Katja; Montgomery, Scott

    2016-09-01

    Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first. Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45). Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors. © 2016 American Heart Association, Inc.

  20. Characteristics of Body Composition and Muscle Strength of North Korean Refugees during South Korean Stay

    Directory of Open Access Journals (Sweden)

    Sun Wook Cho

    2015-12-01

    Full Text Available BackgroundThe aim of this study was to investigate the changes of body composition and muscle strength of North Korean refugees (NKRs according to their duration of stay in South Korea.MethodsNKRs who volunteered and were living in South Korea, aged 20 to 75 years were recruited. Body compositions were analyzed by bioelectrical impedance analysis. Muscle strength was measured with the hand grip test. Demographic and migration information was obtained with a questionnaire.ResultsA total of 158 volunteers were recruited at a mean age of 48.3±11.4 years. The mean time from when they escaped from North Korea and arrived in South Korea was 5.8±4.3 years. Height, weight, and body surface area were significantly smaller in all NKRs compared to South Korean controls, except for women aged over 50 years. In females of younger ages (<50 years, NKRs with more than a 4-year stay in South Korea had a higher weight and fat mass than that of those who had a shorter stay (less than 4 years in South Korea. All NKRs had a weaker grip strength than that of the age-matched controls from South Korea.ConclusionThe NKRs showed relatively smaller physiques and weaker muscle strength than that of the South Korean controls. In younger female NKRs, shorter South Korean stay group showed small body weight and fat mass than that of longer South Korean stay group. Specific health support programs might be needed.