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  1. Temporal geomapping of pediatric surgeons in the United States.

    Science.gov (United States)

    Snyder, Charles L

    2008-03-01

    Several studies have addressed the issue of manpower needs in pediatric surgery. The number of training programs has multiplied dramatically over the past decade. The distribution of surgeons is more significant than the absolute change in numbers--are major metropolitan areas seeing a more dramatic increase than less populated areas? To evaluate the geographic and demographic changes associated with this increase, we used choropleth and geomapping techniques to evaluate the change in number and distribution of American Pediatric Surgical Association (APSA) members (and by proxy, pediatric surgeons) in the United States over the past decade. Data regarding membership were obtained from APSA. In 1996, management companies changed, and accurate data for initial year of membership were only available after 1996. Online sources (www.services.alphaworks.ibm.com/manyeyes/home and www.mapresso.com) were used for data analysis. There was a 175% increase in the number of APSA members over the past decade. The geographic distribution parallels the state population to some extent but is uneven. The number of APSA members by state over time is displayed in color density maps. Predictions of prior manpower studies were generally accurate. The number of pediatric surgeons in the United States has rapidly increased in the past decade, with no sign of diminution in this trend. Increases in the number of surgeons correlates with state population, indicating a tendency for surgeons to reside in more densely populated areas, as expected. Areas with a disproportionately high or low number of surgeons can be identified via choropleth mapping.

  2. Parental Leave Policies and Pediatric Trainees in the United States.

    Science.gov (United States)

    Dixit, Avika; Feldman-Winter, Lori; Szucs, Kinga A

    2015-08-01

    The American Academy of Pediatrics (AAP) states that each residency program should have a clearly delineated, written policy for parental leave. Parental leave has important implications for trainees' ability to achieve their breastfeeding goals. This study aimed to measure the knowledge and awareness among members of the AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) regarding parental leave. An online survey was emailed to SOMSRFT members in June 2013. Quantitative data are presented as percentage of respondents. Awareness of leave policies was analyzed based on having children and the sex of respondents. Nine hundred twenty-seven members responded to the survey. Among those with children, 40% needed to extend the duration of their training in order to have longer maternity leave, 44% of whom did so in order to breastfeed longer. Thirty percent of respondents did not know if their program had a written, accessible policy for parental leave. Trainees without children and men were more unaware of specific aspects of parental leave such as eligibility for the Family Medical Leave Act as compared to women and those with children. Despite the fact that United States national policies support parental leave during pediatrics training, and a majority of programs comply, trainees' awareness regarding these policies needs improvement. © The Author(s) 2015.

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

    Science.gov (United States)

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

    2015-08-01

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

  4. Pediatric transplantation in the United States, 1995-2004

    NARCIS (Netherlands)

    Sweet, SC; Wong, HH; Webber, SA; Horslen, S; Guidinger, MK; Fine, RN; Magee, JC

    2006-01-01

    This article reviews trends in pediatric solid organ transplantation over the last decade, as reflected in OPTN/SRTR data. In 2004, children younger than 18 years made up nearly 3% of the 86378 candidates for organ transplantation and nearly 7% of the 27 031 organ transplant recipients. Children acc

  5. Out-of-hospital pediatric airway management in the United States.

    Science.gov (United States)

    Hansen, Matthew; Lambert, William; Guise, Jeanne-Marie; Warden, Craig R; Mann, N Clay; Wang, Henry

    2015-05-01

    The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset. In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Success and complication rates were analyzed and compared across pediatric age groups, by race, ethnicity, clinical condition, and geographic region. We identified a total of 949,301 pediatric patient care events in the NEMSIS 2012 dataset. 4.5% had airway management procedures (42,936 events). Invasive airway management or ventilation (ETI, cricothyroidotomy, alternate airway, CPAP/BiPAP, BVM and other ventilation) took place in 1.5% of patient care events (14,107). Of those who had invasive airway management, 29.9% were less than 1 year of age, 58.1% were male, 42.3% were white, and 83.6% were in urban areas. ETI occurred in 3124 of patient care events (329 per 100,000; 95% CI 318-341). Overall success of ETI was 81.1% (95% CI 79.7-82.6). Lower success was noted in patients with cardiac arrest (75.5%, 95% CI 72.6-78.3) and those aged 1-12 months (72.1%, 95% CI 68.3-75.6). Out-of-hospital pediatric advanced airway procedures were infrequently performed. Success rates are lowest in patients aged 1-12 months. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Racial and ethnic disparities in pediatric renal allograft survival in the United States.

    Science.gov (United States)

    Patzer, Rachel E; Mohan, Sumit; Kutner, Nancy; McClellan, William M; Amaral, Sandra

    2015-03-01

    This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low- or high-poverty neighborhoods and those with private or public insurance. Among 6216 incident, pediatric end-stage renal disease patients in the United States Renal Data System (kidney transplant from 2000 through September, 2011), 14.4% experienced graft failure, with a median follow-up time of 4.5 years. After controlling for multiple covariates, black race, but not Hispanic ethnicity, was significantly associated with a higher rate of graft failure for both deceased and living donor transplant recipients. Disparities were particularly stark by 5 years post transplant, when black living donor transplant recipients experienced only 63.0% graft survival compared with 82.8 and 80.8% for Hispanics and whites, respectively. These disparities persisted among high- and low-poverty neighborhoods and among both privately and publicly insured patients. Notably profound declines in both deceased and living donor graft survival rates for black, compared with white and Hispanic, children preceded the 3-year mark when transplant Medicare eligibility ends. Further research is needed to identify the unique barriers to long-term graft success among black pediatric transplant recipients.

  7. Increasing Utilization Of Pediatric Epilepsy Surgery In The United States Between 1997 and 2009

    Science.gov (United States)

    Pestana Knight, Elia M.; Schiltz, Nicholas K.; Bakaki, Paul M.; Koroukian, Siran M.; Lhatoo, Samden D.; Kaiboriboon, Kitti

    2014-01-01

    SUMMARY OBJECTIVE To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. METHODS We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. RESULTS The rates of pediatric epilepsy surgery significantly increased from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. SIGNIFICANCE In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery. PMID:25630252

  8. Pediatric martial arts injuries presenting to Emergency Departments, United States 1990-2003.

    Science.gov (United States)

    Yard, Ellen E; Knox, Christy L; Smith, Gary A; Comstock, R Dawn

    2007-08-01

    Although an estimated 6.5 million United States (US) children aged 6-17 practiced a martial art in 2004, there have been no nationally representative studies comparing pediatric injuries among the three most popular disciplines, karate, taekwondo, and judo. Describe pediatric martial arts injuries presenting to a representative sample of US Emergency Departments (EDs) from 1990 to 2003. We reviewed all martial arts injuries captured by the US Consumer Product Safety Commission's (CPSC), National Electronic Injury Surveillance System (NEISS). An estimated 128,400 children martial arts-related injuries from 1990 to 2003. Injured tended to be male (73.0%) and had a mean age of 12.1 years. Most injuries were attributed to karate (79.5%). The most common mechanism of injury was being kicked (25.6%), followed by falling (20.6%) and kicking (18.0%). The majority of injuries occurred to the lower leg/foot/ankle (30.1%) and hand/wrist (24.5%). The most common injury diagnoses were sprains/strains (29.3%), contusions/abrasions (27.8%), and fractures (24.6%). Participants in judo sustained significantly higher proportions of shoulder/upper arm injuries than karate (IPR=4.31, 95% CI: 2.84-6.55) or taekwondo (IPR=9.75, 95% CI: 3.53-26.91) participants. There were also higher proportions of neck injuries sustained by judo participants compared to karate (IPR=4.73, 95% CI: 1.91-11.70) or taekwondo (IPR=4.17, 95% CI: 1.02-17.06) participants. Pediatric martial arts injuries differ by discipline. Understanding these injury patterns can assist with the development of discipline-specific preventive interventions.

  9. Healthcare costs of acute and chronic tonsillar conditions in the pediatric population in the United States.

    Science.gov (United States)

    Duarte, Victor M; McGrath, Caitlin L; Shapiro, Nina L; Bhattacharrya, Neil

    2015-06-01

    To determine the prevalence and healthcare costs associated with the diagnosis and treatment of acute and chronic tonsillar conditions (ACT) in children. Cross-sectional analysis of the 2006, 2008, and 2010 Medical Expenditure Panel Surveys. Pediatric patients (age children with and without a diagnosis of ACT and acute versus chronic tonsillitis, with multivariate adjustment for age, sex, ethnicity, region, insurance coverage and comorbid conditions (e.g., asthma and otitis media). A total of 74.3 million children (mean age 8.55 years, 51% male) were sampled (raw N = 28,873). Of these, 804,229 children (1.1 ± 0.1%) were diagnosed with ACT annually (mean age 7.24 years, 49.1% male); 64.6 ± 2.0% had acute tonsillitis diagnoses and 35.4 ± 2.0% suffered from chronic tonsillitis. Children with ACT incurred an additional 2.3 office visits and 2.1 prescription fills (both p Children with acute tonsillar diagnoses carried total healthcare expenditures of $1303 ± 390 annually versus $2401 ± 618 for those with chronic tonsillitis (p = 0.193). ACT was associated with an incremental increase in total healthcare expense of $1685 per child, annually (p children, parents and the healthcare system. With its prevalence in the United States, pediatric tonsillitis accounts for approximately $1.355 billion in incremental healthcare expense and is a significant healthcare utilization concern. 2C. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Pediatric sports-related traumatic brain injury in United States trauma centers.

    Science.gov (United States)

    Yue, John K; Winkler, Ethan A; Burke, John F; Chan, Andrew K; Dhall, Sanjay S; Berger, Mitchel S; Manley, Geoffrey T; Tarapore, Phiroz E

    2016-04-01

    OBJECTIVE Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from children (age 0-17 years) across 5 sports categories: fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03-0.07, p injury incurred during roller sports was independently associated with prolonged hospital LOS compared

  11. [Pediatric drug development: ICH harmonized tripartite guideline E11 within the United States of America, the European Union, and Japan].

    Science.gov (United States)

    Pflieger, M; Bertram, D

    2014-10-01

    To address the lack of appropriate pediatric drugs available on the global market, in 2000 the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) issued the ICH E11 guideline regarding the Clinical Investigation of Medicinal Products in the Pediatric Population. This guideline considerably changes the environment of drug development for children. It has been written specifically to harmonize, promote, and facilitate high-quality and ethical clinical research for children within the ICH regions, i.e., the United States of America (USA), the European Union (EU), and Japan. This article details the various regulations applicable in each ICH region following the publication of the guideline. The framework of rewards, incentives, and obligations for pharmaceutical companies established for the development of pediatric drugs are compared. It appears that the USA and the EU have both developed specific regulations for pediatric drug development while Japan has not. However, in Japan, pharmaceutical companies (PCs) are encouraged to develop pediatric drugs voluntarily, and they may be granted additional months of market exclusivity or the postponement of the drug re-examination deadline. In both the USA and the EU, regulations aimed to increase the number of clinical studies conducted in children, in order to ensure that the necessary data are generated, determining the conditions in which a drug may be authorized to treat the pediatric population. PCs are encouraged to develop pediatric assessment, including pediatric clinical trials, which is described in a pediatric plan submitted to the relevant authorities. A system of rewards for PCs submitting an application for marketing authorization containing pediatric use information has been put in place to cover the additional investment for testing drugs in children. Subject to conditions, these rewards consist in a 6-month extension of the patent or

  12. The effect of critical care nursing and organizational characteristics on pediatric cardiac surgery mortality in the United States.

    Science.gov (United States)

    Hickey, Patricia A; Gauvreau, Kimberlee; Curley, Martha A Q; Connor, Jean A

    2014-10-01

    This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States. Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality. Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years. The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality. These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality.

  13. Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children's Hospitals.

    Science.gov (United States)

    Chan, Katherine H; Bell, Teresa; Cain, Mark; Carroll, Aaron; Benneyworth, Brian D

    2017-03-01

    Guidelines recommend surgical antibiotic prophylaxis for clean-contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children's hospitals. Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean-contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean-contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean-contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean-contaminated procedures (OR 0.86, 95% CI 0.84-0.88, p variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean-contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Hospitals that used surgical antibiotic prophylaxis appropriately for clean-contaminated procedures were likely to use surgical antibiotic prophylaxis inappropriately for clean procedures. More variation was seen in hospital level guideline compliance for clean-contaminated procedures. Copyright © 2017 American Urological

  14. Pediatric Genitourinary Injuries in the United States from 2002 to 2010

    Science.gov (United States)

    Tasian, Gregory E.; Bagga, Herman S.; Fisher, Patrick B.; McCulloch, Charles E.; Cinman, Nadya M.; McAninch, Jack W.; Breyer, Benjamin N.

    2013-01-01

    Purpose We describe the epidemiological features of pediatric genitourinary injuries, and determine the products and events that may predict an increased risk of genitourinary injury during childhood. Materials and Methods The National Electronic Injury Surveillance System was queried to identify children 18 years or younger who sustained genitourinary injuries and presented to emergency departments in the United States between 2002 and 2010. Demographics and injury characteristics of these children were analyzed. Analyses were performed with adjustments for sample weighting and the stratified survey design. All data are reported as national estimates along with 95% confidence intervals. Results Based on 10,286 actual cases, an estimated 252,392 children (95% CI 205,579–299,194) sustained genitourinary injuries during the 9-year study period. Children 4 to 7 years old were most frequently injured (36.8% of all injuries), followed by those 8 to 11 years old (20.6%). Girls comprised 55% of the injured children. The yearly incidence of genitourinary injuries was stable across the period studied. The most commonly injured organs were female external genitalia (37.7%), penises (21.6%) and testicles (12%). Genitourinary injuries were most commonly associated with sporting and exercise equipment (35.7%), furniture (15.5%) and clothing items (11.9%). Of the patients 91% were treated at the emergency department and discharged home. Conclusions Genitourinary injuries in children result in approximately 28,000 emergency department visits yearly. Efforts should be made to decrease the risk of genitourinary injuries in children by promoting the use of protective gear and safer product selection for those at greatest risk for injury. PMID:23174237

  15. Three phases of disaster relief in Haiti--pediatric surgical care on board the United States Naval Ship Comfort.

    Science.gov (United States)

    Walk, Ryan M; Donahue, Timothy F; Sharpe, Richard P; Safford, Shawn D

    2011-10-01

    On January 12, 2010, Haiti experienced the western hemisphere's worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. These data represent pediatric surgical patients treated aboard the United States Naval Ship Comfort between January 19 and February 27, 2010. Prospective databases managed by patient administration, radiology, blood bank, laboratory services, and surgical services were combined to create an overall patient care database that was retrospectively reviewed for this analysis. Two hundred thirty-seven pediatric surgical patients were treated, representing 27% of the total patient population. These patients underwent a total of 213 operations composed of 243 unique procedures. Orthopedic procedures represented 71% of the total caseload. Patients returned to the operating room up to 11 times and required up to 28 days for completion of surgical management. This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described. Published by Elsevier Inc.

  16. The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

    Science.gov (United States)

    Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M

    2012-01-01

    The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

  17. Status of pediatric anesthesiology fellowship research education in the United States: a survey of fellowship program directors.

    Science.gov (United States)

    Benzon, Hubert A; De Oliveira, Gildasio S; Hardy, Courtney A; Suresh, Santhanam

    2014-03-01

    Currently, very little information is known regarding the research education of pediatric anesthesia fellows. The main objective of the current investigation was to evaluate the status of research training in pediatric anesthesia fellowship programs in the United States. Survey responses were solicited from forty-six pediatric anesthesia fellowship directors. Questions evaluated department demographic information, the extent of faculty research activity, research resources and research funding in the department, the characteristics of fellow research education and fellow research productivity, departmental support for fellow research, and perceived barriers to fellow research education. Thirty-six of forty-six fellowship directors responded to the survey, for a response rate of 78%. Eight of fourteen (57%) programs with a structured curriculum had more than 20% of graduating fellows publish a peer-reviewed manuscript compared with only five of twenty-two (23%) programs, which did not have a structured research curriculum (P = 0.03). While the majority of program directors (thirty of thirty-six (83%)) did not think that fellows are adequately trained to pursue research activities, only a minority of program directors (7 of 36 (19%)) thought that an extra year of fellowship dedicated to research should become a requirement. Structured research curriculum is associated with increased research productivity during pediatric anesthesia fellowship. Important barriers to fellows' research education include high clinical demands and lack of research time for faculty. Despite acknowledging the poor research education, a small minority of fellowship directors supports the addition of an extra year exclusively dedicated to research. © 2013 John Wiley & Sons Ltd.

  18. Contribution of solid organ transplant recipients to the pediatric non-hodgkin lymphoma burden in the United States.

    Science.gov (United States)

    Yanik, Elizabeth L; Shiels, Meredith S; Smith, Jodi M; Clarke, Christina A; Lynch, Charles F; Kahn, Amy R; Koch, Lori; Pawlish, Karen S; Engels, Eric A

    2017-07-31

    Pediatric solid organ transplant recipients have a 100 to 200 times higher risk of non-Hodgkin lymphoma (NHL) than the general pediatric population. Consequently, transplant-related NHL may contribute considerably to the pediatric NHL burden in the United States. A cohort study using a linkage between the US transplant registry and 16 cancer registries was conducted. Cancer incidence rates were calculated for people less than 20 years old in the transplant and general populations. Rates were applied to transplant registry and US census data to estimate pediatric NHL counts for transplant recipients and the general population. During 1990-2012, an estimated 22,270 NHLs were diagnosed in US children and adolescents; they included 628 cases diagnosed in transplant recipients. Thus, 2.82% of pediatric NHL diagnoses in the general population (95% confidence interval [CI], 2.45%-3.19%) occurred in transplant recipients. Among transplant recipients, the most common subtypes were diffuse large B-cell lymphoma (DLBCL; 64.5% of cases) and Burkitt lymphoma (BL; 8.6%). For DLBCL and BL, transplant recipients contributed 7.62% (95% CI, 6.35%-8.88%) and 0.87% (95% CI, 0.51%-1.23%) of diagnoses, respectively. The proportion of NHLs that occurred in transplant recipients was highest among children less than 5 years old (4.46%; 95% CI, 3.24%-5.69%) and in more recent calendar years (3.73% in 2010-2012; 95% CI, 2.07%-5.39%). DLBCL patterns were similar, with transplant recipients contributing 19.78% of cases among children less than 5 years old (95% CI, 12.89%-26.66%) and 11.4% of cases in 2010-2012 (95% CI, 5.54%-17.28%). Among children and adolescents, solid organ transplant recipients contribute a substantial fraction of NHL diagnoses, particularly DLBCL diagnoses. This fraction has increased over time. Prevention efforts targeted toward this group could reduce the overall pediatric NHL burden. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  19. Transitioning youth with rheumatic conditions: perspectives of pediatric rheumatology providers in the United States and Canada.

    Science.gov (United States)

    Chira, Peter; Ronis, Tova; Ardoin, Stacy; White, Patience

    2014-04-01

    To assess North American pediatric rheumatology providers' perspectives on practices, barriers, and opportunities concerning the transition from pediatric-centered to adult-centered care. Childhood Arthritis and Rheumatology Research Alliance (CARRA) members completed a 25-item survey assessing current transition practices, transition policy awareness, and transitional care barriers and needs. Results were compared to the American Academy of Pediatrics (AAP) 2008 survey on transitional care. Over half (158/288, 55%) of CARRA members completed the survey. Fewer than 10% are very familiar with AAP guidelines about transition care for youth with special healthcare needs. Eight percent have a formal written transition policy, but 42% use an informal approach. Patient request (75%) most frequently initiates transfer to adult care. Two major barriers to transition are fragmented adult medical care and lack of sufficient time to provide services. Compared with AAP survey participants, pediatric rheumatology providers are significantly more likely to help youth find an adult specialist (63% vs 45%) and discuss confidentiality and consent before age 18 (45% vs 33%), but are less likely to help with medical summary creation (16% vs 27%) or find a primary care provider (25% vs 47%). Outcomes ranked as "very important" in defining a successful transition are survival (76%), seeing an adult rheumatologist within 6 months of final pediatric rheumatology visit (66%), and maintaining insurance coverage (57%). This comprehensive survey of North American pediatric rheumatology providers regarding transitional care practices demonstrates deficiencies in education, resources, and a formalized process. Respondents support development of standardized rheumatology-specific transition practices.

  20. Health care expenditures associated with pediatric pain-related conditions in the United States.

    Science.gov (United States)

    Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M

    2015-05-01

    The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

  1. Pediatric vancomycin use in 421 hospitals in the United States, 2008.

    Directory of Open Access Journals (Sweden)

    Tamar Lasky

    Full Text Available BACKGROUND: Recommendations to prevent the spread of vancomycin resistance have been in place since 1995 and include guidelines for inpatient pediatric use of vancomycin. The emergence of large databases allows us to describe variation in pediatric vancomycin across hospitals. We analyzed a database with hospitalizations for children under 18 at 421 hospitals in 2008. METHODOLOGY/PRINCIPAL FINDINGS: The Premier hospital 2008 database, consisting of records for 877,201 pediatric hospitalizations in 421 hospitals, was analyzed. Stratified analyses and logistic mixed effects models were used to calculate the probability of vancomycin use while considering random effects of hospital variation, hospital fixed effects and patient effects, and the hierarchical structure of the data. Most hospitals (221 had fewer than 10 hospitalizations with vancomycin use in the study period, and 47 hospitals reported no vancomycin use in 17,271 pediatric hospitalizations. At the other end of the continuum, 21 hospitals (5.6% of hospitals each had over 200 hospitalizations with vancomycin use, and together, accounted for more than 50% of the pediatric hospitalizations with vancomycin use. The mixed effects modeling showed hospital variation in the probability of vancomycin use that was statistically significant after controlling for teaching status, urban or rural location, size, region of the country, patient ethnic group, payor status, and APR-mortality and severity codes. CONCLUSIONS/SIGNIFICANCE: The number and percentage of pediatric hospitalizations with vancomycin use varied greatly across hospitals and was not explained by hospital or patient characteristics in our logistic models. Public health efforts to reduce vancomycin use should be intensified at hospitals with highest use.

  2. Trends in operative experience of pediatric surgical residents in the United States and Canada.

    Science.gov (United States)

    Fingeret, Abbey L; Stolar, Charles J H; Cowles, Robert A

    2013-01-01

    Expansion of the number of training programs in pediatric surgery occurred from 2003 through 2010. We sought to determine the effect of program expansion on case volume and distribution of operative experience. Public domain data on pediatric surgery resident summary statistics available from the Accreditation Council for Graduate Medical Education (ACGME) from July 2003 through June 2010 were analyzed. Total case volume as primary surgeon or teaching assistant, mean case volume per resident, standard deviation, mode, minimum, and maximum number of cases per resident were evaluated. Mean total cases per resident, minimally invasive laparoscopic and thoracoscopic cases, and requisite cases as defined by the ACGME categories of: tumor, important pediatric surgical, and neonatal cases were analyzed by a Cuzick Wilcoxon-type nonparametric trend statistic using a significance level of 0.05. Skew was assessed by Pearson coefficient with levels of -0.5 to 0.5 defining a parametric distribution. The number of pediatric surgical training residents increased by 42% during the years reported, from 24 to 34. No statistically significant difference was found in the mean number of total cases or requisite cases per resident. The mean volume of minimally invasive procedures increased significantly. Case volume per resident was non-parametrically distributed with increasing positive skew over time. The increase in number of pediatric surgical resident training positions has not adversely affected overall operative experience or exposure to highly specialized requisite cases, on average. The increasing positive skew of total and index cases, however, suggests that variability between programs in case exposure is increasing over time. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Perspective of vaccine manufacturers on financing pediatric and adolescent vaccines in the United States.

    Science.gov (United States)

    Shen, Angela K; Rodewald, Lance E; Birkhead, Guthrie S

    2009-12-01

    The goal was to understand vaccine manufacturers' perspectives on vaccine financing as a barrier to immunization. Individual telephone interviews with representatives of the 6 manufacturers that produce routinely recommended vaccines for children and adolescents in the United States were conducted in November and December 2006. Although manufacturers acknowledged that the price of newer vaccines presents challenges to optimal vaccine use, they asserted that children and adolescents have access to vaccinations through public and private insurance. Respondents suggested that the system could be improved through adequate funding of the public-sector safety net. Respondents stated that providers should receive timely reimbursement for the full costs of vaccine purchase and administration, and manufacturers who sell directly to health care providers may provide flexible payment terms for vaccine purchases. Manufacturers supported targeted expansion of the Vaccines for Children program to allow children with incomplete insurance coverage for vaccines to receive vaccines at health department clinics. Manufacturers perceived delays in publication of Advisory Committee on Immunization Practices recommendations as a potential barrier to vaccine uptake. They viewed the perceived lack of public value for vaccines as a potential barrier to adequate reimbursement and optimal utilization. Respondents also maintained that their ability to negotiate vaccine prices through the private market is a crucial priority. Manufacturers assert that children and adolescents have access to immunizations through public and private insurance. Manufacturers think that they have mitigated the challenge most directly in their control: the large financial outlays required for up-front vaccine purchases.

  4. Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

    Science.gov (United States)

    Tarantino, Michael D.; Danese, Mark; Klaassen, Robert J.; Duryea, Jennifer; Eisen, Melissa; Bussel, James

    2016-01-01

    Abstract To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months–17 years with ITP; 43% in children aged 1–5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments. PMID:26941022

  5. Estimates of Pertussis Vaccine Effectiveness in United States Air Force Pediatric Dependents

    Science.gov (United States)

    2015-06-22

    medical treatment facility; OR, odds ratio; PCR, polymerase chain reaction; Tdap, tetanus , diphtheria toxoids, and acellular pertus- sis; U.S., United...interval; ClinChem, Clinical Chemistry Database; DFA, direct fluorescent antibody; DTaP, diphtheria, tetanus toxoids, and acellular pertussis; MTF...100,000 people) [8,9]. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination with diphtheria, tetanus toxoids, and http

  6. Infection related never events in pediatric patients undergoing spinal fusion procedures in United States: prevalence and predictors.

    Directory of Open Access Journals (Sweden)

    Veerajalandhar Allareddy

    Full Text Available OBJECTIVE: To examine the prevalence and predictors of infection related never events (NE associated with spinal fusion procedures (SFP in children (age < = 18 years in the United States. METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample for the years 2004 to 2008. All pediatric hospitalizations that underwent SFP were selected for analysis. The main outcomes measures include occurrence of certain NE's. The association between the occurrence of a NE and factors (patient & hospital related were examined using multivariable logistic regression analysis. RESULTS: Of 56,465 hospitalizations, 61.7% occurred among females. The average age was 13.7 y and two-thirds were whites. The major insurance payer was private insurance (67.4%. About 82% of all hospitalizations occurred on an elective basis. Teaching hospitals accounted for a majority of hospitalizations (87.9%. Two-thirds were posterior fusion techniques, 52.3% had underlying musculoskeletal deformities, and the most frequently present co-morbid conditions (CMC included paralysis (10.9%, chronic pulmonary disease (9.7%, and fluid/electrolyte disorders (7.6%. Overall rate of occurrence of a NE was 4.8%. Post-operative pneumonia was the most frequently occurring NE (2.9%. Female gender (OR = 0.78 and elective admissions (OR = 0.66 were associated with lower risk of NE occurrence. Medicaid coverage (OR = 1.46, primary diagnosis of other acquired deformities (OR = 1.82, spinal cord injury (OR = 6.94, other nervous system disorders (OR = 2.84 were associated with higher risk of NE occurrence. Among CMC, those with chronic blood loss anemia (OR = 2.57, coagulopathy (OR = 1.97, depression (OR = 2, drug abuse (OR = 3.71, fluid/electrolyte disorders (OR = 2.62, neurological disorders (OR = 1.72, paralysis (OR = 1.75, renal failure (OR = 5.45, and weight loss (OR = 4.61 were risk factors for higher odds of a NE occurrence. Hospital teaching status, region, hospital size, and

  7. Maternal-child nutrition practices and pediatric overweight/obesity in the United States and Chile: a comparative study.

    Science.gov (United States)

    Moore, Jean Burley; Gaffney, Kathleen F; Pawloski, Lisa R; Jaimovich, Sonia P; Campos, Maria C

    2012-10-01

    Childhood overweight/obesity is now epidemic in both developed countries and those undergoing economic transition. This study compared maternal and school-age child nutrition practices and body mass index in the United States and in Chile. Children (125 in the United States, 121 in Chile) and their mothers (116 in the United States, 101 in Chile) participated. Findings indicated that child nutrition practices were comparable, but mothers in the U.S. group demonstrated fewer healthy nutrition practices on behalf of their children. Significant associations were found between maternal and child nutrition practices. Substantially more children in the U.S. sample were overweight/obese. Implications for practice are presented.

  8. United States

    Directory of Open Access Journals (Sweden)

    Stephen Bernow

    1998-12-01

    Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.

  9. Improving Pediatric Cancer Care Disparities Across the United States-Mexico Border: Lessons Learned from a Transcultural Partnership between San Diego and Tijuana.

    Science.gov (United States)

    Aristizabal, Paula; Fuller, Spencer; Rivera, Rebeca; Beyda, David; Ribeiro, Raul C; Roberts, William

    2015-01-01

    In 2007, the 5-year survival rate for children with acute leukemia in Baja California, Mexico was estimated at 10% (vs. 88% in the United States). In response, stakeholders at St. Jude Children's Research Hospital, Rady Children's Hospital San Diego, and the Hospital General de Tijuana (HGT) implemented a transcultural partnership to establish a pediatric oncology program. The aim was to improve clinical outcomes and overall survival for children in Baja California. An initial needs assessment evaluation was performed and a culturally sensitive, comprehensive, 5-year plan was designed and implemented. After six years, healthcare system accomplishments include the establishment of a fully functional pediatric oncology unit with 60 new healthcare providers (vs. five in 2007). Patient outcome improvements include a rise in 5-year survival for leukemia from 10 to 43%, a rise in new cases diagnosed per year from 21 to 70, a reduction in the treatment abandonment rate from 10% to 2%, and a 45% decrease in the infection rate. More than 600 patients have benefited from this program. Knowledge sharing has taken place between teams at the HGT and Rady Children's Hospital San Diego. Further, one of the most significant outcomes is that the HGT has transitioned into a regional referral center and now mentors other hospitals in Mexico. Our results show that collaborative initiatives that implement long-term partnerships along the United States-Mexico border can effectively build local capacity and reduce the survival gap between children with cancer in the two nations. Long-term collaborative partnerships should be encouraged across other disciplines in medicine to further reduce health disparities across the United States-Mexico border.

  10. The pediatric intensive care unit business model.

    Science.gov (United States)

    Schleien, Charles L

    2013-06-01

    All pediatric intensivists need a primer on ICU finance. The author describes potential alternate revenue sources for the division. Differentiating units by size or academic affiliation, the author describes drivers of expense. Strategies to manage the bottom line including negotiations for hospital services are covered. Some of the current trends in physician productivity and its described metrics, with particular focus on clinical FTE management is detailed. Methods of using this data to enhance revenue are discussed. Some of the other current trends in the ICU business related to changes at the federal and state level as well as in the insurance sector, moving away from fee-for-service are covered. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia : An international comparison and resources guide

    NARCIS (Netherlands)

    Babl, FE; Weiner, DL; Bhanji, F; Davies, F; Berry, K; Barnett, P

    2005-01-01

    Pediatric emergency medicine is an important subspecialty of pediatrics and emergency medicine. It is a well-established subspecialty in some countries and less well developed or evolving in others. We set out to develop a resource guide and document the current status of pediatric emergency medicin

  12. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?

    Science.gov (United States)

    Morris, Brian J; Bailis, Stefan A; Wiswell, Thomas E

    2014-05-01

    The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision

  13. Pediatric Observation Units in the US: A Systematic Review

    Science.gov (United States)

    Macy, Michelle L.; Kim, Christopher S.; Sasson, Comilla; Lozon, Marie M.; Davis, Matthew M.

    2009-01-01

    Background As the United States' (US) health system seeks more efficient and value-based care models, geographically distinct observation units (OUs) may become an integral part of hospital-based care for children. Purpose To systematically review the literature and evaluate the structure and function of pediatric OUs in the US. Data Sources Searches were conducted in Medline, Web of Science, CINAHL, HCAB, Lexis Nexis, National Guideline Clearinghouse and Cochrane Reviews through February 2009, with review of select bibliographies. Study Selection English language peer-reviewed publications on pediatric OU care in the US. Data Extraction Two authors independently determined study eligibility. Studies were graded using a 5-level quality assessment tool. Data were extracted using a standardized form. Data Synthesis 21 studies met inclusion criteria: 2 randomized trials, 2 prospective observational, 12 retrospective cohort, 2 before and after, and 3 descriptive studies. Studies present data on more than 22,000 children cared for in OUs, most at large academic centers. This systematic review provides a descriptive overview of the structure and function of pediatric OUs in the US. Despite seemingly straightforward outcomes for OU care, significant heterogeneity in the reporting of length of stay, admission rates, return visit rates, and costs precluded our ability to conduct meta-analyses. We propose standard outcome measures and future directions for pediatric OU research. Conclusions Future research using consistent outcome measures will be critical to determining whether OUs can improve the quality and cost of providing care to children requiring observation-length stays. PMID:20235288

  14. Malaria Treatment (United States)

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  15. 31 CFR 535.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory...

  16. 31 CFR 515.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory...

  17. 31 CFR 500.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust...

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

    OpenAIRE

    2016-01-01

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

  19. The current state of evidence-based pediatric surgery.

    Science.gov (United States)

    Ostlie, Daniel J; St Peter, Shawn D

    2010-10-01

    The efficiency of medical care in the United States has become intensely scrutinized with expectations from patients, families, payors, lawmakers, and, currently, the President. The most effective vehicle to bring more efficient care is the employment of evidence-based medicine whenever possible. Evidence-based medicine is dependent on best evidence, and best evidence is generated from prospective trials. To evaluate current state of evidence based practice in pediatric surgery we reviewed the literature for trials conducted in our field the past 10 years. All randomized controlled trials from January 1999 through December 2009 published in the English literature were identified through a literature search using PubMed (www.pubmed.com). We included only those in pediatric general surgery excluding transplant, oncology, and the other nongeneral subspecialties. The search criteria produced 56 manuscripts, of which 51 described appropriate randomization techniques. A definitive trial design with a sample size calculation was utilized in only 19 studies (34%). A statistically significant difference between treatment arms was identified in 29 of the 56 (52%) trials. There were 26 different journals of publication, with the Journal of Pediatric Surgery being most common (20) followed by Pediatric Surgery International (7). The combined total publications from January 1999 through December 2009 for the 26 journals these randomized trials represent 0.04% of all publications. Appendicitis was the most common condition that was studied (n = 10) followed by pyloric stenosis (n = 4). Trials originated in 19 different countries led by the United States (28%), United Kingdom (14%), and Turkey (12%). There was a generally progressive increase in published trials from 1999 to 2009, however, the percentage of prospective articles published in pediatric surgery was similar to a previous review published in 1999. The current state of evidence-based surgery in pediatric surgery has

  20. Evaluating pharmaceutical waste disposal in pediatric units.

    Science.gov (United States)

    Almeida, Maria Angélica Randoli de; Wilson, Ana Maria Miranda Martins; Peterlini, Maria Angélica Sorgini

    2016-01-01

    To verify the disposal of pharmaceutical waste performed in pediatric units. A descriptive and observational study conducted in a university hospital. The convenience sample consisted of pharmaceuticals discarded during the study period. Handling and disposal during preparation and administration were observed. Data collection took place at pre-established times and was performed using a pre-validated instrument. 356 drugs disposals were identified (35.1% in the clinic, 31.8% in the intensive care unit, 23.8% in the surgical unit and 9.3% in the infectious diseases unit). The most discarded pharmacological classes were: 22.7% antimicrobials, 14.8% electrolytes, 14.6% analgesics/pain killers, 9.5% diuretics and 6.7% antiulcer agents. The most used means for disposal were: sharps' disposable box with a yellow bag (30.8%), sink drain (28.9%), sharps' box with orange bag (14.3%), and infectious waste/bin with a white bag (10.1%). No disposal was identified after drug administration. A discussion of measures that can contribute to reducing (healthcare) waste volume with the intention of engaging reflective team performance and proper disposal is necessary. Verificar o descarte dos resíduos de medicamentos realizado em unidades pediátricas. Estudo descritivo e observacional, realizado em um hospital universitário. A amostra de conveniência foi constituída pelos medicamentos descartados durante o período de estudo. Observaram-se a manipulação e o descarte durante o preparo e a administração. A coleta dos dados ocorreu em horários preestabelecidos e realizada por meio de instrumento pré-validado. Identificaram-se 356 descartes de medicamentos (35,1% na clínica, 31,8% na unidade de cuidados intensivos, 23,8% na cirúrgica e 9,3% na infectologia). As classes farmacológicas mais descartadas foram: 22,7% antimicrobianos, 14,8% eletrólitos, 14,6% analgésicos, 9,5% diuréticos e 6,7% antiulcerosos. Vias mais utilizadas: caixa descartável para perfurocortante com

  1. United States Attorney Prosecutions

    Science.gov (United States)

    1993-10-01

    Berceda, 572 F.2d 630 (9th Cir. 1978).. A mere request, such as that made by the defendant, is not sufficient; United States v. Trejo- Zambrano , 582 F.2d...a mere request and more than mere speculation that disclosure will be helpful. United States v. Trejo- Zambrano , 582 F.2d 460 (9th Cir. 1978), eect. dt...both known and unknown to the Grand Jury, including Lane Boudreau, Scott Willard Holland, James Allen Halperin, Maria Ximena Erlandsen, Derek Adrian

  2. "I was able to still be her mom"--parenting at end of life in the pediatric intensive care unit.

    Science.gov (United States)

    McGraw, Sarah A; Truog, Robert D; Solomon, Mildred Z; Cohen-Bearak, Adena; Sellers, Deborah E; Meyer, Elaine C

    2012-11-01

    The death of a child in the pediatric intensive care unit is perhaps one of the most devastating and challenging experiences a parent can ever endure. This article examines how parents of children dying in the pediatric intensive care unit understood their role and discusses implications for clinical care and policy. Retrospective, qualitative study. Two pediatric intensive care units located in children's hospitals within academic medical centers in the northeastern United States. Parents of 18 children who died in the pediatric intensive care unit. Semistructured telephone interviews, digitally recorded and transcribed. Many of the factors deemed important by the parents related to their capacity to be a "good parent" to their child throughout his or her stay in the pediatric intensive care unit. Specifically, parents sought meaningful ways to express and assert their parenthood across three domains: 1) providing love, comfort, and care; 2) creating security and privacy for the family; and 3) exercising responsibility for what happens to one's child. Parents' ability to fulfill the essential features of their role as parents of children dying in the pediatric intensive care unit shapes how they perceive the quality of the experience. Pediatric intensive care unit clinical care and policies can and should uphold and protect these features enabling parents to feel that, despite the outcome, they had done their best on behalf of their children.

  3. State-of-the-Art Pediatric Hypnosis Training: Remodeling Curriculum and Refining Faculty Development.

    Science.gov (United States)

    Kohen, Daniel P; Kaiser, Pamela; Olness, Karen

    2017-01-01

    Training in pediatric hypnosis has been part of clinical hypnosis education in the United States since 1976. Workshops expanded over time and are now taught by highly experienced pediatric clinicians across the globe. In 1987, a small vanguard of North American faculty, academic pediatricians, and pediatric psychologists taught a 3-day pediatric hypnosis workshop at the national meeting of the Society for Developmental and Behavioral Pediatrics (SDBP). This model of annual tri-level concurrent workshops (introductory, intermediate, and advanced) was sponsored by the SDBP for 24 years. In 2009, the National Pediatric Hypnosis Training Institute (NPHTI) assembled, and in 2010, offered its first annual workshops. This article documents this history of pediatric hypnosis education and describes NPHTI's remodeling and ongoing refinement toward a state-of-the-art curriculum with innovative methodology based upon (1) current research about adult experiential and small group learning; (2) design principles for presentations that maximize adult learning and memory; and (3) evaluations by participants and faculty. These underpinnings-including clinical training videos, individualized learning choices, emphasis on personalized, goal-oriented sessions, and advances in faculty selection, and ongoing development-are applicable to adult training models. Integration of developmental and self-regulation strategies may be more unique to pediatric hypnosis skills training programs. The conclusion proposes expansion of pediatric hypnosis education and elimination of related barriers toward goals that all children learn self-hypnosis (SH) for mind-body health.

  4. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps.

    Science.gov (United States)

    Manrique-Rodríguez, S; Sánchez-Galindo, A C; Fernández-Llamazares, C M; Calvo-Calvo, M M; Carrillo-Álvarez, Á; Sanjurjo-Sáez, M

    2016-10-01

    To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. A tertiary level hospital pediatric intensive care unit. Infusions delivered with infusion pumps in all pediatric intensive care unit patients. Design of a drug library with safety limits for all intravenous drugs prescribed. Users' compliance with drug library as well as number and type of errors prevented were analyzed. Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Increasing Vaccination Rates in a Pediatric Chronic Hemodialysis Unit.

    Science.gov (United States)

    Geer, Jessica J

    2016-01-01

    Children with chronic kidney disease (CKD) are at an increased risk for serious complications from vaccine-preventable childhood diseases. Despite this risk, vaccination rates remain low. The barriers to vaccination in the pediatric population on dialysis are multifactorial. The advanced practice registered nurse (APRN) is well poised to serve as a wellness champion for this chronic population. This article chronicles an APRN-led quality improvement project to increase vaccination rates to 100% in an outpatient pediatric population on hemodialysis. A quality improvement system was created to systematically review immunizations upon admission to the hemodialysis unit and annually thereafter. Over a two-year period, immunization rates improved significantly.

  6. Immunizations in the United States: a rite of passage.

    Science.gov (United States)

    Cohn, Amanda C; Broder, Karen R; Pickering, Larry K

    2005-06-01

    Today, vaccination is a cornerstone of pediatric preventive health care and a rite of passage for nearly all of the approximately 11,000 infants born daily in the United States. This article reviews the US immunization program with an emphasis on its role in ensuring that vaccines are effective, safe, and available and highlights several new vaccines and recommendations that will affect the health of children and adolescents and the practice of pediatric medicine in future decades.

  7. Pediatric appendicitis: state of the art review.

    Science.gov (United States)

    Rentea, Rebecca M; Peter, Shawn D St; Snyder, Charles L

    2017-03-01

    Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited. A minimally invasive (laparoscopic) appendectomy is the current standard in US and European children's hospitals. This article reviews the current 'state of the art' in the evaluation and management of pediatric appendicitis.

  8. Procalcitonin use in a pediatric intensive care unit.

    Science.gov (United States)

    Cies, Jeffrey J; Chopra, Arun

    2014-09-01

    We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.

  9. Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

    NARCIS (Netherlands)

    J.M. Latour (Jos); J.B. van Goudoever (Hans); H.J. Duivenvoorden (Hugo); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M.J.I.J. Albers (Marcel); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); M. van Heerde (Marc); J.A. Hazelzet (Jan)

    2009-01-01

    textabstractAbstract: PURPOSE: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. METHODS: Prospective cohort study in tertiary PICUs at seven university

  10. Invasive candidiasis in pediatric intensive care units.

    Science.gov (United States)

    Singhi, Sunit; Deep, Akash

    2009-10-01

    Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

  11. Promoting Staff Resilience in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Lee, K Jane; Forbes, Michael L; Lukasiewicz, Gloria J; Williams, Trisha; Sheets, Anna; Fischer, Kay; Niedner, Matthew F

    2015-09-01

    Health care professionals experience workplace stress, which may lead to impaired physical and mental health, job turnover, and burnout. Resilience allows people to handle stress positively. Little research is aimed at finding interventions to improve resilience in health care professionals. To describe the availability, use, and helpfulness of resilience-promoting resources and identify an intervention to implement across multiple pediatric intensive care units. A descriptive study collecting data on availability, utilization, and impact of resilience resources from leadership teams and individual staff members in pediatric intensive care units, along with resilience scores and teamwork climate scores. Leadership teams from 20 pediatric intensive care units completed the leadership survey. Individual surveys were completed by 1066 staff members (51% response rate). The 2 most used and impactful resources were 1-on-1 discussions with colleagues and informal social interactions with colleagues out of the hospital. Other resources (taking a break from stressful patients, being relieved of duty after your patient's death, palliative care support for staff, structured social activities out of hospital, and Schwartz Center rounds) were highly impactful but underused. Utilization and impact of resources differed significantly between professions, between those with higher versus lower resilience, and between individuals in units with low versus high teamwork climate. Institutions could facilitate access to peer discussions and social interactions to promote resilience. Highly impactful resources with low utilization could be targets for improved access. Differences in utilization and impact between groups suggest that varied interventions would be necessary to reach all individuals. ©2015 American Association of Critical-Care Nurses.

  12. 7 CFR 1160.104 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United......

  13. Nutrition in the pediatric population in the intensive care unit.

    Science.gov (United States)

    Verger, Judy

    2014-06-01

    Nutrition is an essential component of patient management in the pediatric intensive care unit (PICU). Poor nutrition status accompanies many childhood chronic illnesses. A thorough assessment of the critically ill child is required to inform the plan for nutrition support. Accurate and clinically relevant nutritional assessment, including growth measurements, provides important guidance. Indirect calorimetry provides the most accurate measurement of resting energy expenditure, but is too often unavailable in the PICU. To prevent inappropriate caloric intake, reassessment of the child's nutrition status is imperative. Enteral nutrition is the recommended route of intake. Human milk is preferred for infants. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. [Nursing in a pediatric unit. Proposal for systematization].

    Science.gov (United States)

    Santos, E R; de Barros, J R; Baraldi, M M; Minto, C A; Dupas, G

    1997-04-01

    The present work reports an initial process of nursing assistance systematization developed in a Pediatric Unit of a medium size hospital in São Carlos-SP, considering the actual human resources and the type of approach adopted by the institution on the assistance given to the hospitalized child. A Routine Manual was elaborated based on the literature and with the staff participation, and after that, a training was realized with these employees, starting from routines previously sketched, using groupal dynamics that looked forward to rescue the knowledge that they already had about the themes. The work considered the employees opinion about their participation in the systematization process.

  15. The pediatric sedation unit: a prospective analysis of parental satisfaction.

    Science.gov (United States)

    Connor, Matthew P; Dion, Gregory R; Borgman, Matthew; Maturo, Stephen

    2014-12-01

    As financial pressures drive health care to be more cost-effective and efficient, performing procedures outside the main operating room (MOR) is becoming more common. Pediatric sedation units (PSU) have proven both effective and safe at providing anesthesia for children. However, there is limited data available regarding the PSU and its potential application in pediatric otolaryngology. To evaluate the experience of performing pediatric outpatient procedures in a PSU through a parental satisfaction survey. Pediatric otolaryngology procedures performed in the PSU were prospectively recorded in a database. A prospective survey analysis was performed that measured parental satisfaction with scheduling/registration for surgery, nursing care, surgeon care, facility environment, timing/duration, and overall satisfaction. Parents completed this survey for outpatient procedures performed in either the PSU or in the MOR. The same attending surgeon was involved in all cases, with the only independent variable being the location of the surgery. Fifty surveys were collected for each group, and the surveys scores were statistically compared using nonparametric statistical analysis. Parental satisfaction was high in both the PSU and OR, with mean overall satisfaction scores of 4.8 and 4.9 (respectively) on an ordinal scale from 1 to 5. Parents reported greater clarity in preoperative information in the MOR (mean 4.8) compared to the PSU (mean 4.6) (pparents reported that MOR procedures started on time more often than those in the PSU (90-64%, pparent survey has identified education prior to surgery and timeliness of surgery as two areas to improve to meet the satisfaction standard provided by the OR. Published by Elsevier Ireland Ltd.

  16. 31 CFR 800.225 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 800.225 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.225 United States. The term United States or U.S. means the United States of America, the States of the United States, the District of Columbia, and any...

  17. Incidental sinusitis in a pediatric intensive care unit

    Science.gov (United States)

    Moore, Brooke M.; Kurachek, Stephen C.; Blumberg, Karen; Laguna, Theresa A.; Liu, Meixia; Olson, Erin E.

    2013-01-01

    Objective Intubation is a risk factor for nosocomial sinusitis in adult intensive care patients. Sinusitis in intubated adults can be an occult cause of fever. In children nasal intubation may be associated with a greater risk of sinusitis. No pediatric study has determined the incidence of nosocomial sinusitis in the pediatric intensive care unit (PICU) setting. We hypothesized that within a subset of patients who had head CT imaging: (1) the incidence of sinusitis in PICU patients exceeds the incidence in non-PICU patients; (2) the incidence of sinusitis is greater in PICU patients with a tube (nasotracheal, nasogastric, orotracheal, or orogastric); and (3) nasal tubes confer an increased risk for sinusitis compared to oral tubes. Design Retrospective chart review Setting Independent not-for-profit pediatric healthcare system Patients PICU and non-PICU (inpatients hospitalized on medical-surgical wards) patients referred for head CT Interventions None Measurements and Main Results CT images were evaluated for the presence of a tube and sinusitis. Images were scored using the Lund-MacKay (LM) staging system. Sinusitis was defined as a LM score >3.5. 596 patients were studied; 395 (66.3%) PICU. 197 (50%) PICU versus 69 (34.3%) non-PICU patients had sinusitis (p sinusitis versus 88/248 (35.9%) of those without a tube present (p sinusitis based on tube location (p=0.218). Younger age or the presence of a tube increased the probability of sinusitis (p sinus disease had evidence of sinusitis. This finding raises the concern that sinusitis in PICU patients is common and likely should be considered in the differential diagnosis of fever in PICU patients. PMID:21283043

  18. Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units.

    Science.gov (United States)

    Edwards, Jeffrey D; Vasilevskis, Eduard E; Yoo, Erika J; Houtrow, Amy J; Boscardin, W John; Dudley, R Adams; Okumura, Megumi J

    2015-02-01

    The purpose of the study is to compare demographics, intensive care unit (ICU) admission characteristics, and ICU outcomes among adults with childhood-onset chronic conditions (COCCs) admitted to US pediatric and adult ICUs. Retrospective cross-sectional analyses of 6088 adults aged 19 to 40 years admitted in 2008 to 70 pediatric ICUs that participated in the Virtual Pediatric Intensive Care Unit Performance Systems and 50 adult ICUs that participated in Project IMPACT. Childhood-onset chronic conditions were present in 53% of young adults admitted to pediatric units, compared with 9% of those in adult units. The most common COCC in both groups were congenital cardiac abnormalities, cerebral palsy, and chromosomal abnormalities. Adults with COCC admitted to pediatric units were significantly more likely to be younger, have lower functional status, and be nontrauma patients than those in adult units. The median ICU length of stay was 2 days, and the intensive care unit mortality rate was 5% for all COCC patients with no statistical difference between pediatric or adult units. There are marked differences in characteristics between young adults with COCC admitted to pediatric ICUs and adult ICUs. Barriers to accommodating these young adults may be reasons why many such adults have not transitioned from pediatric to adult critical care. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. 7 CFR 1220.129 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.129 Section 1220.129... CONSUMER INFORMATION Soybean Promotion and Research Order Definitions § 1220.129 State and United States. The terms State and United States include the 50 States of the United States of America, the...

  20. 7 CFR 1220.615 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.615 Section 1220.615... CONSUMER INFORMATION Procedures To Request a Referendum Definitions § 1220.615 State and United States. State and United States include the 50 States of the United States of America, the District of...

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

    Directory of Open Access Journals (Sweden)

    Romi Nangalu

    2016-01-01

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

  2. 75 FR 5373 - United States Mint

    Science.gov (United States)

    2010-02-02

    ... United States Mint ACTION: Notification of Pricing for 2010 United States Mint Presidential $1 Coin Proof Set. \\TM\\ SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint Presidential $1 Coin Proof Set. The 2010 United States Mint Presidential $1 Coin Proof Set, featuring $1...

  3. Agricultural Water Pricing: United States

    OpenAIRE

    2010-01-01

    In summary, irrigation costs and prices are rising in most regions of the United States, due to a combination of increasing scarcity, changes in public preferences regarding water allocation among competing uses, increasing budget scrutiny in the national and state legislatures, rising energy prices, and increasing awareness of climate change and the potential implications for rainfall and the availability of surface water resources. These issues likely will continue encouraging public offici...

  4. Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses.

    Science.gov (United States)

    Bratt, M M; Broome, M; Kelber, S; Lostocco, L

    2000-09-01

    High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.

  5. 7 CFR 1250.308 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia....

  6. 31 CFR 592.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States....

  7. 7 CFR 1205.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures...

  8. 7 CFR 1205.313 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America....

  9. 22 CFR 120.13 - United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia,...

  10. 7 CFR 1219.26 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District...

  11. 7 CFR 1150.106 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States....

  12. Education in the United States

    Institute of Scientific and Technical Information of China (English)

    钱富奎

    2009-01-01

    As might be expected,educational institutions in the United States reflect the nation's basic values,especially the ideal of equality of opportunity.From elementary school through college,Americans believe that everyone deserves an equal opportunity to get a good education.

  13. United States Navy DL Perspective

    Science.gov (United States)

    2010-08-10

    United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile

  14. Norovirus in the United States

    Centers for Disease Control (CDC) Podcasts

    2013-09-09

    Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States.  Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/17/2013.

  15. Cholera in the United States

    Centers for Disease Control (CDC) Podcasts

    2011-11-08

    Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola).  Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/8/2011.

  16. 7 CFR 1209.21 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States...

  17. Perceptions of parents on satisfaction with care in the pediatric intensive care unit : the EMPATHIC study

    NARCIS (Netherlands)

    Latour, Jos M.; van Goudoever, Johannes B.; Duivenvoorden, Hugo J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; Albers, Marcel J. I. J.; Verlaat, Carin W. M.; van Vught, Elise M.; van Heerde, Marc; Hazelzet, Jan A.

    2009-01-01

    To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands. Parents

  18. Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

    NARCIS (Netherlands)

    J.M. Latour (Jos); J.B. van Goudoever (Hans); H.J. Duivenvoorden (Hugo); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M.J.I.J. Albers (Marcel); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); M. van Heerde (Marc); J.A. Hazelzet (Jan)

    2009-01-01

    textabstractAbstract: PURPOSE: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. METHODS: Prospective cohort study in tertiary PICUs at seven university med

  19. RADIUS: Research Archive on Disability in the United States. [CD-ROMs].

    Science.gov (United States)

    Sociometrics Corp., Los Altos, CA.

    This Research Archive on Disability in the United States (RADIUS), a database on CD-ROM, contains 19 data sets on the prevalence, incidence, correlates, and consequences of disability in the United States. The 19 data sets are: (1) 1991 National Maternal and Infant Health Follow-Up Survey; (2) National Pediatric Trauma Registry, 1988-1994; (3)…

  20. 75 FR 25925 - United States Mint

    Science.gov (United States)

    2010-05-10

    ... United States Mint ACTION: Notification of Citizens Coinage Advisory Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8)(C), the United States Mint...: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801...

  1. 31 CFR 560.307 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories...

  2. 31 CFR 547.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States,...

  3. 31 CFR 548.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  4. 31 CFR 586.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  5. 7 CFR 1212.31 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States....

  6. 31 CFR 543.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories...

  7. 31 CFR 546.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  8. 31 CFR 538.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 538.314 Section 538.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 538.314 United States. The term United States means the United States, its territories and...

  9. 31 CFR 594.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories...

  10. 31 CFR 588.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories...

  11. 31 CFR 593.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States,...

  12. 31 CFR 537.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and...

  13. 31 CFR 575.319 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and...

  14. 31 CFR 595.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and...

  15. 31 CFR 596.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including...

  16. 31 CFR 587.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  17. 31 CFR 542.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  18. 31 CFR 540.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States,...

  19. 31 CFR 597.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 597.318 United States. The term United States means the United States,...

  20. 31 CFR 544.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States,...

  1. 31 CFR 545.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories...

  2. 31 CFR 585.316 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States,...

  3. 7 CFR 65.255 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States....

  4. 31 CFR 536.315 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories...

  5. 31 CFR 541.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and...

  6. 31 CFR 598.317 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories...

  7. 31 CFR 551.309 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and...

  8. Karakteristik Dengue Berat yang Dirawat di Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Dzulfikar D. Lukmanul Hakim

    2012-09-01

    Full Text Available Dengue viral infections affect all age groups and produce a spectrum of clinical illness that ranges from asymptomatic to severe and occasionally fatal disease. Severe dengue characterized by plasma leakage, hemoconcentration, and hemostatic disorder. The aim of this study was to know the characteristic of severe dengue patients admitted to Pediatric Intensive Care Unit (PICU Dr. Hasan Sadikin Hospital Bandung during January 2009 to December 2010. This was a retrospective descriptive study based on the data collected from the medical records. Twenty-one severe dengue cases in two years were admitted 15/21 girls and 6/21 boys, and 5/21 of them died during hospitalization because of dengue shock syndrome (DSS and disseminated intravascular coagulation (DIC. Most of them were 1−5 years old with good nutritional status. Hepatomegaly was found in all cases with mean hematocrit was 38%. In this research, the most manifestation of severe dengue were DSS (15/21, DIC (11/21, encephalopathy (6/21, pleural effusion (5/21, myocarditis (3/21, and acute respiratory distress syndrome (3/21. In conclusions, severe dengue are more common in girls, 1–5 years old, and well-nourished children. The most common clinical manifestation of severe dengue are shock, disseminated intravascular coagulation, and encephalopathy.

  9. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions.

  10. Ethics of drug research in the pediatric intensive care unit.

    Science.gov (United States)

    Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N

    2015-02-01

    Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child.

  11. Masturbation in the United States.

    Science.gov (United States)

    Das, Aniruddha

    2007-01-01

    Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.

  12. 77 FR 48542 - United States

    Science.gov (United States)

    2012-08-14

    ... outside of the `reaches of the public interest'''); see generally United States v. SBC Commc'ns, Inc., 489... judicial power.'' SBC ] Commc'ns, 489 F. Supp. 2d at 14-15 (citing Microsoft, 56 F.3d at 1462). With... effect of proposed remedies. See, e.g., KeySpan, 763 F. Supp. 2d at 642; SBC Commc'ns, 489 F. Supp. 2d...

  13. President of the United States

    Institute of Scientific and Technical Information of China (English)

    蔡东丽

    2005-01-01

    President of the United States is the chief executive officer of the federal government, the leader of the executive branch1, and the corn man der-in-chief of the armed forces2. The president has the power to make treaties with other nations, with the advice and consent of two-thirds of the Senate3. The president also appoints4, with Senate's consent, diplomatic representatives ,Supreme Court judges5, and many other officials.

  14. Environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' effort to manage its environment including air, water nature, and biodiversity to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 40 figs., 21 tabs.

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

    Directory of Open Access Journals (Sweden)

    Rakhi Balachandran

    2011-01-01

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

  16. Early enteral nutrition therapy and mortality in a pediatric intensive care unit

    OpenAIRE

    2013-01-01

    Objective: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit.Methods: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition.Results: Despite advances in th...

  17. HIV Testing in the United States

    Science.gov (United States)

    ... HIV/AIDS HIV Testing in the United States HIV Testing in the United States Jun 23, 2017 ... States or for refugees. 27 Insurance Coverage of HIV Testing HIV testing that is “medically necessary” – recommended ...

  18. Drought in Southwestern United States

    Science.gov (United States)

    2007-01-01

    The southwestern United States pined for water in late March and early April 2007. This image is based on data collected by the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite from March 22 through April 6, 2007, and it shows the Normalized Difference Vegetation Index, or NDVI, for the period. In this NDVI color scale, green indicates areas of healthier-than-usual vegetation, and only small patches of green appear in this image, near the California-Nevada border and in Utah. Larger areas of below-normal vegetation are more common, especially throughout California. Pale yellow indicates areas with generally average vegetation. Gray areas appear where no data were available, likely due to persistent clouds or snow cover. According to the April 10, 2007, update from the U.S. Drought Monitor, most of the southwestern United Sates, including Utah, Nevada, California, and Arizona, experienced moderate to extreme drought. The hardest hit areas were southeastern California and southwestern Arizona. Writing for the Drought Monitor, David Miskus of the Joint Agricultural Weather Facility reported that March 2007 had been unusually dry for the southwestern United States. While California's and Utah's reservoir storage was only slightly below normal, reservoir storage was well below normal for New Mexico and Arizona. In early April, an international research team published an online paper in Science noting that droughts could become more common for the southwestern United States and northern Mexico, as these areas were already showing signs of drying. Relying on the same computer models used in the Intergovernmental Panel on Climate Change (IPCC) report released in early 2007, the researchers who published in Science concluded that global warming could make droughts more common, not just in the American Southwest, but also in semiarid regions of southern Europe, Mediterranean northern Africa, and the Middle East.

  19. 7 CFR 1206.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States....

  20. 7 CFR 1280.127 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia....

  1. 7 CFR 1218.22 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  2. 7 CFR 1215.20 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board...

  3. 7 CFR 1260.108 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and...

  4. 7 CFR 1216.30 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  5. 7 CFR 1221.32 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth...

  6. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  7. Poverty and Child Health in the United States.

    Science.gov (United States)

    2016-04-01

    Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.

  8. Unit-based clinical pharmacists' prevention of serious medication errors in pediatric inpatients.

    Science.gov (United States)

    Kaushal, Rainu; Bates, David W; Abramson, Erika L; Soukup, Jane R; Goldmann, Donald A

    2008-07-01

    Rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) were measured before and after introduction of unit-based clinical pharmacists. Error rates on the study units and similar patient care units in the same hospital that served as controls were determined during six- to eight-week baseline periods and three-month periods after the introduction of unit-based clinical pharmacists (full-time in the intensive care unit [ICU] and mornings only on the general units). Nurses trained by the investigators reviewed medication orders, medication administration records, and patient charts daily to detect errors, near misses, and adverse drug events (ADEs) and determine whether near misses were intercepted. Two physicians independently reviewed and rated all data collected by the nurses. Serious medication errors were defined as preventable ADEs and nonintercepted near misses. The baseline rates of serious medication errors per 1000 patient days were 29 for the ICU, 8 for the general medical unit, and 7 for the general surgical unit. With unit-based clinical pharmacists, the ICU rate dropped to 6 per 1000 patient days. In the general care units, there was no reduction from baseline in the rates of serious medication errors. A full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units.

  9. A network of Pediatric Environmental Health Specialty Units (PEHSUs: Filling a critical gap in the health care system

    Directory of Open Access Journals (Sweden)

    Christine M. Zachek

    2012-09-01

    Full Text Available A network of pediatric environmental health specialty units (PEHSUs in the United States was formed in 1998 out of a recognized need for clinical expertise in children’s environmental health. Documented trends in a rise of pediatric diseases caused or exacerbated by environmental conditions, coupled with the failure of medical schools and residency programs to cover these issues in a significant way, leaves health care providers, parents, communities, and governments at a loss for this specialized knowledge. The PEHSUs fill this gap by providing: 1 medical education, 2 general outreach and communications, and 3 consultative services to communities and health care professionals. This paper presents examples of key situations where PEHSU involvement was instrumental in improved patient outcomes or advancing clinical expertise in children’s environmental health. Challenges and opportunities for future directions for the program are also discussed.

  10. 7 CFR 1210.315 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1210.315 Section 1210.315 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... PLAN Watermelon Research and Promotion Plan Definitions § 1210.315 United States. United States...

  11. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  12. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  13. Malaria Surveillance - United States, 2014.

    Science.gov (United States)

    Mace, Kimberly E; Arguin, Paul M

    2017-05-26

    Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. This report summarizes cases in persons with onset of illness in 2014 and trends during previous years. Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report. CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively

  14. An impact evaluation of a newly developed pediatric cardiac intensive care unit.

    Science.gov (United States)

    Welander, Michelle Hanna; Keller, Sheila D; Northington, LaDonna

    2015-01-01

    The highly complex pediatric patients with congenital heart disease require interprofessional teamwork and collaboration to ensure high-quality outcomes with low mortality and morbidity (Congenit Heart Dis. 2013;8:3-19). The purpose of this study was to conduct an impact evaluation for a newly formed pediatric cardiac intensive care unit (PCICU) and to answer: Is there a difference between the pediatric intensive care unit and the PCICU on clinical outcome measures of pediatric cardiac postoperative patients and nursing resources? A retrospective pretest/posttest design was used with the independent variables being type of intensive care unit. The confounding variables included demographic data, clinical outcome data, registered nurse (RN) staffing data, and RN turnover data. The setting was a large, level I pediatric medical and surgical intensive care unit (ICU) located at a children's hospital within an academic medical center. The population was pediatric cardiac postoperative patients. Patients excluded were those older than 18 years or cases without a Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality Category score of 1 through 5. Owen's impact evaluation method and descriptive statistical measures, t test and Pearson χ test, were used for analysis. Demographic data were comparable between the pediatric intensive care unit (n = 296) and PCICU (n = 333). No statistical differences were found in several of the clinical outcome measures. Statistically significant differences were found in surgeon (P = .00) and RN nursing hours per patient day for all cardiac patients (P = .01). The PCICU time frame had a higher RN turnover rate. The majority of quality measures were not statistically different between the 2 ICUs. Even though statistical significance was not reached, the clinical impact of the PCICU's reduction in patient infections, mortality, and ICU length of stay was noted. This evaluation has

  15. State-ing the Facts: Exploring the United States.

    Science.gov (United States)

    Bay, Jennifer M.; Bledsoe, Ann M.; Reys, Robert E.

    1998-01-01

    Presents activities on estimation, scaling, area of nonstandard shapes, algebraic thinking, and real-life situations using the United States of America. These activities make it possible to integrate mathematics and social studies. Uses technology by employing geometry software packages such as The Geometer's Sketchpad, Cabri, and Geometric…

  16. Nasogastric Tube Placement Errors and Complications in Pediatric Intensive Care Unit: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahin Seyedhejazi

    2011-11-01

    Full Text Available Nasal ala pressure sores are among complications of nasogastric tube in Pediatric Intensive Care Unit (PICU. The severity of the injury is usually minor and easily ignored. However, the complication could be easily avoided. This is a case of nasal ala sore after the place-ment of nasal enteral tube in a pediatric intensive care unit in our center. A 5-month-old female with pulmonary hypertension secondary to bronchiectasis with nasal ala pressure sore were reported. She was hospitalized in pediatric intensive care unit at Tabriz Children Hospital in 2010.After 53 days of PICU hospitalization she had nasal ala sore. Conclusion: We know that nasal ala pressure sores could easily be avoided when preventive procedures were performed during nasogastric tube insertion.

  17. United States Stateplane Zones - NAD27

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.

  18. United States Stateplane Zones - NAD83

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.

  19. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  20. Use of propofol in pediatric intensive care units: a national survey in Germany.

    Science.gov (United States)

    Kruessell, Markus A; Udink ten Cate, Floris E A; Kraus, Anna-Julia; Roth, Bernhard; Trieschmann, Uwe

    2012-05-01

    Propofol is not licensed for sedation in pediatric intensive care medicine mainly due to the risk of propofol infusion syndrome. Nevertheless, it is applied by many pediatric intensive care units. The aim of this national survey was to asses the current use of propofol in pediatric intensive care units in Germany. We performed a nationwide survey. The questionnaire assessed the intensive care unit type, patient numbers, dosing, duration, age and time limits, indications, side effects, and institutional protocols for propofol usage. Pediatric intensive care units in Germany. Questionnaire about routine use of propofol sent to 214 pediatric departments. None. One hundred ninety-four questionnaires (90.7%) were returned, ten had to be censored. The final analysis comprised 184 questionnaires (134 pediatric/neonatal intensive care units, 28 pediatric intensive care units, 22 neonatal intensive care units). Seventy-nine percent of intensive care units (n = 145 of 184) used propofol in children under the age of 16 yrs. Of these, 98% were for bolus application (n = 142 of 145), 78% for infusion ≥3 hrs (n = 113 of 145), and 33% for infusion >3 hrs (n = 48 of 145). A lower age limit was applied by 52% (n = 75 of 145) and a dose limit by 51% (n = 74 of 145). The median dose limit was 4 mg/kg/hr; 48% (n = 70 of 145) used 3 mg/kg/hr or less. A time limit was applied by 98% (n = 46 of 47), 70% (n = 33 of 47) used it for ≤24 hrs, and 30% (n = 15 of 47) for >24 hrs. MAIN INDICATIONS FOR PROPOFOL APPLICATION WERE: difficult sedation (44%), postoperative ventilation (43%), and difficult extubation (30%). Seven cases of propofol infusion syndrome were reported by seven centers. This study shows that propofol is used off-license by many pediatric intensive care units in Ge. The majority of users has adopted tightly controlled regimens for propofol sedation, and limits the dose to ≤3-4 mg/kg/hr and the maximum application time to 24-48 hrs.

  1. Pediatrics pharmacovigilance: need of a new sub-unit

    OpenAIRE

    Rakesh C. Chaurasia

    2012-01-01

    Pharmacovigilance is a new discipline of pharmacology concerned with adverse drug reaction (ADR) monitoring. Being an emerging section, it gains widespread global popularity within a short span of time. Pediatrics is very special branch of medical science deals with innocent aspect of growing life. As most of their body physiology are varies in accordance to age, therefore ADRs detection needs special attention. [Int J Basic Clin Pharmacol 2012; 1(2.000): 116-117

  2. Filicide in the United States.

    Science.gov (United States)

    Resnick, Phillip J

    2016-12-01

    In the United States the Accreditation Council of Graduate Medical Education determines the curriculum required for fellows in forensic psychiatry to become board certified as a subspecialist. Areas that must be covered during the one year fellowship include criminal issues, such as insanity; civil issues, such as tort law and Workers' Compensation; legal regulation of psychiatry, such as confidentiality and involuntary hospitalization; and correctional psychiatry issues, such as dual agency and prisoner's rights. Fellows are also expected to have knowledge about juvenile courts, the structure of the legal system, and child custody issues. In addition, fellows are required to analyze complex cases and write forensic reports which are well reasoned. Teaching methods include lectures, storytelling, use of video vignettes, and mock trials. Additional teaching methodologies include group supervision of fellows in their report writing and direct observation of giving testimony. During the year we see fellows evolve and shift their orientation from being an advocate for patients to perceiving their role as serving justice.

  3. United States Department of State Strategic Plan

    Science.gov (United States)

    1998-01-01

    targets for worldwide reduction or elimination of the cultiva- tion, production, and commercial-scale import of cocaine, opium, heroin, mari- juana ...international sanctions against state sponsors of terrorism and urges their strict enforcement. State presses state spon- sors to abandon their support for

  4. The United States in the 1980's

    Directory of Open Access Journals (Sweden)

    D. Conradie

    2012-02-01

    Full Text Available The era of optimism which prevailed in the United States since the Korean War, came to an abrupt end after the debacle in Vietnam. By the end of the Seventies the United States was no longer the dominant military power. American foreign policy lacked consistence, coherence and a strategic sense. The United States became indecisive. Under these circumstances the Soviet Union successfully enforced its imperialistic designs upon countries far from its shores.

  5. Abortion Surveillance - United States, 2013.

    Science.gov (United States)

    Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

    2016-11-25

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2013. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2

  6. Abortion Surveillance - United States, 2012.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J

    2015-11-27

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2012. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003-2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003-2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003-2012). In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20-24 and 25-29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of

  7. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

  8. Pediatrics

    Science.gov (United States)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  9. Addressing the United States Debt and Deficit

    Science.gov (United States)

    2010-03-01

    current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining...manner and thereby strengthen the economy of the United States, this paper concludes with three examples that are predicated on the synergistic benefits associated with small reforms.

  10. United States Strategy for Mexico

    Science.gov (United States)

    2005-03-18

    17 March 2005. 2 Homero Aridjis, "Survival of Indigenous Cultures in Mexico," 9 April 1998; available from <http://www.klys.se/worldconference/papers...HomeroAridjis.htm>;Internet; accessed 21 November 2004. 3Tania Carrasco, "Indigenous Peoples in the States of Chiapas, Guerrero and Oaxaca ," 2005...analysis by the State representatives from Chiapas, Guerrero and Oaxaca (3 Southern States). The plan reviewed possible options to reduce poverty and

  11. Pediatric medication errors in the postanesthesia care unit: analysis of MEDMARX data.

    Science.gov (United States)

    Payne, Christopher H; Smith, Christopher R; Newkirk, Laura E; Hicks, Rodney W

    2007-04-01

    Medication errors involving pediatric patients in the postanesthesia care unit may occur as frequently as one in every 20 medication orders and are more likely to cause harm when compared to medication errors in the overall population. Researchers examined six years of records from the MEDMARX database and used consecutive nonprobability sampling and descriptive statistics to compare medication errors in the pediatric data set to those occurring in the total population data set. Nineteen different causes of error involving 28 different products were identified. The results of the study indicate that an organization can focus on causes of errors and products involved in errors to mitigate future error occurrence.

  12. [The prevalence of accidental poisoning in a hospital pediatric unit of Latium].

    Science.gov (United States)

    Faraoni, F; Protano, C; Bini, V; Lizzi, R

    2006-01-01

    The aim of this study was to investigate the trend of accidental poisoning among children, over a period of fifteen years, from 1990 to 2004, in the pediatric wards of a hospital in Latium (Italy). The prevalence of childhood poisoning was calculated based on the medical records of the pediatric unit of the hospital. The derived data was divided into different categories according to age, gender and types of poisoning. The results of this study show a decrease in accidental pediatric poisoning; according to the literature the frequency of poisoning was higher in males, under the age of 2 years, than females. Trends show an increase in pharmaceutical poisonings. The present study underlines the need for continuous information on prevention and educational programs organized by the Institutions, territorial sanitary services and GP with the aim of increasing the awareness of parents regarding the risk factors of poisoning.

  13. State Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the State boundaries of the United States, and the boundaries of Puerto Rico and the U.S. Virgin Islands. The map layer was created by...

  14. Climatography of the United States

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Numbered series of NOAA publications that contain environmental information climate summaries and station normals. Each series contains a volume for each state,...

  15. The department of psychology within a pediatric cardiac transplant unit.

    Science.gov (United States)

    Rossi, A; De Ranieri, C; Tabarini, P; Di Ciommo, V; Di Donato, R; Biondi, G; Parisi, F

    2011-05-01

    In 1979, the department of Psychology started its activity to provide psychological support to patients and their families during the course of treatment and during the follow-up period. Since 1986, a transplantation program was initiated in the cardiology and pediatric cardiac surgery departments, performing 179 cardiac, 3 heart-kidney, 18 heart-lung 14 both lung, 1 heart-lung-liver, and 1 single lung transplantation. From 1993, to September 2010 the kidney transplant program has performed. 218 cases. Since 2008, we performed (32 liver and 1 intestinal transplantations). We examined the quality of life and coping with transplantation attitudes because there is recent evidence of high levels of family anxiety and depression related to a child's poor response to the disease and compliance. Our work associated post-traumatic stress disorder (PTSD) with anxiety and with these clinical variables: gender pathology, rejection, number of drugs frequency of hospital visits, number of hospitalizations, as well as age at and time from transplantation. We examined 56 parents (25 fathers and 31 mothers) of cardiac transplant recipients. Our most relevant data demonstrated the presence of PTSD among 52% of mothers and 40% of fathers. Significant correlations were observed within the trait of anxiety. No correlations were noted between PTSD and other variables. Testing anxiety levels of parents is considered to be basic to provide psychological support to parents, encourage personal skills, and avoid PTSD symptoms.

  16. Sedation and analgesia in the pediatric intensive care unit.

    Science.gov (United States)

    Tobias, Joseph D

    2005-08-01

    Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. Although the synthetic opioid fentanyl frequently is chosen for use in the PICU setting because of its hemodynamic stability, preliminary data suggest morphine may have a slower development of tolerance and may cause fewer withdrawal symptoms than fentanyl. Morphine's safety profile includes long-term follow-up studies that have demonstrated no adverse central nervous system developmental effects from its use in neonates and infants. In the critically ill infant at risk following surgery for congenital heart disease, clinical experience supports the use of the synthetic opioids, given their ability to modulate PVR and prevent pulmonary hypertensive crisis. Alternatives to the benzodiazepines and opioids include ketamine, pentobarbital, or dexmedetomidine. Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.

  17. Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit.

    Science.gov (United States)

    Nadeau, Katie; Pinner, Kerri; Murphy, Katie; Belderson, Kristin M

    2016-02-22

    The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.

  18. Sleep, quality of life and mood of nursing professionals of pediatric intensive care units

    Directory of Open Access Journals (Sweden)

    Priscilla Caetano Guerra

    2016-04-01

    Full Text Available Abstract OBJECTIVE To assess sleep, quality of life and mood of nursing professionals of pediatric intensive care units. METHOD Quantitative, cross-sectional and descriptive study. Professionals grouped by morning, afternoon and evening shifts were assessed by means of the instruments: Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Generic questionnaire for the assessment of quality of life (SF-36; Beck Depression Inventory; Beck Anxiety Inventory; State-Trait Anxiety Inventory. RESULTS Sample consisted of 168 professionals, with prevalence of neutral typology (57.49%. There was no statistical significance regarding sleep, despite scores showing a poor quality of sleep and excessive daytime sleepiness for the three shifts. Quality of life did not reveal any statistical significance, but in the field "social role functioning" of the evening shift, a lower score was observed (p<0.007. There was no statistical significance regarding levels of anxiety and depression. CONCLUSION The results suggest that these professionals may present sleeping problems, but they do not have lower scores of quality of life or mood disorders. Likely explanations for these findings may include an adaptation to their work type over time and the fact that working with children is rewarding.

  19. 2010 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2010 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  20. Mineral operations outside the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Mineral facilities and operations outside the United States compiled by the National Minerals Information Center of the USGS. This representation combines source...

  1. CNPC Exports Drilling Equipment to United States

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ Beijing Petroleum Machinery Plant(BPM) of CNPC and Rowan Drilling Company Inc, one of the most powerful drilling service and driller manufacturing companies in the United States signed a petroleum equipment contract on December 9 in Beijing.

  2. Rest Areas in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Rest areas in the western United States. Data was collected from various data sources including georeferenced locations obtained from other agencies, digitizied...

  3. United States Interagency Elevation Inventory (USIEI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...

  4. Health, United States, 2012: Men's Health

    Science.gov (United States)

    ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook NCHS Health, United States, 2015 - Men's Health ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook File Formats Help: How do I view ...

  5. Agricultural Land in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Agricultural land cover for the western United States. This dataset was developed from Sagestitch, the Eastern Washington Shrubsteppe Mapping Project, and several...

  6. Hydrologic landscape regions of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Hydrologic landscape regions (HLRs) in the United States were delineated by using geographic information system (GIS) tools and statistical methods including...

  7. The Grand Strategy of the United States

    Science.gov (United States)

    2014-10-01

    United States both militarily and by setting the terms of trade. While cultural and ideological affinities with European democra- cies played...military establishments (Japan, Russia, India, South Korea, Vietnam, Taiwan, Indonesia , Malaysia, Singapore) can check possible military expansion when

  8. TB in Children in the United States

    Science.gov (United States)

    ... in Children Treatment Vaccines Statistics Related Links TB in Children in the United States TB disease in children under ... person with infectious TB disease. Testing for TB in Children In the absence of symptoms, usually the ...

  9. 2014 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2014 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  10. 2009 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2009 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  11. 2011 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2011 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  12. 2012 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2012 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  13. Terrestrial Ecosystems of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) modeled the distribution of terrestrial ecosystems for the contiguous United States using a standardized, deductive approach to...

  14. Anthropogenic Fragmentation in the western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — We evaluated the fragmentation of the western United States by anthropogenic features. The addition of roads, railroads, and power lines to wildlands, and the...

  15. Social Studies: United States. Grade 5.

    Science.gov (United States)

    Kellogg, E. G.

    This teachers guide attempts to facilitate the study of the United States through a conceptual approach and multimedia instruction in a spiral curriculum. There are five units: 1) Natural Setting --location, climate, terrain, water, soil, and economic and esthetic value, and conservation; 2) Historial Development --North American Indian cultures,…

  16. 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.

  17. Party Formation in the United States

    OpenAIRE

    2013-01-01

    This dissertation is about how political parties formed in the world's first mass democracy, the United States. I trace the process of party formation from the bottom up. First, I ask: How do individuals become engaged in politics and develop political affiliations? In most states, throughout the antebellum era, the county was the primary unit of political administration and electoral representation. Owing to their small size, contiguity, and economic homogeneity, I expect that each county's ...

  18. Drought in Southeastern United States

    Science.gov (United States)

    2007-01-01

    May 2007 was a record-setting month in Georgia. Typically a dry month in this southern state, May 2007 was exceptionally so, with many locations setting record-low rainfall records and some receiving no rain at all, said state climatologist David Emory Stooksbury on GeorgiaDrought.org. The lack of rain slowed plant growth, as shown in this vegetation index image. The Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite collected the data used to make this image between May 9 and May 24, 2007. The image shows vegetation conditions compared to average conditions observed from 2000 through 2006. Areas in which plants are more sparse or are growing more slowly than average are brown, while better-than-average growth is green. Georgia and its neighbors (South Carolina, Alabama, and Florida) are all brown, an indication that the lack of rainfall is suppressing plant growth. The gray area in southern Georgia and northern Florida shows where MODIS could not collect valid vegetation measurements, either because of clouds or smoke. In this case, the area corresponds with land that burned during this period and was probably masked by smoke. NASA image created by Jesse Allen, Earth Observatory, using data provided by Inbal Reshef, Global Agricultural Monitoring Project.

  19. The transition to competency-based pediatric training in the United Arab Emirates.

    Science.gov (United States)

    Ibrahim, Halah; Al Tatari, Hossam; Holmboe, Eric S

    2015-04-01

    Although competency-based medical education has become the standard for physician training in the West, many developing countries have not yet adopted competency-based training. In 2009 in the United Arab Emirates, the government regulatory and operational authorities for healthcare in Abu Dhabi mandated a wide-scale reform of the emirate's postgraduate residency programs to the competency-based framework of the newly formed Accreditation Council for Graduate Medical Education-International (ACGME-I). This article briefly describes the rationale for competency-based medical education and provides an overview of the transition from traditional, time-based residency training to competency-based postgraduate medical education for the Pediatrics residency programs in Abu Dhabi. We will provide data on the initial impact of this transition on resident performance and patient outcomes in a Pediatrics residency program in an academic medical center in the United Arab Emirates.

  20. 31 CFR 596.313 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 596.313 Section... General Definitions § 596.313 United States person. The term United States person means any United States... States, or any person in the United States....

  1. Estimated United States Transportation Energy Use 2005

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Simon, A J; Belles, R D

    2011-11-09

    A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.

  2. Assessing the generalisability of the pediatric cardiac quality of life inventory in the United Kingdom.

    Science.gov (United States)

    Wray, Jo; Brown, Kate; Franklin, Rodney; Cassedy, Amy; Marino, Bradley S

    2014-04-01

    To demonstrate the generalisability of the Pediatric Cardiac Quality of Life Inventory in the United Kingdom. Children and adolescents with heart disease were recruited from three tertiary paediatric cardiac centres in the United Kingdom and completed the Pediatric Cardiac Quality of Life Inventory. Item response option variability, total and subscale scores, patterns of correlation, and internal consistency were compared between the three sites. A total of 1537 participants--768 children/adolescents and 769 parents--were evaluated from the three sites. Patterns of item response option variability were similar and acceptable for all samples--child, adolescent, parent of child, and parent of adolescent. Internal consistency was high (0.82-0.96) for all samples from each site, and item-subscale, subscale-subscale, subscale-total, and item-total correlations were moderate to excellent for each centre. Comparisons of patterns of subscale and total score correlations between the three sites revealed no significant differences. Scores on the Pediatric Cardiac Quality of Life Inventory are generalisable in the United Kingdom, supporting the use of this measure for multi-centre studies of health-related quality of life of children and adolescents with heart disease.

  3. Characterization of Nosocomial Infection in a Pediatric Intensive Care Unit. Cienfuegos 2005-2009

    Directory of Open Access Journals (Sweden)

    Lourdes Elena Duany Badell

    2014-06-01

    Full Text Available Background: children can frequently develop nosocomial infections in pediatric intensive care units. Objective: to characterize nosocomial infections in pediatric patients treated in intensive care units. Methods: a retrospective case series study was conducted in the Intensive Care Unit at Pediatric Hospital of Cienfuegos, between 2005 and 2009. The sample consisted of 70 patients who developed nosocomial sepsis and were admitted directly to the service. The variables studied were age, procedures performed during hospitalization, type of sepsis by site, isolated germs, microbiological support (microbiology tests and condition at discharge (recovered or deceased. Results: nosocomial infections showed a rate of 3.2 per 100 patients discharged. Children under 1 year (41.4 % were the most frequently affected. Pneumonia associated with mechanical ventilation was the most common infection (29.4%. Venous catheterization was used in all cases. Microbiology tests were performed in 84.2 % of cases, 85.3% of them had a positive result. Pseudomonas aeruginosa was the most frequently isolated bacteria and was also associated with highest mortality. Conclusion: nosocomial sepsis in this service was more frequent in children under one year, as a result of mechanical ventilation. Malnutrition and chronic illness were an important predisposing factor in these patients.

  4. Pseudomonas aeruginosa outbreak in a pediatric oncology care unit caused by an errant water jet into contaminated siphons.

    Science.gov (United States)

    Schneider, Henriette; Geginat, Gernot; Hogardt, Michael; Kramer, Alexandra; Dürken, Matthias; Schroten, Horst; Tenenbaum, Tobias

    2012-06-01

    We analyzed an outbreak of invasive infections with an exotoxin U positive Pseudomonas aeruginosa strain within a pediatric oncology care unit. Environmental sampling and molecular characterization of the Pseudomonas aeruginosa strains led to identification of the outbreak source. An errant water jet into the sink within patient rooms was observed. Optimized outbreak management resulted in an abundance of further Pseudomonas aeruginosa infections within the pediatric oncology care unit.

  5. 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.

  6. Investigation of inhalation anthrax case, United States.

    Science.gov (United States)

    Griffith, Jayne; Blaney, David; Shadomy, Sean; Lehman, Mark; Pesik, Nicki; Tostenson, Samantha; Delaney, Lisa; Tiller, Rebekah; DeVries, Aaron; Gomez, Thomas; Sullivan, Maureen; Blackmore, Carina; Stanek, Danielle; Lynfield, Ruth

    2014-02-01

    Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.

  7. Potential pediatric intensive care unit demand/capacity mismatch due to novel pH1N1 in Canada.

    Science.gov (United States)

    Stiff, David; Kumar, Anand; Kissoon, Niranjan; Fowler, Robert; Jouvet, Philippe; Skippen, Peter; Smetanin, Paul; Kesselman, Murray; Veroukis, Stasa

    2011-03-01

    To investigate the possibility of pediatric intensive care unit shortfalls, using pandemic models for a range of attack rates and durations. The emergence of the swine origin pH1N1 virus has led to concerns about shortfalls in our ability to provide pediatric ventilation and critical care support. Modeling of pediatric intensive care demand based on pH1N1 predictions using simulation techniques. Simulation laboratory. None. None. Data collected during the first wave of the pH1N1 in children in Canada were applied to several second wave pandemic models to explore potential pediatric intensive care unit ventilatory demands for Canada and to investigate the impact of vaccination upon these demands. In almost all cases studied, even for relatively low attack rates of 15%, significant pediatric intensive care unit shortages would be expected to occur. Vaccination strategies targeting 50% of the population significantly reduced demand, but shortages may still be expected. Although shortfalls can occur in all provinces, Ontario and British Columbia may experience the greatest supply-demand difference, even at low attack rates. Reducing the attack rate among children, whether through vaccination or additional measures, such as social distancing, will be critical to ensure sufficient pediatric intensive care unit capacity for continued pediatric care.

  8. 31 CFR 560.314 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 560.314 Section... § 560.314 United States person. The term United States person means any United States citizen, permanent resident alien, entity organized under the laws of the United States (including foreign branches), or...

  9. Incidence and Severity of Prescribing Errors in Parenteral Nutrition for Pediatric Inpatients at a Neonatal and Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Theresa Hermanspann

    2017-06-01

    Full Text Available ObjectivesPediatric inpatients are particularly vulnerable to medication errors (MEs, especially in highly individualized preparations like parenteral nutrition (PN. Aside from prescribing via a computerized physician order entry system (CPOE, we evaluated the effect of cross-checking by a clinical pharmacist to prevent harm from PN order errors in a neonatal and pediatric intensive care unit (NICU/PICU.MethodsThe incidence of prescribing errors in PN in a tertiary level NICU/PICU was surveyed prospectively between March 2012 and July 2013 (n = 3,012 orders. A pharmacist cross-checked all PN orders prior to preparation. Errors were assigned to seven different error-type categories. Three independent experts from different academic tertiary level NICUs judged the severity of each error according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP Index (categories A–I.ResultsThe error rate was 3.9% for all 3,012 orders (118 prescribing errors in 111 orders. 77 (6.0%, 1,277 orders errors occurred in the category concentration range, all concerning a relative overdose of calcium gluconate for peripheral infusion. The majority of all events (60% were assigned to categories C and D (without major harmful consequences while 28% could not be assigned due to missing majority decision. Potential harmful consequences requiring interventions (category E could have occurred in 12% of assessments.ConclusionNext to systematic application of clinical guidelines and prescribing via CPOE, order review by a clinical pharmacist is still required to effectively reduce MEs and thus to prevent minor and major adverse drug events with the aim to enhance medication safety.

  10. Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients.

    Science.gov (United States)

    Widmann, Raphael; Caduff, Rosmarie; Giudici, Luca; Zhong, Qing; Vogetseder, Alexander; Arlettaz, Romaine; Frey, Bernhard; Moch, Holger; Bode, Peter K

    2017-02-01

    Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.

  11. Toll Facilities in the United States - Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  12. Analysis of United States’ Broadband Policy

    Science.gov (United States)

    2007-03-01

    glass fiber. The light signals are then decoded at the end of the fiber by a special optic decoder /encoder. This allows for the light signal to be...CDMA technology while Cingular offers it through the HSDPA/ GSM technology. One quarter of the United States’ Internet users have a cell phone that...well Cingular 900 Kbps 100 Kbps $79.00 HSDPA/ GSM 1 yr contract Table 13. Unlimited Cellular Broadband Plans in the United States (From PCWorld.com

  13. Natural aggregates of the conterminous United States

    Science.gov (United States)

    Langer, William H.

    1988-01-01

    Crushed stone and sand and gravel are the two main sources of natural aggregates. These materials are commonly used construction materials and frequently can be interchanged with one another. They are widely used throughout the United States, with every State except two producing crushed stone. Together they amount to about half the mining volume in the United States. Approximately 96 percent of sand and gravel and 77 percent of the crushed stone produced in the United States are used in the construction industry. Natural aggregates are widely distributed throughout the United States in a variety of geologic environments. Sand and gravel deposits commonly are the results of the weathering of bedrock and subsequent transportation and deposition of the material by water or ice (glaciers). As such, they commonly occur as river or stream deposits or in glaciated areas as glaciofluvial and other deposits. Crushed stone aggregates are derived from a wide variety of parent bedrock materials. Limestone and other carbonates account for approximately three quarters of the rocks used for crushed stone, with granite and other igneous rocks making up the bulk of the remainder. Limestone deposits are widespread throughout the Central and Eastern United States and are scattered in the West. Granites are widely distributed in the Eastern and Western United States, with few exposures in the Midwest. Igneous rocks (excluding granites) are largely concentrated in the Western United States and in a few isolated localities in the East. Even though natural aggregates are widely distributed throughout the United States, they are not universally available for consumptive use. Some areas are devoid of sand and gravel, and potential sources of crushed stone may be covered with sufficient unconsolidated material to make surface mining impractical. In some areas many aggregates do not meet the physical property requirements for certain uses, or they may contain mineral constituents that react

  14. Understanding human trafficking in the United States.

    Science.gov (United States)

    Logan, T K; Walker, Robert; Hunt, Gretchen

    2009-01-01

    The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.

  15. Pakistan: Can the United States Secure an Insecure State?

    Science.gov (United States)

    2010-01-01

    Ethnocentrism is a problem. Pakistan lost Bangladesh in its 1971 civil war in part because West Pakistanis viewed Bengalis, who are the dominant ethnic...137. 64 Pakistan: Can the United States Secure an Insecure State? in the last few years of rapid growth, consumer price inflation surged to 25

  16. Employers mexican migrants in the United States

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández Guzmán

    2013-09-01

    Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.

  17. United States Military Presence in Central Asia: Implications of United States Basing for Central Asian Stability

    Science.gov (United States)

    2006-06-01

    Europe and reducing the number of military personnel by 40,000 to 60,000. According to United States Air Force General Charles Wald , there are...The Deputy Secretary of Defense Paul Wolfowitz is quoted as saying United States presence “…may be more political than actually military” and that

  18. Estimated Water Flows in 2005: United States

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Belles, R D; Simon, A J

    2011-03-16

    Flow charts depicting water use in the United States have been constructed from publicly available data and estimates of water use patterns. Approximately 410,500 million gallons per day of water are managed throughout the United States for use in farming, power production, residential, commercial, and industrial applications. Water is obtained from four major resource classes: fresh surface-water, saline (ocean) surface-water, fresh groundwater and saline (brackish) groundwater. Water that is not consumed or evaporated during its use is returned to surface bodies of water. The flow patterns are represented in a compact 'visual atlas' of 52 state-level (all 50 states in addition to Puerto Rico and the Virgin Islands) and one national water flow chart representing a comprehensive systems view of national water resources, use, and disposition.

  19. Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study.

    Science.gov (United States)

    Farias, Julio A; Fernández, Analía; Monteverde, Ezequiel; Flores, Juan C; Baltodano, Arístides; Menchaca, Amanda; Poterala, Rossana; Pánico, Flavia; Johnson, María; von Dessauer, Bettina; Donoso, Alejandro; Zavala, Inés; Zavala, Cesar; Troster, Eduardo; Peña, Yolanda; Flamenco, Carlos; Almeida, Helena; Nilda, Vidal; Esteban, Andrés

    2012-03-01

    To describe the characteristics and outcomes of mechanical ventilation in pediatric intensive care units during the season of acute lower respiratory infections. Prospective cohort of infants and children receiving mechanical ventilation for at least 12 hrs. Sixty medical-surgical pediatric intensive care units. All consecutive patients admitted to participating pediatric intensive care units during a 28-day period. Of 2,156 patients admitted to pediatric intensive care units, 1185 (55%) received mechanical ventilation for a median of 5 days (interquartile range 2-8). Median age was 7 months (interquartile range 2-25). Main indications for mechanical ventilation were acute respiratory failure in 78% of the patients, altered mental status in 15%, and acute on chronic pulmonary disease in 6%. Median length of stay in the pediatric intensive care units was 10 days (interquartile range 6-18). Overall mortality rate in pediatric intensive care units was 13% (95% confidence interval: 11-15) for the entire population, and 39% (95% confidence interval: 23 - 58) in patients with acute respiratory distress syndrome. Of 1150 attempts at liberation from mechanical ventilation, 62% (95% confidence interval: 60-65) used the spontaneous breathing trial, and 37% (95% confidence interval: 35-40) used gradual reduction of ventilatory support. Noninvasive mechanical ventilation was used initially in 173 patients (15%, 95% confidence interval: 13-17). In the season of acute lower respiratory infections, one of every two children admitted to pediatric intensive care units requires mechanical ventilation. Acute respiratory failure was the most common reason for mechanical ventilation. The spontaneous breathing trial was the most commonly used method for liberation from mechanical ventilation.

  20. Eurabia: Strategic Implications for the United States

    Science.gov (United States)

    2010-03-01

    states of North Africa and the Middle East.5 Eurabia was the name of a journal published in the mid-1970s by the European Committee for...have her extradited to Switzerland so she could be prosecuted under Swiss anti- racism statute, Islamic groups successfully prevailed to have her...options. The United States can forge new relationships with emerging powers such as Brazil, Russia, India and China, the so called BRIC countries

  1. Following Zhang Wenjin to the United States

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    In 1937,Zhang Ying studied at the Lu Xun Art Institute in Yan’an.After graduation she began working in the art world under Zhou Enlai’s direction.In 1983, she followed her husband Zhang Wenjin to the United States as wife of the ambassador.During her two-year stay in the U.S., she came into close contact with many American women while working to promote mutual understanding and friendship between the people of the two countries.After her retirement in 1991,she sponsored the production of a 10-episode documentary TV program,"Zhou Enlai and the Arts."She also wrote a book about her experience in the United States,Called,Following Zhang Wenjin to the United States—Notes of an Ambassador’s Wife.The following are extracts from the book.

  2. Managing nuclear weapons in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.

    1993-03-16

    This report discusses the management and security of nuclear weapons in the post-cold war United States. The definition of what constitutes security is clearly changing in the US. It is now a much more integrated view that includes defense and the economy. The author tries to bring some semblance of order to these themes in this brief adaptation of a presentation.

  3. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...

  4. CTS United States experiments. A progress report

    Science.gov (United States)

    Robbins, W. H.; Donoughe, P. L.

    1976-01-01

    The results are presented of the United States experiments activity to date. Wide segments of the population are involved in the Experiments Program including the scientific community, other government agencies, industry, and the education and health entities. The experiments are associated with both technological objectives and the demonstration of new community and social services via satellite.

  5. Color Vision Deficiencies in Children. United States.

    Science.gov (United States)

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    Presented are prevalence data on color vision deficiencies (color blindness) in noninstitutionalized children, aged 6-11, in the United States, as estimated from the Health Examination Survey findings on a representative sample of over 7,400 children. Described are the two color vision tests used in the survey, the Ishihara Test for Color…

  6. Characterizing Hospice Services in the United States

    Science.gov (United States)

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James

    2008-01-01

    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  7. United States Air Force Annual Financial Statements

    Science.gov (United States)

    2002-01-01

    gains and losses NRV = Net Realizable Value O = Other Inventory, Gross Value Revaluation Allowance Inventory, Net 2002 2001 United States Air Force...losses NRV = Net Realizable Value O = Other For the most part, DMAG is using the consumption method of accounting for OM&S, since OM&S is defined in the

  8. Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows major ports in the United States, Puerto Rico, and the U.S. Virgin Islands. A port is a city, town, or urban area with a harbor where ships load...

  9. Surveillance for Viral Hepatitis - United States, 2014

    Science.gov (United States)

    ... and Programs Resource Center Viral Hepatitis Surveillance for Viral Hepatitis – United States, 2014 Recommend on Facebook Tweet Share ... Cases Hepatitis A Hepatitis B Hepatitis C Discussion Hepatitis A virus Index PAGE DESCRIPTION Table 2.1 Reported ...

  10. Major land uses in the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a polygon coverage of major land uses in the United States. The source of the coverage is the map of major land uses in the National Atlas, pages 158-159,...

  11. EC 92 and the United States

    Science.gov (United States)

    1992-04-15

    34 Rheinischer Merkur (Bonn), January 17, 1992, 5. 17. Robert J. Samuelson, "Europe’s Boom Has Come and Cone," Washington Post, February 12, 1992, A23...34 Rheinischer Merkur (Bonn), January 17, 1992, 5. Riemer, Blanca. "’United States of Europe’? Don’t Hold Your Breath." Business Week, June 17, 1991, 50

  12. Airports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data were derived from an extract of the Public-Use Airports...

  13. AIDS Pandemic in the United States

    Science.gov (United States)

    Erickson, Amy H.; Melendez, Barbra S.; Ball, Daniel L.; Morse, Steven T.; Phillips, Geoffrey P.

    2010-01-01

    This project is one of four that were issued to first semester sophomore undergraduates at the United States Military Academy as part of an integrated learning experience at the end of their Calculus II course work. This project was used during a short, seven lesson block of instruction that was intended to capitalize on their recent academic…

  14. Orienteering: Growth Patterns in the United States.

    Science.gov (United States)

    Jeffery, Charles F.

    The history of orienteering in the United States includes both military and civilian interest, with the period of greatest growth between 1970 and 1980. To investigate growth patterns in orienteering, questionnaires were mailed to 42 civilian orienteering clubs and 286 universities supporting senior Reserve Office Training Corps (ROTC)…

  15. 31 CFR 539.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY WEAPONS OF MASS DESTRUCTION TRADE CONTROL...

  16. Malignant Hyperthermia Association of the United States

    Science.gov (United States)

    ... Videos Blog Get Involved Shop Ask a question right here... MHAUS On Facebook Now view more On Twitter Now view more Tweets by @ ... Malignant Hyperthermia Association of the United States. All rights reserved. ... advertiser and not necessarily the views or opinions of MHAUS, its staff or its ...

  17. 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

  18. Social science findings in the United States

    Science.gov (United States)

    Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce. Shindler

    2015-01-01

    The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...

  19. United States: Exploring the Marriage Debate

    Science.gov (United States)

    Carter, Julie H.

    2004-01-01

    As citizens of the United States respond to legislative and judicial actions that have challenged the prohibition against same-sex couples receiving marriage licenses, schools have a timely opportunity to engage students on this most important debate. Educators can help their students understand the full significance of this issue by encouraging…

  20. Geology of the Coterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — A digital version of the Geologic Map of the United States, originally published at a scale of 1:2,500,000 (King and Beikman, 1974b). It excludes Alaska and Hawaii.

  1. Immigration, parasitic infection, and United States religiosity.

    Science.gov (United States)

    Wall, Jaimie N; Shackelford, Todd K

    2012-04-01

    Fincher & Thornhill (F&T) present a powerful case for the relationship between parasite-stress and religiosity. We argue, however, that the United States may be more religious than can be accounted for by parasite-stress. This greater religiosity might be attributable to greater sensitivity to immigration, which may hyperactivate evolved mechanisms that motivate avoidance of potential carriers of novel parasites.

  2. Women's Music in the United States.

    Science.gov (United States)

    Lont, Cynthia M.

    The purpose of this presentation was to: (1) describe the history of women's music in the United States; (2) define women's music; (3) report on the status of the large women's recording companies; and (4) focus on a recent controversy in the women's music industry involving the desire for political purity versus the need for economic security.…

  3. Nursing continuing education in the united states

    OpenAIRE

    Robert, B.

    1981-01-01

    THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  4. Nursing continuing education in the united states

    Directory of Open Access Journals (Sweden)

    B Robert

    1981-09-01

    Full Text Available THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  5. Dengue Fever in the United States

    Centers for Disease Control (CDC) Podcasts

    2012-04-09

    Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.  Created: 4/9/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/16/2012.

  6. Fragmentation of eastern United States forest types

    Science.gov (United States)

    Kurt H. Riitters; John W. Coulston

    2013-01-01

    Fragmentation is a continuing threat to the sustainability of forests in the Eastern United States, where land use changes supporting a growing human population are the primary driver of forest fragmentation (Stein and others 2009). While once mostly forested, approximately 40 percent of the original forest area has been converted to other land uses, and most of the...

  7. [Predictive variables for mental retardation in a Pediatric Epilepsy Monitoring Unit. Neuropsychological assessment].

    Science.gov (United States)

    López-Sala, A; Palacio-Navarro, A; Donaire, A; García, G; Colomé, R; Boix, C; Sans, A; Campistol, J; Sanmartí, F X

    2010-03-03

    We sought to describe the epidemiological and clinical data from our patients in the Pediatric Epilepsy Monitoring Unit (PEMU) of the Sant Joan de Deu Hospital of Barcelona, and determine the variables of risk for mental retardation. A retrospective review of PEMU reports and hospital discharge summaries from March 2005 to December 2008 was conducted. The data from patients with intelligence quotient (IQ) estimated, older than 3 years of age and with epileptic electroencephalography (EEG) activity was analyzed in 158 patients (8.8 +/- 5.2 years; 55.1% boys). Of those pediatric patients, 63 had IQ less than 70 and 47 an IQ greater than or equal to 70. Intractable epilepsy was present in all of them. The percentage of the patients with mental retardation is significantly higher in patients with onset of epilepsy before 24 months (68.3%) than patients with later onset (27.7%). Onset of seizures, EEG findings and epilepsy etiology are significant risk factors for mental retardation. Early age at seizure, multifocal epilepsy and cryptogenic etiology are factors of worse prognosis to normal development of cognitive functions in pediatric intractable epilepsy.

  8. CPAFFC Working Group Visits the United States

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>From April 13 to 21, a CPAFFC working group led by Yao Mingyu, director general of the Department of American and Oceanian Affairs of the CPAFFC, visited the United States, attended the 18th Forum on US-China Relations sponsored by the US-China Peoples Friendship Association (USCPFA) and had talks with the USCPFA, the Richard Nixon Library & Birthplace Foundation, the Richard Nixon Centre, the Sister Cities International of the U.S., the National Conference of State Legislatures, the Council of State

  9. Failure to Validate a Multivariable Clinical Prediction Model to Identify Pediatric Intensive Care Unit Patients at High Risk for Candidemia.

    Science.gov (United States)

    Fisher, Brian T; Ross, Rachael K; Roilides, Emmanuel; Palazzi, Debra L; Abzug, Mark J; Hoffman, Jill A; Berman, David M; Prasad, Priya A; Localio, A Russell; Steinbach, William J; Vogiatzi, Lambrini; Dutta, Ankhi; Zaoutis, Theoklis E

    2016-12-01

    We attempted to validate a previously derived clinical prediction rule for candidemia in the pediatric intensive care unit. This multicenter case control study did not identify significant association of candidemia with most of the previously identified predictors. Additional study in larger cohorts with other predictor variables is needed. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. [Mother/child affective bond at the unit of the pediatric ward].

    Science.gov (United States)

    Faquinello, Paula; Collet, Neusa

    2003-12-01

    This study presents the importance of the mother-son relationship in the child physical and emotional development. It aims at contributing to the construction of knowledge in nursing, by rescuing the importance of the mothers' stay in the units of the pediatric ward. It is a bibliographical research using as sources: books, scientific articles, journals, magazines, encyclopedias and the Internet. By reading and analyzing the texts it is possible to identify how the consolidation of the mother and son affective bond is processed and to point out the positive aspects of the mother's stay with the hospitalized son.

  11. Benefits of and untoward events during intrahospital transport of pediatric intensive care unit patients

    Directory of Open Access Journals (Sweden)

    M M Harish

    2017-01-01

    Full Text Available Background and Aims: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. Subjects and Methods: Eighty critically ill pediatric (<18 years cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater, accompanying medical personnel, UEs, and benefits obtained during transport. Results: Among eighty pediatric patients, the median age was 8 years (range 2-17 years. During the transport, four (5% patients required endotracheal intubation, three (3.75% patients required intercostal drain placement, and six (7.5% patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75% patients, drain came out in four (5% patients, and three (3.75% patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30% patients and directly helped in change of therapy in the form of interventions in 20 (25% patients. Conclusion: Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy.

  12. [Pediatric tracheostomy: a ten-year analysis in the Intensive Care Unit of Sancti Spiritus “José Martí” Pediatric Teaching Hospital].

    Science.gov (United States)

    Salcedo, Caridad; Martínez, Mirtha; Reyes, Ernestina

    2014-05-05

    There has been a significant change in the role of pediatric tracheostomy over the last twenty years. Obstruction of the upper airway caused by infectious agents is no longer the leading cause of tracheostomy in children. Structural anomalies of the upper airway as well as the need for prolonged ventilator assistance have become the most frequent indication for pediatric tracheostomy. The purpose of this paper is to assess the incidence, indications, complications, and role in mortality of tracheostomy in our pediatric population. A retrospective descriptive study of pediatric patients who underwent tracheostomy was conducted between 1999 and 2008 in the Pediatric Intensive Care Unit of the José Martí de Sancti Spiritus Pediatric Teaching Hospital in Cuba. Tracheostomy was performed in 14 patients during the period of the study (0.5% of admitted patients). Nine of them (64.2%) were younger than one year. The most frequent indication for the procedure was the need for prolonged mechanical ventilation in patients with neurologic disorders in 10 patients (71.42%). Upper airway malformations and acute infections were infrequent indications for tracheostomy. The most frequent complications were infectious in 10 patients (71.4%) and obstruction in four patients (28.5%). The following germs were found: Pseudomona aeruginosa in six patients (60%), Staphylococcus aureus in three patients (30%), and Enterobacter cloacae in three patients (30%). Furthermore, four patients were successfully decannulated (28.5%), five patients died (35.7%) but only in one (7.14%), death could be attributed to tracheostomy. The need for prolonged mechanical ventilation in patients with neurologic disorders was the main indication for tracheostomy in our pediatric population; most of these children were younger than one year. The procedure had little impact in overall mortality in this group of patients.

  13. Antiabortion violence in the United States.

    Science.gov (United States)

    Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

    2012-11-01

    This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. 45 CFR 212.7 - Repayment to the United States.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Repayment to the United States. 212.7 Section 212... UNITED STATES CITIZENS RETURNED FROM FOREIGN COUNTRIES § 212.7 Repayment to the United States. (a) An..., any or all of the cost of such assistance to the United States, except insofar as it is...

  15. 31 CFR 592.305 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... General Definitions § 592.305 Importation into the United States. The term importation into the United States means the bringing of goods into the United States....

  16. 20 CFR 416.215 - You leave the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for...

  17. 78 FR 32356 - United States-Korea Free Trade Agreement

    Science.gov (United States)

    2013-05-30

    ... 178 RIN 1515-AD86 United States-Korea Free Trade Agreement AGENCIES: U.S. Customs and Border... United States-Korea Free Trade Agreement entered into by the United States and the Republic of Korea... ``Korea'') signed the United States-Korea Free Trade Agreement (hereinafter ``UKFTA'' or the ``Agreement...

  18. 7 CFR 1212.32 - United States Customs Service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States Customs Service. 1212.32 Section 1212... § 1212.32 United States Customs Service. “United States Customs Service” or “Customs” means the United States Customs and Border Protection, an agency of the Department of Homeland Security. Honey Packers...

  19. 32 CFR 575.6 - Catalogue, United States Military Academy.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Catalogue, United States Military Academy. 575.6... ADMISSION TO THE UNITED STATES MILITARY ACADEMY § 575.6 Catalogue, United States Military Academy. The latest edition of the catalogue, United States Military Academy, contains additional information...

  20. 75 FR 13345 - Pricing for Certain United States Mint Products

    Science.gov (United States)

    2010-03-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of...

  1. 77 FR 27612 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK11 Modifications to Definition of United States Property... or clearing agency do not constitute United States property. These regulations affect United States...)) that invests certain earnings and profits in United States property (U.S. property) ``on the...

  2. The State of Homeless Children in the United States

    Science.gov (United States)

    Kabler, Brenda; Weinstein, Elana

    2009-01-01

    Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…

  3. [Undocumented migrant labor in the United States].

    Science.gov (United States)

    Dinand, J

    1985-09-01

    The author identifies two factors contributing to the increase in the number of illegal migrant workers in the United States. The first is the complex system of legal immigration, which contributes to massive evasion. The second is the preference by many employers for hiring illegal aliens. The author concludes that the proposed changes in U.S. immigration laws, even though they include employer sanctions, are likely to prove as ineffective as previous measures adopted in several states some 10 years ago that also penalized employers hiring illegal aliens. It is suggested that the economic pressures leading to large-scale labor immigration will prove stronger than political pressures to control such immigration

  4. Inclusive Education in the United States

    OpenAIRE

    C. Kenneth Tanner; Deborah Jan Vaughn Linscott; Susan Allan Galis

    1996-01-01

    School reform issues addressing inclusive education were investigated in this nationwide (United States) study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive ed...

  5. Summary of Notifiable Diseases, United States, 1993.

    Science.gov (United States)

    2007-11-02

    incidence of drug-resistant Streptococcus pneumoniae (DRSP) strains in the United States has created an emerging public health challenge. CDC...only 1,280 cases of Legionnaires’ disease were reported through NNDSS in 1993, data from recent prospective pneumonia studies suggest that between...surveillance data from 1992 indicated that the prevalence of pneumococcal strains that are highly resistant to penicillin increased 60-fold (from 0.02% to 1.3

  6. The United States Military and Humanitarian Operations

    Science.gov (United States)

    1995-01-01

    stated that, "The wave of the future will be putting together task forces that will be able to respond to crisis management or humanitarian...examine three options for the military’s role in humanitaria operations at home and abroad. Option 1: Virtually Eliminate Anv Military Role This is the...humanitarian aid in almost any crisis .36 The military resists the creation of specially designated units because such specialization reduces the

  7. Energy Security in the United States

    Science.gov (United States)

    2012-05-01

    increase the domestic price of those 41. Coal gasification is a process that converts solid coal—through several energy-intensive steps—into gasoline and...for switching to other fuels or reducing consumption of transportation fuels . In con- trast, electricity can be produced from several sources of...the prices of those fuels in the United States. Although the global nature of the market for oil makes U.S. consumers vulnerable to price

  8. West Coast, United States and Mexico

    Science.gov (United States)

    1990-01-01

    This view shows the west coast of the United States and Mexico (32.5N, 118.0W) and gives an indication of the range of view from orbital altitude. The visual range of this particular scene is from Skammon's Lagoon on Baja to the northern tip of California's Central Valley and Sierra Nevada, a range of over 15 degrees of latitude. Coastal fog drapes over southern California and northern Baja California. White Sands, New Mexico is at far right center.

  9. Continental United States Military Housing Inspections Southeast

    Science.gov (United States)

    2015-09-24

    standards. 3. Work with the privatized housing partner to ensure that fire protection inspection and maintenance plans are achieved. Deputy Assistant...Secretary stated that Hunt Military Communities and Patrick AFB civil engineers were working to correct all of the other fire protection system...create a plan for the performance of ongoing inspection and maintenance of all housing units to applicable electrical codes and standards. 3. Work

  10. United States of Europe, Dream or Possibility?

    Science.gov (United States)

    1966-04-08

    center between the United States and the Soviet Union. The method chosen to examine this trend is to review three major politico-military problems...de France, pp. 3-7. ൫ Supra-nationalism must go! De Gaulle’s heir presumptive, Georges Pompidou , has given voice to de Gaulle’s thoughts on... Pompidou said: Certainly we do not believe in integration as a method of approach to European unity, precisely because we believe that there can be no

  11. OECD environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' efforts to manage its environment including air, water, nature, and biodiversity; to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 47 figs., 20 tabs.

  12. Toxic plants of the Northeastern United States.

    Science.gov (United States)

    Bischoff, Karyn; Smith, Mary C

    2011-07-01

    This article lists commonly encountered toxic plants that affect ruminants in the Northeastern United States. Livestock are at risk for ingestion of a large variety of toxic plants. Plant poisonings are likely to be underdiagnosed because tests for most plant toxins are not routinely available at veterinary diagnostic laboratories. Prevention of access to poisonous plants is usually more effective and economical than treatment of plant poisonings. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. PERMITTING LEADERSHIP IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Ken Nemeth

    2002-09-01

    In accordance with the Southern States Energy Board (SSEB) proposal, as incorporated into NETL/DE-FC26-97FT34199, the objective of this agreement is to streamline the environmental technology permitting process site-to-site, state-to-state, and industry-to-industry to achieve remediation and waste processing faster, better and cheaper. SSEB is working with member Governors, legislators and regulators to build consensus on streamlining the permitting process for new and innovative technologies for addressing the legacy of environmental problems from 50 years of weapons research, development and production. This report reviews mechanisms whereby industry consortiums and the Department of Energy (DOE) have been working with State regulators and other officials in technology deployment decisions within the DOE complex. The historic development of relationships with State regulators is reviewed and the current nature of the relationships examined. The report contains observations from internal DOE reviews as well as recommendations from the General Accounting Office (GAO) and other external organizations. The report discusses reorganization initiatives leading up to a DOE Top-to-Bottom review of the Environmental Management (EM) Program and highlights points of consideration for maintaining effective linkages with State regulators. It notes how the proposed changes will place new demands upon the National Energy Technology Laboratory (NETL) and how NETL can leverage its resources by refocusing existing EM efforts specifically to states that have DOE facilities within their borders (host-states). Finally, the report discusses how SSEB's Permitting Leadership in the United States (PLUS) program can provide the foundation for elements of NETL's technical assistance program that are delivered to regulators and other decision- makers in host-states. As a regional compact commission, SSEB provides important direct linkages to regulators and stakeholders who need

  14. Human prion diseases in the United States.

    Directory of Open Access Journals (Sweden)

    Robert C Holman

    Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.

  15. Taxation of United States general aviation

    Science.gov (United States)

    Sobieralski, Joseph Bernard

    General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and

  16. Actual implementation of sick children's rights in Italian pediatric units: a descriptive study based on nurses' perceptions.

    Science.gov (United States)

    Bisogni, Sofia; Aringhieri, Corinna; McGreevy, Kathleen; Olivini, Nicole; Lopez, José Rafael Gonzalez; Ciofi, Daniele; Merlo, Alberta Marino; Mariotti, Paola; Festini, Filippo

    2015-05-13

    Several charters of rights have been issued in Europe to solemnly proclaim the rights of children during their hospital stay. However, notwithstanding such general declarations, the actual implementation of hospitalized children's rights is unclear. The purpose of this study was to understand to which extent such rights, as established by the two main existing charters of rights, are actually implemented and respected in Italian pediatric hospitals and the pediatric units of Italian general hospitals, as perceived by the nurses working in them. Cross-sectional study. A 12-item online questionnaire was set up and an invitation was sent by email to Italian pediatric nurses using professional mailing lists and social networks. Responders were asked to score to what extent each right is respected in their hospital using a numeric scale from 1 (never) to 5 (always). 536 questionnaires were returned. The best implemented right is the right of children to have their mothers with them (mean score 4.47). The least respected one is the right of children to express their opinion about care (mean 3.01). Other rights considered were the right to play (4.29), the right to be informed (3.95), the right to the respect of privacy (3.75), the right to be hospitalized with peers (3.39), the right not to experience pain ever (3.41), and the right to school (3.07). According to the majority of nurses, the most important is the right to pain relief. Significant differences in the implementation of rights were found between areas of Italy and between pediatric hospitals and pediatric units of general hospitals. According to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited.

  17. Pediatric Pes Planus: A State-of-the-Art Review.

    Science.gov (United States)

    Carr, James B; Yang, Scott; Lather, Leigh Ann

    2016-03-01

    Flatfoot (pes planus) is common in infants and children and often resolves by adolescence. Thus, flatfoot is described as physiologic because it is usually flexible, painless, and of no functional consequence. In rare instances, flatfoot can become painful or rigid, which may be a sign of underlying foot pathology, including arthritis or tarsal coalition. Despite its prevalence, there is no standard definition for pediatric flatfoot. Furthermore, there are no large, prospective studies that compare the natural history of idiopathic, flexible flat feet throughout development in response to various treatments. The available literature does not elucidate which patients are at risk for developing pain and disability as young adults. Current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flat feet. Painful flexible flatfoot may benefit from orthopedic intervention, such as physical therapy, bracing, or even a surgical procedure. Orthotics, although generally unproven to alter the course of flexible flatfoot, may provide relief of pain when present. Surgical procedures include Achilles tendon lengthening, bone-cutting procedures that rearrange the alignment of the foot (osteotomies), fusion of joints (arthrodesis), or insertion of a silicone or metal cap into the sinus tarsi to establish a medial foot arch (arthroereisis). It is important for a general pediatrician to know when a referral to an orthopedic specialist is indicated and which treatments may be offered to the patient. Updated awareness of the current evidence regarding pediatric flatfoot helps the provider confidently and appropriately counsel patients and families.

  18. The state of amphibians in the United States

    Science.gov (United States)

    Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.

    2012-01-01

    More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.

  19. Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

    Directory of Open Access Journals (Sweden)

    Juliana Pena Porto

    2012-08-01

    Full Text Available INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI, namely, sepsis, pneumonia, and urinary tract infection (UTI, in a pediatric intensive care unit (PICU in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN was conducted in the unit and children with NI (cases were compared with a group (matched controls in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each; Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%, and in UTI the most frequent agents were yeasts (33.3%. The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube, and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

  20. [Surveying the status of continuous blood purification technology application in Chinese pediatric intensive care unit].

    Science.gov (United States)

    Li, Leilei; Lu, Guoping

    2014-03-01

    To learn application status of continuous blood purification (CBP) in pediatric intensive care unit (PICU), to provide reference to promote the development of CBP technology. The survey of CBP application was conducted using questionnaire in 40 hospitals providing intensive care, which included children's hospitals and the pediatric sections of general hospitals from 28 provinces/municipalities/autonomous regions in China during March to July of 2012. Totally 38 hospital replied, 25 hospitals carried out CBP technology, first carried out in 1997, the median year was 2008, 21 hospitals' PICU could independently carry out CBP device, 18 hospitals had the nurses who could professionally operate, routinely maintain the device. Continuous veno-venous hemodiafiltration was the largest implementation mode of CBP, accounting for 51.9%. Twenty-three hospitals used ordinary heparin, and 2 hospitals used low molecular weight heparin; 21 hospitals chose activated partial thromboplastin time as the coagulation testing, due to lack of equipment, only four hospitals chose activated clotting time as coagulation testing. Only 3 hospitals could apply before and after dilution joint technology. Kidney failure is still the disease accounting for the highest proportion of diseases requiring CBP application, accounting for 38.1%, followed by sepsis, 19.1%, drug poisoning 16.7%. CBP started 10 years ago, and got attention and promotion nearly five years ago in China, but the associated personnel, equipment were inadequate, anticoagulation, before and after dilution and other technical applications were not complete enough, high volume hemofiltration mode was seldom used.

  1. Impact of Hospital Admission Care At a Pediatric Unit: A Qualitative Study.

    Science.gov (United States)

    Macías, Marta; Zornoza, Carmen; Rodriguez, Elena; García, José A; Fernández, José A; Luque, Rafaela; Collado, Rosa

    2015-01-01

    The time of admission to a hospital, especially when unplanned, has been reported as the most stressful moment of hospitalization for both parents and children (Odievre, 2001). This qualitative study explored parents and hospital staff's perceptions and experiences related to the process of admission to a pediatric unit. Focus groups, two with parents (total n = 12) and one with health care professionals (n = 6), were conducted, and content analysis inspired by Graneheim and Lundman (2004) was performed. Parents identified four categories of perceptions: 1) management of an uncertain situation at the time of admission, 2) feelings related to the child's illness, 3) parent perception of professional's performance, and 4) parent experience of their role. Health care professionals identified two categories: 1) hospital admission as a continuous care process, and 2) undertaking improvements in the admission process. A common theme emerged about the importance of parents' trust in professionals in order to build a therapeutic relationship. Findings underscore the need for strategies to improve the hospital pediatric admission process based on a parent-professional relationship of trust and confidence through continuous quality communication and support. These strategies would include providing a nurse in charge of the admission process to assure continuity of care throughout the child's hospitalization.

  2. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure.

  3. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Science.gov (United States)

    Okumura, Lucas Miyake; da Silva, Daniella Matsubara; Comarella, Larissa

    2016-01-01

    Abstract Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications. PMID:27578187

  4. Fusarium spp infections in a pediatric burn unit: nine years of experience.

    Science.gov (United States)

    Rosanova, María Teresa; Brizuela, Martín; Villasboas, Mabel; Guarracino, Fabian; Alvarez, Veronica; Santos, Patricia; Finquelievich, Jorge

    2016-01-01

    Fusarium spp are ubiquitous fungi recognized as opportunistic agents of human infections, and can produce severe infections in burn patients. The literature on Fusarium spp infections in pediatric burn patients is scarce. To describe the clinical and epidemiological features as well as outcome of Fusarium spp infections in pediatric burn patients. Retrospective, descriptive study of Fusarium spp infections in a specialized intensive care burn unit. In 15 patients Fusarium spp infections were diagnosed. Median age was 48 months. Direct fire injury was observed in ten patients. The median affected burn surface area was 45%. Twelve patients had a full thickness burn. Fourteen patients had a Garces Index ≥3. Fungal infection developed at a median of 11 days after burn injury. Fungi were isolated from burn wound in 14 patients and from the bone in one patient. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of treatment completion was 23 days. One patient (7%) died of fungal infection-related causes. In our series Fusarium spp was an uncommon pathogen in severely burnt patients. The burn wound was the most common site of infection and mortality was low. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  5. Pediatric and youth traffic-collision injuries in Al Ain, United Arab Emirates: a prospective study.

    Directory of Open Access Journals (Sweden)

    Michal Grivna

    Full Text Available AIM: To study the mechanism of road traffic collisions (RTC, use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries. METHODS: All RTC injured children and youth (0-19-year-olds who were admitted to Al Ain City's two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed. RESULTS: 245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37% followed by front impact collision (32%. 32 (13% of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170 vehicle passengers used seatbelts and 13% (3/23 motorcyclists a helmet. CONCLUSIONS: Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

  6. 22 CFR 22.3 - Remittances in the United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2)...

  7. Maximum floodflows in the conterminous United States

    Science.gov (United States)

    Crippen, John R.; Bue, Conrad D.

    1977-01-01

    Peak floodflows from thousands of observation sites within the conterminous United States were studied to provide a guide for estimating potential maximum floodflows. Data were selected from 883 sites with drainage areas of less than 10,000 square miles (25,900 square kilometers) and were grouped into regional sets. Outstanding floods for each region were plotted on graphs, and envelope curves were computed that offer reasonable limits for estimates of maximum floods. The curves indicate that floods may occur that are two to three times greater than those known for most streams.

  8. United States/Canada electricity exchanges

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The United States and Canada have been cooperating in all areas of energy exchange for many years. Electrical energy has been chosen to be the focus of this study because substantial means for exchanges offer benefits that have not yet been fully exploited. There may be some bilateral benefits from additional interconnections because of the buffers which they represent against domestic imbalances. After the history of the electricity exchanges between the two countries is reviewed, opportunities and incentives and obstacles and constraints are discussed in the next two chapters. The final chapter examines procedures to resolve obstacles and minimize constraints. (MCW)

  9. Coordinating the United States Interagency Partnering Effort

    Science.gov (United States)

    2013-03-01

    stage over the last 6 years.7 The DoD is on the cutting edge of partnering and there have been valuable lessons learned at the tactical and...global stage . “3D are the three pillars that provide the foundation for promoting and protecting U.S. national security interests abroad.”33 DoD, DoS...operations now will mean throwing 18 away hard-fought gains, and expose the United States to new risks from across the globalising

  10. Contraceptive failure in the United States.

    Science.gov (United States)

    Trussell, James

    2011-05-01

    This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

  11. Mobile satellite service in the United States

    Science.gov (United States)

    Agnew, Carson E.; Bhagat, Jai; Hopper, Edwin A.; Kiesling, John D.; Exner, Michael L.; Melillo, Lawrence; Noreen, Gary K.; Parrott, Billy J.

    1988-05-01

    Mobile satellite service (MSS) has been under development in the United States for more than two decades. The service will soon be provided on a commercial basis by a consortium of eight U.S. companies called the American Mobile Satellite Consortium (AMSC). AMSC will build a three-satellite MSS system that will offer superior performance, reliability and cost effectiveness for organizations requiring mobile communications across the U.S. The development and operation of MSS in North America is being coordinated with Telesat Canada and Mexico. AMSC expects NASA to provide launch services in exchange for capacity on the first AMSC satellite for MSAT-X activities and for government demonstrations.

  12. Wind Lidar Activities in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew; Newman, Jennifer; St. Pe, Alexandra; Iungo, G. Valerio; Wharton, Sonia; Herges, Tommy; Filippelli, Matthew; Pontbriand, Philippe; Osler, Evan

    2017-06-28

    IEA Wind Task 32 seeks to identify and mitigate the barriers to the adoption of lidar for wind energy applications. This work is partly achieved by sharing experience across researchers and practitioners in the United States and worldwide. This presentation is a short summary of some wind lidar-related activities taking place in the country, and was presented by Andrew Clifton at the Task 32 meeting in December 2016 in his role as the U.S. Department of Energy-nominated country representative to the task.

  13. Geothermal power generation in United States

    Science.gov (United States)

    Braun, Gerald W.; McCluer, H. K.

    1993-03-01

    Geothermal energy is an indigenous environmentally benign heat source with the potential for 5000-10,000 GWe of power generation in the United States. Approximately 2535 MWe of installed capacity is currently operating in the U.S. with contracted power costs down to 4.6 cents/kWh. This paper summarizes: 1) types of geothermal resources; 2) power conversion systems used for geothermal power generation; 3) environmental aspects; 4) geothermal resource locations, potential, and current power plant development; 5) hurdles, bottlenecks, and risks of geothermal power production; 6) lessons learned; and 7) ongoing and future geothermal research programs.

  14. Present state and future challenges in pediatric abdominal pain therapeutics research: Looking beyond the forest

    Institute of Scientific and Technical Information of China (English)

    Craig; A; Friesen; Jennifer; V; Schurman; Susan; M; Abdel-Rahman

    2015-01-01

    At the present time, it is nearly impossible to treat pediatric functional gastrointestinal disorders associated with pain in an evidence based fashion. This is due to the overall lack of controlled studies and, even more importantly, the complexity of the contributors to disease phenotype which are not controlled or accounted for in most therapeutic trials. In this manuscript, we review the challenges of defining entry criteria, controlling for the large number of biopsychosocial factors which may effect outcomes, and understanding pharmacokinetic and pharmacodynamic factors when designing therapeutic trials for abdominal pain in children. We also review the current state of pediatric abdominal pain therapeutics and discuss trial design considerations as we move forward.

  15. State of stress in the conterminous United States

    Science.gov (United States)

    Zoback, Mary Lou; Zoback, Mark

    1980-11-01

    Inferring principal stress directions from geologic data, focal mechanisms, and in situ stress measurements, we have prepared a map of principal horizontal stress orientations for the conterminous United States. Stress provinces with linear dimensions which range between 100 and 2000 km were defined on the basis of the directions and relative magnitude of principal stresses. Within a given province, stress orientations appear quite uniform (usually within the estimated range of accuracy of the different methods used to determine stress). Available data on the transition in stress direction between the different stress provinces indicate that these transitions can be abrupt, occurring over characterized by high levels of seismicity and generally high heat flow, the stress pattern is complex, but numerous stress provinces can be well delineated. Despite relative tectonic quiescence in the eastern and central United States, a major variation in principal stress orientation is apparent between the Atlantic Coast and midcontinent areas. Most of the eastern United States is marked by predominantly compressional tectonism (combined thrust and strike slip faulting), whereas much of the region west of the southern Great Plains is characterized by predominantly extensional tectonism (combined normal and strike slip faulting). Deformation along the San Andreas fault and in parts of the Sierra Nevada is nearly pure strike slip. Exceptions to this general pattern include areas of compressional tectonics in the western United States (the Pacific Northwest, the Colorado Plateau interior, and the Big Bend segment of the San Andreas fault) and the normal growth faulting along the Gulf Coastal Plain. Sources of stress are constrained not only by the orientation and relative magnitude of the stresses within a given province but also by the manner of transition of the stress field from one province to another. Much of the modern pattern of stress in the western United States can be

  16. Regional and State Level Water Scarcity Report: Northeast United States

    Science.gov (United States)

    Nicoletti, C. K.; Lopez-Morales, C. A.; Hoover, J. H.; Voigt, B. G.; Vorosmarty, C. J.; Mohammed, I. N.

    2010-12-01

    There are an abundance of large-scale, coarse resolution global water scarcity studies, but the existing literature fails to address regional and state specific scarcity measures. Moreover, while environmental water requirements are an integral factor in the development and implementation of sustainable water management practices, only recently has this notion been introduced to water scarcity research. In this paper, we argue that developing a preliminary measure of water scarcity, at the regional and state levels, will allow for more informed policy development. The goal of this study is to generate a more comprehensive understanding of water scarcity in the Northeast, by gathering fine scale data, applying a consistent methodology to the calculation of a scarcity index, and analyzing the results to see relative trends in spatio-temporal water scarcity. Public supply, irrigation, rural, industrial and thermo-power withdrawals have been compiled from USGS state water use publications from 1950 to 1985. Using the WBMplus water model runoff data, state specific in-stream environmental water requirements were calculated using the accepted hydro-ecological methodology. Water scarcity was then calculated as a ratio of water withdrawals to total available water minus environmental flow requirements for the system. In so doing, this study generates a spatially explicit and temporally varying water scarcity indicator (WSI) for the Northeastern United States between 1950 and 2000 at the regional and state levels at a five-year time interval. Calculation of a spatial and temporal water scarcity indicator enabled us to identify regions and specific states that were: slightly exploited (WSI 1.0). The minimum environmental water requirements to maintain in-stream aquatic and riparian ecosystems for the Northeastern states ranged between 27.5 to 36.3 percent of the mean annual runoff within Vermont and Maryland, respectively. The regional WSI values ranged between 0.199 in 1950

  17. Construction and psychometric testing of the EMPATHIC questionnaire measuring parent satisfaction in the pediatric intensive care unit

    NARCIS (Netherlands)

    Latour, Jos M.; van Goudoever, Johannes B.; Duivenvoorden, Hugo J.; Albers, Marcel J. I. J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; van Heerde, Marc; de Neef, Marjorie; Verlaat, Carin W. M.; van Vught, Elise M.; Hazelzet, Jan A.

    2011-01-01

    To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU). Structured development and psychometric testing of a parent satisfaction-with-care instrument wit

  18. A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units

    NARCIS (Netherlands)

    Latour, Jos M.; van Goudoever, Johannes B.; Schuurman, Beatrix Elink; Albers, Marcel J. I. J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; van Heerde, Marc; Verlaat, Carin W. M.; van Vught, Elise M.; Hazelzet, Jan A.

    2011-01-01

    To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU). Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents' experiences. Thirty-nine mothers and 25 fathers of 41 children admitted to seven of the ei

  19. 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

  20. A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units

    NARCIS (Netherlands)

    J.M. Latour (Jos); J.B. van Goudoever (Hans); B.E. Schuurman (Beatrix); M.J.I.J. Albers (Marcel); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M. van Heerde (Marc); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); J.A. Hazelzet (Jan)

    2011-01-01

    textabstractPurpose: To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU). Method: Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents' experiences. Thirty-nine mothers and 25 fathers of 41 childre

  1. Taiwanese Parents' Experience of Making a “Do Not Resuscitate” Decision for Their Child in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Shu-Mei Liu, RN, MN

    2014-03-01

    Conclusion: Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process.

  2. Construction and psychometric testing of the EMPATHIC questionnaire measuring parent satisfaction in the pediatric intensive care unit

    NARCIS (Netherlands)

    J.M. Latour (Jos); J.B. van Goudoever (Hans); H.J. Duivenvoorden (Hugo); M.J.I.J. Albers (Marcel); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M. van Heerde (Marc); M. de Neef (Marjorie); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); J.A. Hazelzet (Jan)

    2011-01-01

    textabstractAbstract PURPOSE: To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU). METHODS: Structured development and psychometric testing of a paren

  3. Community Poverty and Child Abuse Fatalities in the United States.

    Science.gov (United States)

    Farrell, Caitlin A; Fleegler, Eric W; Monuteaux, Michael C; Wilson, Celeste R; Christian, Cindy W; Lee, Lois K

    2017-05-01

    Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources. Copyright © 2017 by the American Academy of Pediatrics.

  4. Western United States beyond the Four Corners

    Science.gov (United States)

    2002-01-01

    The breathtaking beauty of the western United States is apparent in this image from the Multi-angle Imaging SpectroRadiometer on NASA's Terra spacecraft. Data from 16 different swaths acquired between April 2000 and September 2001by MISR's vertical-viewing (nadir) camera were used to create this cloud-free natural-color image mosaic. The image is draped over a 100-meter (328-foot)shaded relief Digital Terrain Elevation Model from the United States Geological Survey.Among the prominent features are the snow-capped Rocky Mountains traversing Montana, Wyoming, Colorado and New Mexico. In the northern portion of the image, the Columbia Plateau stretches across Washington, Oregon and Idaho. Many major rivers originate in this region, including the Missouri to the east of the Continental Divide, the Snake to the west, and the Colorado which wends across Utah and Arizona. The Colorado Plateau and vibrant red-colored rocks of the Painted Desert extend south from Utah into Arizona. In the southwestern portion of the image, California's San Joaquin Valley and the Mojave Desert of California and Nevada give way to the Los Angeles basin and the Pacific Ocean.The Terra spacecraft is part of NASA's Earth Science Enterprise, a long-term research and technology program designed to examine Earth's land, oceans, atmosphere, ice and life as a total integrated system.

  5. Renewable energy atlas of the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J.A.; Hlava, K.Greenwood, H.; Carr, A. (Environmental Science Division)

    2012-05-01

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. It is designed for the U.S. Department of Agriculture Forest Service (USFS) and other federal land management agencies to evaluate existing and proposed renewable energy projects. Much of the content of the Atlas was compiled at Argonne National Laboratory (Argonne) to support recent and current energy-related Environmental Impact Statements and studies, including the following projects: (1) West-wide Energy Corridor Programmatic Environmental Impact Statement (PEIS) (BLM 2008); (2) Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2010); (3) Supplement to the Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2011); (4) Upper Great Plains Wind Energy PEIS (WAPA/USFWS 2012, in progress); and (5) Energy Transport Corridors: The Potential Role of Federal Lands in States Identified by the Energy Policy Act of 2005, Section 368(b) (in progress). This report explains how to add the Atlas to your computer and install the associated software; describes each of the components of the Atlas; lists the Geographic Information System (GIS) database content and sources; and provides a brief introduction to the major renewable energy technologies.

  6. Activity-based costing in radiology. Application in a pediatric radiological unit.

    Science.gov (United States)

    Laurila, J; Suramo, I; Brommels, M; Tolppanen, E M; Koivukangas, P; Lanning, P; Standertskjöld-Nordenstam, G

    2000-03-01

    To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

  7. [Reducing patient pressure sore incidence density in the pediatric surgical intensive care unit].

    Science.gov (United States)

    Huang, Wei-Chen; Chang, Shiow-Ru; Tang, Chi-Min

    2014-04-01

    Our unit recorded 21 cases of pressure sores from January 2011 to June 2011. The resulting pressure-sore incidence density of 0.74% exceeded the Taiwan Clinical Performance Indicator (TCPI) for medical centers (0.62%) as well as the mean incidence density for our unit (0.55%) during the same period in 2010. We developed this project to decrease the incidence density of pressure sores at our pediatric-surgical-intensive-care unit from 0.74% to 0.31%. Strategies implemented included: 1. providing on-the-job education; 2. providing bedside teaching; 3. developing a series of pictures to illustrate proper sitting, lying, and changing positions and the proper fixation of catheters; 4. implementing a reminder mechanism; 5. introducing pressure-preventing devices; 6. and establishing an audit team. Incidence density decreased from 0.74% (Jan. to Jun. 2011) to 0.18% (Mar. to Jul. 2012). We demonstrated that the developed improvement program effectively reduced the incidence density of pressure sores and increased the quality of nursing care.

  8. United States 2030 Food Loss and Waste Reduction Goal

    Science.gov (United States)

    On September 16, 2015, the United States Department of Agriculture (USDA) and the United States Environmental Protection Agency (EPA) announced the first ever domestic goal to reduce food loss and waste by half by the year 2030.

  9. Average annual runoff in the United States, 1951-80

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a line coverage of average annual runoff in the conterminous United States, 1951-1980. Surface runoff Average runoff Surface waters United States

  10. 78 FR 61446 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2013-10-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... for services of FAA Flight Standards Aviation Safety Inspectors outside the United States....

  11. Coal Fields of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows the coal fields of Alaska and the conterminous United States. Most of the material for the conterminous United States was collected from James...

  12. Abortion Policy in Britain and the United States.

    Science.gov (United States)

    Francome, Colin

    1980-01-01

    Compares the number of legal abortions performed in the United States and Britain. Reveals that the rate of abortion in the United States is more than twice that of Britain. Analyzes the reasons for the different rates. (Author)

  13. Satellite View of the Conterminous United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Satellite View of the Conterminous United States map layer is a 200- meter-resolution simulated-natural-color image of the United States. Vegetation is generally...

  14. Comparison of Constitutional Spirit Between United States and China

    Institute of Scientific and Technical Information of China (English)

    杨琅琅

    2007-01-01

    This paper compares the differences in constitutional spirit between United States and China, and then brings out the influence of the constitutional spirit in United States to the constitutional spirit in China.

  15. Weather pattern climatology of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Barchet, W.R.; Davis, W.E.

    1984-01-01

    In this study the geographic domain covered the 48 conterminous states of the United States. The daily synoptic weather pattern was classified into nine types for the 10-year period January 1, 1969 to December 31, 1978. Weather pattern types were defined relative to the classical polar front model of a mid-latitude cyclonic storm system and its associated air masses. Guidelines for classifying weather patterns on an operational basis were developed. These were applied to 3652 daily surface weather maps to produce a time series of weather pattern type at 120 grid points of a 160 point, 3/sup 0/ latitude by 4/sup 0/ longitude array over the United States. Statistics on the frequency of occurrence, persistence and alternation of weather patterns were calculated for each grid point. Summary statistics for the entire grid and for six regions were also presented. Frequency of occurrence and persistence were found to depend on the size and speed of movement of the weather pattern. Large, slow moving air masses had higher frequency of occurrence and longer persistence than small (fronts) or rapidly moving (or changing) features (fronts, storm centers). Some types showed distinct regional preferences. The subtropical maritime high occurred mainly in the south central and southeast. An indeterminate weather pattern type accounted for those weather patterns that did not fit the polar front model or were too disorganized to be classified. The intermountain thermal low of the desert southwest was one such feature that dominated both frequency of occurrence and persistence in this region. Alternation from one weather pattern to another followed the polar front model of a moving cyclonic storm. The tendency for anticyclonic weather patterns to become disorganized as they weakened was seen in the high percentage of these patterns that changed to an indeterminate pattern as they aged.

  16. 27 CFR 479.89 - Transfers to the United States.

    Science.gov (United States)

    2010-04-01

    ... Transfers to the United States. A firearm may be transferred to the United States or any department... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transfers to the United States. 479.89 Section 479.89 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL,...

  17. 46 CFR 67.97 - United States built.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false United States built. 67.97 Section 67.97 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DOCUMENTATION AND MEASUREMENT OF VESSELS DOCUMENTATION OF VESSELS Build Requirements for Vessel Documentation § 67.97 United States built. To be considered built in the United States a vessel...

  18. 26 CFR 1.993-7 - Definition of United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Definition of United States. 1.993-7 Section 1... (CONTINUED) INCOME TAXES Domestic International Sales Corporations § 1.993-7 Definition of United States. Under section 993(g), the term “United States” includes the States, the District of Columbia,...

  19. 31 CFR 593.411 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... TAYLOR SANCTIONS REGULATIONS Interpretations § 593.411 Importation into the United States. With respect to the prohibitions set forth in § 593.205, the term importation into the United States...

  20. 32 CFR 150.21 - Appeals by the United States.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Appeals by the United States. 150.21 Section 150... the United States. (a) Restricted filing. Only a representative of the government designated by the Judge Advocate General of the respective service may file an appeal by the United States under...

  1. 31 CFR 545.304 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... REGULATIONS General Definitions § 545.304 Importation into the United States. (a) With respect to goods, software, or technology, the term importation into the United States means the bringing of any...

  2. 26 CFR 1.953-2 - Actual United States risks.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1... (CONTINUED) INCOME TAXES Controlled Foreign Corporations § 1.953-2 Actual United States risks. (a) In general. For purposes of paragraph (a) of § 1.953-1, the term “United States risks” means risks described...

  3. 31 CFR 539.307 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... CONTROL REGULATIONS General Definitions § 539.307 Importation into the United States. The term importation into the United States means: (a) With respect to goods or technology, the bringing of any goods...

  4. 78 FR 70275 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... United States Travel and Tourism Advisory Board. SUMMARY: The Department of Commerce is currently seeking applications for membership on the United States Travel and Tourism Advisory Board (Board). The purpose of the...

  5. 78 FR 77103 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-12-20

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... on the United States Travel and Tourism Advisory Board. SUMMARY: On November 25, 2013, the Department... 70275) soliciting applications for membership on the United States Travel and Tourism Advisory Board...

  6. Framework for Naval Cooperation between Vietnam and the United States

    Science.gov (United States)

    2017-06-09

    the Vietnam-United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership... platform for future relationship between Vietnam and the United States. Finally, this research suggests a framework for naval cooperation between Vietnam...United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership Agreement signed

  7. 31 CFR 515.334 - United States national.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States national. 515.334 Section 515.334 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... of the United States, and which has its principal place of business in the United States....

  8. 76 FR 68067 - United States-Peru Trade Promotion Agreement

    Science.gov (United States)

    2011-11-03

    ... to trade in textile and apparel goods between Peru and the United States. The provisions within...] RIN 1515-AD79 United States-Peru Trade Promotion Agreement AGENCIES: U.S. Customs and Border... of the United States- Peru Trade Promotion Agreement. DATES: Interim rule effective November 3, 2011...

  9. 77 FR 27669 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK10 Modifications to Definition of United States Property... clearing agency do not constitute United States property. The text of the temporary regulations also serves... Federal Register establish an exception to the definition of United States property (within the meaning...

  10. Advances in pediatric pharmacology, therapeutics, and toxicology.

    Science.gov (United States)

    Gonzalez, Daniel; Paul, Ian M; Benjamin, Daniel K; Cohen-Wolkowiez, Michael

    2014-08-01

    In the United States, passage of the FDASIA legislation made BPCA and PREA permanent, no longer requiring reauthorization every 5 years. This landmark legislation also stressed the importance of performing clinical trials in neonates when appropriate. In Europe the Pediatric Regulation, which went into effect in early 2007, also provides a framework for expanding pediatric clinical research. Although much work remains, as a result of greater regulatory guidance more pediatric data are reaching product labels.

  11. China, Southeast Asia, and the United States

    Directory of Open Access Journals (Sweden)

    Lowell Dittmer

    2016-04-01

    Full Text Available Southeast Asia has historically been a meeting point between East Asia and South Asia before Western colonialism opened the region to the West and to the winds of global modernization. Since Japan’s coercive decolonization during the Second World War, the dominant outside influences have come from the United States and from the People’s Republic of China. The post-Cold War era began with a withdrawal of both China’s and US power projection from Southeast Asia, facilitating the configuration of a triangular ménage à trios, with ASEAN expanding to include all of Southeast Asia and introducing a number of extended forums intended to socialize the rest of East Asia into the ASEAN way. The “rise of China” occurred within this friendly context, though beginning around 2010 its strategic implications began to appear more problematic with the mounting dispute over the issue of the South China Sea.

  12. Inclusive Education in the United States

    Directory of Open Access Journals (Sweden)

    C. Kenneth Tanner

    1996-12-01

    Full Text Available School reform issues addressing inclusive education were investigated in this nationwide (United States study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive education and collaborative strategies. For example, principals and special education teachers were more positive about inclusive education than regular education teachers. Collaboration as an instructional strategy for "included" students was viewed as a high priority item. Responders who had taken two or more courses in school law rated the identified barriers to inclusive education higher than those with less formal training in the subject.

  13. Detailed gravimetric geoid for the United States.

    Science.gov (United States)

    Strange, W. E.; Vincent, S. F.; Berry, R. H.; Marsh, J. G.

    1972-01-01

    A detailed gravimetric geoid was computed for the United States using a combination of satellite-derived spherical harmonic coefficients and 1 by 1 deg mean gravity values from surface gravimetry. Comparisons of this geoid with astrogeodetic geoid data indicate that a precision of plus or minus 2 meters has been obtained. Translations only were used to convert the NAD astrogeodetic geoid heights to geocentric astrogeodetic heights. On the basis of the agreement between the geocentric astrogeodetic geoid heights and the gravimetric geoid heights, no evidence is found for rotation in the North American datum. The value of the zero-order undulation can vary by 10 to 20 meters, depending on which investigator's station positions are used to establish it.

  14. Electric trade in the United States 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994.

  15. Renewable Energy Atlas of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J. [Environmental Science Division; Hlava, K. [Environmental Science Division; Greenwood, H. [Environmentall Science Division; Carr, A. [Environmental Science Division

    2013-12-13

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. This report explains how to add the Atlas to your computer and install the associated software. The report also includes: A description of each of the components of the Atlas; Lists of the Geographic Information System (GIS) database content and sources; and A brief introduction to the major renewable energy technologies. The Atlas includes the following: A GIS database organized as a set of Environmental Systems Research Institute (ESRI) ArcGIS Personal GeoDatabases, and ESRI ArcReader and ArcGIS project files providing an interactive map visualization and analysis interface.

  16. Industry economics in the United States.

    Science.gov (United States)

    2004-04-01

    Demand for medical equipment in the United States (US) is projected to grow by 8% between 2001 and 2006, to reach 105 billion dollars. In 2001,the market was valued at 71.4 billion dollars, based on an annual growth of 7.5% between 1996 and 2001, according to The Freedonia Group. Product innovation and the growing ageing population is driving the industry, despite health-care cost containment measures. Medical and surgical instruments continue to be the largest sector, which is expected to grow to 30.5 billion dollars in 2006. However, electromedical/electrotherapeutic apparatus will remain the fastest growing sector, with annual gains of 10.8% predicted for this period.

  17. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2016-07-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on USimports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  18. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  19. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2011-10-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on US
    imports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  20. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  1. A prospective, longitudinal study to assess use of continuous and reactive low-pressure mattresses to reduce pressure ulcer incidence in a pediatric intensive care unit

    OpenAIRE

    García Molina, Pablo; Balaguer López, Evelin; Torra i Bou, Joan Enric; Álvarez Ordiales, Adán; Quesada Ramos, Cristina; Verdú Soriano, José

    2012-01-01

    Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009–2011) study was conducted among PICU patients. The two pediatric mattresses — one for children we...

  2. Developing a drug library for smart pumps in a pediatric intensive care unit.

    Science.gov (United States)

    Manrique-Rodríguez, Silvia; Sánchez-Galindo, Amelia; Fernández-Llamazares, Cecilia M; López-Herce, Jesús; García-López, Isabel; Carrillo-Álvarez, Angel; Sanjuro-Sáez, María

    2012-03-01

    The most serious medication errors occur during intravenous administration. The potential consequences are more serious the more critical and younger the patient. Smart pumps can help to prevent infusion-related programming errors, thanks to associated dose-limiting software known as "drug library". Drug libraries alert the user if pre-determined high dosage limits are exceeded or if entry is below pre-determined low dosage limits. To describe the process for developing a specific drug library for a pediatric intensive care unit (PICU) and the key factors for preventing programming errors. The study was performed by a multidisciplinary team consisting of a clinical pharmacist, a PICU pediatrician, and the chief nurse of the unit. The process of developing the drug library lasted seven months. A literature review was carried out to determine standard concentrations and accurate limits for intravenous administration of high-risk drugs. Alaris(®) syringe pumps and Guardrails(®) CQI v4.1 Event Reporter software were used. Several manufacturers offer smart pump technology. Users should be aware of differences in features, such as definition of parameters and associations between them, definition of safety limits, organization of the drug library, and data use. Our infusion pump technology covered 108 drugs. Compliance with the drug library was 85% and nurses' acceptance of the drug library was high as 94% would recommend implementation of this technology in other units. After nine months of implementation, several potentially harmful infusion-related programming errors were intercepted. Drug libraries are specifically designed for a particular hospital unit, and may condition the success in implementing this technology. Implementation of smart pumps proved effective in intercepting infusion-related programming errors after nine months of implementation in a PICU. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    Full Text Available Abstract Objective: Clinical Pharmacy Services (CPS are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU. Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs which were solved within clinicians (89% acceptance of all interventions. The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21% and a composite of inadequate doses (17% due to low, high and non-optimized doses. Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.

  4. Asthma changes at a Pediatric Intensive Care Unit after 10 years: Observational study

    Directory of Open Access Journals (Sweden)

    Ayman A Al-Eyadhy

    2015-01-01

    Full Text Available Objectives: To describe the change in the management, and outcome of children with acute severe asthma (ASA admitted to Pediatric Intensive Care Unit (PICU at tertiary institute, as compared to previously published report in 2003. Methods : This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort. Results: In comparison to previous 2003 Cohort, current Cohort (2013 revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001, higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007, less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03, less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001. There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001, intravenous magnesium sulfate (68.2% vs. none, intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015, and noninvasive ventilation (NIV (35.8% vs. none while no patients were treated with theophylline (none vs. 62.5%. The median length of stay (LOS was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality. Conclusion: We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.

  5. Testing the pediatric cardiac quality of life inventory in the United kingdom.

    Science.gov (United States)

    Wray, Jo; Franklin, Rodney; Brown, Kate; Cassedy, Amy; Marino, Bradley S

    2013-02-01

    To establish the validity and reliability of the Pediatric Cardiac Quality of Life Inventory (PCQLI) for children with heart disease in the United Kingdom. Three paediatric cardiac centres recruited patients aged 8-18 years with heart disease. Patient-parent pairs completed a disease-specific paediatric cardiac quality of life measure (PCQLI), a generic quality of life measure (PedsQL4.0) and behaviour and self-perception questionnaires. Validity was assessed by correlation of PCQLI scores with heart disease severity, medical care utilization, and PedsQL, behaviour and self-perception scores, and by correlation of patient and parent PCQLI scores. Reliability was evaluated by administering the PCQLI at two time points. The study was completed by 771 patient-parent pairs. Validity was confirmed by the association of lower total PCQLI scores with more complex heart disease and a greater number of hospitalizations and cardiac surgeries (all p disease-specific quality-of-life measure for children with heart disease in the United Kingdom. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

  6. 78 FR 3398 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-01-16

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). The Board will meet to present...

  7. 78 FR 70274 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). This will be the last meeting of...

  8. Hansen Disease among Micronesian and Marshallese Persons Living in the United States

    Science.gov (United States)

    Woodall, Patricia; Rajan, Latha

    2011-01-01

    An increasing proportion of Hansen disease cases in the United States occurs among migrants from the Micronesian region, where leprosy prevalence is high. We abstracted surveillance and clinical records of the National Hansen’s Disease Program to determine geographic, demographic, and clinical patterns. Since 2004, 13% of US cases have occurred in this migrant population. Although Hawaii reported the most cases, reports have increased in the central and southern states. Multibacillary disease in men predominates on the US mainland. Of 49 patients for whom clinical data were available, 37 (75%) had leprosy reaction, neuropathy, or other complications; 17 (37%) of 46 completed treatment. Comparison of data from the US mainland with Hawaii and country-of-origin suggests under-detection of cases in pediatric and female patients and with paucibacillary disease in the United States. Increased case finding and management, and avoidance of leprosy-labeled stigma, is needed for this population. PMID:21762573

  9. Brackish groundwater in the United States

    Science.gov (United States)

    Stanton, Jennifer S.; Anning, David W.; Brown, Craig J.; Moore, Richard B.; McGuire, Virginia L.; Qi, Sharon L.; Harris, Alta C.; Dennehy, Kevin F.; McMahon, Peter B.; Degnan, James R.; Böhlke, John Karl

    2017-04-05

    For some parts of the Nation, large-scale development of groundwater has caused decreases in the amount of groundwater that is present in aquifer storage and that discharges to surface-water bodies. Water supply in some areas, particularly in arid and semiarid regions, is not adequate to meet demand, and severe drought is affecting large parts of the United States. Future water demand is projected to heighten the current stress on groundwater resources. This combination of factors has led to concerns about the availability of freshwater to meet domestic, agricultural, industrial, mining, and environmental needs. To ensure the water security of the Nation, currently [2016] untapped water sources may need to be developed.Brackish groundwater is an unconventional water source that may offer a partial solution to current and future water demands. In support of the national census of water resources, the U.S. Geological Survey completed the national brackish groundwater assessment to better understand the occurrence and characteristics of brackish groundwater in the United States as a potential water resource. Analyses completed as part of this assessment relied on previously collected data from multiple sources; no new data were collected. Compiled data included readily available information about groundwater chemistry, horizontal and vertical extents and hydrogeologic characteristics of principal aquifers (regionally extensive aquifers or aquifer systems that have the potential to be used as a source of potable water), and groundwater use. Although these data were obtained from a wide variety of sources, the compiled data are biased toward shallow and fresh groundwater resources; data representing groundwater that is at great depths and is saline were not as readily available.One of the most important contributions of this assessment is the creation of a database containing chemical characteristics and aquifer information for the known areas with brackish groundwater

  10. Characterization of floods in the United States

    Science.gov (United States)

    Saharia, Manabendra; Kirstetter, Pierre-Emmanuel; Vergara, Humberto; Gourley, Jonathan J.; Hong, Yang

    2017-05-01

    Floods have gained increasing global significance in the recent past due to their devastating nature and potential for causing significant economic and human losses. Until now, flood characterization studies in the United States have been limited due to the lack of a comprehensive database matching flood characteristics such as peak discharges and flood duration with geospatial and geomorphologic information. The availability of a representative and long archive of flooding events spanning 78 years over a variety of hydroclimatic regions results in a spatially and temporally comprehensive flood characterization over the continental U.S. This study, for the first time, employs a large-event database that is based on actual National Weather Service (NWS) definitions of floods instead of the frequently-adopted case study or frequentist approach, allowing us to base our findings on real definitions of floods. It examines flooding characteristics to identify how space and time scales of floods vary with climatic regimes and geomorphology. Flood events were characterized by linking flood response variables in gauged basins to spatially distributed variables describing climatology, geomorphology, and topography. The primary findings of this study are that the magnitude of flooding is highest is regions such as West Coast and southeastern U.S. which experience the most extraordinary precipitation. The seasonality of flooding varies greatly from maxima during the cool season on the West Coast, warm season in the desert Southwest, and early spring in the Southeast. The fastest responding events tend to be in steep basins of the arid Southwest caused by intense monsoon thunderstorms and steep terrain. The envelope curves of unit peak discharge are consistent with those reported for Europe and worldwide. But significant seasonal variability was observed in floods of the U.S. compared to Europe that is attributed to the diversity of causative rainfall ranging from synoptic

  11. Pain Neuroscience Education: State of the Art and Application in Pediatrics.

    Science.gov (United States)

    Robins, Hannah; Perron, Victoria; Heathcote, Lauren C; Simons, Laura E

    2016-12-21

    Chronic pain is a widespread problem in the field of pediatrics. Many interventions to ameliorate pain-related dysfunction have a biobehavioral focus. As treatments for chronic pain (e.g., increased movement) often stand in stark contrast to treatments for an acute injury (e.g., rest), providing a solid rationale for treatment is necessary to gain patient and parent buy-in. Most pain treatment interventions incorporate psychoeducation, or pain neuroscience education (PNE), as an essential component, and in some cases, as a stand-alone approach. The current topical review focuses on the state of pain neuroscience education and its application to pediatric chronic pain. As very little research has examined pain neuroscience education in pediatrics, we aim to describe this emerging area and catalyze further work on this important topic. As the present literature has generally focused on adults with chronic pain, pain neuroscience education merits further attention in the realm of pediatric pain in order to be tailored and implemented in this population.

  12. Invasive cancer incidence - United States, 2010.

    Science.gov (United States)

    Henley, S Jane; Singh, Simple; King, Jessica; Wilson, Reda; Ryerson, Blythe

    2014-03-28

    Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV.

  13. 20 CFR 404.1093 - Possession of the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Possession of the United States. 404.1093... Income § 404.1093 Possession of the United States. In using the exclusions from gross income provided under section 931 of the Code (relating to income from sources within possessions of the United...

  14. 26 CFR 400.5-1 - Redemption by United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Redemption by United States. 400.5-1 Section... by United States. (a) Scope. The purpose of this section is to prescribe rules with respect to the provisions contained in section 7425(d), relating to redemption of real property by the United...

  15. 75 FR 41927 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2010-07-19

    ... United States Sentencing Commission is an independent agency in the judicial branch of the United States..., and judicial branches of government, and other interested parties, to study the manner in which United... might be appropriate in light of the information obtained from that study. (12) Resolution of...

  16. 2011 floods of the central United States

    Science.gov (United States)

    ,

    2013-01-01

    The Central United States experienced record-setting flooding during 2011, with floods that extended from headwater streams in the Rocky Mountains, to transboundary rivers in the upper Midwest and Northern Plains, to the deep and wide sand-bedded lower Mississippi River. The U.S. Geological Survey (USGS), as part of its mission, collected extensive information during and in the aftermath of the 2011 floods to support scientific analysis of the origins and consequences of extreme floods. The information collected for the 2011 floods, combined with decades of past data, enables scientists and engineers from the USGS to provide syntheses and scientific analyses to inform emergency managers, planners, and policy makers about life-safety, economic, and environmental-health issues surrounding flood hazards for the 2011 floods and future floods like it. USGS data, information, and scientific analyses provide context and understanding of the effect of floods on complex societal issues such as ecosystem and human health, flood-plain management, climate-change adaptation, economic security, and the associated policies enacted for mitigation. Among the largest societal questions is "How do we balance agricultural, economic, life-safety, and environmental needs in and along our rivers?" To address this issue, many scientific questions have to be answered including the following: * How do the 2011 weather and flood conditions compare to the past weather and flood conditions and what can we reasonably expect in the future for flood magnitudes?

  17. Building the United States National Vegetation Classification

    Science.gov (United States)

    Franklin, S.B.; Faber-Langendoen, D.; Jennings, M.; Keeler-Wolf, T.; Loucks, O.; Peet, R.; Roberts, D.; McKerrow, A.

    2012-01-01

    The Federal Geographic Data Committee (FGDC) Vegetation Subcommittee, the Ecological Society of America Panel on Vegetation Classification, and NatureServe have worked together to develop the United States National Vegetation Classification (USNVC). The current standard was accepted in 2008 and fosters consistency across Federal agencies and non-federal partners for the description of each vegetation concept and its hierarchical classification. The USNVC is structured as a dynamic standard, where changes to types at any level may be proposed at any time as new information comes in. But, because much information already exists from previous work, the NVC partners first established methods for screening existing types to determine their acceptability with respect to the 2008 standard. Current efforts include a screening process to assign confidence to Association and Group level descriptions, and a review of the upper three levels of the classification. For the upper levels especially, the expectation is that the review process includes international scientists. Immediate future efforts include the review of remaining levels and the development of a proposal review process.

  18. Derecho Hazards in the United States.

    Science.gov (United States)

    Ashley, Walker S.; Mote, Thomas L.

    2005-11-01

    Convectively generated wind-storms occur over broad temporal and spatial scales; however, the more widespread and longer lived of these windstorms have been given the name "derecho." Utilizing an integrated derecho database, including 377 events from 1986 to 2003, this investigation reveals the amount of insured property losses, fatalities, and injuries associated with these windstorms in the United States. Individual derechos have been responsible for up to 8 fatalities, 204 injuries, forest blow-downs affecting over 3,000 km2 of timber, and estimated insured losses of nearly a $500 million. Findings illustrate that derecho fatalities occur more frequently in vehicles or while boating, while injuries are more likely to happen in vehicles or mobile homes. Both fatalities and injuries are most common outside the region with the highest derecho frequency. An underlying synthesis of both physical and social vulnerabilities is suggested as the cause of the unexpected casualty distribution. In addition, casualty statistics and damage estimates from hurricanes and tornadoes are contrasted with those from derechos to emphasize that derechos can be as hazardous as many tornadoes and hurricanes.

  19. Romantic Love in the United States

    Directory of Open Access Journals (Sweden)

    Victor C. de Munck

    2016-01-01

    Full Text Available We seek to advance cultural models theory by contributing to issues related to theory, methods, and testing the external validity of a cultural model. We propose that cultural models are learned as if they were truly properties of collectivities but have no primary existence except in individual representations of them. The shared aspect of cultural models also implies collective awareness of the if–then entailments of cultural models. We use inductive ethnographic methods of freelisting (n = 80 and pile sorting (n = 39 to derive a cultural model of romantic love in the United States. From these tasks, we developed a cultural model of successful romantic love consisting of normative scenarios. For successful romantic love relations, a person would feel excited about meeting their beloved; make passionate and intimate love as opposed to only physical love; feel comfortable with the beloved, behaving in a companionable, friendly way with one’s partner; listen to the other’s concerns, offering to help out in various ways if necessary; and, all the while, keeping a mental ledger of the degree to which altruism and passion are mutual. Our model is supported through an examination of two extended case studies. Further research is required, of course, but we believe we have a rather novel and dynamic cultural model that is falsifiable and predictive of successful love relationships. The model is unique in that it combines passion with comfort and friendship as properties of romantic love.

  20. Health System Reform in the United States

    Directory of Open Access Journals (Sweden)

    John E McDonough

    2014-01-01

    Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.

  1. United States and world energy sources

    Energy Technology Data Exchange (ETDEWEB)

    Berg, L.L.; Baird, L.M.; Varanini, E.E. III (eds.)

    1982-01-01

    This volume examines the economic, political, and social implications of the oil-dependence dilemma facing the United States. Most of the contributors are energy consultants in the public or private sector. Their analyses of the changing oil situation and its impact on other energy policies reflect either an international, national, or regional perspective with a unique combination of pragmatic insights and academic analyses of these complex issues. While examining the various aspects of the energy dependence dilemma presented here, one critical theme will probably recur to the reader. That is, given the inadequate nature of the US response to the 1973 and 1979 shortfalls in foreign oil supplies, how will we manage the projected future shortages in foreign oil supplies. The 18 papers of this volume were presented at a conference at Los Angeles in July 1980 and cosponsored by the University of Southern California and the California Energy Commission; a separate abstract was prepared for each paper. See also EAPA 7:3231 and Energy Research Abstracts (ERA) 6:18036.

  2. The United Mexican States: an update.

    Science.gov (United States)

    Hakkert, R; Aguirre, E J

    1988-09-01

    Although the popular North American opinion of Mexico is one that paints a picture of a poor, disadvantaged country, South America sees Mexico has a richer more prosperous nation. It is observed that only in the Latin American countries of Venezuela, Suriname and Trinidad and Tobago do consumers have higher incomes than Mexican consumers. Moreover, while millions of Mexicans migrate to the United States to seek a better standard of living, several thousand Central American refugees illegally migrate to Mexico in search of a better life. This better life includes an increased age of lie expectancy from 51 years in the 1950s to 64 years in the late 1970s. There have also been improvements in health care and school enrollments and in the low cost availability of education. Tourism and the prospect of the manufacturing of energy are significant, positive factors working in favor of an improved Mexican economy and a higher overall quality of life. However, Mexico faces serious problems such as a mounting foreign debt. Also rising is Mexico's population which has doubled since 1964 and which continues to grow at a rate of 1.9%. Economic programs and reforms and family development planning have been instituted in response to the countries' current recession and population growth and have begun to show positive results.

  3. United States Holocaust Museums: Pathos, Possession, Patriotism

    Directory of Open Access Journals (Sweden)

    Rob Baum

    2011-12-01

    Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.

  4. USEEIO: a New and Transparent United States ...

    Science.gov (United States)

    National-scope environmental life cycle models of goods and services may be used for many purposes, not limited to quantifying impacts of production and consumption of nations, assessing organization-wide impacts, identifying purchasing hot spots, analyzing environmental impacts of policies, and performing streamlined life cycle assessment. USEEIO is a new environmentally extended input-output model of the United States fit for such purposes and other sustainable materials management applications. USEEIO melds data on economic transactions between 389 industry sectors with environmental data for these sectors covering land, water, energy and mineral usage and emissions of greenhouse gases, criteria air pollutants, nutrients and toxics, to build a life cycle model of 385 US goods and services. In comparison with existing US input-output models, USEEIO is more current with most data representing year 2013, more extensive in its coverage of resources and emissions, more deliberate and detailed in its interpretation and combination of data sources, and includes formal data quality evaluation and description. USEEIO was assembled with a new Python module called the IO Model Builder capable of assembling and calculating results of user-defined input-output models and exporting the models into LCA software. The model and data quality evaluation capabilities are demonstrated with an analysis of the environmental performance of an average hospital in the US. All USEEIO f

  5. Electric trade in the United States, 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1996, the wholesale trade market totaled 2.3 trillion kilowatthours, over 73% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1996 (ELECTRA), is the sixth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1996. The electric trade data collected and presented in this report furnish important information on the wholesale structure found within the US electric power industry. The patterns of interutility trade in the report support analyses of wholesale power transactions and provide input for a broader understanding of bulk power market issues that define the emerging national electric energy policies. The report includes information on the quantity of power purchased, sold, exchanged, and wheeled; the geographical locations of transactions and ownership classes involved; and the revenues and costs. 1 fig., 43 tabs.

  6. United States orbital transfer vehicle programs

    Science.gov (United States)

    Gunn, Charles R.

    The United States will rely on five orbital transfer vehicles to carry spacecraft to higher energy orbits than achievable by the Space Shuttle or various Expendable Launch Vehicles (ELV). These vehicles are the Payload Assist Module-Delta (PAM-D), an upgraded version designated PAM-DII, the Inertial Upper Stage (IUS), the Transfer Orbit Stage (TOS), and the Orbital Maneuvering Vehicle (OMV). Development of these vehicles have evolved through contrasting cultures of government and commercial management. The spectrum of their capabilities range from providing spacecraft with only a preprogrammed perigee velocity additions to man-in-the-loop remote controlled spacecraft rendezvous, docking, retrieval and return to a space base; either the Shuttle or the Space Station Freedom. The PAM-D, PAM-DII, and IUS are now nearing maturity. Their characteristics, flight record, costs, and projected future uses are defined. The TOS and OMV are currently in development with first uses scheduled in 1992 and 1993, respectively. The TOS is being commercially developed while the OMV is government developed. The TOS and OMV capabilities, constraints, and costs are reviewed.

  7. Russian: United States Environmental Restoration Workshop

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    The Russian - United States Environmental Restoration Workshop, held in Washington, D.C., and Richland, Washington, from April 5 through 18, 1993, was the first extended collaborative information exchange between the US Department of Energy (DOE) and Russian scientists at the site level. In addition to the Russian scientists, workshop participants included scientists and staff from DOE, Pacific Northwest Laboratory (PNL), Westinghouse Hanford Company (WHC), the US Environmental Training Institute (USETI), universities, and the private sector. The first week (April 5 through 10) of the workshop took place in Washington, D.C., where the Russian and US participants were presented with a US perspective on environmental restoration and remediation issues from representatives in DOE and the US Environmental Protection Agency (EPA). The second week (April 11 through 18) occurred in Richland, Washington, where the participants were presented with site-specific environmental restoration and remediation issues related to Hanford Site cleanup. This report is a compilation of the presentations, discussions, and experiences shared during the second week of the workshop in Richland, Washington.

  8. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

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

    Science.gov (United States)

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

    2017-01-31

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

  10. Moral Dilemmas in Pediatric Orthopedics.

    Science.gov (United States)

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result. Copyright 2015, SLACK Incorporated.

  11. Tracheotomy in Pediatric Patients: In Operating Room or Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Umut Kaygusuz

    2014-08-01

    Full Text Available Introduction: The morbidity and mortality rates of tracheotomy are higher in the pediatric population because the incision is small and the trachea is more prone to surgical trauma. Tracheotomy procedure is mostly performed in operating room in most institutions. The aim of the study is to compare the outcomes of tracheotomy procedures between intensive care unit (ICU and operating room (OR in terms of pitfalls, complications and family preferences. Materials and Methods: In between June 2012 and July 2013, at a single institution, 39 patients were prospectively analyzed for age, gender, primary pathology, tracheotomy indications, location of operation, the duration of family consent, perioperative complications and presence of decanulation. Results: Male/female ratio was 20/19. Mean age was 49.9±52.5 (4-204 months. Tracheotomy procedure was performed in OR in 19 patients (45% and in ICU in 20 (54.5% patients. There was no statistically significant difference between groups in terms of complications (OR-48.7%, ICU-51.3%. The time of informed consent was significantly shorter in ICU patients. Conclusions: There is no significant difference in terms of safety for tracheotomy procedure in ICU or OR. Parents give approval to a bedside invasive procedure faster. The words ‘Surgery’ and ‘Operating room’ can easily confuse the parents, extend the duration for endolaryngeal intubation, and increase the cost and labour loss.

  12. Needs of Parents in Caring for Their Children in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mery Luz Valderrama Sanabria

    Full Text Available Objective.This work sought to describe the needs of parents to participate in caring for their children hospitalized in a pediatric intensive care unit (PICU. Methods. This is a qualitative study based on the ethno-nursing research method proposed by Leininger. For data collection and analysis, in-depth open interviews were used, along with field notes and enabler guidelines proposed by Leininger: stranger-friend, observation, participation, reflexion, and the Sunrise model. Parents of children hospitalized in a PICU in the city of Tunja (Boyacá, Colombia participated between February 2012 and October 2013. Results. The needs of parents to care for their children were described in the following themes: clear and timely communication, familiarization with technology, the value of the family, favoring the parent-children interaction during visits, and valuing and respecting generic (folk knowledge. Conclusion. The study provides knowledge, from the cultural perspective of parents with children hospitalized in PICU, as input to plan and develop care actions with them, according to their own needs.

  13. Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects

    Directory of Open Access Journals (Sweden)

    Selir M Straliotto

    2004-12-01

    Full Text Available A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3% and RSV (7.7%. There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3% showed a borderline significance (p = 0.055, Fisher's exact test as compared to those with adenovirus (87.5%. The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25% than RSV (2.8% (p = 0.005. Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.

  14. Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Martinez, Enid E; Ariagno, Katelyn A; Stenquist, Nicole; Anderson, Daniela; Muñoz, Eliana; Mehta, Nilesh M

    2017-06-01

    Early and optimal energy and protein delivery have been associated with improved clinical outcomes in the pediatric intensive care unit (PICU). Overweight and obese children in the PICU may be at risk for suboptimal macronutrient delivery; we aimed to describe macronutrient delivery in this cohort. We performed a retrospective study of PICU patients ages 2-21 years, with body mass index (BMI) ≥85th percentile and >48 hours stay. Nutrition variables were extracted regarding nutrition screening and assessment, energy and protein prescription, and delivery. Data from 83 patient encounters for 52 eligible patients (52% male; median age 9.6 [5-15] years) were included. The study cohort had a longer median PICU length of stay (8 vs 5 days, P Energy expenditure was estimated primarily by predictive equations. Stress factor >1.0 was applied in 44% (22/50). Median energy delivered as a percentage of estimated requirements by the Schofield equation was 34.6% on day 3. Median protein delivered as a percentage of recommended intake was 22.1% on day 3. The study cohort had suboptimal nutrition assessments and macronutrient delivery during their PICU course. Mortality and duration of PICU stay were greater when compared with the general PICU population. Nutrition assessment, indirect calorimetry-guided energy prescriptions, and optimizing the delivery of energy and protein must be emphasized in this cohort. The impact of these practices on clinical outcomes must be investigated.

  15. Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit.

    Science.gov (United States)

    Balasuriya, Lilanthi; Vyles, David; Bakerman, Paul; Holton, Vanessa; Vaidya, Vinay; Garcia-Filion, Pamela; Westdorp, Joan; Sanchez, Christine; Kurz, Rhonda

    2017-09-01

    An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit. An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed. Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written. Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.

  16. 77 FR 60005 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2012-10-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... of charges for services of FAA Flight Standards Aviation Safety Inspectors outside the United...

  17. Continental Divide of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the Continental Divide of the United States. The map layer was created by extracting Hydrologic Unit Boundary line features from an existing...

  18. Global Map: Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing ferry ports in the United States and Puerto Rico. The data are a modified version of the National Atlas of the United...

  19. Cities and Towns of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes cities in the United States, Puerto Rico and the U.S. Virgin Islands. These cities were collected from the 1970 National Atlas of the United...

  20. Living donor liver transplantation for inborn errors of metabolism - An underutilized resource in the United States.

    Science.gov (United States)

    Pham, Thomas A; Enns, Gregory M; Esquivel, Carlos O

    2016-09-01

    Inborn metabolic diseases of the liver can be life-threatening disorders that cause debilitating and permanent neurological damage. Symptoms may manifest as early as the neonatal period. Liver transplant replaces the enzymatically deficient liver, allowing for metabolism of toxic metabolites. LDLT for metabolic disorders is rarely performed in the United States as compared to countries such as Japan, where they report >2000 cases performed within the past two decades. Patient and graft survival is comparable to that of the United States, where most of the studies are based on deceased donors. No living donor complications were observed, suggesting that LDLT is as safe and effective as deceased donor transplants performed in the USA. Increased utilization of living donors in the USA will allow for early transplantation to prevent permanent neurological damage in those with severe disease. Pediatric transplant centers should consider utilizing living donors when feasible for children with metabolic disorders of the liver.

  1. United States Military in Central Asia: Beyond Operation Enduring Freedom

    Science.gov (United States)

    2009-10-23

    Malinowski , advocacy director for Human Rights Watch, stated, “the United States is most effective in promoting liberty around the world when people...26 U.S. President, The National Security Strategy of the United States of America, page? 27 Thomas Malinowski , “Testimony

  2. Environmental Assessment: Interim Western United States C-17 Landing Zone

    Science.gov (United States)

    2008-05-01

    RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENEGGER GOVERNOR January 7, 2008 Doug Allbright U.S. Air Force Headquarters Air...STATE OF CALIFORNIA GoVERNOR’S OFFICE of PLANNING AND RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENBGGER. CYNTHJABRYANT DIRECTOR

  3. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Ismail, Ahmad

    2016-12-01

    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  4. Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents

    Directory of Open Access Journals (Sweden)

    Lie Affendi Kartikahadi

    2012-02-01

    Full Text Available Background Hospitalization of a child is known to be a dreadful and stressful situation for parents. One study reported that admitting a child to a general ward caused mild anxiety to mothers, while admitting a child to the pediatric intensive care unit (PICU caused moderate anxiety to mothers. Objective To compare Hamilton anxiety scores of mothers whose children were admitted to the PICU to those of mothers whose children were admitted to the general ward. Methods A cross-sectional study was done on mothers of children aged 1 month-12 years. Children were admitted to either the intensive care unit or the general ward from October 2010-January 2011. All subjects were assessed by Hamilton anxiety scores and questioned for risk factors and other causes of maternal anxiety. Consecutive sampling was used to allocate the subjects. Differences were considered statistically significant for P < 0.05. Results Of the 72 subjects, the median Hamilton anxiety score in mothers of children admitted to the PICU was 20.5 (interquartile range 14-29.75, higher than that of mothers of children admitted to the general ward (14, interquartile range 9-16.75. Mann-Whitney U test revealed a statistically significant difference in scores between the two groups (P = 0.001. Ancova multivariate analysis showed the admission location to be the only significant relationship to Hamilton anxiety score (P = 0.0001. Conclusion Hamilton anxiety scores were higher for mothers of children admitted to the PICU than that of mothers with children admitted to the general ward. [Paediatr Indones.2012;52:95-8].

  5. 26 CFR 31.3121(e)-1 - State, United States, and citizen.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false State, United States, and citizen. 31.3121(e)-1... § 31.3121(e)-1 State, United States, and citizen. (a) When used in the regulations in this subpart, the... is used in a geographical sense. The term “citizen of the United States” includes a citizen of the...

  6. Airport geomagnetic surveys in the United States

    Science.gov (United States)

    Berarducci, A.

    2006-01-01

    The Federal Aviation Administration (FAA) and the United States military have requirements for design, location, and construction of compass calibration pads (compass roses), these having been developed through collaboration with US Geological Survey (USGS) personnel. These requirements are detailed in the FAA Advisory Circular AC 150/5300-13, Appendix 4, and in various military documents, such as Handbook 1021/1, but the major requirement is that the range of declination measured within 75 meters of the center of a compass rose be less than or equal to 30 minutes of arc. The USGS Geomagnetism Group has developed specific methods for conducting a magnetic survey so that existing compass roses can be judged in terms of the needed standards and also that new sites can be evaluated for their suitability as potentially new compass roses. First, a preliminary survey is performed with a total-field magnetometer, with differences over the site area of less than 75nT being sufficient to warrant additional, more detailed surveying. Next, a number of survey points are established over the compass rose area and nearby, where declination is to be measured with an instrument capable of measuring declination to within 1 minute of arc, such as a Gurley transit magnetometer, DI Flux theodolite magnetometer, or Wild T-0. The data are corrected for diurnal and irregular effects of the magnetic field and declination is determined for each survey point, as well as declination range and average of the entire compass rose site. Altogether, a typical survey takes about four days to complete. ?? 2006 Springer.

  7. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Sutton, Deanna A.; Wiederhold, Nathan; Robert, Vincent A. R. G.; Crous, Pedro W.; Geiser, David M.

    2016-01-01

    Multilocus DNA sequence data were used to assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically distinct species, all but two of which were previously known to infect humans, distributed among eight species complexes. The majority of the veterinary isolates (47/67 = 70.1%) were nested within the Fusarium solani species complex (FSSC), and these included 8 phylospecies and 33 unique 3-locus sequence types (STs). Three of the FSSC species (Fusarium falciforme, Fusarium keratoplasticum, and Fusarium sp. FSSC 12) accounted for four-fifths of the veterinary strains (38/47) and STs (27/33) within this clade. Most of the F. falciforme strains (12/15) were recovered from equine keratitis infections; however, strains of F. keratoplasticum and Fusarium sp. FSSC 12 were mostly (25/27) isolated from marine vertebrates and invertebrates. Our sampling suggests that the Fusarium incarnatum-equiseti species complex (FIESC), with eight mycoses-associated species, may represent the second most important clade of veterinary relevance within Fusarium. Six of the multilocus STs within the FSSC (3+4-eee, 1-b, 12-a, 12-b, 12-f, and 12-h) and one each within the FIESC (1-a) and the Fusarium oxysporum species complex (ST-33) were widespread geographically, including three STs with transoceanic disjunctions. In conclusion, fusaria associated with veterinary mycoses are phylogenetically diverse and typically can only be identified to the species level using DNA sequence data from portions of one or more informative genes. PMID:27605713

  8. Indonesian and United States of American Economic Partnership Agreement Effect

    Directory of Open Access Journals (Sweden)

    Tajerin Tajerin

    2011-09-01

    Full Text Available The paper analyzes fisheries trade effects from the implementation of Indonesian and the UnitedStates of American Economic Partnership Agreement (IUSEPA. The analysis is performed on theintegrated world trade databases owned by World Trade Organization, United Nations Conferenceon Trade and Development, and United Nations Statistics Division, using Wits software packagedeveloped by the World Bank. The result indicates that in the future, Indonesian government as aparty that will conduct bilateral economic partnership agreement with the United states, needs topropose or negotiate fishery import tariffs that imposed by the United States ranges from 0 to 7percent.Keywords: Bilateral economic agreement, fisheries, trade effect

  9. United States Federal Guidance on Witness Protection in Human Trafficking

    Science.gov (United States)

    2015-06-12

    UNITED STATES FEDERAL GUIDANCE ON WITNESS PROTECTION IN HUMAN TRAFFICKING A thesis presented to the Faculty of the U.S. Army...JUN 2015 4. TITLE AND SUBTITLE United States Federal Guidance on Witness Protection in Human Trafficking 5a. CONTRACT NUMBER 5b. GRANT NUMBER...United States needs overarching federal guidance on witness protection for human trafficking victims/witnesses in order to enhance their safety and

  10. Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study.

    Science.gov (United States)

    Al-Tonbary, Youssef A; Soliman, Othman E; Sarhan, Mohammed M; Hegazi, Moustafa A; El-Ashry, Rasha A; El-Sharkawy, Ashraf A; Salama, Osama S; Yahya, Raida

    2011-02-01

    pediatric hematology/oncology patients are faced with an increased risk of nosocomial infections (NIs) that vary in different populations and different institutions with considerable morbidity and mortality. This study was undertaken to assess the frequency and patterns of NIs in 1564 pediatric patients and to determine the prevalence of causative organisms and their antimicrobial sensitivity. a retrospective analysis was made in the patients admitted between January 2007 and January 2008 to the pediatric hematoloy/oncology unit of Mansoura University, Egypt. The 1564 patients showed 2084 admissions and 27 092 inpatient days. The Centers for Disease Control and Prevention criteria were used as a standard definition for NI. the overall rate of NIs in all patients and neutropenic patients was 8.6 and 25.3 per 1000 patient-days respectively. The frequent sites of NIs were blood stream (42.7%), the respiratory system (25.3%), the urinary system (22.2%) and the central nervous system (9.8%), whereas nosocomial fever of unknown origin constituted 52.9% of cases. The incidence of NIs was significantly higher during neutropenic days (Pfever of unknown origin are the most common nosocomial infections in pediatric hematology/oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with a high incidence of methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci organisms.

  11. 1:2,000,000-scale Hydrologic Units of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set has been superseded by huc2m. This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii,...

  12. (SUPERSEDED) 1:2,000,000-scale Hydrologic Units of the United States (SUPERSEDED)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii, Puerto Rico and the U.S. Virgin Islands. It was...

  13. Abortion surveillance--United States, 2009.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B; Burley, Kim D; Jamieson, Denise J

    2012-11-23

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2009. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000-2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000-2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000-2009. In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20-24 and 25-29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20-24 years and 20.4 abortions per 1,000 women aged 25-29 years. In contrast, women aged 30-34, 35-39, and ≥40 years

  14. The United States of America country update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W.; Bloomquist, R. Gordon; Boyd, Tonya L.; Renner, Joel

    2005-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  15. The United States of America Country Update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W. (1); Bloomquist, R. Gordon (2); Boyd, Tonya L. (1); Renner, Joel (3); (1) Geo-Heat Center, Oregon Institute of Technology, Klamath Falls, OR; (2) Washington State University Energy Program, Olympia, WA; (3) Idaho National Engineering and Environmental Laboratory, Idaho Falls, ID

    0001-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  16. The Human Rights Record of the United States in 2006

    Institute of Scientific and Technical Information of China (English)

    THE INFORMATION OFFICE OF THE STATE COUNCIL OF THE

    2007-01-01

    @@ EDITOR'S NOTE: On March 8, the Information Office of the State Council of the People's Republic of China published a document entitled the Human Rights Record of the United States in 2006. Following is the full text.

  17. 1990 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 1990 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  18. Major Roads of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set portrays the major roads in the United States, Puerto Rico, and the U.S. Virgin Islands. The file was produced by joining the individual State roads...

  19. NCHS - Births and General Fertility Rates: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes crude birth rates and general fertility rates in the United States since 1909. The number of states in the reporting area differ historically....

  20. 2000 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 2000 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  1. International issues: Obtaining an adult neurology residency position in the United States: an overview.

    Science.gov (United States)

    Jordan, Justin T; Sellner, Johann; Struhal, Walter; Schneider, Logan; Mayans, David

    2014-04-08

    Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.

  2. Landfills in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Locations of landfills and waste transfer stations in 11 western states. Data was obtained from state and federal agencies in GIS, tabular, and map format.

  3. A visit to the intensive cares unit: a family-centered culture change to facilitate pediatric visitation in an adult intensive care unit.

    Science.gov (United States)

    Hanley, Julie Boyer; Piazza, Julie

    2012-01-01

    To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. Fears centered on risks to both patient and child. Literature was reviewed before a book was written entitled A Visit to the ICU. It contained information about what a child visiting the ICU would see, hear, and feel when visiting a loved one. The book provided reassurance for caregivers and children, informing them about what to expect when visiting. The goal of the book was to provide caregivers with a framework for age-appropriate education. Staff education was provided on developmental stages, including a child's understandings of illness and death. Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings.

  4. Principal thorium resources in the United States

    Science.gov (United States)

    Staatz, Mortimer Hay; Armbrustmacher, T.J.; Olson, J.C.; Brownfield, I.K.; Brock, M.R.; Lemons, J.F.; Coppa, L.V.; Clingan, B.V.

    1979-01-01

    Resources were assessed for thorium in the higher grade and better known deposits in the United States in: (1) veins, (2) massive carbonatites, (3) stream placers of North and South Carolina, and (4) disseminated deposits. Thorium resources for the first three categories were divided into reserves and probable potential resources. Each of these then were separated into the following cost categories: (1) the amount of ThO2 producible at less than $15 per pound, (2) the amount producible at between $15 and $30 per pound, and (3) the amount producible at more than $50 per pound. The type of mining and milling needed at each deposit determines the capital, operating, and fixed costs of both mining and milling. Costs start with the clearing of land and are carried through to the final product, which for all deposits is ThO2. Capital costs of mining are affected most by the type of mining and the size of the mine. Those of milling are affected most by the kind of mill, its size, and whether or not extra circuits are needed for the separation of rare earths or some other byproduct. Veins, massive carbonatites, and stream placers of North and South Carolina have reserves of 188,000 short tons of ThO2 and probable potential resources of 505,000 tons of ThO2. Approximately half of the reserves and probable potential resources can be produced at less than $30 per pound of ThO2. Veins are the highest grade source in the United States and have total reserves of 142,000 tons of ThO2 and probable potential resources of 343,000 tons. About 90 percent of the reserves and 91 percent of the probable potential resources can be produced at less than $15 per pound of ThO2. Seven vein districts were evaluated: (1) Lemhi Pass, Mont.-Idaho, (2) Wet Mountains, Colo., (3) Powderhorn, Colo., (4) Hall Mountain, Idaho, (5) Diamond Creek, Idaho, (6) Bear Lodge Mountains, Wyo. and (7) Mountain Pass, Calif. Eighty-seven percent of the total reserves and probable potential resources are in the

  5. A survey of airway and ventilator management strategies in North American pediatric burn units.

    Science.gov (United States)

    Silver, Geoffrey M; Freiburg, Carter; Halerz, Marcia; Tojong, Jonathan; Supple, Kathy; Gamelli, Richard L

    2004-01-01

    A survey was used to gather information regarding airway management patterns in thermally injured children. North American pediatric burn centers listed by the American Burn Association were sent a survey designed to examine patterns of pediatric airway management in children with acute respiratory failure. The sample population means for the number of patients ventilated more than 48 hours and the number of patients ventilated more than 48 hours with inhalation injury were used to separate centers into large and small pediatric burn centers. Small pediatric burn centers had less than 50 patients who were intubated during a 5-year period. A five-point nominal scale was used to facilitate statistical analysis. Twenty-five pediatric burn centers included in the analysis estimated that 11,494 children were admitted during the 5-year period. There was no statistically dominant ventilator mode being used in the setting of acute respiratory failure identified by this survey. Large pediatric burn centers reported more frequent use of cuffed endotracheal tubes and more frequent change from an uncuffed to a cuffed endotracheal tube in patients who were difficult to ventilate because of an excess leak. Large pediatric burn centers reported a higher prevalence of tracheomalacia then small pediatric burn centers. Steroids were used by most centers before extubation in patients with persistent airway edema. No centers reported complications from steroid use. There is lack of clear consensus regarding the application of various ventilator modes in the setting of acute respiratory failure irrespective of center volume. There were divergent of practice patterns between large and small pediatric burn centers regarding the use of cuffed endotracheal tubes and the timing of tracheostomy. There was agreement between large and small pediatric burn centers in tracheostomy use in children older the age of 7 and the use of steroids as an adjunct to extubation in patients with lingering

  6. Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

    Directory of Open Access Journals (Sweden)

    Thiago de Oliveira Ferreira

    Full Text Available Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996, and fungi (p = 0.985 were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%, followed by Streptococcus spp. (18.5%, Acinetobacter spp. (15.9%, coagulase-negative staphylococci (11.2%, and Klebsiella spp. (8.6%. Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%, we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of

  7. Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moran Lazaryan

    2016-08-01

    Full Text Available Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU. Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9-10.9 minutes. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11 minutes. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8 and 12 (9-15 minutes, respectively, for patients with psychiatric-neurologic disorders compared to those without (p=0.032. Usually, a daily workload of 240 minutes was needed for the pharmacist accompanying the round in contrast to 108 minutes per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9% and made no comment on 36.9% of the recommendations. Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

  8. End-of-life care decisions in the pediatric intensive care unit: roles professionals play

    Science.gov (United States)

    Michelson, Kelly Nicole; Patel, Rachna; Haber-Barker, Natalie; Emanuel, Linda; Frader, Joel

    2014-01-01

    Objective Describe the roles and respective responsibilities of pediatric intensive care unit (PICU) health care professionals (HCPs) in end-of-life care decisions faced by PICU parents. Design Retrospective qualitative study Setting University based tertiary care children’s hospital Participants Eighteen parents of children who died in the PICU and 48 PICU HCPs (physicians, nurses, social workers, child-life specialists, chaplains, and case managers). Interventions In depth, semi-structured focus groups and one-on-one interviews designed to explore experiences in end-of-life care decision making. Measurements and Main Results We identified end-of-life care decisions that parents face based on descriptions by parents and HCPs. Participants described medical and non-medical decisions addressed toward the end of a child’s life. From the descriptions, we identified seven roles HCPs play in end-of-life care decisions. The family supporter addresses emotional, spiritual, environmental, relational and informational family needs in a nondirective way. The family advocate helps families articulate their views and needs to HCPs. The information giver provides parents with medical information, identifies decisions or describes available options, and clarifies parents’ understanding. The general care coordinator helps facilitate interactions among HCPs in the PICU, among HCPs from different subspecialty teams, and between HCPs and parents. The decision maker makes or directly influences the defined plan of action. The end-of-life care coordinator organizes and executes functions occurring directly before, during and after dying/death. The point person develops a unique trusting relationship with parents. Conclusions Our results describe a framework for HCPs’ roles in parental end-of-life care decision making in the PICU that includes directive, value-neutral and organizational roles. More research is needed to validate these roles. Actively ensuring attention to these

  9. Predictors of stress among parents in pediatric intensive care unit: a prospective observational study.

    Science.gov (United States)

    Aamir, Mohd; Mittal, Kundan; Kaushik, Jaya Shankar; Kashyap, Haripal; Kaur, Gurpreet

    2014-11-01

    To determine the sociodemographic and clinical factors leading to stress among parents whose children are admitted in pediatric intensive care unit (PICU). A prospective observational study was conducted in PICU of a tertiary care hospital of north India. Parents of children admitted to PICU for at least 48 h duration were eligible for participation. At the end of 48 h, parental stress was assessed using parental stress scale (PSS:PICU) questionnaire which was administered to the parents. Baseline demographic and clinical parameters of children admitted to PICU were recorded. The parental stress was compared with demographic and clinical characteristics of children using appropriate statistical methods. A total of 49 parents were finally eligible for participation. Mean (SD) parental stress scores was highest in domains of procedures [1.52 (0.66)] and behavior and emotional [1.32 (0.42)] subscales. Mean (SD) total parental stress score among intubated children [1.31 (0.25)] was significantly more than among non intubated children [0.97 (0.26)] (p parental stress score were comparable in terms of gender (p = 0.15) and socioeconomic status (p = 0.32). On subscale analysis, it was found that professional communication is a significant stressor in age groups 0-12 mo [0.61(0.41)] (p = 0.02). It was observed that parents of intubated children were significantly stressed by the physical appearance of their children (p parental role (p = 0.002). Total parental stress score had a positive correlation with PRISM score (r = 0.308). Indian parents are stressed maximally with environment of PICU. Factor leading to parental stress was intubation status of the child and was not affected by gender or socio demographic profile of the parents.

  10. Effect of Gastric Acid Suppressant Prophylaxis on Incidence of Gastrointestinal Bleeding in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Tahoora Abdollahi

    2016-11-01

    Full Text Available Background: Critically ill children admitted to pediatric intensive care unit (PICU are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI and H2 Blocker (H2B prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99, incidence of gastrointestinal bleeding (GB was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB. Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB and (CSGB in experimental and control groups (P>0.05 as well as ranitidine and pantoprazole prophylaxis (P>0.05. Significant risk factors of (GB were mechanical ventilation and loss of consciousness and corticosteroid therapy

  11. Talismans and amulets in the Pediatric Intensive Care Unit: legendary powers in contemporary medicine.

    Science.gov (United States)

    Barr, J; Berkovitch, M; Matras, H; Kocer, E; Greenberg, R; Eshel, G

    2000-04-01

    For centuries talismans and amulets have been used in many cultures for their legendary healing powers. We asked the parents of every child (Jews and Arabs) admitted to the Pediatric Intensive Care Unit over a 2 month period to complete a questionnaire, which included demographic data on the patient and the family, the use of talismans or other folk medicine practices, and the perception of the effects of these practices on the patient's well-being. A different questionnaire was completed by the ICU staff members on their attitude toward the use of amulets. Thirty percent of the families used amulets and talismans in the ICU, irrespective of the socioeconomic status of the family or the severity of the patient's illness. Amulets and talismans were used significantly more by religious Jews, by families with a higher parental educational level, and where the hospitalized child was very young. The estimated frequency of amulet use by the children's families, as perceived by the staff, was significantly higher than actual use reported by the parents. In Jewish families the actual use of amulets was found to be 30% compared to the 60% rate estimated by the medical staff; while in Moslem families the actual use was zero compared to the staff's estimation of about 36%. Of the 19 staff members, 14 reported that the use of amulets seemed to reduce the parents' anxiety, while 2 claimed that amulet use sometimes interfered with the staff's ability to carry out medical treatment. The use of talismans in a technologically advanced western society is more frequent than may have been thought. Medical and paramedical personnel dealing with very ill patients should be aware of the emotional and psychological implications of such beliefs and practices on patients and their families.

  12. Parent Participation in Pediatric Intensive Care Unit Rounds via Telemedicine: Feasibility and Impact.

    Science.gov (United States)

    Yager, Phoebe H; Clark, Maureen; Cummings, Brian M; Noviski, Natan

    2017-06-01

    To evaluate feasibility and impact of telemedicine for remote parent participation in pediatric intensive care unit (PICU) rounds when parents are unable to be present at their child's bedside. Parents of patients admitted to a 14-bed PICU were approached, and those unable to attend rounds were eligible subjects. Nurse and physician caregivers were also surveyed. Parents received an iPad (Apple Inc, Cupertino, California) with an application enabling audio-video connectivity with the care team. At a predetermined time for bedside rounds with the PICU team, parents entered a virtual meeting room to participate. Following each telemedicine encounter, participants (parent, physician, nurse) completed a brief survey rating satisfaction (0?=?not satisfied, 10?=?completely satisfied) and disruption (0?=?no disruption at all, 10?=?very disruptive). A total of 153 surveys were completed following 51 telemedicine encounters involving 13 patients. Parents of enrolled patients cited work demands (62%), care for other dependents (46%), and transportation difficulties (31%) as reasons for study participation. The median levels of satisfaction and disruption were 10 (range 5-10) and 0 (range 0-5), respectively. All parents reported that telemedicine encounters had a positive effect on their level of reassurance regarding their child's care and improved communication with the care team. This proof-of-concept study indicates that remote parent participation in PICU rounds is feasible, enhances parent-provider communication, and offers parents reassurance. Providers reported a high level of satisfaction with minimal disruption. Technological advancements to streamline teleconferencing workflow are needed to ensure program sustainability. Copyright © 2017. Published by Elsevier Inc.

  13. Sizing personnel: evaluation of nursing in obstetric and mixed pediatric intensive care units

    OpenAIRE

    Mendes,Rodrigo Nonato Coelho; Carmo, Amanda de Figueirôa Silva; Salum, Rosana Dourado Loula; Gusmão-filho,Fernando Antônio Ribeiro de; Vidal, Suely Arruda; Santos, Viviane Euzébia Perreira

    2013-01-01

    Objectives: To assess the adequacy of nursing staff and understand how these professionals perceive this issue. Methods: evaluative, exploratory, descriptive, quantitative and qualitative study, developed in Obstetric and Mixed Pediatric ICUs for the Hospital Don Malan / IMIP in Petrolina-PE. Was calculated the scaling nursing and 13 semistructured interviews were conducted, analyzed according to Bardin. Results: Mixed Pediatric ICU has correct number of staff and Obstetric decrea...

  14. Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital.

    Science.gov (United States)

    Humphreys, Stacey; Totapally, Balagangadhar R

    2016-01-01

    Variability in disposition of children according to the time of rapid response calls is unknown. To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit. Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions. ©2016 American Association of Critical-Care Nurses.

  15. Comparison of alterations in frequency and cost of antibiotic use in neonatal and pediatric intensive care units of a hospital following protocol to an education and research hospital

    Directory of Open Access Journals (Sweden)

    Mustafa Dogan

    2015-04-01

    Full Text Available AiM: The objective of this study is to show the alterations in frequency and cost of antibiotic use in neonatal and pediatric intensive care units of a state hospital after it started to service as an education and research hospital. We also aimed to raise an awareness related to rational antibiotic use. METHODS: The surveillance of antibiotic use and comparison of costs were evaluated in 392 patients in between August 2013-January 2014. The rate and cost of antibiotic use during last 90 days before the protocol of state hospital to research and education hospital and the first 90 days after protocol were evaluated. Antibiotics were assessed according to the treatment protocols of the Committee of Rational Drug Use, Infection Control Committee and Antibiotic Control Committee. Antibiotics were provided from administrative system and the data related to costs were obtained from Ministry of Health and Ministry of Finance. The demographic data and the data related to indication for admission to intensive care units, antibiotic dosages and pathogens causing infections were also obtained. For statistical analysis, SPSS program was used and descriptive analysis were made. In comparison of the groups, Mann Whitney U and chi-square tests were used. The data were evaluated within a 95% confidence interval. RESULTS: In first and second period, 143 patients were hospitalized for 3.18+/-1.13 days and 105 patients were hospitalized for 2.69+/-4.14 days in pediatric intensive care unit(PICU; 79 patients were hospitalized for 17.29+/-3.61 days and 65 patients stayed for 21.29+/-3.29 days in neonatal intensive care unit(NICU, respectively. In the first and second period, cost of antibiotics in PICU was found 341.81+/-744.49 (med:14.91 and 585.35+/-796.62 (med:256.44 (p=0.02 Turkish Liras (TL; in NICU 137.92+/-178.78 (med:14.59 and 247.40+/-370.13(med:19.23 (p=0.76 TL respectively. CONCLUSiON: In the second period, in PICU, duration of hospitalization was found

  16. 78 FR 27857 - United States Standards for Wheat

    Science.gov (United States)

    2013-05-13

    ... Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards Administration, USDA. ACTION: Final... United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change will help facilitate the...

  17. 12 CFR 561.53 - United States Treasury General Account.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false United States Treasury General Account. 561.53 Section 561.53 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY DEFINITIONS FOR REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The...

  18. 76 FR 18198 - European Union-United States Atlantis Program

    Science.gov (United States)

    2011-04-01

    ... European Union-United States Atlantis Program AGENCY: Office of Postsecondary Education, Department of... (IFLE): Fund for the Improvement of Postsecondary Education (FIPSE)--Special Focus Competition: European Union-(EU) United States (U.S.) Atlantis Program Notice inviting applications for new awards for...

  19. 19 CFR 10.46 - Articles for the United States.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles for the United States. 10.46 Section 10... THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. General Provisions Articles for Institutions § 10.46 Articles for the United States. Pursuant to subheadings 9808.00.10 and...

  20. Foreign Students and Scholars and the United States Tax System.

    Science.gov (United States)

    Williams, David, II.

    1994-01-01

    During the 1992-93 school year more than 425,000 foreign students were studying in the United States. In addition, hundreds of foreign nationals were in the United States as visiting research scholars, lecturers, and professors. Offers a guide to help foreign nationals comply with the tax system while affording them the least possible tax…

  1. Forest management and water in the United States [Chapter 13

    Science.gov (United States)

    Daniel G. Neary

    2017-01-01

    This chapter outlines a brief history of the United States native forests and forest plantations. It describes the past and current natural and plantation forest distribution (map, area, main species), as well as main products produced (timber, pulp, furniture, etc.). Integrated into this discussion is a characterization of the water resources of the United States and...

  2. The United States Today: An Atlas of Reproducible Pages.

    Science.gov (United States)

    World Eagle, Inc., Wellesley, MA.

    Black and white maps, graphs and tables that may be reproduced are presented in this volume focusing on the United States. Some of the features of the United States depicted are: size, population, agriculture and resources, manufactures, trade, citizenship, employment, income, poverty, the federal budget, energy, health, education, crime, and the…

  3. United States’ Interests in the Horn of Africa.

    Science.gov (United States)

    1986-04-23

    while Haile Selassie intended to ensure that the United States had a vested interest in the survival of his regime. "There was never an alliance between...company; and he sent troops to fight in Korea. Emperor Haile Selassie’s political manuevering achieved the establishment of a United States vested

  4. 7 CFR 65.260 - United States country of origin.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING... 7 Agriculture 3 2010-01-01 2010-01-01 false United States country of origin. 65.260 Section 65.260..., PEANUTS, AND GINSENG General Provisions Definitions § 65.260 United States country of origin....

  5. Immigration to the United States: 1996 Update. Executive Summary.

    Science.gov (United States)

    Keuffel, Eric; Pemberton, Alissa

    Immigration, both legal and illegal, has a profound impact on the United States. The public policy implications of immigration include the impact on population growth, employment, wages, taxes, and social spending. In 1994, a net total of between 900,000 and 1.1 million immigrants were added to the foreign-born population of the United States.…

  6. 31 CFR 560.319 - United States depository institution.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States depository institution. 560.319 Section 560.319 Money and Finance: Treasury Regulations Relating to Money and Finance... associations, credit unions, trust companies and United States bank holding companies)....

  7. Civic Engagement in the United States: Roots and Branches

    Science.gov (United States)

    Imel, Susan

    2012-01-01

    The adult education and civic education movements are not synonymous, but the two were intertwined during the early years of adult education's formation as a field in the United States. This chapter traces the development of adult civic education in the United States, focusing on the 1920s through the 1950s. First, the roots of civic education…

  8. Pine Engraver, Ips pini, in the Western United States (FIDL)

    Science.gov (United States)

    Sandra J. Kegley; R. Ladd Livingston; Kenneth E. Gibson

    1997-01-01

    The pine engraver, Ips pini (Say), is one of the most common and widely distributed bark beetles in North America. It occurs from southern Appalachia north to Maine and Quebec, westward across the northern United States and Canada, into the interior of Alaska, throughout the Pacific Coast States and the Rocky Mountain region, to northern Mexico. In the western United...

  9. The Organization of Paralympic Sport in the United States

    Science.gov (United States)

    Walsh, Joe; Mushett, Mike

    2012-01-01

    In the United States, Paralympic sport is governed by the United States Olympic Committee (USOC), as set forth in the Ted Stevens Olympic and Amateur Sports Act of 1998. The USOC formed a dedicated Paralympic Division in 2001 to manage this responsibility in close cooperation with other USOC divisions and many of the sport-specific national…

  10. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  11. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  12. 78 FR 26425 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2013-05-06

    ..., the simple movement of a stolen trade secret within a domestic multinational company (e.g., from a United States office to an overseas office of the same company) may not pose the same risks or harms. More generally, the Commission heard that foreign actors increasingly target United States companies...

  13. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all......, there is a substantial inpatient financial burden of AD in the United States....

  14. Improving Pediatric Cancer Care Disparities Across the United States–Mexico Border: Lessons Learned from a Transcultural Partnership between San Diego and Tijuana

    Science.gov (United States)

    Aristizabal, Paula; Fuller, Spencer; Rivera, Rebeca; Beyda, David; Ribeiro, Raul C.; Roberts, William

    2015-01-01

    In 2007, the 5-year survival rate for children with acute leukemia in Baja California, Mexico was estimated at 10% (vs. 88% in the United States). In response, stakeholders at St. Jude Children’s Research Hospital, Rady Children’s Hospital San Diego, and the Hospital General de Tijuana (HGT) implemented a transcultural partnership to establish a pediatric oncology program. The aim was to improve clinical outcomes and overall survival for children in Baja California. An initial needs assessment evaluation was performed and a culturally sensitive, comprehensive, 5-year plan was designed and implemented. After six years, healthcare system accomplishments include the establishment of a fully functional pediatric oncology unit with 60 new healthcare providers (vs. five in 2007). Patient outcome improvements include a rise in 5-year survival for leukemia from 10 to 43%, a rise in new cases diagnosed per year from 21 to 70, a reduction in the treatment abandonment rate from 10% to 2%, and a 45% decrease in the infection rate. More than 600 patients have benefited from this program. Knowledge sharing has taken place between teams at the HGT and Rady Children’s Hospital San Diego. Further, one of the most significant outcomes is that the HGT has transitioned into a regional referral center and now mentors other hospitals in Mexico. Our results show that collaborative initiatives that implement long-term partnerships along the United States–Mexico border can effectively build local capacity and reduce the survival gap between children with cancer in the two nations. Long-term collaborative partnerships should be encouraged across other disciplines in medicine to further reduce health disparities across the United States–Mexico border. PMID:26157788

  15. Satisfaction with care and decision making among parents/caregivers in the pediatric intensive care unit: a comparison between English-speaking whites and Latinos.

    Science.gov (United States)

    Epstein, David; Unger, Jennifer B; Ornelas, Beatriz; Chang, Jennifer C; Markovitz, Barry P; Dodek, Peter M; Heyland, Daren K; Gold, Jeffrey I

    2015-04-01

    Because of previously documented health care disparities, we hypothesized that English-speaking Latino parents/caregivers would be less satisfied with care and decision making than English-speaking non-Latino white (NLW) parents/caregivers. An intensive care unit (ICU) family satisfaction survey, Family Satisfaction in the Intensive Care Unit Survey (pediatric, 24 question version), was completed by English-speaking parents/caregivers of children in a cardiothoracic ICU at a university-affiliated children's hospital in 2011. English-speaking NLW and Latino parents/caregivers of patients, younger than 18 years, admitted to the ICU were approached to participate on hospital day 3 or 4 if they were at the bedside for greater than or equal to 2 days. Analysis of variance, χ(2), and Student t tests were used. Cronbach αs were calculated. Fifty parents/caregivers completed the survey in each group. Latino parents/caregivers were younger, more often mothers born outside the United States, more likely to have government insurance or no insurance, and had less education and income. There were no differences between the groups' mean overall satisfaction scores (92.6 ± 8.3 and 93.0 ± 7.1, respectively; P = .80). The Family Satisfaction in the Intensive Care Unit Survey (pediatric, 24 question version) showed high internal consistency reliability (α = .95 and .91 for NLW and Latino groups, respectively). No disparities in ICU satisfaction with care and decision making between English-speaking NLW and Latino parents/caregivers were found. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  17. Does racism affect health? Evidence from the United States and the United Kingdom.

    Science.gov (United States)

    Muennig, Peter; Murphy, Michael

    2011-02-01

    Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.

  18. Leveling of Tuberculosis Incidence - United States, 2013-2015.

    Science.gov (United States)

    Salinas, Jorge L; Mindra, Godwin; Haddad, Maryam B; Pratt, Robert; Price, Sandy F; Langer, Adam J

    2016-03-25

    After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013-2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S.

  19. Introduction of Eucalyptus spp. into the United States with Special Emphasis on the Southern United States

    Directory of Open Access Journals (Sweden)

    R. C. Kellison

    2013-01-01

    Full Text Available Introduction of Eucalyptus spp. into the United States from Australia on a significant scale resulted from the gold rush into California in 1849. Numerous species were evaluated for fuel, wood products, and amenity purposes. The first recorded entry of eucalyptus into the southern United Stated was in 1878. Subsequent performance of selected species for ornamental purposes caused forest industry to visualize plantations for fiber production. That interest led the Florida Forestry Foundation to initiate species-introduction trials in 1959. The results were sufficiently promising that a contingent of forest products companies formed a cooperative to work with the USDA Forest Service, Lehigh Acres, FL, USA, on genetic improvement of selected species for fiber production. The Florida initiative caused other industrial forestry companies in the upper South to establish plantations regardless of the species or seed source. The result was invariably the same: failure. Bruce Zobel, Professor of Forestry, North Carolina State University, initiated a concerted effort to assess the potential worth of eucalyptus for plantation use. The joint industrial effort evaluated 569 sources representing 103 species over a 14-year period. The three levels of testing, screening, in-depth, and semioperational trials led to identification of some species and sources that offered promise for adaptation, but severe winter temperatures in late 1983 and early 1984 and 1985 terminated the project. Despite the failed attempt valuable silvicultural practices were ascertained that will be beneficial to other researchers and practitioners when attempts are again made to introduce the species complex into the US South.

  20. Forest Resources of the United States, 2002

    Science.gov (United States)

    W. Brad Smith; Patrick D. Miles; John S. Vissage; Scott A. Pugh

    2004-01-01

    Forest resource growth, harvests, and land use conversion can change inventories within States, among regions, and even among countries, and can significantly influence the future performance of resources. This could affect the State, regional, and national economies that depend on the affected resources, as well as the resource environments. Periodic surveys provide...

  1. Competitive Electricity Market Regulation in the United States: A Primer

    Energy Technology Data Exchange (ETDEWEB)

    Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Mackay [National Grid, Warwick (United Kingdom)

    2016-12-01

    The electricity system in the United States is a complex mechanism where different technologies, jurisdictions and regulatory designs interact. Today, two major models for electricity commercialization operate in the United States. One is the regulated monopoly model, in which vertically integrated electricity providers are regulated by state commissions. The other is the competitive model, in which power producers can openly access transmission infrastructure and participate in wholesale electricity markets. This paper describes the origins, evolution, and current status of the regulations that enable competitive markets in the United States.

  2. North Atlantic Treaty Organization, the United States, and International Legitimacy

    Science.gov (United States)

    2014-05-22

    8. 42Following the signing of the Treaty of Versailles in 1919, the Albanian State was created but with only one-half of the Albanian population...NORTH ATLANTIC TREATY ORGANIZATION, THE UNITED STATES, AND INTERNATIONAL LEGITIMACY A Monograph by MAJ Mark Van Gelder...North Atlantic Treaty Organization, The United States, and International Legitimacy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT

  3. Geothermal overviews of the western United States

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, D.N.; Axtell, L.H. (comps.)

    1972-01-01

    This compendium presents data on geothermal resources for all those western states with geothermal potential. Individual sections, which have been processed separately for inclusion in the EDB data base, are devoted to each of the following states: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. A separate section is also devoted to the U.S. Bureau of Reclamation Imperial Valley Project. Maps and references are included for each section. (JGB)

  4. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  5. Toxaphene in the United States: 1. Usage gridding

    Science.gov (United States)

    Li, Y. F.

    2001-08-01

    Toxaphene, as a general-purpose insecticide, was widely used in the United States. The use of toxaphene in the United States can be divided into four different periods between 1947 and 1986, with total usage of about 490 kt, and total production around 720 kt. Inventories of gridded usage of toxaphene in the United States with 1/6° by 1/4° latitude/longitude resolution have been created by using different gridded cropland and cattle as surrogate data. The intensive use of toxaphene on croplands was concentrated in the southeastern part of the United States with the highest usage of 2 kt per grid cell. The results show that the state of Alabama was the largest user of toxaphene, reaching as much as 87 kt, followed by Mississippi at 60 kt. The total usage in the top 10 states is 410 kt, 84% of the national usage in the United States. The use in the first six states, Alabama, Mississippi, Georgia, Arkansas, Texas, and South Carolina, is 350 kt, 71% of the national usage in the United States.

  6. Sleeping beauties in pediatrics.

    Science.gov (United States)

    Završnik, Jernej; Kokol, Peter

    2016-10-01

    Sleeping beauties (SBs) in science have been known for few decades; however, it seems that only recently have they become popular. An SB is a publication that "sleeps" for a long time and then almost suddenly awakes and becomes highly cited. SBs present interesting findings in science. Pediatrics research literature has not yet been analyzed for their presence, and 5 pediatrics SBs were discovered in this research. Their prevalence was approximately 0.011%. Some environments or periods are more "SB fertile" than others: 3 of 5 SBs were published in the journal Pediatrics, 4 originated from the United States, and 4 were published in the period from 1992 to 1993. No institutions or authors published more than 1 SB.

  7. Sleeping beauties in pediatrics

    Directory of Open Access Journals (Sweden)

    Jernej Završnik, PhD

    2017-01-01

    Full Text Available Sleeping beauties (SBs in science have been known for few decades; however, it seems that only recently have they become popular. An SB is a publication that ‘‘sleeps’’ for a long time and then almost suddenly awakes and becomes highly cited. SBs present interesting findings in science. Pediatrics research literature has not yet been analyzed for their presence, and 5 pediatrics SBs were discovered in this research. Their prevalence was approximately 0.011%. Some environments or periods are more ‘‘SB fertile’’ than others: 3 of 5 SBs were published in the journal Pediatrics, 4 originated from the United States, and 4 were published in the period from 1992 to 1993. No institutions or authors published more than 1 SB.

  8. Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units.

    Science.gov (United States)

    Siebelink, Marion J; Albers, Marcel J I J; Roodbol, Petrie F; Van de Wiel, Harry B M

    2012-12-01

    A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy-four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty-two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty-three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent.

  9. United States Geological Survey, programs in Nevada

    Science.gov (United States)

    ,

    1995-01-01

    The U.S. Geological Survey (USGS) has been collecting and interpreting natural-resources data in Nevada for more than 100 years. This long-term commitment enables planners to manage better the resources of a State noted for paradoxes. Although Nevada is one of the most sparsely populated States in the Nation, it has the fastest growing population (fig. 1). Although 90 percent of the land is rural, it is the fourth most urban State. Nevada is the most arid State and relies heavily on water resources. Historically, mining and agriculture have formed the basis of the economy; now tourism and urban development also have become important. The USGS works with more than 40 local, State, and other Federal agencies in Nevada to provide natural-resources information for immediate and long-term decisions.Subjects included in this fact sheet:Low-Level Radioactive-Waste DisposalMining and Water in the Humboldt BasinAquifer Systems in the Great BasinWater Allocation in Truckee and Carson BasinsNational Water-Quality Assessment ProgramMinerals Assessment for Land ManagementIrrigation DrainageGround-Water Movement at Nevada Test SiteOil and Gas ResourcesNational Mapping ProgramDigital Mapping and Aerial PhotographyCollection of Hydrologlc DataGeologic MappingEarthquake HazardsAssessing Mineral Resources of the SubsurfaceEarth Observation DataCooperative Programs

  10. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Emiliana Motta

    Full Text Available Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU, in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

  11. Needs of Parents in Caring for Their Children in a Pediatric Intensive Care Unit.

    Science.gov (United States)

    Valderrama Sanabria, Mery Luz; Muñoz de Rodríguez, Lucy

    2016-04-01

    This work sought to describe the needs of parents to participate in caring for their children hospitalized in a pediatric intensive care unit (PICU). This is a qualitative study based on the ethno-nursing research method proposed by Leininger. For data collection and analysis, in-depth open interviews were used, along with field notes and enabler guidelines proposed by Leininger: stranger-friend, observation, participation, reflexion, and the Sunrise model. Parents of children hospitalized in a PICU in the city of Tunja (Boyacá, Colombia) participated between February 2012 and October 2013. The needs of parents to care for their children were described in the following themes: clear and timely communication, familiarization with technology, the value of the family, favoring the parent-children interaction during visits, and valuing and respecting generic (folk) knowledge. The study provides knowledge, from the cultural perspective of parents with children hospitalized in PICU, as input to plan and develop care actions with them, according to their own needs.Objetivo.Describir las necesidades de padres para participar del cuidado de sus hijos hospitalizados en la Unidad de Cuidado Intensivo Pediátrico (UCIP). Métodos. Investigación cualitativa basada en el método de la etnoenfermería propuesto por Leininger. Para la recolección y análisis de la información se utilizaron la entrevista abierta a profundidad, las notas de campo y guías facilitadoras propuestas por Leininger: Extraño amigo, Observación, Participación Reflexión y el modelo del sol naciente. Participaron los padres de niños hospitalizados en una UCIP de Tunja (Boyacá, Colombia) entre febrero de 2012 y Octubre de 2013. Resultados. Se describen las necesidades de los padres para cuidar a sus hijos en los siguientes temas: Comunicación clara y oportuna, Familiarización con la Tecnología, El valor de la familia, Favorecer la interacción de padres-hijos durante la visita y Valorar y

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

    Directory of Open Access Journals (Sweden)

    Fariba Khodapanahandeh

    2009-12-01

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

  13. Progress toward sodium reduction in the United States.

    Science.gov (United States)

    Levings, Jessica; Cogswell, Mary; Curtis, Christine J; Gunn, Janelle; Neiman, Andrea; Angell, Sonia Y

    2012-10-01

    The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.

  14. 76 FR 697 - United States-Oman Free Trade Agreement

    Science.gov (United States)

    2011-01-06

    ... States--Oman Free Trade Agreement AGENCY: U.S. Customs and Border Protection, Department of Homeland... Free Trade Agreement entered into by the United States and the Sultanate of Oman. DATES: Interim rule...'') entered into the U.S.--Oman Free Trade Agreement (``OFTA'' or ``Agreement''). The stated objectives of the...

  15. A Comparative Analysis of Indian Gaming in the United States

    Science.gov (United States)

    Ackerman, William V.; Bunch, Rick L.

    2012-01-01

    Previous research on Indian gaming in South Dakota discovered very restrictive and unfavorable tribal-state compacts that appear to border on economic racism. This article expands this previous research by exploring the influence of tribal-state Indian gaming compacts for the Indian casinos located in the contiguous United States. The purpose is…

  16. Babesiosis among Elderly Medicare Beneficiaries, United States, 2006–2008

    Science.gov (United States)

    Anderson, Steven A.; Izurieta, Hector S.; Kumar, Sanjai; Burwen, Dale R.; Gibbs, Jonathan; Kropp, Garner; Erten, Tugce; MaCurdy, Thomas E.; Worrall, Christopher M.; Kelman, Jeffrey A.; Walderhaug, Mark O.

    2012-01-01

    We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006–2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states. PMID:22257500

  17. Long-term aridity changes in the western United States.

    Science.gov (United States)

    Cook, Edward R; Woodhouse, Connie A; Eakin, C Mark; Meko, David M; Stahle, David W

    2004-11-01

    The western United States is experiencing a severe multiyear drought that is unprecedented in some hydroclimatic records. Using gridded drought reconstructions that cover most of the western United States over the past 1200 years, we show that this drought pales in comparison to an earlier period of elevated aridity and epic drought in AD 900 to 1300, an interval broadly consistent with the Medieval Warm Period. If elevated aridity in the western United States is a natural response to climate warming, then any trend toward warmer temperatures in the future could lead to a serious long-term increase in aridity over western North America.

  18. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  19. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  20. Forest Resources of the United States, 2007

    Science.gov (United States)

    W. Brad, tech. coord. Smith; Patrick D., data coord. Miles; Charles H., map coord. Perry; Scott A., Data CD coord. Pugh

    2009-01-01

    Forest resource statistics from the 2000 Resources Planning Act (RPA) Assessment were updated to provide current information on the Nation's forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data and trends are analyzed...

  1. Forest Resources of the United States, 1997

    Science.gov (United States)

    W. Brad Smith; John S. Vissage; David R. Darr; Raymond M. Sheffield

    2001-01-01

    Forest resource statistics from the 1987 Resources Planning Act (RPA) Assessment were updated to 1997 to provide current information on the Nation`s forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data are analyzed and...

  2. The effect of gun control laws on hospital admissions for children in the United States.

    Science.gov (United States)

    Tashiro, Jun; Lane, Rebecca S; Blass, Lawrence W; Perez, Eduardo A; Sola, Juan E

    2016-10-01

    Gun control laws vary greatly between states within the United States. We hypothesized that states with strict gun laws have lower mortality and resource utilization rates from pediatric firearms-related injury admissions. Kids' Inpatient Database (1997-2012) was searched for accidental (E922), self-inflicted (E955), assault (E965), legal intervention-related (E970), or undetermined circumstance (E985) firearm injuries. Patients were younger than 20 years and admitted for their injuries. Case incidence trends were examined for the study period. Propensity score-matched analyses were performed using 38 covariates to compare outcomes between states with strict or lenient gun control laws. Overall, 38,424 cases were identified, with an overall mortality of 7%. Firearm injuries were most commonly assault (64%), followed by accidental (25%), undetermined circumstance (7%), or self-inflicted (3%). A small minority involved military-grade weapons (0.2%). Most cases occurred in lenient gun control states (48%), followed by strict (47%) and neutral (6%).On 1:1 propensity score-matched analysis, in-hospital mortality by case was higher in lenient (7.5%) versus strict (6.5%) states, p = 0.013. Lenient states had a proportionally higher rate of accidental (31%) and self-inflicted injury (4%) versus strict states (17% and 1.6%, respectively), p gun control contributes not only to worse outcomes per case, but also to a more significant and detrimental impact on public health. Epidemiologic study, level III.

  3. Geographic Determinants of Access to Pediatric Deceased Donor Kidney Transplantation

    OpenAIRE

    Reese, Peter P; Hwang, Hojun; Potluri, Vishnu; Abt, Peter L.; Shults, Justine; Amaral, Sandra

    2014-01-01

    Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005–2010. For each donor service area, we assigned a category of short (270 days) median waiting time and calculated the ratio of pediatric-...

  4. Explaining the United States-Israel Relationship

    Science.gov (United States)

    2013-06-01

    influxes of Ethiopian Jews during and Soviet Jews after the Cold War. Loan guarantees have been 77...and Saudi Arabia .88 President Bill Clinton stated that America’s interests in the Middle East are: “pursuing a comprehensive breakthrough to Middle...been, at least to some extent, an asset to the Arab regimes, as a strategic counterweight to radicalism.”136 Saudi Arabia and the members of the Gulf

  5. Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?

    Science.gov (United States)

    Chevrette, Marianne; Abenhaim, Haim Arie

    2015-10-01

    The United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates. We carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates. The state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different-for sex education policies, 39.8 of 1000 vs 45.1 of 1000 (P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent (P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 (P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent. While teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  6. Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.

    Science.gov (United States)

    Poley, Marten J; van der Starre, Cynthia; van den Bos, Ada; van Dijk, Monique; Tibboel, Dick

    2011-11-01

    Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies. Prospective longitudinal survey study at two points in time. Pediatric surgical intensive care unit at a Dutch university hospital. All unit personnel. To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers. The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety

  7. United States Food Loss and Waste 2030 Champions

    Science.gov (United States)

    U.S. Food Loss and Waste 2030 Champions are businesses and organizations that have made a public commitment to reduce food loss and waste in their own operations in the United States by 50 percent by the year 2030.

  8. Real Estate Across the United States (REXUS) (Lease)

    Data.gov (United States)

    General Services Administration — Real Estate Across the United States (REXUS) is the primary tool used by PBS to track and manage the government's real property assets and to store inventory data,...

  9. 1:100,000-scale Counties of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a coverage of the county boundaries of the conterminous United States (AK, HI and Puerto Rico are available separately). The lines were extracted from U.S....

  10. National Wilderness Preservation System of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer consists of National Wilderness Preservation System areas of 640 acres or more, in the United States, Puerto Rico, and the U.S. Virgin Islands. The...

  11. Sand and Gravel Operations in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes sand and gravel operations in the United States. These data were obtained from information reported voluntarily to the USGS by the aggregate...

  12. Quaternary Fault and Fold Database of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Quaternary Fault and Fold Database contains the results of thousands of scientific assessments of faults and associated folds in the United States that...

  13. Plant and Animal Phenology Data for the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — As of January 1, 2013, the dataset contains phenology data on 591 species of plants and animals, with 7,512 locations registered across the United States. Protocols...

  14. United States Average Annual Precipitation, 2000-2004 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 2000-2004. Parameter-elevation...

  15. United States Coast Pilot (volume 1 through 9)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The United States Coast Pilot is a series of 9 nautical books that cover a wide variety of information important to navigators of U.S. coastal and intercoastal...

  16. Use of the Internet for Health Information: United States, 2009

    Science.gov (United States)

    ... National Technical Information Service NCHS Use of the Internet for Health Information: United States, 2009 Recommend on ... more likely than men to have used the Internet for health information. Women were more likely than ...

  17. Real Estate Across the United States (REXUS) Inventory (Building)

    Data.gov (United States)

    General Services Administration — Real Estate Across the United States (REXUS) is the primary tool used by PBS to track and manage the government's real property assets and to store inventory data,...

  18. Global Map: Railroad Stations of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing Amtrak intercity railroad terminals in the United States. The data are a modified version of the National Atlas of...

  19. Costly Regional Landslide Events in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer contains information on costly regional landslide events in the 50 United States and Puerto Rico. The extents of the regional events were drawn from...

  20. Arsenic in Ground Water of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This image shows national-scale patterns of naturally occurring arsenic in potable ground-water resources of the continental United States. The image was generated...

  1. US Forest Service Forest Carbon Stocks Contiguous United States

    Data.gov (United States)

    US Forest Service, Department of Agriculture — Through application of a nearest-neighbor imputation approach, mapped estimates of forest carbon density were developed for the contiguous United States using the...

  2. Indian Lands of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows Indian lands of the United States. Only areas of 640 acres or more are included. Federally-administered lands within a reservation are included...

  3. Barack Obama’s infrastructure policies for the United States

    NARCIS (Netherlands)

    Auger, J.F.

    2008-01-01

    The new president of the United States, Barack Obama, has set his policies on infrastructures. To carry them out, he will resort mostly to economics incentives and, to a lesser extent, regulatory constraints.

  4. United States Mortality Database, 1988-1992 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer contains mortality information for United States Health Service Areas (805 groups of counties). Included are mortality rates by sex and race (white...

  5. Protected Areas Database of the United States (PAD-US)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The USGS Protected Areas Database of the United States (PAD-US) is the nation's inventory of protected areas, including public open space and voluntarily provided,...

  6. Human Population in the Western United States (1900 - 2000)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Map containing historical census data from 1900 - 2000 throughout the western United States at the county level. Data includes total population, population density,...

  7. Adult Cigarette Smoking in the United States: Current Estimates

    Science.gov (United States)

    ... of Reproductive Health More CDC Sites Current Cigarette Smoking Among Adults in the United States Recommend on ... reported smoking every day or some days. Current Smoking Among Adults in 2015 (Nation) By Gender 2 ...

  8. Terrestrial Ecosystems - Topographic Moisture Potential of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) has generated topographic moisture potential classes for the contiguous United States. These topographic moisture potential classes...

  9. Map service: United States Decadal Production History Cells

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map service displays present and past oil and gas production in the United States, as well as the location and intensity of exploratory drilling outside...

  10. Streamflow Gaging Stations of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows selected streamflow gaging stations of the United States, Puerto Rico, and the U.S. Virgin Islands, in 2013. Gaging stations, or gages, measure...

  11. Premature death rates diverge in the United States

    Science.gov (United States)

    An NCI press release on a study that shows premature death rates have declined in the United States among Hispanics, blacks, and Asian/Pacific Islanders but increased among whites and American Indian/Alaska Natives.

  12. Elevation in the Western United States (90 meter DEM)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Elevation in the western United States obtained from the National Elevation Dataset. Data was converted from float point to integer format and resampled from 30m...

  13. Territorial Acquisitions of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the major acquisitions of territory by the United States of America. Only areas in North America, the Caribbean, and Hawaii are included....

  14. 1990 point population coverage for the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a point coverage of the 1990 Census of Population and Housing for the conterminous United States. (Alaska and Hawaii are available separately). The coverage...

  15. Streams and Waterbodies of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows areal and linear water features of the United States, Puerto Rico, and the U.S. Virgin Islands. The original file was produced by joining the...

  16. Terrestrial Ecosystems - Surficial Lithology of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) has generated a new classification and map of the lithology of surficial materials for the contiguous United States. This was...

  17. United States Earthquake Intensity Database, 1638-1985

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The United States Earthquake Intensity Database is a collection of damage and felt reports for over 23,000 U.S. earthquakes from 1638-1985. The majority of...

  18. NCHS - Births to Unmarried Women by Age Group: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes number of births to unmarried women by age group in the United States since 1940. Methods for collecting information on marital status changed...

  19. Base-flow index grid for the conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This 1-kilometer raster (grid) dataset for the conterminous United States was created by interpolating base-flow index (BFI) values estimated at U.S. Geological...

  20. United States Average Annual Precipitation, 2005-2009 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 2005-2009. Parameter-elevation...

  1. Seismic Hazard Map for the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows seismic hazard in the United States. The data represent a model showing the probability that ground motion will reach a certain level. This map...

  2. Global Map: Airports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data are a modified version of the...

  3. United States Crimes Database 1994-2000 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows crime statistics for the United States for the years 1994-2000, drawn from the Uniform Crime Reporting Program data compiled by the Federal...

  4. United States Crimes Database 2001-2002 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows crime statistics for the United States for the years 2001-2002, drawn from the Uniform Crime Reporting Program data compiled by the Federal...

  5. Public Land Survey System of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set portrays the Public Land Surveys of the United States, including areas of private survey, Donation Land Claims, and Land Grants and Civil Colonies....

  6. United States Tornado Touchdown Points 1950-2004 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows tornado touchdown points in the United States, Puerto Rico, and the U.S. Virgin Islands, from 1950 to 2004. Statistical data were obtained from...

  7. Costly Landslide Events in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows point locations of costly individual landslide events in the 50 United States and Puerto Rico. Landslide locations were determined from...

  8. Current Developments in Communications Law in the United States

    Science.gov (United States)

    Hadl, Robert D.

    1973-01-01

    Article reviews some of the major developments in communications law in the United States in the past year (1972). Significant events are covered in the areas of cable television, television programming and domestic satelites. (Author)

  9. Inorganic Nitrogen Wet Deposition for the Conterminous United States, 1962

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Annual inorganic nitrogen wet deposition were estimated for the conterminous United States for 1962. The estimates were derived from inorganic nitrogen...

  10. United States Average Annual Precipitation, 1961-1990 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 1961-1990. Parameter-elevation...

  11. Crushed Stone Operations in the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes crushed stone operations in the United States. These data were obtained from information reported voluntarily to the USGS by the aggregate...

  12. Map service: United States Oil and Gas Production 2008

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map service displays present and past oil and gas production in the United States, as well as the location and intensity of exploratory drilling outside...

  13. Decline of forest interior conditions in the conterminous United States

    Science.gov (United States)

    Forest fragmentation threatens the sustainability of forest interior environments, thereby endangering subordinate ecological attributes and functions. We analyzed the spatial patterns of forest disturbance and recovery for the conterminous United States from 2001 to 2006 to det...

  14. Inorganic Nitrogen Wet Deposition for the Conterminous United States, 1984

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Annual inorganic nitrogen wet deposition were estimated for the conterminous United States for 1984. The estimates were derived from inorganic nitrogen...

  15. Disseminating Library and Information Science Research in the United States

    Science.gov (United States)

    Ferguson, Douglas

    1975-01-01

    A descriptive survey of the organizations and institutions which conduct and support current research in library and information science in the United States of America and of the major sources of research information. (Author)

  16. Elevation in the Western United States (180 meter DEM)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Elevation in the western United States obtained from the National Elevation Dataset. Data was converted from float point to integer format and resampled from 30m...

  17. Psychotropic Medication Use among Adolescents: United States, 2005-2010

    Science.gov (United States)

    ... from the National Technical Information Service NCHS Psychotropic Medication Use Among Adolescents: United States, 2005–2010 Recommend ... 0% of adolescents reported the use of psychotropic medications. Figure 1. Percentage of adolescents aged 12–19 ...

  18. United States Average Annual Precipitation, 1995-1999 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 1995-1999. Parameter-elevation...

  19. United States Average Annual Precipitation, 1990-1994 - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows polygons of average annual precipitation in the contiguous United States, for the climatological period 1990-1994. Parameter-elevation...

  20. Terrestrial Ecosystems - Isobioclimates of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) has generated and mapped isobioclimate classes for the contiguous United States. These isobioclimate classes were created as part...