WorldWideScience

Sample records for units providing level

  1. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom.

    Science.gov (United States)

    Hill, Harry; Macey, Richard; Brocklehurst, Paul

    2017-03-08

    To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.

  2. Propulsion-unit and robot provided with such a propulsion-unit

    NARCIS (Netherlands)

    Breedveld, P.; Dodou, D.

    2010-01-01

    The invention relates to a propulsion-unit provided with a body and comprising at least one element having an external adhesive layer for providing frictional contact with an object's surface along which the unit in use moves, wherein the element is a supporting layer that supports said adhesive lay

  3. Practice Characteristics Among Dental Anesthesia Providers in the United States

    Science.gov (United States)

    Boynes, Sean G.; Moore, Paul A.; Tan, Peter M.; Zovko, Jayme

    2010-01-01

    Abstract General descriptions or “snapshots” of sedation/general anesthesia practices during dental care are very limited in reviewed literature. The objective of this study was to determine commonalities in dental sedation/anesthesia practices, as well as to accumulate subjective information pertaining to sedation/anesthesia care within the dental profession. This questionnaire-based survey was completed by participating anesthesia providers in the United States. A standardized questionnaire was sent via facsimile, or was delivered by mail, to 1500 anesthesia providers from a randomized list using an online database. Data from the returned questionnaires were entered onto an Excel spreadsheet and were imported into a JMP Statistical Discovery Software program for analyses. Quantitative evaluations were confined to summation of variables, an estimation of means, and a valid percent for identified variables. A total of 717 questionnaires were entered for data analysis (N  =  717). Data from this study demonstrate the wide variation that exists in sedation/anesthesia care and those providing its administration during dental treatment in the United States. The demographics of this randomized population show anesthesia providers involved in all disciplines of the dental profession, as well as significant variation in the types of modalities used for sedation/anesthesia care. Data from this study reveal wide variation in sedation/anesthesia care during dental treatment. These distinctions include representation of sedation/anesthesia providers across all disciplines of the dental profession, as well as variations in the techniques used for sedation/anesthesia care. PMID:20553135

  4. Practice characteristics among dental anesthesia providers in the United States.

    Science.gov (United States)

    Boynes, Sean G; Moore, Paul A; Tan, Peter M; Zovko, Jayme

    2010-01-01

    General descriptions or "snapshots" of sedation/general anesthesia practices during dental care are very limited in reviewed literature. The objective of this study was to determine commonalities in dental sedation/anesthesia practices, as well as to accumulate subjective information pertaining to sedation/anesthesia care within the dental profession. This questionnaire-based survey was completed by participating anesthesia providers in the United States. A standardized questionnaire was sent via facsimile, or was delivered by mail, to 1500 anesthesia providers from a randomized list using an online database. Data from the returned questionnaires were entered onto an Excel spreadsheet and were imported into a JMP Statistical Discovery Software program for analyses. Quantitative evaluations were confined to summation of variables, an estimation of means, and a valid percent for identified variables. A total of 717 questionnaires were entered for data analysis (N=717). Data from this study demonstrate the wide variation that exists in sedation/anesthesia care and those providing its administration during dental treatment in the United States. The demographics of this randomized population show anesthesia providers involved in all disciplines of the dental profession, as well as significant variation in the types of modalities used for sedation/anesthesia care. Data from this study reveal wide variation in sedation/anesthesia care during dental treatment. These distinctions include representation of sedation/anesthesia providers across all disciplines of the dental profession, as well as variations in the techniques used for sedation/anesthesia care.

  5. Shared Savings Program ACO Provider-level RIF

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare (CM) has created a set of standard analytical files that contain Shared Savings Program Accountable Care Organizations. Provider-level RIF...

  6. Biological risk in nursing care provided in family health units

    National Research Council Canada - National Science Library

    Cardoso, Ana Carla Moreira; Figueiredo, Rosely Moralez de

    2010-01-01

    .... This exploratory and descriptive study characterizes the potential risk of biological exposure in procedures performed by nursing professionals in ten Family Health units in São Carlos-SP, Brazil...

  7. 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

  8. Strategies business of the unit providing services of virtual training – unipanamericana compensar.

    Directory of Open Access Journals (Sweden)

    Jenny Marcela Cardona Bedoya

    2015-03-01

    Full Text Available This article presents the results of processes thesis of "Master in Management and Marketing Management and Global New Markets" for the University Camilo José Cela. The data collection is done through an exploratory research and the study of business unit Unit Providing Services of Virtual Training Unipanamericana - Compensate. Considering secondary sources we identified: 1 The most important in the world and in Colombia at the level of new technologies, 2 The development trends of the array Mic Mac establishes the relationship between trends and portfolio of the business unit. And 3 Identify the growth of applications and the impact of E-learning. The collection and analysis of information on the qualitative method developed through interviews, aiming to identify trends that impact the marketing plan. In the analysis were found four trends that impact the line of business: The joint educational levels, The new educational experiences, Changes in learning models and Strengthening education systems. These trends were explored in an evaluative context, to identify new technologies that are necessary for professional development.   

  9. A Level Converter provided with Slew-Rate Controlling Means

    NARCIS (Netherlands)

    Annema, Anne J.

    2000-01-01

    A level converter for the converting of a first digital signal (U1) having a first voltage range into a second digital signal (U2) having a second voltage range comprising an amplifier (T0) having an input for receiving the first digital signal (U1) and an output for supplying the second digital

  10. Level 2 Foundation Units. Key Stage 3: National Strategy.

    Science.gov (United States)

    Department for Education and Skills, London (England).

    These foundation units are aimed at pupils working within Level 2 entry to Year 7. They are designed to remind pupils what they know and take them forward. The units also will teach phonics knowledge from consonant-vowel-consonant (CVC) words to long vowel phonemes. The writing units focus on developing the following skills: understanding what a…

  11. ANALISIS TINGKAT KEMATANGAN (MATURITY LEVELS UNIT LAYANAN PENGADAAN KABUPATEN BADUNG

    Directory of Open Access Journals (Sweden)

    I Gde Uma Darmapramita

    2015-07-01

    Full Text Available The implementation of government procurement of goods and service is governed by presidential regulation number 70 year of 2012.  According to that, in Badung Regency implemented centralized in Procurement Service Unit of Badung Regency. As the one of Indonesia procurement unit pilot, Procurement Service Unit of Badung Regency has given the opportunity to perform a self assessment of its  maturity levels as government unit. The objective of this research is to find factors that influence Procuremet Service Unit of Badung Regency maturity levels, and also to find out in what level is Procurement Service Unit of Badung Regency stand. Data collection for this research have done by  using questionnaire that involve 50 respondents who understand very well about the duties and function of Procurement Service Unit of Badung Regency to perform a government procurement of good and services. The data analysis have been performed by use of factor analysis and supported by SPSS program. The result shows there are 3 factors that influent the Procurement Service Unit of Badung Regency maturity levels, which are : the synergy and organization culture, resources and risk management and organization’s performance development.  Whereas the maturity levels of Procurement Service Unit of Badung Regency is stand at compliance. Based to the factors that formed, the highly commitment and strong leadership of Badung Regency leader are very decisive to push ahead the enhancement  and  the development of Procurement Service Unit of Badung Regency.  First thing can be done is to establish an independent Procurement Service Unit therewith its Procurement Unit Development road maps that can be tiered and sustainable plan, monitor and evaluate

  12. Noise level analysis in adult intensive care unit

    Directory of Open Access Journals (Sweden)

    Helen Katharine Christofel

    2016-01-01

    Full Text Available Objective: to analyze the noise level in adult intensive care unit. Methods: a quantitative study, in which the sound levels of the intensive care unit have been assessed by means of a decibel meter. Results: comparing the groups, there was a reduction in noise levels in both periods studied, but only in the afternoon there was a statistically significant difference (p<0.05. The health professionals pointed out that the unit had moderate noise, coming mainly from equipment and professionals. Conclusion: adjusting the ventilator alarms contributed to the reduction of noise levels in the unit, and there was the perception that it is a moderate noise environment, although the noise levels in decibels observed were above the recommended values.

  13. Initial Survey Instructions for management unit water monitoring : level

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Initial survey instructions for 1.08 management unit water monitoring (level) survey on Fish Springs National Wildlife Refuge. This survey is conducted weekly and is...

  14. 26 CFR 1.964-3 - Records to be provided by United States shareholders.

    Science.gov (United States)

    2010-04-01

    ... which § 1.952-3 does not apply, such amounts shall be determined under 26 CFR § 1.954-1(d)(3)(i) and (ii... shareholders. 1.964-3 Section 1.964-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... provided by United States shareholders. (a) Shareholder's responsibility for providing records....

  15. The benefits and challenges of providing nursing student clinical rotations in the intensive care unit.

    Science.gov (United States)

    Swinny, Betsy; Brady, Melanie

    2010-01-01

    The goal of providing a clinical rotation in a basic nursing program is to integrate skills and knowledge from the classroom setting into the clinical practice setting. In the intensive care unit (ICU), nursing students have the ability to learn about the complex health issues of critically ill patients, practice selected technical skills, and develop communication skills. There are both benefits and challenges to having nursing students in the intensive care setting. With preparation, the student is able to immerse in the ICU environment, acquire new knowledge and skills, and participate alongside the nurse caring for critically ill patients. The staff nurse must balance patient care with the added responsibilities of helping the student meet the clinical goals. It is optimal to have faculty that are also intensive care clinically competent and can facilitate the clinical experience. The school, the hospital, and the ICU need to collaborate to provide a positive clinical experience that is safe for the patient. In return, the hospital can recruit student nurses and clinical faculty. Planned with thought and intention, rotations in the ICU can be an ideal clinical setting for upper-level student nurses to learn the role of the registered nurse.

  16. Providing Source Code Level Portability Between CPU and GPU with MapCG

    Institute of Scientific and Technical Information of China (English)

    Chun-Tao Hong; De-Hao Chen; Yu-Bei Chen; Wen-Guang Chen; Wei-Min Zheng; Hai-Bo Lin

    2012-01-01

    Graphics processing units (GPU) have taken an important role in the general purpose computing market in recent years.At present,the common approach to programming GPU units is to write GPU specific code with low level GPU APIs such as CUDA.Although this approach can achieve good performance,it creates serious portability issues as programmers are required to write a specific version of the code for each potential target architecture.This results in high development and maintenance costs.We believe it is desirable to have a programming model which provides source code portability between CPUs and GPUs,as well as different GPUs.This would allow programmers to write one version of the code,which can be compiled and executed on either CPUs or GPUs efficiently without modification.In this paper,we propose MapCG,a MapReduce framework to provide source code level portability between CPUs and GPUs.In contrast to other approaches such as OpenCL,our framework,based on MapReduce,provides a high level programming model and makes programming much easier.We describe the design of MapCG,including the MapReduce-style high-level programming framework and the runtime system on the CPU and GPU.A prototype of the MapCG runtime,supporting multi-core CPUs and NVIDIA GPUs,was implemented. Our experimental results show that this implementation can execute the same source code efficiently on multi-core CPU platforms and GPUs,achieving an average speedup of 1.6~2.5x over previous implementations of MapReduce on eight commonly used applications.

  17. SMOS Level 3 and Level 4 Research Products Provided by the Barcelona Expert Center

    Science.gov (United States)

    Gabarro, Carolina; Martinez, Justino; Ballabrera, Joaquim; Piles, Maria; Umbert, Marta; Perez, Fernando; Turiel, Antonio; Font, Jordi; Portabella, Marcos; Huoareau, Nina; Olmedo, Estrella

    2013-04-01

    More than three years have passed since the launch, on November 2, 2009, of the European Space Agency's (ESA) Soil Moisture and Ocean Salinity (SMOS) satellite carrying a microwave synthetic aperture radiometer working at 1.4 GHz. The aim of the mission is to provide Sea Surface Salinity and Soil Moisture observations, with a spatial resolution of 30-50 km, and an accuracy suited for climate studies. From the brightness temperature observations, experimental sea surface salinity (SSS) and Soil Moisture (SM) maps are being developed and distributed at the SMOS Barcelona Expert Center (SMOS-BEC) to take the most out of SMOS observations. Data are distributed in NetCDF format using THREDDS and maps are served through a Web Map Service (ncWMS), both at the SMOS-BEC distribution data website (http://cp34-bec.cmima.csic.es/). For ocean applications the following SSS products are being served at spatial resolution of 0.25°: • Level 3 maps by spatial and temporal weighted average of level 2 SSS data. Three- and nine-day averaged maps are produced every 3 days. Monthly, seasonal and annual maps are also computed. • Level 3 maps from optimal interpolation of level 2 SSS data. Nine-day averaged maps are produced every 3 days, as well as monthly, seasonal and annual maps. • Level 4 maps from SMOS SSS fused with satellite-derived SST [1]. Similar to Level 3 data, nine-day averaged maps are produces every 3 days, as well as monthly, seasonal and annual maps. • Singularity Exponents products obtained by applying singularity analysis [1] on OSTIA SST products (http://myocean.eu/) are also served. Three versions of each product are generated using ascending passes, descending passes, and full orbit passes (i.e., ascending + descending). Both absolute salinity value and its anomaly (difference between the absolute value and climatology data (WOA 2009)) are stored in the product. L3 and L4 maps are validated with near-surface measurements provided by Argo profilers, and

  18. Moral distress in nurses providing direct care on inpatient oncology units.

    Science.gov (United States)

    Sirilla, Janet

    2014-10-01

    Moral distress is defined as knowing the right thing to do when policy constraints do not allow for appropriate choices. The purpose of the current study was to explore the existence of moral distress in oncology nurses with a cross-sectional survey completed by nurses working on inpatient units at a midwestern cancer hospital. Investigators distributed the Moral Distress Scale-Revised to all direct care staff nurses. The main research variables were moral distress, level of education, age, and type of unit. Most of the 73 nurses had low to moderate scores, and two had high scores. No significant correlations were observed among age or years of experience. Type of unit and level of moral distress were correlated, and an inverse relationship between level of education and moral distress was found. Moral distress exists in nurses who work on oncology units irrespective of experience in oncology or the specific unit. Nurses must be aware of the existence of moral distress and finds ways to reduce potential emotional problems.

  19. Routine Prenatal Care Visits by Provider Specialty in the United States, 2009-2010

    Science.gov (United States)

    ... in the United States, 2009–2010 Recommend on Facebook Tweet Share Compartir NCHS Data Brief No. 145, March 2014 On This Page Key findings The percentage of routine prenatal care visits at which women saw non-ob/gyn providers generally decreased with age. ...

  20. Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units

    Science.gov (United States)

    Hoonakker, Peter L T; Carayon, Pascale; Brown, Roger L; Cartmill, Randi S; Wetterneck, Tosha B; Walker, James M

    2013-01-01

    Background Implementation of Computerized Provider Order Entry (CPOE) has many potential advantages. Despite the potential benefits of CPOE, several attempts to implement CPOE systems have failed or met with high levels of user resistance. Implementation of CPOE can fail or meet high levels of user resistance for a variety of reasons, including lack of attention to users’ needs and the significant workflow changes required by CPOE. User satisfaction is a critical factor in information technology implementation. Little is known about how end-user satisfaction with CPOE changes over time. Objective To examine ordering provider and nurse satisfaction with CPOE implementation over time. Methods We conducted a repeated cross-sectional questionnaire survey in four intensive care units of a large hospital. We analyzed the questionnaire data as well as the responses to two open-ended questions about advantages and disadvantages of CPOE. Results Users were moderately satisfied with CPOE and there were interesting differences between user groups: ordering providers and nurses. User satisfaction with CPOE did not change over time for providers, but it did improve significantly for nurses. Results also show that nurses and providers are satisfied with different aspects of CPOE. PMID:23100129

  1. Effect of a laboratory result pager on provider behavior in a neonatal intensive care unit.

    Science.gov (United States)

    Samal, L; Stavroudis, Ta; Miller, Re; Lehmann, Hp; Lehmann, Cu

    2011-01-01

    A computerized laboratory result paging system (LRPS) that alerts providers about abnormal results ("push") may improve upon active laboratory result review ("pull"). However, implementing such a system in the intensive care setting may be hindered by low signal-to-noise ratio, which may lead to alert fatigue. To evaluate the impact of an LRPS in a Neonatal Intensive Care Unit. Utilizing paper chart review, we tallied provider orders following an abnormal laboratory result before and after implementation of an LRPS. Orders were compared with a predefined set of appropriate orders for such an abnormal result. The likelihood of a provider response in the post-implementation period as compared to the pre-implementation period was analyzed using logistic regression. The provider responses were analyzed using logistic regression to control for potential confounders. The likelihood of a provider response to an abnormal laboratory result did not change significantly after implementation of an LRPS. (Odds Ratio 0.90, 95% CI 0.63-1.30, p-value 0.58) However, when providers did respond to an alert, the type of response was different. The proportion of repeat laboratory tests increased. (26/378 vs. 7/278, p-value = 0.02). Although the laboratory result pager altered healthcare provider behavior in the Neonatal Intensive Care Unit, it did not increase the overall likelihood of provider response.

  2. Sex trafficking of adolescents and young adults in the United States: healthcare provider's role.

    Science.gov (United States)

    Chaffee, Tonya; English, Abigail

    2015-10-01

    Sex trafficking of adolescents and young adults is both a human rights violation and a public health problem, globally and in the United States. Healthcare providers, including obstetricians and gynecologists, interact with victims, often while they remain under their traffickers' control, but because of providers' lack of training in identification and response many victims go unrecognized and unaided. This review provides an overview of the definitions of sex trafficking and commercial sexual exploitation, contributing factors, health consequences, recruitment of victims, and identification and response by healthcare providers. The literature on definitions and risk factors associated with sex trafficking is growing; however, literature on healthcare providers' role in addressing sex trafficking remains more limited. It is increasingly recognized that healthcare providers have an important role in victim identification and response and as advocates, collaborating with national, regional, and local agencies to increase awareness of sex trafficking as a public health problem and to address the needs of adolescent and young adult victims and survivors globally and in the United States. As professionals who interact with adolescent and young adult victims of sex trafficking, healthcare providers have an important role: in collaboration with other professionals and agencies they can help to identify, respond to, extricate, protect, and advocate for victims and survivors.

  3. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas

    OpenAIRE

    Fielding, William J.

    2010-01-01

    This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel) in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the s...

  4. Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States

    OpenAIRE

    Sanchez, Guillermo V.; Roberts, Rebecca M.; Albert, Alison P.; Darcia D. Johnson; Hicks, Lauri A.

    2014-01-01

    Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for ...

  5. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas

    Directory of Open Access Journals (Sweden)

    Fielding, William J.

    2010-01-01

    Full Text Available This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the size of the dog is an important factor which determines the level of care provided. Pit bulls generally received similar care to potcakes which are often considered neglected. Large dogs were more likely to be kept outside and less likely to be allowed inside the home than small dogs. It is conjectured that in many instances the level of care offered constitutes partial abandonment due to a lack of interaction between caregivers and their dogs.

  6. Family participation in intensive care unit rounds: Comparing family and provider perspectives.

    Science.gov (United States)

    Au, Selena S; Roze des Ordons, Amanda; Soo, Andrea; Guienguere, Simon; Stelfox, Henry T

    2017-04-01

    To describe and compare intensive care unit (ICU) patient family member and provider experiences, preferences, and perceptions of family participation in ICU rounds. Cross-sectional survey of ICU family members and providers of patients admitted to 4 medical-surgical ICUs from September 2014 to March 2015. Surveys were completed by 63 (62%) family members and 258 (43%) providers. Provider respondents included physicians (9%), nurses (56%), respiratory therapists (24%), and other ICU team members (11%). Although 38% of providers estimated only moderate family member interest in participating in rounds, 97% of family members expressed high interest. Family members and providers reported listening (95% vs 96%; P=.594) and sharing information about the patient (82% vs 82%; P=.995) as appropriate roles for family members during rounds, but differed in their perceptions on asking questions (75% vs 86%; P=.043) and participating in decision making (36% vs 59%; P=.003). Compared with family members, providers were more likely to perceive family participation in rounds to cause family stress (7% vs 22%; P=.020) and confusion (0% vs 28%; PFamily members and providers share some perspectives on family participation in ICU rounds although other perspectives are discordant, with implications for communication strategies and collaborative decision making. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Level 0 trigger decision unit for the LHCb experiment

    OpenAIRE

    2006-01-01

    LHCb, présenté par J. Laubser, à paraître dans les proceedings; International audience; The Level-0 Decision Unit( L0DU)is the central part of the first trigger level of the LHCb detector. The L0DU receives information from the Calorimeter, Muon and Pile-Up sub-triggers, with fixed latencies, at 40 MHz via 24 high speed optical fiber links running at 1.6 Gb/s. The L0DU performs simple physics algorithm to compute the decision in order to reduce the data flow down to 1 MHz for the next trigger...

  8. Determination of optimum pressurizer level for kori unit 1

    Energy Technology Data Exchange (ETDEWEB)

    Song, Dong Soo; Lee, Chang Sup; Lee Jae Yong; Kim, Yo Han; Lee, Dong Hyuk [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1997-12-31

    To determine the optimum pressurizer water level during normal operation for Kori unit 1, performance and safety analysis are performed. The methodology is developed by evaluating {sup d}ecrease in secondary heat removal{sup e}vents such as Loss of Normal Feedwater accident. To demonstrate optimum pressurizer level setpoint, RETRAN-03 code is used for performance analysis. Analysis results of RETRAN following reactor trip are compared with the actual plant data to justify RETRAN code modelling. The results of performance and safety analyses show that the newly established level setpoints not only improve the performance of pressurizer during transient including reactor trip but also meet the design bases of the pressurizer volume and pressure. 6 refs., 5 figs. (Author)

  9. UNITE: a database providing web-based methods for the molecular identification of ectomycorrhizal fungi

    DEFF Research Database (Denmark)

    Köljalg, U.; Larsson, K.H.; Abarenkov, K.

    2005-01-01

    sequence after alignment either to pre-existing generic alignments, or to matches retrieved from a blast search on the UNITE data. It should be noted that the current version of UNITE is dedicated to the reliable identification of ECM fungi. •  The UNITE database is accessible through the URL http://unite.zbi.ee...

  10. Community-based opioid overdose prevention programs providing naloxone - United States, 2010.

    Science.gov (United States)

    2012-02-17

    Drug overdose death rates have increased steadily in the United States since 1979. In 2008, a total of 36,450 drug overdose deaths (i.e., unintentional, intentional [suicide or homicide], or undetermined intent) were reported, with prescription opioid analgesics (e.g., oxycodone, hydrocodone, and methadone), cocaine, and heroin the drugs most commonly involved . Since the mid-1990s, community-based programs have offered opioid overdose prevention services to persons who use drugs, their families and friends, and service providers. Since 1996, an increasing number of these programs have provided the opioid antagonist naloxone hydrochloride, the treatment of choice to reverse the potentially fatal respiratory depression caused by overdose of heroin and other opioids. Naloxone has no effect on non-opioid overdoses (e.g., cocaine, benzodiazepines, or alcohol) . In October 2010, the Harm Reduction Coalition, a national advocacy and capacity-building organization, surveyed 50 programs known to distribute naloxone in the United States, to collect data on local program locations, naloxone distribution, and overdose reversals. This report summarizes the findings for the 48 programs that completed the survey and the 188 local programs represented by the responses. Since the first opioid overdose prevention program began distributing naloxone in 1996, the respondent programs reported training and distributing naloxone to 53,032 persons and receiving reports of 10,171 overdose reversals. Providing opioid overdose education and naloxone to persons who use drugs and to persons who might be present at an opioid overdose can help reduce opioid overdose mortality, a rapidly growing public health concern.

  11. Evolutionary epistemology as a scientific method: a new look upon the units and levels of evolution debate.

    Science.gov (United States)

    Gontier, Nathalie

    2010-09-01

    Evolutionary epistemology can provide a unified scientific methodology that enables scholars to study the evolution of life as well as the evolution of cognition, science, culture and any other phenomenon displayed by living organisms. In this article, three heuristics are provided that allow for a thorough search for the units, levels and mechanisms of evolution. Contrary to previous approaches, units, levels and mechanisms are not identified by pointing out essential features, but rather ostensive definitions are preferred. That is, units are considered as such if a level of evolution and a mechanism of evolution is identifiable. Levels are levels if one can point out units that evolve at that level according to evolutionary mechanisms, and mechanisms are considered as such if one can point out units and levels where the mechanism is active.

  12. Perceived quality in a dementia unit: patients' caregivers as information providers.

    Science.gov (United States)

    López-Picazo, J J; de Dios Cánovas-García, J; Antúnez, C; Marín, J; Antequera, M M; Vivancos, L; Martínez, B; Legaz, A; Navarro, D; Leal, M

    2016-10-22

    Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Stress Levels of Nurses in Oncology Outpatient Units.

    Science.gov (United States)

    Ko, Woonhwa; Kiser-Larson, Norma

    2016-04-01

    Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.

  14. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2013-03-01

    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  15. Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States.

    Science.gov (United States)

    Sanchez, Guillermo V; Roberts, Rebecca M; Albert, Alison P; Johnson, Darcia D; Hicks, Lauri A

    2014-12-01

    Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. Participants were generally familiar with guideline recommendations for antibiotic drug selection for common infections, but did not always comply with them. Reasons for nonadherence included the belief that nonrecommended agents are more likely to cure an infection, concern for patient or parent satisfaction, and fear of infectious complications. Providers inconsistently defined broad- and narrow-spectrum antibiotic agents. There was widespread concern for antibiotic resistance; however, it was not commonly considered when selecting therapy. Strategies to encourage use of first-line agents are needed in addition to limiting unnecessary prescribing of antibiotic drugs.

  16. The "virtual" obstetrical intensive care unit: providing critical care for contemporary obstetrics in nontraditional locations.

    Science.gov (United States)

    Leovic, Michael P; Robbins, Hailey N; Foley, Michael R; Starikov, Roman S

    2016-12-01

    Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness. The health care needs of the critically ill obstetric patient calls for clinicians to move beyond the traditional definition of the intensive care unit and develop a well-rounded, quickly responsive, and communicative interdisciplinary team that can provide high-quality, unique, and versatile care that best meets the needs of each particular patient. We propose a model in which a virtual intensive care unit team composed of preselected specialists from multiple disciplines (maternal-fetal medicine, neonatology, obstetric anesthesiology, cardiology, pulmonology, etc) participate in the provision of individualized, precontemplated care that is readily adapted to the specific patient's clinical needs, regardless of setting. With this team-based approach, an environment of trust and familiarity is fostered among team members and well thought-out patient care plans are developed through routine prebrief discussions regarding individual clinical care for parturients anticipated to required critical care services. Incorporating debriefings between team members following these intricate cases will allow for the continued evolution of care as the medical needs of this patient population change as well.

  17. Health care provider knowledge and practices regarding folic acid, United States, 2002-2003.

    Science.gov (United States)

    Williams, Jennifer L; Abelman, Stephen M; Fassett, Elizabeth M; Stone, Cheryl E; Petrini, Joann R; Damus, Karla; Mulinare, Joseph

    2006-09-01

    To assess health care providers (HCP) knowledge and practices regarding folic acid (FA) use for neural tube defect (NTD) prevention. Two identical surveys were conducted among 611 obstetricians/gynecologists (OB/GYNs) and family/general physicians (FAM/GENs) (2002), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (2003) to ascertain knowledge and practices regarding FA. For analysis, T-tests, univariate and multivariate logistic regression modeling were used. Universally, providers knew that FA prevents birth defects. Over 88% knew when a woman should start taking folic acid for the prevention of NTDs; and over 85% knew FA supplementation beyond what is available in the diet is necessary. However, only half knew that 50% of all pregnancies in the United States are unplanned. Women heard information about multivitamins or FA most often during well woman visits in obstetrical/gynecology (ob/gyn) practice settings (65%), and about 50% of the time during well woman visits in family/general (fam/gen) practice settings and 50% of the time at gynecology visits (both settings). Among all providers, 42% did not know the correct FA dosage (400 mug daily). HCPs taking multivitamins were more than twice as likely to recommend multivitamins to their patients (Odds Ratio [OR] 2.27 95%, Confidence Interval [CI] 1.75-2.94). HCPs with lower income clients (OR 1.49, CI 1.22-1.81) and HCPs with practices having more than 10% minorities (OR 1.46, CI 1.11-1.92) were more likely to recommend supplements. NPs in ob/gyn settings were most likely and FAM/GENs were least likely to recommend supplements (OR 3.06, CL 1.36-6.90 and OR 0.64, CL 0.45-0.90 respectively). Knowledge about birth defects and the necessity of supplemental FA was high. Increasing knowledge about unintended pregnancy rates and correct dosages of FA is needed. The strongest predictor for recommending the use of FA supplements was whether the provider

  18. 42 CFR 433.67 - Limitations on level of FFP for permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Limitations on level of FFP for permissible... General Administrative Requirements State Financial Participation § 433.67 Limitations on level of FFP for... the amount of bona fide provider-related donations that a State may receive without a reduction in...

  19. 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

  20. Master's-Level Practitioners as Cognitive Behavioral Therapy for Insomnia Providers: An Underutilized Resource

    Science.gov (United States)

    Fields, Barry G.; Schutte-Rodin, Sharon; Perlis, Michael L.; Myers, Megin

    2013-01-01

    Despite the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating chronic insomnia, it remains underutilized. Lack of appropriately-trained CBT-I providers is a major reason. Master's-level practitioners (MLPs) may, in addition to doctoral-level psychologists, be uniquely positioned to fill this role, based not only on “goodness of professional fit” but also given a handful of studies showing these individuals' care outcomes meet or exceed standard outcomes. However, the ability of MLPs to provide CBT-I will be significantly restricted until a clear pathway is established that extends from training opportunities to credentialing. Further questions remain about how to attract and incorporate MLPs into established practices. Citation: Fields BG; Schutte-Rodin S; Perlis ML; Myers M. Master's-level practitioners as cognitive behavioral therapy for insomnia providers: an underutilized resource. J Clin Sleep Med 2013;9(10):1093-1096. PMID:24127157

  1. Patterns of salivary cortisol levels can manifest work stress in emergency care providers.

    Science.gov (United States)

    Nakajima, Yasushi; Takahashi, Takayuki; Shetty, Vivek; Yamaguchi, Masaki

    2012-05-01

    To develop objective assessments of work fatigue, we investigated the patterns of changes in salivary cortisol levels in emergency care providers working extended work shifts. Fourteen subjects, comprising seven physicians and seven physician assistants, provided unstimulated saliva samples at regular intervals over the course of a 24-h work shift and over their subsequent free day. There was a significant time effect, with early morning cortisol levels being significantly attenuated following the work shift. Native diurnal variations varied by gender, with the female subjects manifesting greater cortisol levels. Physicians also had higher cortisol profiles even though their wake-rest cycles were similar to those of the physician assistants. Our results suggest that temporal changes, as well as diurnal similarities, in the salivary cortisol patterns can reflect work-related stress and recovery. In particular, early morning cortisol levels may manifest individual reactivity to work stressors as well as sleep deprivation.

  2. Fact or fiction? An empirical analysis of cooperation between mass sport providers at the local level

    NARCIS (Netherlands)

    Vos, Steven; Scheerder, Jeroen

    2014-01-01

    This paper explores inter-organisational relationships, in terms of cooperation, between three main types of sport providers at the local level: voluntary sport clubs, for-profit fitness and health clubs, and local sports authorities. Both withinand cross-sector cooperation are analysed and related

  3. Examining the Satisfaction Levels of Continual Professional Development Provided by a Rural Accounting Professional Body

    Science.gov (United States)

    Halabi, Abdel K.

    2014-01-01

    The Society for the Provision of Education in Rural Australia (SPERA) recognises education as a lifelong process, and there is a need for continuing education and training to be available to rural communities. This paper examines the satisfaction levels of accounting continual professional development (CPD) when provided by a rural accounting…

  4. FACTOR ANALYSIS ABOUT EXCLUSIVE BREASTFEEDING ACHIEVEMENT LEVEL AMONG MOTHERS WHO PROVIDE BREASTMILK TO THEIR CHILDREN

    Directory of Open Access Journals (Sweden)

    Tiyas Kusumaningrum

    2017-04-01

    Full Text Available Introduction: The number of mother who breastfeed their babies exclusively in Indonesia is low. It caused by many factors such as high intensity of formula milk advertisement, lack of awareness about the importance of breastfeeding, working mother, social culture, family support and the role of health care provider. The purpose of this research was to analyze factors related with successfulness level of exclusive breastfeeding. Method: Design used in this research was analytic retrospective. The population were all mothers at Pacarkeling Public Health Center area. Sample obtained through purposive sampling. Total sample was 61 respondents. Independent variables were knowledge, information and promotion, family support, social cultural, role of health provider, work/occupation, education and breast physiology anatomy. The dependent variable was exclusive breastfeeding. Result: The result indicated that exclusive breastfeeding achievement level was related with information and promotion (r = 0.271, family support (r = 373, health care provider role (r = 231, mother occupation (r = 251, anatomy and physiology of breast (r = 293, while the knowledge (r = 108, social cultural (r = 180 and education (r = 093 not significantly related. Discussion: In conclusion, there was a positive correlation between information and promotion, family support, health care provider role, mother’s occupation, anatomy and physiology of breast with successfulness level of exclusive breastfeeding. While the knowledge, social cultural and education did not indicate significant result. Therefore it is suggested to increase the quantity and quality of information and promotion about exclusive breastfeeding to the society, health care provider and pregnant and breastfeeding mother.

  5. Windows to the Future: Can the United Nations Sustainable Development Goals Provide Opportunities for Nursing?

    Science.gov (United States)

    Benton, David C; Ferguson, Stephanie L

    2016-01-01

    Windows of opportunity are wide open for the nursing profession to actively participate and engage in the policy implementation, evaluation, and achievement of the United Nations Sustainable Development Goals. Nurses bring valuable perspectives as members of diverse governance structures and offer a range of solutions that can help governments pursue and achieve the Sustainable Development Goals and targets by 2030.

  6. 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.

  7. Hair Analysis Provides a Historical Record of Cortisol Levels in Cushing’s Syndrome

    Science.gov (United States)

    Thomson, S.; Koren, G.; Fraser, L.-A.; Rieder, M.; Friedman, T. C.; Van Uum, S. H. M.

    2010-01-01

    The severity of Cushing’s Syndrome (CS) depends on the duration and extent of the exposure to excess glucocorticoids. Current measurements of cortisol in serum, saliva and urine reflect systemic cortisol levels at the time of sample collection, but cannot assess past cortisol levels. Hair cortisol levels may be increased in patients with CS, and, as hair grows about 1 cm/month, measurement of hair cortisol may provide historical information on the development of hypercortisolism. We attempted to measure cortisol in hair in relation to clinical course in six female patients with CS and in 32 healthy volunteers in 1 cm hair sections. Hair cortisol content was measured using a commercially available salivary cortisol immune assay with a protocol modified for use with hair. Hair cortisol levels were higher in patients with CS than in controls, the medians (ranges) were 679 (279–2500) and 116 (26–204) ng/g respectively (P <0.001). Segmental hair analysis provided information for up to 18 months before time of sampling. Hair cortisol concentrations appeared to vary in accordance with the clinical course. Based on these data, we suggest that hair cortisol measurement is a novel method for assessing dynamic systemic cortisol exposure and provides unique historical information on variation in cortisol, and that more research is required to fully understand the utility and limits of this technique. PMID:19609841

  8. 42 CFR 447.206 - Cost limit for providers operated by units of government.

    Science.gov (United States)

    2010-10-01

    ... are limited to reimbursement not in excess of the individual health care provider's cost of providing..., each provider must submit annually a cost report to the Medicaid agency that reflects the individual... to the filed cost report for the spending year in which interim payment rates were made. (3)...

  9. Dynamic Pricing Strategy of Provider with Different QoS Levels in Web Service

    Directory of Open Access Journals (Sweden)

    Wei Pan

    2009-06-01

    Full Text Available In order to improve the service provider profit, the pricing strategies in service network have been studied, but primarily in static pricing setting without considering different quality of service (QoS levels. However, in real situation, providers usually dynamically adjust their prices and offer multiple class services to meet different customers. Moreover, because service provider will satisfy demands of customers on a specific future date, customers may cancel order. In this paper, we establish a new dynamic pricing model to consider order cancellation ration and different QoS levels for maximizing provider revenue. The analytical results from this new model reveal that the optimal capacity and prices are derived via closed-form solutions. Finally, a numerical example is presented to illustrate that the proposed method is effective for determining the optimal capacity and prices. In addition, sensitivity analysis of the optimal capacity and profit with respect to some important parameters are also conducted to illustrate the optimal decision characteristics.

  10. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care.

    Science.gov (United States)

    Fukui, Sadaaki; Salyers, Michelle P; Matthias, Marianne S; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C

    2014-05-01

    The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.

  11. Cameroon mid-level providers offer a promising public health dentistry model

    Directory of Open Access Journals (Sweden)

    Achembong Leo

    2012-11-01

    Full Text Available Background Oral health services are inadequate and unevenly distributed in many developing countries, particularly those in sub-Saharan Africa. Rural areas in these countries and poorer sections of the population in urban areas often do not have access to oral health services mainly because of a significant shortage of dentists and the high costs of care. We reviewed Cameroon’s experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. We anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon, which is currently served by only 3% of the total number of dentists. Methods The setting of this study was the Cameroon Baptist Convention Health Board (BCHB, which has four dentists and 42 mid-level providers. De-identified data were collected manually from the registries of 10 Baptist Convention clinics located in six of Cameroon’s 10 regions and then entered into an Excel format before importing into STATA. A retrospective abstraction of all entries for patient visits starting October 2010, and going back in time until 1500 visits were extracted from each clinic. Results This study showed that mid-level providers in BCHB clinics are offering a full scope of dental work across the 10 clinics, with the exception of treatment for major facial injuries. Mid-level providers alone performed 93.5% of all extractions, 87.5% of all fillings, 96.5% of all root canals, 97.5% of all cleanings, and 98.1% of all dentures. The dentists also typically played a teaching role in training the mid-level providers. Conclusions The Ministry of Health in Cameroon has an opportunity to learn from the BCHB model to expand access to oral health care across the country. This study shows the benefits of using a simple, workable, low

  12. Macintosh support is provided at the level of the Service Desk

    CERN Multimedia

    2011-01-01

    Since September 2010 the Apple laptops & desktops with Mac OS are recognized and supported at CERN by the IT department. Therefore, the “Macintosh support” procedure now follows the same ITIL*) schema as for all IT services, i.e.: All CERN users must address any request for support on Macintosh PCs to the Service Desk. The Service Desk will move on questions or problems they cannot solve to “IT 2nd level” support people, provided by the “computing support” contract managed by IT department. Mac OS being officially supported by the IT department, a 3rd level support is provided by CERN IT staff; they may give specialized expert assistance, within the scope described at the ITUM-2 presentation, for all incidents or requests which can be neither resolved nor fulfilled by the Service Desk (1st level) and the 2nd level support people. Therefore, users who have problems related to Mac OS should simply fill-in the appropriate form from th...

  13. Managing Highway Maintenance: Budget Preparation, Unit 9, Level 3.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit describes the essential steps in developing a maintenance budget, or performance budget, based on the work to be done. It is designed for field engineers and supervisors who assist department officials in preparing work programs and budgets. The format is a programed,…

  14. 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.

  15. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

    DEFF Research Database (Denmark)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders

    2014-01-01

    OBJECTIVE: To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. DESIGN: Descriptive cross-sectional study using descriptive analyses including t.......30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care...... data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level...

  16. Providing vertical coherence in explanations and promoting reasoning across levels of biological organization when teaching evolution

    Science.gov (United States)

    Jördens, Janina; Asshoff, Roman; Kullmann, Harald; Hammann, Marcus

    2016-04-01

    Students' explanations of biological phenomena are frequently characterized by disconnects between levels and confusion of levels. The purpose of this research is to investigate the effects of a hands-on lab activity that aims at fostering the ability to reason across levels. A total of 197 students (18 years of age) participated in a randomized, pre-post-test design study. Students in the experimental group engaged in a lab activity focused on artificial selection and designed to demonstrate how selection affects both phenotypes and genotypes. In contrast, the lab activity in the comparison group focused on phenotype alone. Data sources for the study included pre-tests of basic concepts in genetics and evolution and two post-test items requiring the students to reproduce and apply their knowledge about artificial selection. The findings indicated that the lab activity which allowed students to explore the interplay between different levels, provided vertical coherence and enhanced students' ability to explain evolutionary change in both reproduction and transfer items. In contrast, the lab activity in the comparison group failed to do so, and most students did not improve their ability to explain evolutionary change. Implications for instruction and recommendations for further research are discussed in light of these findings.

  17. Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico

    Directory of Open Access Journals (Sweden)

    Filipa de Castro

    2016-07-01

    Full Text Available Objective. To provide evidence on perinatal mental healthcare in Mexico. Materials and methods. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Results. Over half (64.0% of units offer mental healthcare; fewer offer perinatal depression (PND detection (37.1% and care (40.3%. More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1% than in Southern (26.5%; 36.4%, Northern (27.3%; 28.1% and Central Mexico (50.0%; 52.7%. Conclusion. Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.      DOI: http://dx.doi.org/10.21149/spm.v58i4.8028

  18. The Health Tourists’ Satisfaction Level of Services Provided: A Cross-Sectional Study in Iran

    Science.gov (United States)

    Varzi, Ali Mohammad; Saki, Koroush; Momeni, Khalil; Vasokolaei, Ghasem Rajabi; Khodakaramifard, Zahra; Zouzani, Morteza Arab; Jalilian, Habib

    2016-01-01

    Introduction: Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015. Method: In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyze the data both descriptive and inferential statistics were used. Results: Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%. Discussion and Conclusion: Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centered issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs. PMID:27157181

  19. Following up infant bronchiolitis patients provided new evidence for and against the united airway disease hypothesis.

    Science.gov (United States)

    Lauhkonen, Eero; Koponen, Petri; Nuolivirta, Kirsi; Helminen, Merja; Paassilta, Marita; Toikka, Jyri; Korppi, Matti

    2016-11-01

    The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months. This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test. Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT. This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Non-Psychiatric Services Provided in a Mental Health Unit in a County Jail.

    Science.gov (United States)

    Young, Diane S.

    2002-01-01

    Examines mental health service provision by social workers in a county jail through a retrospective review of 359 mentally ill jail inmates' health and mental health records. Of the non-psychiatric, mental health services provided beyond initial assessment, housing placement evaluations and follow-up sessions were the most frequent. Suggestions…

  1. Multi-unit Providers Survey. For-profits report decline in acute-care hospitals ... newcomers to top 10.

    Science.gov (United States)

    Bellandi, D; Kirchheimer, B

    1999-05-24

    For-profit hospital systems cleaned house last year. After years of adding hospitals, investor-owned operators shed facilities in 1998, recording the first decline in the number of acute-care hospitals they've owned or managed since 1991, according to our 23rd annual Multi-unit Providers Survey.

  2. Evaluation of Support Provided to Mobilized Army National Guard and U.S. Army Reserve Units

    Science.gov (United States)

    2005-08-05

    with family members. CENTCOM and the Space and Naval Warfare Systems Command have significantly improved access to communications with family as the...contract with Bahrain Maritime and Mercantile International, beginning in August 2002 through December 2003.10 Seven Seas Shiphandlers became the...Switching Network (DSN) • MWR phone banks through the Army and Air Force Exchange System (AAFES) • Internet cafes (provided by the Navy Space and Naval

  3. Ebola Knowledge and Attitudes Among Pediatric Providers Before the First Diagnosed Case in the United States.

    Science.gov (United States)

    Highsmith, Heather Y; Cruz, Andrea T; Guffey, Danielle; Minard, Charles G; Starke, Jeffrey R

    2015-08-01

    The 2014 Ebola virus disease outbreak triggered concerns about health-care worker (HCW) readiness. Two hundred and forty-five HCWs at a children's hospital were surveyed. Knowledge scores were lower for nurses than physicians (50-61%, P = 0.001). Despite HCWs lacking Ebola virus disease knowledge, their perceived lack of institutional preparedness and their own lack of training, most HCWs wanted to believe that they would be safe and were willing to provide care.

  4. The Operational Preparedness of United States Air Force Certified Registered Nurse Anesthetists to Provide Trauma Anesthesia

    Science.gov (United States)

    1999-10-01

    deployed in field hospitals and must be well versed in the management of trauma (Bellamy, 1995 ). To this end, the anesthesia provider needs to be trained...result of aggression encountered during peacekeeping missions such as those recently undertaken. Bellamy ( 1995 ) has shown that ninety percent of combat...Flavel, Brown, Schon, Spiro and Vygotsky . In this model, McAulife states that the best way to learn and instruct others is by a method of case based

  5. [Fetal distress: Information provided by lactate levels and antioxidant status, compared with the Apgar score].

    Science.gov (United States)

    Abessolo, Felix Ovono; Ngou, J P J F Ngou-Mve; Meye, J F; Yangou, Jf Moutsinga; Lemamy, G J J F; Ngou-Milama, E J F

    2009-01-01

    The multitude of criteria used to assess fetal distress and the subjective character of the Apgar score led us to compare the information it provides with that from measurements of lactate and two principal antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx). We measured plasma lactates, SOD, and GPX from the umbilical cord blood of live-born children whose mothers had had at least three prenatal consultations. The correlation of these measurements with the 5-minute Apgar score was tested with the Spearman correlation coefficient. Lactate levels were correlated with the baby's blood glucose (r=0.212; p=0.0084), and GPx activity (r=0.179; p=0.0061), the Apgar score (r=0.258; p=0.001) and the mother's blood glucose (r=0.167; p=0.035). GPx was correlated not only with the lactate level but also with birth weight (r=0.205; p=0.000) and height (r=0.316; p=0.0056), while SOD was correlated only with the mother's blood glucose (r=0.161; p=0.046). In multivariate analysis, followed by stepwise analysis, lactate was the main variable associated with the Apgar score. It thus seems better able to replace the Apgar score than the antioxidant enzyme levels. GPx was higher in children of high birth weight and may make them better able to combat the free radicals due to anoxia or hypoxia.

  6. Level of knowledge about anaphylaxis and its management among health care providers

    Directory of Open Access Journals (Sweden)

    H S Drupad

    2015-01-01

    Full Text Available Objectives: This study was conducted to assess the level of knowledge of health care providers regarding anaphylaxis and its management at a tertiary care teaching hospital. Materials and Methods: A pretested structured questionnaire was administered to interns, MBBS Phase II students, and nursing students. The subjects were asked to answer the questionnaire, which included questions regarding anaphylaxis and its management. Results: Of 265 subjects, 151 (56.9% of subjects answered correctly that adrenaline is the first line of drug for the treatment of anaphylaxis. Among 151 subjects, 40 (26.4% answered the correct dose of adrenaline, of which 25 (16.5% subjects selected intramuscular injection as the most appropriate route of administration. Medical students′ performance was better than interns and nursing students on questions regarding dose, route, and site of adrenaline administration. Conclusion: Knowledge regarding the management of anaphylaxis was inadequate in almost all the health care providers who were included in the study. Improved education and training of health care providers are necessary for better management of anaphylaxis.

  7. The Assessment of Romanian Customers’ Level of Satisfaction with Pharmaceutical Providers

    Directory of Open Access Journals (Sweden)

    Călin Cherecheş Marius

    2015-12-01

    Full Text Available The aim of the current study is to assess the level of satisfaction towards pharmaceutical services among Romanian customers. Moreover, we were interested in building the socio-demographical profile of a Romanian satisfied customer. The study has a transversal design and uses a quantitative approach. Data was collected at the national level in June 2012 by using Computer Assisted Telephone Interviews (CATI and resulted in 1,478 valid questionnaires. Descriptive statistics were performed in order to properly present the sample of interest according to socio-demographic characteristics, as well as general attitudes towards pharmaceutical market. According to our analysis, only half of the respondents have a favorite pharmacy (50,4%. Regarding their level of satisfaction, the majority of respondents (53% declared themselves as being quite satisfied with the pharmacy that they usually collaborate with, whereas 42% of respondents are very satisfied with their favorite pharmacies. According to our analysis, the most satisfied customer has the following socio-demographic characteristics: female (N=351, aged between 56 and 70 years old (N=259, having high school as the highest level of education (N=184, living in an urban area (N=343, having a monthly income of 501-1000 RON (N=217, married (N=396, having no chronic disease (N=312, having a family composed of two members (N=185. Customer’s satisfaction represents a personal evaluation on the pharmaceutical services and providers and is an essential part of the quality of health care. Therefore, it is vital to assess the customer’s expectation and satisfaction in order to ensure the success of the pharmaceutical company.

  8. Customer Satisfaction Survey With Clinical Laboratory and Phlebotomy Services at a Tertiary Care Unit Level

    National Research Council Canada - National Science Library

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-01-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate...

  9. Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers' perceptions.

    Science.gov (United States)

    Okoniewska, Barbara; Santana, Maria Jose; Groshaus, Horacio; Stajkovic, Svetlana; Cowles, Jennifer; Chakrovorty, David; Ghali, William A

    2015-01-01

    The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient's discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers. Health care providers provided comments to a single open-ended question: "What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?" We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process. Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership. While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, "bullet rounds", a condensed form of discharge rounds, were introduced to the medical teaching unit and occurred on a daily basis between the multidisciplinary team. To help facilitate provider-patient communication, electronic transfer of care summaries were suggested as a potential solution. To help role clarity, a discharge coordinator and/or liaison was suggested. Communication can be enhanced through use of electronic discharge summaries, bullet rounds, and implementation of a discharge coordinator(s). The findings from this study can be used to aid future researchers in devising appropriate

  10. Managing Highway Maintenance: Maintenance Activities, Work Units, and Classifying Work, Unit 6, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit explains how maintenance work should be described, measured, and classified. It is designed for supervisors who need to know the mechanics of describing work. The format is a programed, self-instruction approach in which information is presented in progressive segments or…

  11. Can circular dichroism in core-level photoemission provide a spectral fingerprint of adsorbed chiral molecules?

    Energy Technology Data Exchange (ETDEWEB)

    Allegretti, F [Physics Department, University of Warwick, Coventry CV4 7AL (United Kingdom); Polcik, M [Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, D 14195 Berlin (Germany); Sayago, D I [Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, D 14195 Berlin (Germany); Demirors, F [Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, D 14195 Berlin (Germany); O' Brien, S [Physics Department, University of Warwick, Coventry CV4 7AL (United Kingdom); Nisbet, G [Centre for Applied Catalysis, Department of Chemical and Biological Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH (United Kingdom); Lamont, C L A [Centre for Applied Catalysis, Department of Chemical and Biological Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH (United Kingdom); Woodruff, D P [Physics Department, University of Warwick, Coventry CV4 7AL (United Kingdom)

    2005-04-01

    The results of experimental measurements and theoretical simulations of circular dichroism in the angular distribution (CDAD) of photoemission from atomic core levels of each of the enantiomers of a chiral molecule, alanine, adsorbed on Cu(1 1 0) are presented. Measurements in, and out of, substrate mirror planes allow one to distinguish the CDAD due to the chirality of the sample from that due to a chiral experimental geometry. For these studies of oriented chiral molecules, the CDAD is seen not only in photoemission from the molecular chiral centre, but also from other atoms which have chiral geometries as a result of the adsorption. The magnitude of the CDAD due to the sample chirality differs for different adsorption phases of alanine, and for different emission angles and energies, but is generally small compared with CDAD out of the substrate mirror planes which is largely unrelated to the molecular chirality. While similar measurements of other molecules may reveal larger CDAD due to molecular chirality, the fact that the results for one chiral molecule show weak effects means that such CDAD is unlikely to provide a simple and routine general spectral fingerprint of adsorbed molecular chirality.

  12. Measuring relative efficiency of applied science and technology universities in province of Semnan, Iran and providing suggestions for merging units

    Directory of Open Access Journals (Sweden)

    Abolfazl Danaei

    2013-03-01

    Full Text Available University of applied science and technology has been designed to create a platform for multilateral activities such as industrial, military and academic in developing countries to promote science and scientific research applications. These universities are responsible to promote practical training in quantitative and qualitative indicators and they provide appropriate infrastructure to implement theoretical graduates to solve practical problems to build necessary infrastructure to transfer modern technology into developing countries. During the past few years, there have been tremendous development on these units but some of them have not been efficient. In this paper, we present an empirical study to measure the relative efficiencies of various units of applied science and technology universities using data envelopment analysis. The proposed model of this paper uses two inputs including human resources as well as total assets and two outputs including the number of graduate students as well as operating profit. The results of the study have indicated that some of the units are inefficient and need to be merged with other units to increase the relative efficiency of these universities.

  13. Snatch technique of United States national level weightlifters.

    Science.gov (United States)

    Whitehead, Paul N; Schilling, Brian K; Stone, Michael H; Kilgore, J Lon; Chiu, Loren Z F

    2014-03-01

    This study analyzed the top 3 successful snatch attempts by individual lifters in each weight class at a U.S. National Championship weightlifting meet. Two-dimensional (2-D) body position and characteristics of the lifts were compared via 2D video analysis in groups of lifters who displaced forward, showed no displacement, or displaced backward to receive the bar. No significant group differences (p > 0.05) were noted for body mass, bar mass, or hip angle. The rearward displacement group had a significantly greater horizontal distance between the shoulder and heel at the end of the pull (determined as the point where the bar ceases to accelerate vertically). Hip angles for the no displacement group had a small-to-moderate effect size (0.50) in comparison to the forward displacement group, but they only showed a small effect size (0.17) when compared with the rearward displacement group. The forward displacement group showed a small-to-moderate effect size compared with both the no displacement group (0.51) and the rearward displacement group (0.55) concerning the horizontal distance from the shoulder to the heel. These data seem to suggest that rearward displacement in the drop-under phase in the snatch is not detrimental to performance and actually seems to be a preferred technique in U.S. national level lifters. In addition to evidence that rearward displacement is exhibited in elite lifters and is coached globally, it seems this is the preferred technique in international competitions. This technique may be considered a viable variation of the snatch by coaches and athletes of all levels.

  14. Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level

    NARCIS (Netherlands)

    Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, van der G.

    2009-01-01

    OBJECTIVES: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient s

  15. Measuring patient safety culture : an assessment of the clustering of responses at unit level and hospital level

    NARCIS (Netherlands)

    Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, G. van der; Groenewegen, P.P.

    2009-01-01

    Objectives: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient s

  16. Providing Vertical Coherence in Explanations and Promoting Reasoning across Levels of Biological Organization When Teaching Evolution

    Science.gov (United States)

    Jördens, Janina; Asshoff, Roman; Kullmann, Harald; Hammann, Marcus

    2016-01-01

    Students' explanations of biological phenomena are frequently characterized by disconnects between levels and confusion of levels. The purpose of this research is to investigate the effects of a hands-on lab activity that aims at fostering the ability to reason across levels. A total of 197 students (18 years of age) participated in a randomized,…

  17. Geoecology: a county-level environmental data base for the conterminous United States

    Energy Technology Data Exchange (ETDEWEB)

    Olson, R.J.; Emerson, C.J.; Nungesser, M.K.

    1980-09-01

    The Geoecology Data Base represents a unique compilation of computerized environmental data for research and development needs. Environmental assessment and planning for energy development require rapid access to data at appropriate spatial and temporal scales. In the Environmental Sciences Division (ESD) at Oak Ridge National Laboratory (ORNL), we have developed an integrated data base of diverse environmental resource information from extant sources. Data are stored at the county level of resolution for the conterminous United States with some data available for subcounty units within larger, more diverse eastern counties. The Geoecology Data Base contains selected data on terrain and soils, water resources, forestry, vegetation, agriculture, land use, wildlife, air quality, climate, natural areas, and endangered species. Basic files on human population are also included to complement the environmental files. Data are stored in metric-SI units. The Geoecology Data Base is currently fulfilling diverse ongoing research needs while it is being expanded and updated as needs and new data are identified. This report is both a documentation and a user's guide to the Geoecology Data Base. It describes the Data Base design, illustrates applications, provides examples of accessing the Data Base, and gives general information on the data set contents.

  18. Variation in Residential Care Community Nurse and Aide Staffing Levels: United States, 2014.

    Science.gov (United States)

    Rome, Vincent; Harris-Kojetin, Lauren D

    2016-02-19

    This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014. Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level. In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide

  19. Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.

    Science.gov (United States)

    Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen

    2016-04-01

    This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.

  20. Providing the Scientific Backbone for Positive Psychology: A Multi-Level Conception of Human Thriving

    Directory of Open Access Journals (Sweden)

    Kennon M. Sheldon

    2009-12-01

    Full Text Available This article begins with a consideration of what is missing in positive psychology – namely, an integrative framework within which to view the entire person, especially as nested within more-or-less supportive social contexts and cultures. Thus, I presented a multi-level hierarchical framework for considering and explaining human behavior, arguing that all levels of the framework are necessary for complete exposition. From this point of view, personality processes cannot be reduced to "mere" cognitive processes; there are trans-cognitive rules and laws operating at this higher level. I also considered a four level sub-framework within the personality level of analysis, consisting of organismic needs/characteristics, traits/dispositions, goals/intentions, and self/self-narratives. I contended that each of these spheres of the person operates via unique rules and regularities, processes that cannot be reduced to lower levels of analysis (such as biological, neurological, and cognitive levels of analysis. Finally, I described some recent research that simultaneously examines factors at multiple levels of the SLOPIC model, showing that each has influence for predicting SWB, and moreover, that all of these effects are mediated by basic need satisfaction. Hopefully this line of research will prove useful for other positive psychologists seeking "the big picture" on human flourishing.

  1. Antitrust and affiliations among healthcare providers: the need for a level playing field.

    Science.gov (United States)

    Heightchew, A

    1997-01-01

    Under pressure to remain competitive in the rapidly changing healthcare industry, policy leaders and healthcare administrators face the challenge of resolving antitrust matters arising from the creation of innovative healthcare provider affiliations. Although guidance from the Federal Trade Commission (FTC) is available, development of new affiliations is hindered due to contradictory rulings and ambiguous guidelines. Provider associations are further disadvantaged by a federal act granting insurance companies antitrust exemption, which enables insurance companies to affiliate more easily. Current antitrust regulations create unequal market powers, resulting in the development of inefficient systems. Softening antitrust laws in favor of provider-sponsored healthcare affiliations will provide for the flexibility necessary for effective healthcare reform.

  2. Improving the United States airline industry's capacity to provide safe and dignified services to travelers with disabilities: focus group findings.

    Science.gov (United States)

    McCarthy, Michael J

    2011-01-01

    As a component of a training development project for intercity air travel providers, we investigated the capacity of the airline industry to meet the needs of travelers with disabilities by exploring: (1) the level of sensitivity among personnel to travelers' needs, (2) training currently provided, (3) areas in which additional training might be beneficial, and (4) organisational/systems-level commitment to dignified assistance to all travelers. Forty-four airline/vendor employees participated in nine focus groups in four US cities. Groups were audio recorded and transcribed. A grounded-theory approach was used to develop a coding system which was then applied to transcripts to identify themes. Factors influencing capacity grouped broadly into four areas: characteristics of the job/system, characteristics of current training, characteristics of providers themselves, and characteristics of travelers. At an interpersonal level, providers were empathetic and desired to provide dignified services. They lacked training and adequate equipment in some cases, however, and organisational commitment varied between companies. Traveler characteristics were also shown to impact service delivery. Results are promising but additional regulatory and organisational policies are needed to ensure quality services. Providers and consumers of intercity air travel services may benefit from the findings and recommendations of this study.

  3. Global Strategy Implementation at the Business Unit Level: Operational Capabilities and Administrative Mechanisms

    OpenAIRE

    Kendall Roth; David M Schweiger; Allen J Morrison

    1991-01-01

    The study examines the impact of internationally strategy on organizational design and the influence of the organizational design on effectiveness at the business unit level. The empirical findings are based on survey responses from eighty-two business units competing in global industries. The findings are supportive of the contingency notion which suggests that business unit effectiveness is a function of the fit between the international strategy and the organizational design.© 1991 JIBS. J...

  4. Global Strategy Implementation at the Business Unit Level: Operational Capabilities and Administrative Mechanisms

    OpenAIRE

    Kendall Roth; David M Schweiger; Allen J Morrison

    1991-01-01

    The study examines the impact of internationally strategy on organizational design and the influence of the organizational design on effectiveness at the business unit level. The empirical findings are based on survey responses from eighty-two business units competing in global industries. The findings are supportive of the contingency notion which suggests that business unit effectiveness is a function of the fit between the international strategy and the organizational design.© 1991 JIBS. J...

  5. IDENTIFICATION REQUIREMENTS CUSTOMER SERVICE PROVIDED ON THE LEVEL OF LIGHT INDUSTRY COMPANIES

    National Research Council Canada - National Science Library

    MALCOCI Marina; GONCEAR Tatiana

    2015-01-01

    .... Improving customer service is one of the main objectives of production enterprises. Service level directly affects the economic capacity of the enterprise by increasing its contribution in increasing company profits...

  6. Maintenance of CO2 level in a BLSS by controlling solid waste treatment unit

    Science.gov (United States)

    Dong, Yingying; Li, Leyuan; Liu, Hong; Fu, Yuming; Xie, Beizhen; Hu, Dawei; Liu, Dianlei; Dong, Chen; Liu, Guanghui

    A bioregenerative life support system (BLSS) is an artificial closed ecosystem for providing basic human life support for long-duration, far-distance space explorations such as lunar bases. In such a system, the circulation of gases is one of the main factor for realizing a higher closure degree. O2 produced by higher plants goes to humans, as well as microorganisms for the treatment of inedible plant biomass and human wastes; CO2 produced by the crew and microorganisms is provided for plant growth. During this process, an excessively high CO2 level will depress plant growth and may be harmful to human health; and if the CO2 level is too low, plant growth will also be affected. Thus, keeping the balance between CO2 and O2 levels is a crucial problem. In this study, a high-efficiency, controllable solid waste treatment unit is constructed, which adopts microbial fermentation of the mixture of inedible biomass and human wastes. CO2 production during the fermentation process is controlled by adjusting fermentation temperature, aeration rate, moisture, etc., so as to meet the CO2 requirement of plants

  7. An artificial pancreas provided a novel model of blood glucose level variability in beagles.

    Science.gov (United States)

    Munekage, Masaya; Yatabe, Tomoaki; Kitagawa, Hiroyuki; Takezaki, Yuka; Tamura, Takahiko; Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-12-01

    Although the effects on prognosis of blood glucose level variability have gained increasing attention, it is unclear whether blood glucose level variability itself or the manifestation of pathological conditions that worsen prognosis. Then, previous reports have not been published on variability models of perioperative blood glucose levels. The aim of this study is to establish a novel variability model of blood glucose concentration using an artificial pancreas. We maintained six healthy, male beagles. After anesthesia induction, a 20-G venous catheter was inserted in the right femoral vein and an artificial pancreas (STG-22, Nikkiso Co. Ltd., Tokyo, Japan) was connected for continuous blood glucose monitoring and glucose management. After achieving muscle relaxation, total pancreatectomy was performed. After 1 h of stabilization, automatic blood glucose control was initiated using the artificial pancreas. Blood glucose level varied for 8 h, alternating between the target blood glucose values of 170 and 70 mg/dL. Eight hours later, the experiment was concluded. Total pancreatectomy was performed for 62 ± 13 min. Blood glucose swings were achieved 9.8 ± 2.3 times. The average blood glucose level was 128.1 ± 5.1 mg/dL with an SD of 44.6 ± 3.9 mg/dL. The potassium levels after stabilization and at the end of the experiment were 3.5 ± 0.3 and 3.1 ± 0.5 mmol/L, respectively. In conclusion, the results of the present study demonstrated that an artificial pancreas contributed to the establishment of a novel variability model of blood glucose levels in beagles.

  8. L'Economie Francais. Units in Economics for French Classes. Intermediate Level.

    Science.gov (United States)

    Jennings, Carol; And Others

    Four units on the French economy, designed for classroom use at the intermediate level, are related in their educational objectives: to shed light on French culture and strengthen second language skills. Each unit describes its specific objectives, materials, texts, instructional procedures, and student evaluation methods. Sample tests and…

  9. ICT and Europe's productivity performance : Industry-level growth account comparisons with the United States

    NARCIS (Netherlands)

    Inklaar, R.; O'Mahony, M.; Timmer, M.P.

    2005-01-01

    In this paper we present a new industry-level database to analyze sources of growth in four major European countries: France, Germany, Netherlands and the United Kingdom (EU-4), in comparison with the United States for the period 1979-2000. Aggregate labor productivity growth is decomposed into indu

  10. [Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2015-01-01

    Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  11. Comparison of selection methods to deduce natural background levels for groundwater units

    NARCIS (Netherlands)

    Griffioen, J.; Passier, H.F.; Klein, J.

    2008-01-01

    Establishment of natural background levels (NBL) for groundwater is commonly performed to serve as reference when assessing the contamination status of groundwater units. We compare various selection methods to establish NBLs using groundwater quality data forfour hydrogeologically different areas i

  12. Comparison of selection methods to deduce natural background levels for groundwater units

    NARCIS (Netherlands)

    Griffioen, J.; Passier, H.F.; Klein, J.

    2008-01-01

    Establishment of natural background levels (NBL) for groundwater is commonly performed to serve as reference when assessing the contamination status of groundwater units. We compare various selection methods to establish NBLs using groundwater quality data forfour hydrogeologically different areas

  13. Developing advanced units of learning using IMS Learning Design level B

    NARCIS (Netherlands)

    Koper, Rob; Burgos, Daniel

    2005-01-01

    Please cite the original publication: Koper, R., Burgos, D. (2005). Developing advanced units of learning using IMS Learning Design level B. International Journal on Advanced Technology for Learning, 2 (4), 252-259.

  14. Variations in levels of care within a hospital provided to acute ...

    African Journals Online (AJOL)

    and given a quality rating out of five levels ranging from excellent to incomplete. Points were ... porters unaccompanied by medical staff in 3 cases. One patient .... must be completed and stuck onto the patient's file would force staff to formally ...

  15. Evaluation of Chosen Cytokine Levels among Patients with Herpes Zoster as Ability to Provide Immune Response.

    Directory of Open Access Journals (Sweden)

    Agata Zajkowska

    Full Text Available Herpes zoster is a viral disease caused by the reactivation of varicella-zoster virus (VZV which remained latent in the cranial nerve or dorsal root ganglia. Cell-mediated immunity is known to decline with age as part of immunosenescence and can lead to the reactivation of VZV. Whereas herpes zoster is usually mild in healthy young persons, older patients are at increased risk for complications. In the present study we investigated the serum cytokine profile (IL-17, IL-23, IL-21, IL-4, IL-12, representing cellular and humoral immunity and assessed the level of VZV IgG antibodies in patients with herpes zoster.We investigated the serum concentrations of IL-17, IL-23, IL-21, IL-4, IL-12 and the level of VZV IgG antibodies in 23 patients with herpes zoster who did not develop superinfection. The control group was represented by 21 individuals in similar age with no inflammatory and infectious diseases. Cytokine and antibodies levels were measured by ELISA method. Statistical analysis was performed using the ROC curve (receiver operating characteristic, t-test, Welch's t-test, and nonparametric tests with STATISTICA 10 software.In patients with herpes zoster, the serum level of IL-17, IL-23, IL-21, IL-4 and IL-12 as well as VZV IgG antibodies titer were statistically significantly increased compared to control group.Our results confirm the broad activation of the immune system involving humoral and cell-mediated immunity.

  16. Long-chain omega-3 from low-trophic-level fish provides value to farmed seafood.

    Science.gov (United States)

    Bibus, Douglas M

    2015-03-01

    Low-trophic-level fish are a crucial source of long-chain (LC) omega-3 fatty acids for farmed fish and humans. Many farm-raised fish species have a clear need for these nutrients. Farmed fish deposit the LC omega-3s in their flesh and transfer them up the food chain. However, the content of LC omega-3s in farm-raised seafood continues to decline, while the content of shorter-chain plant-sourced omega-3s, and pro-inflammtory omega-6s continue to increase. This reduces its nutritional worth. The value of low-trophic-level fish is often viewed merely as its price at the dock. Some reports and metrics steer public attention towards the mass balance between quantities of low-trophic-level fish and farmed seafood. However, the the nutritional value of seafood is more important than its mere quantities. The role of low-trophic-level fish in human nutrition, health, and wellbeing is a fundamental component of its economic value to society.

  17. COMPARISON OF NOVORONEZH UNIT 5 NPP AND SOUTH UKRAINE UNIT 1 NPP LEVEL I PRA RESULTS.

    Energy Technology Data Exchange (ETDEWEB)

    MUSICKI,Z.; GINSBERG,T.

    2002-04-18

    This paper describes a study undertaken to explain the risk profile differences in the results of PRAs of two similar WER-1000 nuclear power plants. The risk profile differences are particularly significant in the area of small steam/feedwater line breaks, small-small LOCAs, support system initiators and containment bypass initiators. A top level (limited depth) approach was used in which we studied design differences, major assumptions, data differences, and also compared the two PRA analyses on an element-by-element basis in order to discern the major causative factors for the risk profile differences. We conclude that the major risk profile differences are due to differences in assumptions and engineering judgment (possibly combined with some design and data differences) involved in treatment of uncertain physical phenomena (primarily sump plugging in LOCAs and turbine building steaming effects in secondary system breaks). Additional major differences are attributable to support system characteristics.

  18. Providing Student Opportunities to Respond in Reading and Mathematics: A Look across Grade Levels

    Science.gov (United States)

    Whitney, Todd; Cooper, Justin T.; Lingo, Amy S.

    2015-01-01

    The evidence for providing sufficient opportunities for students to respond has been established in terms of student engagement and achievement in reading and mathematics. Although supported by research, the question remains whether teachers are incorporating this effective practice in their classroom instruction. This study examines the analysis…

  19. Use of Flumazenil to Provide Adequate Recovery Time Post-Midazolom Infusion in a General Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    MOJTABA MOJTAHEDZADEH

    1999-08-01

    Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.

  20. Evaluation of Chosen Cytokine Levels among Patients with Herpes Zoster as Ability to Provide Immune Response

    Science.gov (United States)

    Zajkowska, Agata; Garkowski, Adam; Świerzbińska, Renata; Kułakowska, Alina; Król, Monika Emilia; Ptaszyńska-Sarosiek, Iwona; Nowicka-Ciełuszecka, Anna; Pancewicz, Sławomir; Czupryna, Piotr; Moniuszko, Anna; Zajkowska, Joanna

    2016-01-01

    Aim and Background Herpes zoster is a viral disease caused by the reactivation of varicella–zoster virus (VZV) which remained latent in the cranial nerve or dorsal root ganglia. Cell-mediated immunity is known to decline with age as part of immunosenescence and can lead to the reactivation of VZV. Whereas herpes zoster is usually mild in healthy young persons, older patients are at increased risk for complications. In the present study we investigated the serum cytokine profile (IL-17, IL-23, IL-21, IL-4, IL-12), representing cellular and humoral immunity and assessed the level of VZV IgG antibodies in patients with herpes zoster. Methods We investigated the serum concentrations of IL-17, IL-23, IL-21, IL-4, IL-12 and the level of VZV IgG antibodies in 23 patients with herpes zoster who did not develop superinfection. The control group was represented by 21 individuals in similar age with no inflammatory and infectious diseases. Cytokine and antibodies levels were measured by ELISA method. Statistical analysis was performed using the ROC curve (receiver operating characteristic), t-test, Welch’s t-test, and nonparametric tests with STATISTICA 10 software. Results In patients with herpes zoster, the serum level of IL-17, IL-23, IL-21, IL-4 and IL-12 as well as VZV IgG antibodies titer were statistically significantly increased compared to control group. Conclusion Our results confirm the broad activation of the immune system involving humoral and cell-mediated immunity. PMID:26934574

  1. IDENTIFICATION REQUIREMENTS CUSTOMER SERVICE PROVIDED ON THE LEVEL OF LIGHT INDUSTRY COMPANIES

    Directory of Open Access Journals (Sweden)

    MALCOCI Marina

    2015-05-01

    Full Text Available Moldova is a small country whose territory is 350 km from north to south and 150 km from West to East. Analyzing data from the Statistical Yearbook 2012 shows that 437 enterprises were active dealing with textiles, footwear etc., from 2005 - only 310 companies. Motivation is the business of an assured market, the demand for products and services - volume and structure - which manifests itself on the domestic and foreign markets. Improving customer service is one of the main objectives of production enterprises. Service level directly affects the economic capacity of the enterprise by increasing its contribution in increasing company profits. Increasing the level of service in shops can be determined by reducing factors that negatively influence the desire to purchase, ie ,, eyes scan "; lengthy speech to the seller on the phone; excessive attention to the buyer; arrogant and indifferent gaze of the seller. As a tool for gathering information served questionnaire that was distributed to 50 respondents, which ranks in the age group: 18-27 years with urban living environment. The questionnaire included questions that allow to analyze the efficiency of customer service and the factors influencing the decision to purchase in local shops in the field of Light Industry. The paper identified measures to increase the level of customer service, which would help to increase sales.

  2. Evaluation of the Level of Food Safety Protection Provided by the U.S. Grade "A" Pasteurized Milk Ordinance and Its Associated Cooperative Grade "A" Milk Safety Program.

    Science.gov (United States)

    Ma, Yinqing; Klontz, Karl C; DiNovi, Michael J; Edwards, Alison J; Hennes, Robert F

    2015-08-01

    The present study was conducted to evaluate the level of food safety protection provided to consumers of Grade "A" milk and milk products in the United States by the National Conference on Interstate Milk Shipments (NCIMS) Grade "A" Milk Safety Program through its implementation and enforcement of the U.S. Grade "A" Pasteurized Milk Ordinance (PMO). The number of reported illnesses associated with Grade "A" milk and milk products in the United States was obtained from state and federal agencies and published articles. The consumption of Grade "A" milk and milk products in the United States was estimated from food consumption survey data for individuals. The level of food safety protection was measured quantitatively using the metric of annual illness attack rate. During a 15-year period (1999 through 2013), the estimated annual illness attack rate was 0.41 reported illnesses per 1 billion exposures (estimated using person-day intake data) or 0.52 reported illnesses per 1 billion lb (454 million kg) of Grade "A" milk and milk products consumed. Food safety protection provided to consumers of Grade "A" milk and milk products by the NCIMS through its implementation and enforcement of the PMO is important given the common consumption of Grade "A" milk and milk products in the United States.

  3. Guidebook for Providing Economic Assistance at the Tactical Level During Stability Operations

    Science.gov (United States)

    2009-01-01

    updated annually and can be purchased directly from the World Bank through the inter- net site at http://publications.worldbank.org/ ecommerce /catalog...publications.worldbank.org/ ecommerce /catalog/product?item_id=5363808. CIA’s • World Factbook, available at https://www.cia.gov/library/publications/the-world... ecommerce / catalog/product?item_id=5363808.) International Monetary Fund, • Balance of Payments Statistics Yearbook, annual. (This doc- ument provides

  4. Adaptation to Sea Level Rise in Coastal Units of the National Park Service (Invited)

    Science.gov (United States)

    Beavers, R. L.

    2010-12-01

    83 National Park Service (NPS) units contain nearly 12,000 miles of coastal, estuarine and Great Lakes shoreline and their associated resources. Iconic natural features exist along active shorelines in NPS units, including, e.g., Cape Cod, Padre Island, Hawaii Volcanoes, and the Everglades. Iconic cultural resources managed by NPS include the Cape Hatteras Lighthouse, Fort Sumter, the Golden Gate, and heiaus and fish traps along the coast of Hawaii. Impacts anticipated from sea level rise include inundation and flooding of beaches and low lying marshes, shoreline erosion of coastal areas, and saltwater intrusion into the water table. These impacts and other coastal hazards will threaten park beaches, marshes, and other resources and values; alter the viability of coastal roads; and require the NPS to re-evaluate the financial, safety, and environmental implications of maintaining current projects and implementing future projects in ocean and coastal parks in the context of sea level rise. Coastal erosion will increase as sea levels rise. Barrier islands along the coast of Louisiana and North Carolina may have already passed the threshold for maintaining island integrity in any scenario of sea level rise (U.S. Climate Change Science Program Synthesis and Assessment Program Report 4.1). Consequently, sea level rise is expected to hasten the disappearance of historic coastal villages, coastal wetlands, forests, and beaches, and threaten coastal roads, homes, and businesses. While sea level is rising in most coastal parks, some parks are experiencing lower water levels due to isostatic rebound and lower lake levels. NPS funded a Coastal Vulnerability Project to evaluate the physical and geologic factors affecting 25 coastal parks. The USGS Open File Reports for each park are available at http://woodshole.er.usgs.gov/project-pages/. These reports were designed to inform park planning efforts. NPS conducted a Storm Vulnerability Project to provide ocean and coastal

  5. Sea Levels Online: Sea Level Variations of the United States Derived from National Water Level Observation Network Stations

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Water level records are a combination of the fluctuations of the ocean and the vertical land motion at the location of the station. Monthly mean sea level (MSL)...

  6. Low-level radioactive waste disposal in the United States: An overview of current commercial regulations and concepts

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, W.E. Jr.

    1993-08-01

    Commercial low-level radioactive waste disposal in the United States is regulated by the US Nuclear Regulatory Commission (NRC) under 10 CFR 61 (1991). This regulation was issued in 1981 after a lengthy and thorough development process that considered the radionuclide concentrations and characteristics associated with commercial low-level radioactive waste streams; alternatives for waste classification; alternative technologies for low-level radioactive waste disposal; and data, modeling, and scenario analyses. The development process also included the publication of both draft and final environmental impact statements. The final regulation describes the general provisions; licenses; performance objectives; technical requirements for land disposal; financial assurances; participation by state governments and Indian tribes; and records, reports, tests, and inspections. This paper provides an overview of, and tutorial on, current commercial low-level radioactive waste disposal regulations in the United States.

  7. Noise level in intensive care units of a public university hospital in Santa Marta (Colombia).

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2016-10-01

    To evaluate the noise level in adult, pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta (Colombia). A descriptive, observational, non-interventional study with follow-up over time was carried out. Continuous sampling was conducted for 20 days for each unit using a type i sound level meter, filter frequency in A weighting and Fast mode. We recorded the maximum values, the 90th percentile as background noise, and the continuous noise level. The mean hourly levels in the adult unit varied between 57.40±1.14-63.47±2.13dBA, with a maximum between 71.55±2.32-77.22±1.94dBA, and a background noise between 53.51±1.16-60.26±2.10dBA; in the pediatric unit the mean hourly levels varied between 57.07±3.07-65.72±2.46dBA, with a maximum of 68.69±3.57-79.06±2.34dBA, and a background noise between 53.33±3.54-61.96±2.85dBA; the neonatal unit in turn presented mean hourly values between 59.54±2.41-65.33±1.77dBA, with a maximum value between 67.20±2.13-77.65±3.74dBA, and a background noise between 55.02±2.03-58.70±1.95dBA. Analysis of variance revealed a significant difference between the hourly values and between the different units, with the time of day exhibiting a greater influence. The type of unit affects the noise levels in intensive care units, the pediatric unit showing the highest values and the adult unit the lowest values. However, the parameter exerting the greatest influence upon noise level is the time of day, with higher levels in the morning and evening, and lower levels at night and in the early morning. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  8. The Levels of Decision Making in Multi-Unit Community College Systems.

    Science.gov (United States)

    Henry, Thomas C.; Creswell, John W.

    1983-01-01

    Describes a survey of 33 multi-unit community colleges designed to determine the relationship between (1) the levels at which decisions were made in nine selected areas; (2) institutional size and history; and (3) the number of system-level personnel. Discusses the implications of the findings for practice. (AYC)

  9. Teaching at the University Level: Cross-Cultural Perspectives from the United States and Russia

    Science.gov (United States)

    Wiseman, Dennis G.; Hunt, Gilbert H.; Zhukov, Vassiliy I.; Mardahaev, Lev V.

    2007-01-01

    Interest in what constitutes effective teaching in Pre-K-12 and higher education is nearly universal. This important text explores this interest at the college and university level from a unique, international perspective. "Teaching at the University Level: Cross-Cultural Perspectives from the United States and Russia" brings to one…

  10. The Levels of Decision Making in Multi-Unit Community College Systems.

    Science.gov (United States)

    Henry, Thomas C.; Creswell, John W.

    1983-01-01

    Describes a survey of 33 multi-unit community colleges designed to determine the relationship between (1) the levels at which decisions were made in nine selected areas; (2) institutional size and history; and (3) the number of system-level personnel. Discusses the implications of the findings for practice. (AYC)

  11. An Analysis of Grades, Class Level and Faculty Evaluation Scores in the United Arab Emirates

    Science.gov (United States)

    Waller, Lee

    2016-01-01

    This study examined the results of a student evaluation of faculty against the grades awarded and the level of the course for a higher education institution in the United Arab Emirates. The purpose of the study was to determine if the grades awarded in the course and/or level of the course impacted the evaluation scores awarded to the faculty…

  12. Research Needs Assessment in the Health Insurance Organization: Level of Health Care Provider

    Directory of Open Access Journals (Sweden)

    Mohammadkarim Bahadori

    2011-12-01

    Full Text Available Objective: Setting research priorities in the research management cycle is a key. It is important to set the research priorities to make optimal use of scarce resources. The aim of this research was to determine the research needs of Health Insurance Organization based on its health care centers research needs.Methods: This is a qualitative, descriptive and cross-sectional study that was conducted in 2011. A purposeful sample of 60 participants from 14 hospitals, seven dispensaries, five dental clinics, two rehabilitation centers, four radiology centers, six medical diagnostic laboratories, 12 pharmacies, and 20 medical offices that were contracted with the Health Insurance Organization in Iran was interviewed. The framework analysis method (a qualitative research method was used for analysis of interviews. Atlas-Ti software was used to analyze quantitative data, respectively. The topics were prioritized using the Analytical Hierarchy Process (AHP method through Expert Choice software.Results: Based on the problems extracted in our qualitative study, 12 research topics were proposed by the experts. Among these “Design of standard treatment protocols,” “Designing model of ranking the health care centers under contract,” and “Pathology of payment system” took the priority ranks of 1 to 3, earning the scores of 0.44, 0.42, and 0.37, respectively.Conclusion: Considering limited resources and unlimited needs and to prevent research resource wasting, conducting research related to health care providers in the Health Insurance Organization can help it achieve its goals.

  13. Nurse manager perspective of staff participation in unit level shared governance.

    Science.gov (United States)

    Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J

    2017-08-30

    To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.

  14. Experiences of health care providers managing sexual assault victims in the emergency unit Part 1: Background and methodology

    Directory of Open Access Journals (Sweden)

    Rebecca M. Skhosana

    2009-04-01

    Full Text Available

    The objective of  this  study was  to  explore  and describe  the  experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the  Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select participants from health care providers who were working in the emergency unit and had managed more than four sexual assault victims. Data were collected by means of individual interviews and analysed according to the Tesch method of data analysis by the researcher and the independent co-coder.

    Main categories, subcategories and themes were identified. Participants expressed their emotions, challenges and police attitudes and behaviours as well as  inconsistencies in guidelines and needs identification. It was recommended that members of the multidisciplinary team engage in community activities and that the community participate  in matters pertaining to sexual assault. Government should develop  clear guidelines  that are applicable  to  rural and urban South Africa. Health  care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents.

     

    Opsomming:

    Die doel van hierdie studie was om die ervaringe van gesondheidsorgverskaffers wat slagoffers van seksuele aanranding in die

  15. Are Productivity Levels Higher in Some European Countries than in the United States?

    OpenAIRE

    Gilbert Cette

    2005-01-01

    Estimates produced by the OECD indicate that labour productivity levels are higher in a number of European countries than in the United States, implying that Europe and not the United States is the world technological leader. The author argues that a structural measure of labour productivity, closer to a measure of technical efficiency, would take into account the much lower employment rates and hours of work in Europe. Low employment rates reflect the exclusion of certain low-porductivity gr...

  16. Assessing the level of healthcare information technology adoption in the United States: a snapshot

    Directory of Open Access Journals (Sweden)

    Middleton Blackford

    2006-01-01

    Full Text Available Abstract Background Comprehensive knowledge about the level of healthcare information technology (HIT adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. Methods We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. Results Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. Conclusion Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.

  17. Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients

    Science.gov (United States)

    Obara, Vitor Yuzo; Zacas, Carolina Petrus; Carrilho, Claudia Maria Dantas de Maio; Delfino, Vinicius Daher Alvares

    2016-01-01

    Objective This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients. Methods A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours. Results Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023). Conclusion Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged. PMID:28099635

  18. The geographic distribution of eye care providers in the United States: Implications for a national strategy to improve vision health.

    Science.gov (United States)

    Gibson, Diane M

    2015-04-01

    To describe the patterns of local eye care provider availability in the US. Data from 2011 on the number of ophthalmologists and optometrists in each of the 3143 counties in the US were drawn from the Area Health Resources File. Population-weighted quartiles of the county-level number of ophthalmologists per capita and the county-level number of optometrists per capita were defined. Descriptive statistics were calculated and a cross tabulation of quartiles of ophthalmologist availability and quartiles of optometrist availability was conducted for all the counties in the US and for the set of counties in each region of the US. 24.0% of US counties had no ophthalmologists or optometrists. 60.7% of counties in the US were in one of the lower two quartiles of both ophthalmologist availability and optometrist availability, and 24.1% of counties were in one of the lower two quartiles of ophthalmologist availability but in one of the upper two quartiles of optometrist availability. Public health interventions that are effective in a context of limited local eye care provider availability or that are able to leverage optometrist availability effectively in areas with limited ophthalmologist availability could be of widespread use in the US. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Reforming state-level chemicals management policies in the United States: status, challenges, and opportunities.

    Science.gov (United States)

    Geiser, Ken; Tickner, Joel; Torrie, Yve

    2009-01-01

    During the last several years there has been increasing public concern about chemicals in everyday products. Scientific studies are increasingly revealing the build-up of some substances in ecosystems and in our bodies and new findings are linking exposures to hazardous chemicals to a range of adverse human health effects. Despite these trends, there has been little federal initiative in the United States on reforming chemicals management policies for well over two decades, even though a variety of analyses have identified significant gaps in the regulatory structure. As has historically been the case, states are beginning to fill the holes in federal leadership. This article explores this emerging state leadership and establishes a vision for and elements of policies to reduce hazardous chemicals in the products we buy and the places we go. It examines international efforts to reform chemicals management policies, such as the European REACH legislation and corporate leadership in advancing safer products. Finally, it outlines specific challenges states face in developing integrated, comprehensive chemicals management policies. We conclude that while there are plenty of challenges to implementation of chemicals policy reforms, it is a propitious time for states to become leaders in policy innovation that can help achieve safer production systems and products for future generations. This article is part of a Lowell Center for Sustainable Production report entitled "Options for State Chemicals Policy Reform" that provides in-depth analysis of the pros and cons of policy options to address a range of aspects of state-level chemicals policy reform. The article has been edited slightly for use in New Solutions. The report has been widely distributed to policy-makers, advocates, and others across the United States.

  20. Factors Associated with Comfort Level of School-Based Occupational Therapists in Providing Low-Vision Services.

    Science.gov (United States)

    Workman, Melissa; Vogtle, Laura K; Yuen, Hon K

    2016-01-01

    This study identified factors associated with the comfort level of school-based occupational therapists in providing services to children with visual impairments. Sixty-one school-based occupational therapists completed an on-line survey. Fifty-four percent of respondents were comfortable or somewhat comfortable when choosing assessments and 84% were comfortable or somewhat comfortable in providing occupational therapy services for children with visual impairments. Multivariable linear regression analyses indicated years of professional experience, history of a caseload of children with visual impairments, and training received in treating children with visual impairments from continuing education were uniquely and significantly associated with the respondents' comfort level. Though not included in the final model, collaboration with other low vision service providers (e.g., teachers, optometrists, ophthalmologists, and orientation/mobility specialists) was also significantly associated with respondents' comfort level in the univariate analysis. Findings provide an initial direction and strategies to improve occupational therapists' comfort level in providing services to children with visual impairments in school settings.

  1. Final environmental assessment : Using livestock grazing as a management tool to provide quality wildlife habitat : Silver Dollar Habitat Unit

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This final environmental assessment is for the use of livestock grazing to improve the quality of wildlife habitats within the Silver Dollar Habitat Unit on Charles...

  2. Measuring and managing the work environment of the mid-level provider – the neglected human resource

    Directory of Open Access Journals (Sweden)

    McAuliffe Eilish

    2009-02-01

    Full Text Available Abstract Background Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years. Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries. Methods Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction. Findings The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: (1 levels of staffing and resources; (2 management support; (3 workplace relationships; and (4 control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession

  3. Network Physics anounces first product to provide business-level management of the most complex and dynamic networks

    CERN Multimedia

    2003-01-01

    Network Physics, provider of business-level, traffic flow-based network management solutions, today announced the introduction of the Network Physics NP/BizFlow-1000. With the NP/BizFlow-1000, Fortune 1000 companies with complex and dynamic networks can analyze the flows that link business groups, critical applications, and network software and hardware (1 page).

  4. THE INFORMATION CONTENT OF THE FARM AND UNIT LEVEL NUTRIENT BALANCES FOR THE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    T SOMOGYI

    2007-07-01

    Full Text Available The farm gate balance is well known from the environmental literature. This method is not suitable in every case to show the nutrient load for the environment of agricultural companies that is the reason why unit level internal nutrient balances are applied to express the level of nutrient pollution on the environment. These also help to determine the source of the pollution. With the survey of the nutrient flows within the farm we determine the keystones of nutrient management to control the nutrient load of the pollution sources. On the basis of the results and the controlled data of the unit level internal balances we make recommendations for the most appropriate environmental policy instrument to reduce the nutrient pollution.

  5. Evaluation of vitamin D level in patients from neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon

    2013-01-01

    Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

  6. Lead, Allergen, and Pesticide Levels in Licensed Child Care Centers in the United States

    Science.gov (United States)

    The First National Environmental Health Survey of Child Care Centers was conducted to provide information about lead, allergens, and pesticide levels in licensed U.S. child care centers. Lead levels were measured in settled dust, paint, and play area soil; indoor allergen levels ...

  7. Managerial modes of influence and counterproductivity in organizations: a longitudinal business-unit-level investigation.

    Science.gov (United States)

    Detert, James R; Treviño, Linda K; Burris, Ethan R; Andiappan, Meena

    2007-07-01

    The authors studied the effect of 3 modes of managerial influence (managerial oversight, ethical leadership, and abusive supervision) on counterproductivity, which was conceptualized as a unit-level outcome that reflects the existence of a variety of intentional and unintentional harmful employee behaviors in the unit. Counterproductivity was represented by an objective measure of food loss in a longitudinal study of 265 restaurants. After prior food loss and alternative explanations (e.g., turnover, training, neighborhood income) were controlled for, results indicated that managerial oversight and abusive supervision significantly influenced counterproductivity in the following periods, whereas ethical leadership did not. Counterproductivity was also found to be negatively related to both restaurant profitability and customer satisfaction in the same period and to mediate indirect relationships between managerial influences and distal unit outcomes.

  8. A Mathematical Model of Metabolism and Regulation Provides a Systems-Level View of How Escherichia coli Responds to Oxygen

    Directory of Open Access Journals (Sweden)

    Michael eEderer

    2014-03-01

    Full Text Available The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon and redox metabolism. The measurement of transcript levels, metabolite concentrations and metabolic fluxes per se gives an incomplete picture. An appreciation of the interdependencies between the different measurement values is essential for systems-level understanding. Mathematical modeling has the potential to provide a coherent and quantitative description of the interplay between gene expression, metabolite concentrations and metabolic fluxes. Escherichia coli undergoes major adaptations in central metabolism when the availability of oxygen changes. Thus, an integrated description of the oxygen response provides a benchmark of our understanding of carbon, energy and redox metabolism. We present the first comprehensive model of the central metabolism of E. coli that describes steady-state metabolism at different levels of oxygen availability. Variables of the model are metabolite concentrations, gene expression levels, transcription factor activities, metabolic fluxes and biomass concentration. We analyze the model with respect to the production capabilities of central metabolism of E. coli. In particular, we predict how precursor and biomass concentration are affected by product formation.

  9. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016.

    Science.gov (United States)

    Oduyebo, Titilope; Igbinosa, Irogue; Petersen, Emily E; Polen, Kara N D; Pillai, Satish K; Ailes, Elizabeth C; Villanueva, Julie M; Newsome, Kim; Fischer, Marc; Gupta, Priya M; Powers, Ann M; Lampe, Margaret; Hills, Susan; Arnold, Kathryn E; Rose, Laura E; Shapiro-Mendoza, Carrie K; Beard, Charles B; Muñoz, Jorge L; Rao, Carol Y; Meaney-Delman, Dana; Jamieson, Denise J; Honein, Margaret A

    2016-07-25

    CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(†) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks

  10. Impact of Climate Change on Ambient Ozone Level and Mortality in Southeastern United States

    OpenAIRE

    Montserrat Fuentes; Chang, Howard H.; Jingwen Zhou

    2010-01-01

    There is a growing interest in quantifying the health impacts of climate change. This paper examines the risks of future ozone levels on non-accidental mortality across 19 urban communities in Southeastern United States. We present a modeling framework that integrates data from climate model outputs, historical meteorology and ozone observations, and a health surveillance database. We first modeled present-day relationships between observed maximum daily 8-hour average ozone concentrations an...

  11. Family participation during intensive care unit rounds: goals and expectations of parents and health care providers in a tertiary pediatric intensive care unit.

    Science.gov (United States)

    Stickney, Carolyn A; Ziniel, Sonja I; Brett, Molly S; Truog, Robert D

    2014-12-01

    To compare perceptions, goals, and expectations of health care providers and parents regarding parental participation in morning rounds and target specific areas of opportunity for educational interventions. Semistructured interviews of parents and focus groups of health care providers to learn about their experiences in, goals for, and perceived barriers to successful parental participation in morning rounds. Qualitative methods were used to analyze interview and focus group transcripts. Parents (n = 21) and health care providers (n = 24) participated in interviews and focus groups, respectively. Analyses revealed key areas of agreement between providers and parents regarding goals for rounds when parents are present, including helping parents achieve an understanding of the child's current status and plan of care. Providers and parents disagreed, however, about the nature of opportunities to ask questions. Parents additionally reported a strong desire to provide expert advice about their children and expected transparency from their care team, while providers stated that parental presence sometimes hindered frank discussions and education. Some agreement in goals for parent participation in morning rounds exists, although there are opportunities to calibrate expectations for both parents and health care providers. Solutions may involve a protocol for orienting parents to morning rounds, focusing on improving communication with parents outside of morning rounds, and the preservation of a forum for providers to have private discussions as a team. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Effects of sea level rise on economy of the United States

    OpenAIRE

    Novackova, Monika; Tol, Richard,

    2017-01-01

    We report the first ex post study of the economic impact of sea level rise. We apply two econometric approaches to estimate the past effects of sea level rise on the economy of the USA, viz. Barro type growth regressions adjusted for spatial patterns and a matching estimator. Unit of analysis is 3063 counties of the USA. We fit growth regressions for 13 time periods and we estimated numerous varieties and robustness tests for both growth regressions and matching estimator. Although there is s...

  13. Inadequate prenatal care and elevated blood lead levels among children born in Providence, Rhode Island: a population-based study.

    Science.gov (United States)

    Greene, Anna; Morello-Frosch, Rachel; Shenassa, Edmond D

    2006-01-01

    This study was conducted to determine whether children born to mothers receiving inadequate prenatal care are at an increased risk for having an elevated blood lead level during early childhood. The authors conducted a population-based study of children born in Providence, Rhode Island, from 1997 to 2001 whose mothers had received adequate, intermediate, or inadequate prenatal care. The children's blood lead levels were compared between groups using bivariate and logistic regression. To understand the regulatory implications and public health impact of changing the definition of an elevated blood lead level, "elevated" was defined as 5 microg/dL, 10 microg/dL, and 15 microg/dL. Children born to mothers who received inadequate prenatal care were at an elevated risk for having an elevated blood lead level later in life. This relationship remained statistically significant for each definition of elevated blood lead level and after controlling for other socio-economic status measures and birthweight (at 5 microg/dL, odds ratio [OR] = 1.36, 95% confidence interval [CI] 1.09, 1.68, p = 0.006; at 10 microg/dL, OR = 1.68, 95% CI 1.26, 2.24, p prenatal care provision could help identify women possibly experiencing ongoing lead exposure and help reduce or prevent exposures to their offspring.

  14. An Examination of the Relationship between Acculturation Level and PTSD among Central American Immigrants in the United States

    Science.gov (United States)

    Sankey, Sarita Marie

    2010-01-01

    The purpose of this study was to examine the relationship between acculturation level and posttraumatic stress disorder (PTSD) prevalence in Central American immigrants in the United States. Central American immigrants represent a population that is a part of the Latino/Hispanic Diaspora in the United States. By the year 2050 the United States…

  15. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries - United States, 2014.

    Science.gov (United States)

    Luo, Feijun; Florence, Curtis

    2017-01-13

    Injury-associated deaths have substantial economic consequences in the United States. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 were $214 billion (1). In 2014, unintentional injury, suicide, and homicide (the fourth, tenth, and seventeenth leading causes of death, respectively) accounted for 194,635 deaths in the United States (2). In 2014, a total of 199,756 fatal injuries occurred in the United States, and the associated lifetime medical and work-loss costs were $227 billion (3). This report examines the state-level economic burdens of fatal injuries by extending a previous national-level study (1). Numbers and rates of fatal injuries, lifetime costs, and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for four injury intent categories (all intents, unintentional, suicide, and homicide). During 2014, injury mortality rates and economic burdens varied widely among the states and DC. Among fatal injuries of all intents, the mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 per 100,000 and $491 (New York). States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas.

  16. Mendelian randomization provides no evidence for a causal role of serum urate in increasing serum triglyceride levels.

    Science.gov (United States)

    Rasheed, Humaira; Hughes, Kim; Flynn, Tanya J; Merriman, Tony R

    2014-12-01

    Triglycerides and their lipoprotein transport molecules are risk factors for heart disease. Observational studies have associated elevated levels of serum urate (SU) with triglycerides and risk of heart disease. However, owing to unmeasured confounding, observational studies do not provide insight into the causal relationship between SU and triglyceride. The aim of this study was to test for a causal role of SU in increasing triglyceride using Mendelian randomization that accounts for unmeasured confounding. Subjects were of European ancestry from the atherosclerosis risk in communities (n=5237) and Framingham heart (n=2971) studies. Mendelian randomization by the 2-stage least squares regression method was done with SU as the exposure, a uric acid transporter genetic risk score as instrumental variable, and triglyceride as the outcome. In ordinary linear regression, SU was significantly associated with triglyceride levels (β=2.69 mmol/L change in triglyceride per mmol/L increase in SU). However, Mendelian randomization-based estimation showed no evidence for a direct causal association of SU with triglyceride concentration-there was a nonsignificant 1.01 mmol/L decrease in triglyceride per mmol/L increase in SU attributable to the genetic risk score (P=0.21). The reverse analysis using a triglyceride genetic risk score provided evidence of a causal role for triglyceride in raising urate in men (P(Corrected)=0.018). These data provide no evidence for a causal role for SU in raising triglyceride levels, consistent with a previous Mendelian randomization report of no association between SU and ischemic heart disease. © 2014 American Heart Association, Inc.

  17. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures.

    Science.gov (United States)

    Chaudoir, Stephenie R; Dugan, Alicia G; Barr, Colin H I

    2013-02-17

    Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles. We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation-related constructs in their ongoing and

  18. [Initiation to military medical corps activity modalities: a teaching unit providing a new approach to recruiting reserve pharmacists].

    Science.gov (United States)

    Labrude, P

    2004-07-01

    During the last ten Years, major reforms have been implemented in the French armies due to discontinuation of mandatory enlistment. For the medical corps, recruitment and training for reservists has ceased since the national school for reserve officers in Libourne was closed. During this same time, the number of foreign engagements of the French armies has revealed the need for available young reserve officers in the medical corps. Reserve training of students in medicine, pharmacy, odontology, or nursing has been considered and different possibilities considered. One option is to develop a teaching unit during the third Year of the curriculum allowing volunteer students to become junior officers. For pharmacy students, specific training on drug supply, nuclear, biological and chemical weapons and terrorism as well as clinical chemistry, toxicology, and hygiene are also organized.

  19. Position Paper. Safety for K-12 students: United States policy concerning LGBT student safety must provide inclusion

    Directory of Open Access Journals (Sweden)

    April Sanders

    2013-07-01

    Full Text Available Students who identify as lesbian, gay, bisexual, or transgender (LGBT are at risk for harassment due to their sexual orientation or gender identification with over 85% of LGBT students in the United States (US reporting such harassment. These statistics demonstrate one aspect of the significance of this issue, but the cost of human life in some instances has revealed another layer of importance related to a need for safety policies for LGBT students. Even though a need exists for such policies, the practice of heteronormativity found in US policymaking regarding bullying does not protect victims or curb the violence. This essay highlights several recent developments in anti-bullying policy in US schools that shows the existence of heteronormativity, which is not helping to pro-tect LGBT students. By understanding the discrimination encouraged by current policy, future policy can be better shaped to protect LGBT students.

  20. Tax Area Boundaries, Tax unit boundries, Published in Not Provided, 1:4800 (1in=400ft) scale, Rice County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Tax Area Boundaries dataset, published at 1:4800 (1in=400ft) scale, was produced all or in part from Published Reports/Deeds information as of Not Provided. It...

  1. Understanding the Nature of Small Business. PACE Revised. Level 3. Unit 1. Research & Development Series No. 240CB1.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on understanding the nature of small business, the first of 18 modules, is on the third level of the revised Program for Acquiring Competence in Entrepreneurship (PACE). Intended for the advanced secondary and postsecondary levels and for adults wanting training or retraining, this unit, together with the…

  2. Organizational Culture in Middle and Upper Level Hotel Units in Greece

    Directory of Open Access Journals (Sweden)

    Thanos Kriemadis

    2008-06-01

    Full Text Available This study examines the level of awareness of organizational culture (OC of hotel managers in middle and upper level Hotel Units (HU in Greece. A random sample of 140 hotel managers from middle and upper Hotel Units (HU in Greece were surveyed using the Organizational Culture Assessment Questionnaire (OCAQ, a 30-item OC scale developed by Sashkin (1997. The results indicated that the mean values of the OC factors “managing change”, “achieving goals” and “cultural strength” are considered as average, while “coordinated teamwork”, “customer orientation” and the total OC score are considered to be high, when compared to Sashkin (1997 norms. Further results revealed significant differences only for the “customer orientation” factor. Generally, no significant differences were found among managers of middle and upper level HU for general awareness of OC. It is concluded that the results are rather homogenous, with all HU managers placing more or less the same importance to Sashkin’s five OC factors, with each HU manager reporting a rather satisfactory organizational culture.

  3. Two-level, two-objective evolutionary algorithms for solving unit commitment problems

    Energy Technology Data Exchange (ETDEWEB)

    Georgopoulou, Chariklia A.; Giannakoglou, Kyriakos C. [National Technical University of Athens, School of Mechanical Engineering, Laboratory of Thermal Turbomachines, Parallel CFD and Optimization Unit, P.O. Box 64069, Athens 157 10 (Greece)

    2009-07-15

    A two-level, two-objective optimization scheme based on evolutionary algorithms (EAs) is proposed for solving power generating Unit Commitment (UC) problems by considering stochastic power demand variations. Apart from the total operating cost to cover a known power demand distribution over the scheduling horizon, which is the first objective, the risk of not fulfilling possible demand variations forms the second objective to be minimized. For this kind of problems with a high number of decision variables, conventional EAs become inefficient optimization tools, since they require a high number of evaluations before reaching the optimal solution(s). To considerably reduce the computational burden, a two-level algorithm is proposed. At the low level, a coarsened UC problem is defined and solved using EAs to locate promising solutions at low cost: a strategy for coarsening the UC problem is proposed. Promising solutions migrate upwards to be injected into the high level EA population for further refinement. In addition, at the high level, the scheduling horizon is partitioned in a small number of subperiods of time which are optimized iteratively using EAs, based on objective function(s) penalized to ensure smooth transition from/to the adjacent subperiods. Handling shorter chromosomes due to partitioning increases method's efficiency despite the need for iterating. The proposed two-level method and conventional EAs are compared on representative test problems. (author)

  4. Nondisclosure of Smoking Status to Health Care Providers among Current and Former Smokers in the United States

    Science.gov (United States)

    Curry, Laurel Erin; Richardson, Amanda; Xiao, Haijun; Niaura, Raymond S.

    2013-01-01

    An unintended consequence of tobacco control's success in marginalizing smoking is that smokers may conceal their smoking from those who are best positioned to help them quit: health care providers (HCPs). The purpose of this study was to identify the prevalence of, and factors related to, nondisclosure of smoking to HCPs. Data were obtained from…

  5. Improving environmental performance through unit-level organizational citizenship behaviors for the environment: A capability perspective.

    Science.gov (United States)

    Alt, Elisa; Spitzeck, Heiko

    2016-11-01

    Organizational citizenship behaviors for the environment (OCBEs) are increasingly advocated as a means of complementing formal practices in improving environmental performance. Adopting a capability perspective, we propose that a firm's employee involvement capability translates into environmental performance through the manifestation of unit-level OCBEs, and that this relationship is amplified by a shared vision capability. In a cross-country and multi-industry sample of 170 firms, we find support for our hypotheses, shedding light on contextual determinants of OCBEs, and on how firms may engender a positive relationship between top-down environmental initiatives and bottom-up behaviors.

  6. Unit cell modeling in support of interim performance assessment for low level tank waste disposal

    Energy Technology Data Exchange (ETDEWEB)

    Kline, N.W., Westinghouse Hanford

    1996-08-01

    A unit cell model is used to simulate the base analysis case and related sensitivity cases for the interim performance assessment of low level tank waste disposal. Simulation case results are summarized in terms of fractional contaminant release rates to the vadose zone and to the water table at the unconfined aquifer. Results suggest that the crushed glass water conditioning layer at the top of the facility and the chemical retardation pad at the bottom of the facility can be important components of the facility. Results also suggest that the release rates to the water table are dominated by the release rate from the waste form.

  7. The Costs of Providing Instruction in French Language Instructional Units: In-Depth Study of Eight Areas Where There Exists a High Concentration of Francophones.

    Science.gov (United States)

    Desjarlais, Lionel

    The purpose of this study was to determine the costs of providing instruction in French to students enrolled in French-language instructional units in areas of high concentration of Francophones. Chapter 1, which makes up most of the study, consists of separate case studies of eight educational jurisdictions that encompass a major proportion of…

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  9. AN OVERVIEW AT MACROECONOMIC LEVEL THROUGH ACCOUNTING FIGURES PROVIDED BY THE ECB ASSESSMENT ON EUROZONE BANKING SYSTEM

    Directory of Open Access Journals (Sweden)

    Olivera Ecaterina OROS

    2014-05-01

    Full Text Available Along with the main macroeconomic indicators, the credit risk indicators became an important leverage in monitoring and evaluating the standard of living at a national level and the country’s economic evolution. These two types of indicators show a strong interconnection, and the correct assessment of the credit risk indicators becomes a must. As a consequence, the central banks and the main regulators in the Europe aria provided for a strict monitoring of such indicators and further on, for constant update of the banking supervisory regulations. In October 2013, the European Central bank (ECB issued the Note of Comprehensive Assessment that will be carried out during 2014, on the Euro-zone1 banking system. The outcome of the assessment will impact not only the accounting figures of the banking system, but also might change the macroeconomic overview of Euro-zone and the IASB's Conceptual Framework for Financial Reporting.

  10. Hospital-Level Changes in Adult ICU Bed Supply in the United States.

    Science.gov (United States)

    Wallace, David J; Seymour, Christopher W; Kahn, Jeremy M

    2017-01-01

    Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time. We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services. All United States acute care hospitals with adult intensive care beds over the years 1996-2011. None. None. We described the number of beds, teaching status, ownership, intensive care occupancy, and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net, +13,471 beds; 72.1% of total growth), hospitals with 250 or more beds (net, +18,327 beds; 91.8% of total growth), and hospitals in the highest quartile of occupancy (net, +10,157 beds; 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing ICU beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted odds ratio, 18.9; 95% CI, 14.0-25.5; p hospitals in the highest quartile of occupancy (adjusted odds ratio, 7.3; 95% CI, 5.3-9.9; p bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high ICU occupancy.

  11. Climate-driven ground-level ozone extreme in the fall over the Southeast United States.

    Science.gov (United States)

    Zhang, Yuzhong; Wang, Yuhang

    2016-09-06

    Ground-level ozone is adverse to human and vegetation health. High ground-level ozone concentrations usually occur over the United States in the summer, often referred to as the ozone season. However, observed monthly mean ozone concentrations in the southeastern United States were higher in October than July in 2010. The October ozone average in 2010 reached that of July in the past three decades (1980-2010). Our analysis shows that this extreme October ozone in 2010 over the Southeast is due in part to a dry and warm weather condition, which enhances photochemical production, air stagnation, and fire emissions. Observational evidence and modeling analysis also indicate that another significant contributor is enhanced emissions of biogenic isoprene, a major ozone precursor, from water-stressed plants under a dry and warm condition. The latter finding is corroborated by recent laboratory and field studies. This climate-induced biogenic control also explains the puzzling fact that the two extremes of high October ozone both occurred in the 2000s when anthropogenic emissions were lower than the 1980s and 1990s, in contrast to the observed decreasing trend of July ozone in the region. The occurrences of a drying and warming fall, projected by climate models, will likely lead to more active photochemistry, enhanced biogenic isoprene and fire emissions, an extension of the ozone season from summer to fall, and an increase of secondary organic aerosols in the Southeast, posing challenges to regional air quality management.

  12. Analysis of death anxiety levels in nursing staff of critical care units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2011-01-01

    Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.

  13. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level.

    Science.gov (United States)

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-09-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.

  14. A support vector machine model provides an accurate transcript-level-based diagnostic for major depressive disorder

    Science.gov (United States)

    Yu, J S; Xue, A Y; Redei, E E; Bagheri, N

    2016-01-01

    Major depressive disorder (MDD) is a critical cause of morbidity and disability with an economic cost of hundreds of billions of dollars each year, necessitating more effective treatment strategies and novel approaches to translational research. A notable barrier in addressing this public health threat involves reliable identification of the disorder, as many affected individuals remain undiagnosed or misdiagnosed. An objective blood-based diagnostic test using transcript levels of a panel of markers would provide an invaluable tool for MDD as the infrastructure—including equipment, trained personnel, billing, and governmental approval—for similar tests is well established in clinics worldwide. Here we present a supervised classification model utilizing support vector machines (SVMs) for the analysis of transcriptomic data readily obtained from a peripheral blood specimen. The model was trained on data from subjects with MDD (n=32) and age- and gender-matched controls (n=32). This SVM model provides a cross-validated sensitivity and specificity of 90.6% for the diagnosis of MDD using a panel of 10 transcripts. We applied a logistic equation on the SVM model and quantified a likelihood of depression score. This score gives the probability of a MDD diagnosis and allows the tuning of specificity and sensitivity for individual patients to bring personalized medicine closer in psychiatry. PMID:27779627

  15. Prevalence of Doctor-Diagnosed Arthritis at State and County Levels - United States, 2014.

    Science.gov (United States)

    Barbour, Kamil E; Helmick, Charles G; Boring, Michael; Zhang, Xingyou; Lu, Hua; Holt, James B

    2016-05-20

    Doctor-diagnosed arthritis is a common chronic condition that affects approximately 52.5 million (22.7%) adults in the United States and is a leading cause of disability (1,2). The prevalence of doctor-diagnosed arthritis has been well documented at the national level (1), but little has been published at the state level and the county level, where interventions are carried out and can have their greatest effect. To estimate the prevalence of doctor-diagnosed arthritis among adults at the state and county levels, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which found that, for all 50 states and the District of Columbia (DC) overall, the age-standardized median prevalence of doctor-diagnosed arthritis was 24% (range = 18.8%-35.5%). The age-standardized model-predicted prevalence of doctor-diagnosed arthritis varied substantially by county, with estimates ranging from 15.8% to 38.6%. The high prevalence of arthritis in all counties, and the high frequency of arthritis-attributable limitations (1) among adults with arthritis, suggests that states and counties might benefit from expanding underused, evidence-based interventions for arthritis that can reduce arthritis symptoms and improve self-management.

  16. Feasibility and utility of mapping disease risk at the neighbourhood level within a Canadian public health unit: an ecological study

    Directory of Open Access Journals (Sweden)

    Wanigaratne Susitha

    2010-05-01

    Full Text Available Abstract Background We conducted spatial analyses to determine the geographic variation of cancer at the neighbourhood level (dissemination areas or DAs within the area of a single Ontario public health unit, Wellington-Dufferin-Guelph, covering a population of 238,326 inhabitants. Cancer incidence data between 1999 and 2003 were obtained from the Ontario Cancer Registry and were geocoded down to the level of DA using the enhanced Postal Code Conversion File. The 2001 Census of Canada provided information on the size and age-sex structure of the population at the DA level, in addition to information about selected census covariates, such as average neighbourhood income. Results Age standardized incidence ratios for cancer and the prevalence of census covariates were calculated for each of 331 dissemination areas in Wellington-Dufferin-Guelph. The standardized incidence ratios (SIR for cancer varied dramatically across the dissemination areas. However, application of the Moran's I statistic, a popular index of spatial autocorrelation, suggested significant spatial patterns for only two cancers, lung and prostate, both in males (p Conclusion This paper demonstrates the feasibility and utility of a systematic approach to identifying neighbourhoods, within the area served by a public health unit, that have significantly higher risks of cancer. This exploratory, ecologic study suggests several hypotheses for these spatial patterns that warrant further investigations. To the best of our knowledge, this is the first Canadian study published in the peer-reviewed literature estimating the risk of relatively rare public health outcomes at a very small areal level, namely dissemination areas.

  17. Design of a high-level waste repository system for the United States

    Energy Technology Data Exchange (ETDEWEB)

    Baeza, J.L.; Boerigter, S.T.; Broadbent, G.E.; Cabello, E.D.; Duran, V.B.; Hollaway, W.R.; Karlberg, R.P.; Siegel, M.J.; Simonson, S.A.

    1988-05-12

    This report presents a conceptual design for a High Level Waste disposal system for fuel discharged by US commercial power reactors, using the Yucca Mountain repository site recently designated by federal legislation. Principal features of the resulting conceptual design include use of unit trains for periodic removal of old spent fuel from at-reactor storage facilities, buffer storage at the repository site using dual purpose transportation/storage casks, repackaging of the spent fuel from the dual purpose transportation/storage casks directly into special-alloy disposal canisters as intact fuel assemblies, without rod consolidation, emplacement into a repository of modular design, use of excavation techniques that minimize disturbance, both mechanical and chemical, to the geologic environment, a unit rail mounted vehicle for both the transportation and emplacement of the canister from the surface facilities to the underground repository, and a cost-effectiveness computer model of Yucca Mountain and an independent cost evaluation by members of the design team. 31 refs., 58 figs., 15 tabs.

  18. Nutritional levels of diets fed to captive Amazon parrots: does mixing seed, produce, and pellets provide a healthy diet?

    Science.gov (United States)

    Brightsmith, Donald J

    2012-09-01

    Poor nutrition is a serious problem in captive psittacine birds. Seed-based diets are known to contain excess fat, low calcium:phosphorus ratios, and other nutrient deficiencies, whereas many consider nutritionally superior, formulated diets to be monotonous. As a result, many bird owners feed a mixture of seed, produce, and formulated diet. However, the nutritional contents of such mixed diets have rarely been evaluated. In this study, we describe the nutrient contents of diets consumed by 7 adult (>6 years old), captive Amazon parrots offered produce (50% fresh weight), formulated diet (25%), and seed (25%). Diets consumed were deficient in calcium, sodium, and iron and contained more than the recommended amount of fat. In addition, the birds chose foods that exacerbated these imbalances. Birds offered low-seed diets (60% pellet, 22% produce, 18% seed, wet weight) consumed diets with more fat than recommended but acceptable levels of calcium and all other nutrients measured, as well as acceptable calcium:phosphorus ratios. This suggests that small quantities of seeds may not result in nutritionally imbalanced diets. Birds fed 75% formulated diet and 25% produce consumed diets within the recommendations for nearly all measured nutrients, demonstrating that owners of psittacine birds should be encouraged to supplement manufactured diets with low energy-density, fresh produce items to provide stimulation and foraging opportunities without fear of causing major nutritional imbalances.

  19. Explaining the Growth in US Health Care Spending Using State-Level Variation in Income, Insurance, and Provider Market Dynamics.

    Science.gov (United States)

    Herring, Bradley; Trish, Erin

    2015-01-01

    The slowed growth in national health care spending over the past decade has led analysts to question the extent to which this recent slowdown can be explained by predictable factors such as the Great Recession or must be driven by some unpredictable structural change in the health care sector. To help address this question, we first estimate a regression model for state personal health care spending for 1991-2009, with an emphasis on the explanatory power of income, insurance, and provider market characteristics. We then use the results from this simple predictive model to produce state-level projections of health care spending for 2010-2013 to subsequently compare those average projected state values with actual national spending for 2010-2013, finding that at least 70% of the recent slowdown in health care spending can likely be explained by long-standing patterns. We also use the results from this predictive model to both examine the Great Recession's likely reduction in health care spending and project the Affordable Care Act's insurance expansion's likely increase in health care spending.

  20. A geospatial model of ambient sound pressure levels in the contiguous United States.

    Science.gov (United States)

    Mennitt, Daniel; Sherrill, Kirk; Fristrup, Kurt

    2014-05-01

    This paper presents a model that predicts measured sound pressure levels using geospatial features such as topography, climate, hydrology, and anthropogenic activity. The model utilizes random forest, a tree-based machine learning algorithm, which does not incorporate a priori knowledge of source characteristics or propagation mechanics. The response data encompasses 270 000 h of acoustical measurements from 190 sites located in National Parks across the contiguous United States. The explanatory variables were derived from national geospatial data layers and cross validation procedures were used to evaluate model performance and identify variables with predictive power. Using the model, the effects of individual explanatory variables on sound pressure level were isolated and quantified to reveal systematic trends across environmental gradients. Model performance varies by the acoustical metric of interest; the seasonal L50 can be predicted with a median absolute deviation of approximately 3 dB. The primary application for this model is to generalize point measurements to maps expressing spatial variation in ambient sound levels. An example of this mapping capability is presented for Zion National Park and Cedar Breaks National Monument in southwestern Utah.

  1. Impact of Climate Change on Ambient Ozone Level and Mortality in Southeastern United States

    Directory of Open Access Journals (Sweden)

    Montserrat Fuentes

    2010-07-01

    Full Text Available There is a growing interest in quantifying the health impacts of climate change. This paper examines the risks of future ozone levels on non-accidental mortality across 19 urban communities in Southeastern United States. We present a modeling framework that integrates data from climate model outputs, historical meteorology and ozone observations, and a health surveillance database. We first modeled present-day relationships between observed maximum daily 8-hour average ozone concentrations and meteorology measured during the year 2000. Future ozone concentrations for the period 2041 to 2050 were then projected using calibrated climate model output data from the North American Regional Climate Change Assessment Program. Daily community-level mortality counts for the period 1987 to 2000 were obtained from the National Mortality, Morbidity and Air Pollution Study. Controlling for temperature, dew-point temperature, and seasonality, relative risks associated with short-term exposure to ambient ozone during the summer months were estimated using a multi-site time series design. We estimated an increase of 0.43 ppb (95% PI: 0.14–0.75 in average ozone concentration during the 2040’s compared to 2000 due to climate change alone. This corresponds to a 0.01% increase in mortality rate and 45.2 (95% PI: 3.26–87.1 premature deaths in the study communities attributable to the increase in future ozone level.

  2. Impact of climate change on ambient ozone level and mortality in southeastern United States.

    Science.gov (United States)

    Chang, Howard H; Zhou, Jingwen; Fuentes, Montserrat

    2010-07-01

    There is a growing interest in quantifying the health impacts of climate change. This paper examines the risks of future ozone levels on non-accidental mortality across 19 urban communities in Southeastern United States. We present a modeling framework that integrates data from climate model outputs, historical meteorology and ozone observations, and a health surveillance database. We first modeled present-day relationships between observed maximum daily 8-hour average ozone concentrations and meteorology measured during the year 2000. Future ozone concentrations for the period 2041 to 2050 were then projected using calibrated climate model output data from the North American Regional Climate Change Assessment Program. Daily community-level mortality counts for the period 1987 to 2000 were obtained from the National Mortality, Morbidity and Air Pollution Study. Controlling for temperature, dew-point temperature, and seasonality, relative risks associated with short-term exposure to ambient ozone during the summer months were estimated using a multi-site time series design. We estimated an increase of 0.43 ppb (95% PI: 0.14-0.75) in average ozone concentration during the 2040's compared to 2000 due to climate change alone. This corresponds to a 0.01% increase in mortality rate and 45.2 (95% PI: 3.26-87.1) premature deaths in the study communities attributable to the increase in future ozone level.

  3. Space-Time Unit-Level EBLUP for Large Data Sets

    Directory of Open Access Journals (Sweden)

    D’Aló Michele

    2017-03-01

    Full Text Available Most important large-scale surveys carried out by national statistical institutes are the repeated survey type, typically intended to produce estimates for several parameters of the whole population, as well as parameters related to some subpopulations. Small area estimation techniques are becoming more and more important for the production of official statistics where direct estimators are not able to produce reliable estimates. In order to exploit data from different survey cycles, unit-level linear mixed models with area and time random effects can be considered. However, the large amount of data to be processed may cause computational problems. To overcome the computational issues, a reformulation of predictors and the correspondent mean cross product estimator is given. The R code based on the new formulation enables the elaboration of about 7.2 millions of data records in a matter of minutes.

  4. Levels of genetic diversity and taxonomic status of Epinephelus species in United Arab Emirates fish markets.

    Science.gov (United States)

    Ketchum, Remi N; Dieng, Mame M; Vaughan, Grace O; Burt, John A; Idaghdour, Youssef

    2016-04-30

    Understanding the patterns of genetic diversity of fish species is essential for marine conservation and management. This is particularly important in the Arabian Gulf where marine life is subject to extreme environmental conditions that could impact genetic diversity. Here we assess genetic diversity of the most commercially important fish in the United Arab Emirates; groupers (Epinephelus spp.). Sequencing of 973 bp mitochondrial DNA from 140 tissue samples collected in four main fish markets revealed 58 haplotypes clustered within three groups. Data analysis revealed the presence of three distinct Epinephelus species being marketed as one species (hammour): Epinephelus coioides, Epinephelus areolatus and Epinephelus bleekeri. We report species-specific genetic markers and demonstrate that all three species exhibit relatively low levels of genetic variation, reflecting the effect of overfishing and environmental pressures. In light of the genetic evidence presented here, conservation and management of groupers in the UAE warrant the implementation of species-specific measures.

  5. The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership.

    Science.gov (United States)

    Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R

    2014-04-14

    In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for

  6. The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership

    Science.gov (United States)

    2014-01-01

    Background In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Methods Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. Results The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. Conclusions The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation

  7. NOAA Water Level Predictions Stations for the Coastal United States and Other Non-U.S. Sites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Ocean Service (NOS) maintains a long-term database containing water level measurements and derived tidal data for coastal waters of the United States...

  8. County-Level Estimates of Nitrogen and Phosphorus from Commercial Fertilizer for the Conterminous United States, 1987-2006

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set contains county-level estimates of nitrogen and phosphorus from fertilizer, for both farm and nonfarm uses, for the conterminous United States, for...

  9. NOAA Water Level (Tidal) Data of 205 Stations for the Coastal United States and Other Non-U.S. Sites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Ocean Service (NOS) maintains a long-term database containing water level measurements and derived tidal data for coastal waters of the United States...

  10. Predicting Periodontitis at State and Local Levels in the United States.

    Science.gov (United States)

    Eke, P I; Zhang, X; Lu, H; Wei, L; Thornton-Evans, G; Greenlund, K J; Holt, J B; Croft, J B

    2016-05-01

    The objective of the study was to estimate the prevalence of periodontitis at state and local levels across the United States by using a novel, small area estimation (SAE) method. Extended multilevel regression and poststratification analyses were used to estimate the prevalence of periodontitis among adults aged 30 to 79 y at state, county, congressional district, and census tract levels by using periodontal data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012, population counts from the 2010 US census, and smoking status estimates from the Behavioral Risk Factor Surveillance System in 2012. The SAE method used age, race, gender, smoking, and poverty variables to estimate the prevalence of periodontitis as defined by the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions at the census block levels and aggregated to larger administrative and geographic areas of interest. Model-based SAEs were validated against national estimates directly from NHANES 2009-2012. Estimated prevalence of periodontitis ranged from 37.7% in Utah to 52.8% in New Mexico among the states (mean, 45.1%; median, 44.9%) and from 33.7% to 68% among counties (mean, 46.6%; median, 45.9%). Severe periodontitis ranged from 7.27% in New Hampshire to 10.26% in Louisiana among the states (mean, 8.9%; median, 8.8%) and from 5.2% to 17.9% among counties (mean, 9.2%; median, 8.8%). Overall, the predicted prevalence of periodontitis was highest for southeastern and southwestern states and for geographic areas in the Southeast along the Mississippi Delta, as well as along the US and Mexico border. Aggregated model-based SAEs were consistent with national prevalence estimates from NHANES 2009-2012. This study is the first-ever estimation of periodontitis prevalence at state and local levels in the United States, and this modeling approach complements public health surveillance efforts to identify areas with a high burden of

  11. The United Nations High Level Meeting on the Prevention and Control of Noncommunicable Diseases: a missed opportunity?

    Science.gov (United States)

    Sivaramakrishnan, Kavita; Parker, Richard G

    2012-11-01

    The United Nations High Level Meeting on the Prevention and Control of Noncommunicable Diseases (September 19-20, 2011) provided an opportunity to recast the current global health agenda and offered a formidable platform to mobilize political will for concerted action. We argue that the opportunity was missed because the World Health Organization (WHO) neglected the politics of process that are key to mobilizing political support for global noncommunicable disease policies. Instead, it focused on the implementation process. The lessons to be drawn from the summit are critical because the WHO is the key agency that will be expected in the near future to steer further discussions and debate on the noncommunicable disease agenda.

  12. Past and future sea-level rise along the coast of North Carolina, United States

    CERN Document Server

    Kopp, Robert E; Kemp, Andrew C; Tebaldi, Claudia

    2014-01-01

    Focusing on factors that cause relative sea-level (RSL) rise to differ from the global mean, we evaluate RSL trajectories for North Carolina, United States, in the context of tide gauge and geological sea-level proxy records spanning the last $\\mathord{\\sim}$11,000 years. RSL rise was fastest ($\\mathord{\\sim}$7 mm/yr) during the early Holocene and decreased over time. During the Common Era before the 19th century, RSL rise ($\\mathord{\\sim}$0.7 to 1.1 mm/yr) was driven primarily by glacio-isostatic adjustment, dampened by tectonic uplift along the Cape Fear Arch. Ocean/atmosphere dynamics caused centennial variability of up to $\\mathord{\\sim}$0.6 mm/yr around the long-term rate. It is extremely likely (probability $P = 0.95$) that 20th century RSL rise at Sand Point, NC, (2.8 $\\pm$ 0.5 mm/yr) was faster than during any other century in $\\geq2,900$ years. Projections based on a fusion of process models, statistical models, expert elicitation and expert assessment indicate that RSL at Wilmington, NC, is very lik...

  13. Variation in low-frequency estimates of sound levels based on different units of analysis.

    Science.gov (United States)

    Hawkins, Russell S; Miksis-Olds, Jennifer L; Smith, Chad M

    2014-02-01

    The measurement and analysis of underwater sound is a complicated process because of the variable durations of contributing sources and constantly changing water column dynamics. Because the ambient sound distribution does not always follow a Gaussian structure and may be nonstationary in time, analysis over an extended period is required to accurately characterize the data. Utilizing recordings from the Indian Ocean, the temporal variation in ambient sound including transient signals was examined using multiple processing window lengths and subsampling intervals. Results illustrate the degree of uncertainty in sound levels based on different units of analysis. The average difference between sound level estimates in the 10-30 Hz band due to subsampling was 2 dB and as high as 4 dB. The difference in the full band (5-110 Hz) was as high as 6 dB. Longer averaging windows (200 vs 60 s) resulted in larger variations over different subsampling intervals. This work demonstrates how sampling protocols within a single dataset can influence results and acknowledges that comparative studies at the same location but with different sampling protocols can be substantial if signal processing parameters are not statistically accounted for to confirm interpretation of results and observed trends.

  14. Managing Highway Maintenance: Instructor's Manual for Management by Objectives Review, Unit 11, All Levels.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit is designed for the training group leader and contains selected highlights and suggested discussion questions from six units of training: maintenance activities, work units, and classifying work; maintenance feature inventories; how to conduct a maintenance feature inventory;…

  15. Managing Highway Maintenance: Standards for Maintenance Work, Part 2, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit describes the ways maintenance standards are developed and some of the factors which are considered in setting standards; the preceding unit on standards (part 1) should be completed before reading this unit. The format is a programed, self-instruction approach in which…

  16. Influenza-Related Hospitalizations and Poverty Levels - United States, 2010-2012.

    Science.gov (United States)

    Hadler, James L; Yousey-Hindes, Kimberly; Pérez, Alejandro; Anderson, Evan J; Bargsten, Marisa; Bohm, Susan R; Hill, Mary; Hogan, Brenna; Laidler, Matt; Lindegren, Mary Lou; Lung, Krista L; Mermel, Elizabeth; Miller, Lisa; Morin, Craig; Parker, Erin; Zansky, Shelley M; Chaves, Sandra S

    2016-02-12

    Annual influenza vaccine is recommended for all persons aged ≥6 months in the United States, with recognition that some persons are at risk for more severe disease (1). However, there might be previously unrecognized demographic groups that also experience higher rates of serious influenza-related disease that could benefit from enhanced vaccination efforts. Socioeconomic status (SES) measures that are area-based can be used to define demographic groups when individual SES data are not available (2). Previous surveillance data analyses in limited geographic areas indicated that influenza-related hospitalization incidence was higher for persons residing in census tracts that included a higher percentage of persons living below the federal poverty level (3-5). To determine whether this association occurs elsewhere, influenza hospitalization data collected in 14 FluSurv-NET sites covering 27 million persons during the 2010-11 and 2011-12 influenza seasons were analyzed. The age-adjusted incidence of influenza-related hospitalizations per 100,000 person-years in high poverty (≥20% of persons living below the federal poverty level) census tracts was 21.5 (95% confidence interval [CI]: 20.7-22.4), nearly twice the incidence in low poverty (poverty level) census tracts (10.9, 95% CI: 10.3-11.4). This relationship was observed in each surveillance site, among children and adults, and across racial/ethnic groups. These findings suggest that persons living in poorer census tracts should be targeted for enhanced influenza vaccination outreach and clinicians serving these persons should be made aware of current recommendations for use of antiviral agents to treat influenza (6).

  17. Plutonium and Uranium Atom Ratios and Activity Levels in Cochiti Lake Bottom Sediments Provided by Pueblo de Cochiti

    Energy Technology Data Exchange (ETDEWEB)

    Gallaher, B.M.; Efurd, D.W.; Rokop, D.J.; Benjamin, T.M.

    1999-05-01

    Historical operations at the Los Alamos National Laboratory have contaminated stream sediments with plutonium and other radionuclides. A small portion of these contaminated sediments has been carried by floods into the Rio Grande drainage system, eventually to be trapped by Cochiti Lake located on Pueblo de Cochiti lands approximately 8 km downstream of the Laboratory. In this study, lake bottom sediment samples provided by the Pueblo de Cochiti were analyzed by thermal ionization mass spectrometry to determine plutonium and uranium activity levels and isotopic atom ratios. This specialized analytical method allows us to take isotopic fingerprints of radionuclides found in the sediment and to determine how much plutonium and uranium came from the Laboratory and how much was deposited by worldwide fallout or is natural. Two distinct types of samples were processed: segments of a continuous vertical core of the entire accumulated sediment sequence and other samples from across the lake bottom at the water/sediment interface. Based on measurement of the {sup 240}Pu/{sup 239}Pu atom ratio, Laboratory-derived plutonium is present in eight of nine samples at the core site. On a depth-weighted basis, approximately one-half of the {sup 239}Pu and {sup 240}Pu came from early operations at the Laboratory; the remaining plutonium came from fallout dispersed by above-ground nuclear tests. In contrast to the core site, the samples from the other locations showed little or no evidence of Laboratory-derived plutonium, with more than 90 percent of the plutonium attributable to fallout. The overall amount of plutonium in all the samples is of the same magnitude as other reservoirs in the region. The net increase in plutonium over upstream reservoirs unaffected by Laboratory activities is a maximum of 0.014 pCi/g or 3.5 times. All of the samples reflect natural uranium compositions. Laboratory-derived uranium is not identifiable, presumably because the sediment contains abundant

  18. Trabajadores de salud de nivel intermedio: un recurso prometedor Mid-level health providers: a promising resource

    Directory of Open Access Journals (Sweden)

    Andrew Brown

    2011-06-01

    Full Text Available Los trabajadores de salud de nivel intermedio (TSNI son trabajadores capacitados en una institución de educación superior durante al menos dos a tres años, quienes son autorizados y regulados para trabajar de forma autónoma para el diagnóstico, control y tratamiento de dolencias, enfermedades y discapacidades, así como participar en la prevención y promoción de la salud. Su papel se ha ampliado progresivamente y ha recibido atención en particular en países de ingresos bajos y medios, como parte de una estrategia para superar los desafíos del personal sanitario, mejorar el acceso a servicios básicos de salud y lograr objetivos relacionados con los Objetivos del Desarrollo del Milenio. La evidencia, aunque limitada e imperfecta, muestra que donde los TSNI están debidamente capacitados, apoyados y coherentemente integrados en el sistema de salud, tienen el potencial para mejorar la distribución de los trabajadores de la salud y el acceso equitativo a los servicios de salud, manteniendo -si no sobrepasando- los estándares de calidad comparables a los servicios prestados por el personal médico. Sin embargo, existen desafíos importantes en términos de la marginación y el limitado apoyo a la gestión de los TSNI en los sistemas de salud. La expansión de los TSNI debe tener prioridad entre las opciones de política consideradas por países que enfrentan problemas de escasez y desigualdad en la distribución de recursos humanos. Una mejor educación, supervisión, administración y regulación de las prácticas y la integración en el sistema de salud tienen el potencial de maximizar los beneficios de la utilización de este personal.Mid-level health providers (MLP are health workers trained at a higher education institution for at least a total of 2-3 years, and authorized and regulated to work autonomously to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care. Their role

  19. Low-impact sampling under an active solid low-level radioactive waste disposal unit using horizontal drilling technology

    Energy Technology Data Exchange (ETDEWEB)

    Puglisi, C.V.; Vold, E.L.

    1995-12-01

    The purpose of this project was to determine the performance of the solid low-level radioactive waste (LLRW) disposal units located on a mesa top at TA-54, Area G, Los Alamos National Laboratory (LANL), Los Alamos, NM, and to provide in-situ (vadose zone) site characterization information to Area G`s Performance Assessment. The vadose zone beneath an active disposal unit (DU 37), was accessed by utilizing low-impact, air-rotary horizontal drilling technology. Core samples were pulled, via wire-line core method, in 3 horizontal holes fanning out below DU 37 at approximately 5 foot intervals depending on recovery percentage. Samples were surveyed and prepared in-field following Environmental Restoration (ER) guidelines. Samples were transferred from the field to the CST-9 Radvan for initial radiological screening. Following screening, samples were delivered to CST-3 analytical lab for analyses including moisture content, 23 inorganics, 60 volatile organic compounds (VOC`s), 68 semivolatile organic compounds (SVOC`s), tritium, lead 210, radium 226 & 228, cesium 137, isotopic plutonium, americium 241, strontium 90, isotopic uranium, and isotopic thorium. Other analyses included matric potential, alpha spectroscopy, gamma spectroscopy, and gross alpha/beta. The overall results of the analysis identified only tritium as having migrated from the DU. Am-241, Eu-152, and Pu-238 were possibly identified above background but the results are not definitive. Of all organics analysed for, only ethyl acetate was tentatively identified slightly above background. All inorganics were found to be well below regulatory limits. Based on the results of the above mentioned analyses, it was determined that Area G`s disposal units are performing well and no significant liquid phase migration of contaminants has occurred.

  20. Verification of a level-3 diesel emissions control strategy for transport refrigeration units

    Science.gov (United States)

    Shewalla, Umesh

    Transport Refrigeration Units (TRUs) are refrigeration systems used to control the environment of temperature sensitive products while they are being transported from one place to another in trucks, trailers or shipping containers. The TRUs typically use an internal combustion engine to power the compressor of the refrigeration unit. In the United States TRUs are most commonly powered by diesel engines which vary from 9 to 40 horsepower. TRUs are capable of both heating and cooling. The TRU engines are relatively small, inexpensive and do not use emissions reduction techniques such as exhaust gas recirculation (EGR). A significant number of these engines operate in highly populated areas like distribution centers, truck stops, and other facilities which make them one of the potential causes for health risks to the people who live and work nearby. Diesel particulate matter (PM) is known for its adverse effects on both human beings and the environment. Considering these effects, regulatory bodies have imposed limitations on the PM emissions from a TRU engine. The objective of this study was to measure and analyze the regulated emissions from a TRU engine under both engine out and particulate filter system out conditions during pre-durability (when the filter system was new) and post-durability test (after the filter system was subjected to 1000 hours in-field trial). The verification program was performed by the Center for Alternative Fuel, Engines and Emissions (CAFEE) at West Virginia University (WVU). In this program, a catalyzed silicon carbide (SiC) diesel particulate filter (DPF) was evaluated and verified as a Level-3 Verified Diesel Emissions Control Strategy (VDECS) (. 85% PM reduction) under California Air Resources Board (CARB) regulations 2702 [1]. The emissions result showed that the filter system reduced diesel PM by a percentage of 96 +/- 1 over ISO 8178-C1 [2] cycle and 92 +/- 5 over EPA TRU [3] cycle, qualifying as a Level 3 VDECS. The percentage

  1. Low HDL levels in sepsis versus trauma patients in intensive care unit.

    Science.gov (United States)

    Tanaka, Sébastien; Labreuche, Julien; Drumez, Elodie; Harrois, Anatole; Hamada, Sophie; Vigué, Bernard; Couret, David; Duranteau, Jacques; Meilhac, Olivier

    2017-12-01

    The protective cardiovascular effect of high-density lipoproteins (HDLs) is considered to chiefly rely on reverse cholesterol transport from peripheral tissues back to the liver. However, HDL particles display pleiotropic properties, including anti-inflammatory, anti-apoptotic or antioxidant functions. Some studies suggest that HDL concentration decreases during sepsis, and an association was reported between low HDL levels and a poor outcome. Like sepsis, trauma is also associated with a systemic inflammatory response syndrome. However, no study has yet explored changes in lipid profiles during trauma. We sought to compare lipid profiles between sepsis and trauma patients in intensive care unit (ICU). In septic patients, we analyzed the association between lipid profile, severity and prognosis. A prospective, observational, single-centered study was conducted in a surgical ICU. For each patient, total cholesterol, HDL, triglyceride and low-density lipoprotein cholesterol levels were assessed at admission. Short-term prognosis outcome was prospectively assessed. Seventy-five consecutive patients were admitted (50 sepsis and 25 trauma). There was no difference in SOFA and SAPSII scores between the two groups. Patients with sepsis had lower total cholesterol levels than patients with trauma. Regarding the lipoprotein profile, only HDLs differed significantly between the two groups (median [IQR] = 0.33 mmol/l [0.17-0.78] in sepsis patients versus median [IQR] = 0.99 mmol/l [0.74-1.28] in trauma patients; P HDL concentration and the length of ICU stay (r = -0.35; P = 0.03) in the group of survivor septic patients at ICU discharge. In addition, poor outcome defined as death or a SOFA score >6 at day 3 was associated with lower HDL levels (median [IQR] = 0.20 mmol/l [0.11-0.41] vs. 0.35 mmol/l [0.19-0.86] in patients with poor outcome versus others; P = 0.03). Lipid profile was totally different between sepsis and trauma in ICU patients: HDL levels were

  2. Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers--United States, 2012-2013.

    Science.gov (United States)

    Francois Watkins, Louise K; Sanchez, Guillermo V; Albert, Alison P; Roberts, Rebecca M; Hicks, Lauri A

    2015-07-24

    Appropriate antibiotic use, in particular avoidance of antibiotics for upper respiratory infections likely to be caused by viruses, is a key component of efforts to slow the increase in antibiotic-resistant infections. Studies suggest that Hispanic consumers might differ from non-Hispanic consumers in their knowledge and attitudes regarding antibiotic use (4). To better understand health care provider and consumer knowledge and attitudes that influence antibiotic use, CDC analyzed national internet survey data collected from participants living in the United States during 2012-2013. The participants represented three groups: 1) the total population of adult consumers (all ethnicities); 2) adult Hispanic consumers; and 3) health care providers. Hispanic consumers were more likely than all consumers to believe that if they have a cold, antibiotics would help them to get better more quickly (48% versus 25%), and more likely to obtain antibiotics not prescribed by a clinician, such as antibiotics left over from a previous illness (25% versus 9%), obtained from a neighborhood grocery store (23% versus 5%), or obtained from a friend or family member (17% versus 6%). Most providers surveyed (54%) reported that they believed their patients expect antibiotics during visits for a cough or cold, whereas 26% of all consumers reported this expectation. To maximize knowledge about appropriate antibiotic use among outpatients in the United States, public health initiatives should target Hispanic as well as general audiences.

  3. Changes in the frequency and return level of high ozone pollution events over the eastern United States following emission controls

    Science.gov (United States)

    Rieder, H. E.; Fiore, A. M.; Polvani, L. M.; Lamarque, J.-F.; Fang, Y.

    2013-03-01

    In order to quantify the impact of recent efforts to abate surface ozone (O3) pollution, we analyze changes in the frequency and return level of summertime (JJA) high surface O3 events over the eastern United States (US) from 1988-1998 to 1999-2009. We apply methods from extreme value theory (EVT) to maximum daily 8-hour average ozone (MDA8 O3) observed by the Clean Air Status and Trends Network (CASTNet) and define O3 extremes as days on which MDA8 O3 exceeds a threshold of 75 ppb (MDA8 O3>75). Over the eastern US, we find that the number of summer days with MDA8 O3>75 declined on average by about a factor of two from 1988-1998 to 1999-2009. The applied generalized Pareto distribution (GPD) fits the high tail of MDA8 O3 much better than a Gaussian distribution and enables the derivation of probabilistic return levels (describing the probability of exceeding a value x within a time window T) for high O3 pollution events. This new approach confirms the significant decline in both frequency and magnitude of high O3 pollution events over the eastern US during recent years reported in prior studies. Our analysis of 1-yr and 5-yr return levels at each station demonstrates the strong impact of changes in air quality regulations and subsequent control measures (e.g., the ‘NOx SIP Call’), as the 5-yr return levels of the period 1999-2009 correspond roughly to the 1-yr return levels of the earlier time period (1988-1998). Regionally, the return levels dropped between 1988-1998 and 1999-2009 by about 8 ppb in the Mid-Atlantic (MA) and Great Lakes (GL) regions, while the strongest decline, about 13 ppb, is observed in the Northeast (NE) region. Nearly all stations (21 out of 23) have 1-yr return levels well below 100 ppb and 5-yr return levels well below 110 ppb in 1999-2009. Decreases in eastern US O3 pollution are largest after full implementation of the nitrogen oxide (NOx) reductions under the ‘NOx SIP Call’. We conclude that the application of EVT methods

  4. Epidemiological Study of Hospital-Acquired Bacterial Conjunctivitis in a Level III Neonatal Unit

    Directory of Open Access Journals (Sweden)

    Catarina Dias

    2013-01-01

    Full Text Available Background. Conjunctivitis is one of the most frequently occurring hospital-acquired infections among neonates, although it is less studied than potentially life-threatening infections, such as sepsis and pneumonia. Objectives. The aims of our work were to identify epidemiologic characteristics, pathogens, and susceptibility patterns of bacterial hospital-acquired conjunctivitis (HAC in a level III neonatal unit. Materials and Methods. Data were collected retrospectively from patient charts and laboratory databases. Hospital-acquired conjunctivitis was defined in accordance with the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN diagnostic criteria. Results. One or more episodes of HAC were diagnosed in 4,0% ( of 1492 neonates admitted during the study period. Most of the episodes involved premature (75,4% and low birth weight (75,4% neonates. Infection rates were higher among patients undergoing noninvasive mechanical ventilation (46,7%, parenteral nutrition (13,6%, and phototherapy (6,8%. Predominant pathogens included Serratia marcescens (27,9%, Escherichia coli (23%, and Pseudomonas aeruginosa (18%. Susceptibility patterns revealed bacterial resistances to several antibiotic classes. Gentamicin remains the adequate choice for empirical treatment of HAC in our NICU. Conclusion. It is important to know the local patterns of the disease in order to adjust prevention strategies. Our work contributes to the epidemiological characterization of a sometimes overlooked disease.

  5. Epidemiological Study of Hospital-Acquired Bacterial Conjunctivitis in a Level III Neonatal Unit

    Science.gov (United States)

    Dias, Catarina; Gonçalves, Márcia; João, Anabela

    2013-01-01

    Background. Conjunctivitis is one of the most frequently occurring hospital-acquired infections among neonates, although it is less studied than potentially life-threatening infections, such as sepsis and pneumonia. Objectives. The aims of our work were to identify epidemiologic characteristics, pathogens, and susceptibility patterns of bacterial hospital-acquired conjunctivitis (HAC) in a level III neonatal unit. Materials and Methods. Data were collected retrospectively from patient charts and laboratory databases. Hospital-acquired conjunctivitis was defined in accordance with the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) diagnostic criteria. Results. One or more episodes of HAC were diagnosed in 4,0% (n = 60) of 1492 neonates admitted during the study period. Most of the episodes involved premature (75,4%) and low birth weight (75,4%) neonates. Infection rates were higher among patients undergoing noninvasive mechanical ventilation (46,7%), parenteral nutrition (13,6%), and phototherapy (6,8%). Predominant pathogens included Serratia marcescens (27,9%), Escherichia coli (23%), and Pseudomonas aeruginosa (18%). Susceptibility patterns revealed bacterial resistances to several antibiotic classes. Gentamicin remains the adequate choice for empirical treatment of HAC in our NICU. Conclusion. It is important to know the local patterns of the disease in order to adjust prevention strategies. Our work contributes to the epidemiological characterization of a sometimes overlooked disease. PMID:23766676

  6. Variation in Provider Identification of Obesity by Individual- and Neighborhood-Level Characteristics among an Insured Population

    Directory of Open Access Journals (Sweden)

    Sara N. Bleich

    2010-01-01

    Conclusions. Most health care providers do not include an obesity diagnosis code in their obese patients' claims. Rates of obesity identification were strongly related to individual characteristics and somewhat associated with neighborhood characteristics.

  7. Evaluating County-Level Heat Vulnerability and Social Inequity in the United States through Climate and Socioeconomic Indices

    Science.gov (United States)

    Gannon, C.

    2016-12-01

    Climate change will have many impacts on human health, perhaps most directly through extreme heat. High temperature and humidity combinations inhibit the body's ability to cool through physiological responses such as sweating. In conjunction with extended periods of extreme heat and shifted seasonality, these conditions are particularly dangerous. Current research and literature can be used to show where dangerous heat and humidity conditions are likely to be most prevalent, or where populations vulnerable to heat stress reside. To provide a better assessment of overall heat vulnerability, however, many complex factors, such as relative changes in temperature patterns or local socioeconomic conditions, must also be considered. Here, we utilize a multivariate approach to establish county-level risk scores by combining the most relevant indicators for heat vulnerability with climate model projections of wet bulb globe temperature, a metric useful for understanding how the human body will respond to conditions of high heat and humidity. We present our findings as an ESRI ArcOnline Story Map with data aggregated at the county-level in the continental United States. This format allows users to access maps showing each county's score in four categories related to heat vulnerability: heat and humidity hazards, population vulnerability, medical access, and physical infrastructure. A final map showcases a composite heat vulnerability score for each county, with comparisons to state and national averages. Our tool, part of the White House's Climate Data Initiative, is presented as a series of maps with a normalized scoring system to provide clear and easy access to the indicators most relevant to evaluating heat vulnerability at a local level. Ultimately, this readily available tool with general indices helps community decision makers communicate heat vulnerability and identify which resilience factors are most critical to improving local resilience.

  8. Topical treatment with coenzyme Q10-containing formulas improves skin's Q10 level and provides antioxidative effects.

    Science.gov (United States)

    Knott, Anja; Achterberg, Volker; Smuda, Christoph; Mielke, Heiko; Sperling, Gabi; Dunckelmann, Katja; Vogelsang, Alexandra; Krüger, Andrea; Schwengler, Helge; Behtash, Mojgan; Kristof, Sonja; Diekmann, Heike; Eisenberg, Tanya; Berroth, Andreas; Hildebrand, Janosch; Siegner, Ralf; Winnefeld, Marc; Teuber, Frank; Fey, Sven; Möbius, Janne; Retzer, Dana; Burkhardt, Thorsten; Lüttke, Juliane; Blatt, Thomas

    2015-01-01

    Ubiquinone (coenzyme Q10, Q10) represents an endogenously synthesized lipid-soluble antioxidant which is crucial for cellular energy production but is diminished with age and under the influence of external stress factors in human skin. Here, it is shown that topical Q10 treatment is beneficial with regard to effective Q10 replenishment, augmentation of cellular energy metabolism, and antioxidant effects. Application of Q10-containing formulas significantly increased the levels of this quinone on the skin surface. In the deeper layers of the epidermis the ubiquinone level was significantly augmented indicating effective supplementation. Concurrent elevation of ubiquinol levels suggested metabolic transformation of ubiquinone resulting from increased energy metabolism. Incubation of cultured human keratinocytes with Q10 concentrations equivalent to treated skin showed a significant augmentation of energy metabolism. Moreover, the results demonstrated that stressed skin benefits from the topical Q10 treatment by reduction of free radicals and an increase in antioxidant capacity.

  9. Unit-level voluntary turnover rates and customer service quality: implications of group cohesiveness, newcomer concentration, and size.

    Science.gov (United States)

    Hausknecht, John P; Trevor, Charlie O; Howard, Michael J

    2009-07-01

    Despite substantial growth in the service industry and emerging work on turnover consequences, little research examines how unit-level turnover rates affect essential customer-related outcomes. The authors propose an operational disruption framework to explain why voluntary turnover impairs customers' service quality perceptions. On the basis of a sample of 75 work units and data from 5,631 employee surveys, 59,602 customer surveys, and organizational records, results indicate that unit-level voluntary turnover rates are negatively related to service quality perceptions. The authors also examine potential boundary conditions related to the disruption framework. Of 3 moderators studied (group cohesiveness, group size, and newcomer concentration), results show that turnover's negative effects on service quality are more pronounced in larger units and in those with a greater concentration of newcomers.

  10. Leadership Provided by Non-Academic Middle-Level Managers in the Australian Higher Education Sector: The Enablers

    Science.gov (United States)

    Vilkinas, Tricia

    2014-01-01

    This study seeks to identify the leadership behaviours displayed by non-academic middle-level managers in the Australian higher education sector. The study also identifies the importance of these leadership behaviours and the leadership effectiveness of these managers. The integrated competing values framework was used to measure leadership…

  11. The Effects of Providing Additional Reading Opportunities for Struggling Readers at Their Independent Reading Levels within Content Areas

    Science.gov (United States)

    Vasinko, Teresa

    2013-01-01

    A mixed-methods study was conducted to determine if extra reading practice incorporated into fifth-and sixth-grade social studies and science content classes would have a positive impact on reading assessments for readers at risk. At-risk readers' independent reading levels were assessed using Dynamic Indicator of Basic Early Literacy Skills or…

  12. Leadership Provided by Non-Academic Middle-Level Managers in the Australian Higher Education Sector: The Enablers

    Science.gov (United States)

    Vilkinas, Tricia

    2014-01-01

    This study seeks to identify the leadership behaviours displayed by non-academic middle-level managers in the Australian higher education sector. The study also identifies the importance of these leadership behaviours and the leadership effectiveness of these managers. The integrated competing values framework was used to measure leadership…

  13. Barriers and facilitators to preparing families with premature infants for discharge home from the neonatal unit. Perceptions of health care providers.

    Science.gov (United States)

    Raffray, Marie; Semenic, Sonia; Osorio Galeano, Sandra; Ochoa Marín, Sandra Catalina

    2014-01-01

    To explore Colombian health care provider perceptions of barriers and facilitators to preparing families with premature infants for discharge home from the neonatal intensive care unit (NICU). Using a qualitative descriptive design, in-depth semi-structured interviews were conducted with fifteen neonatal health care providers (HCPs) in Colombia. Data were analyzed using qualitative content analysis. Participant responses centered on three main themes: 1) establishment of the parent-infant bond, 2) acquisition of parenting skills, and 3) getting ready for the transition from hospital to home. Barreirs to preparing parents for NICU discharge included obstacles to parental visiting in the NICU, communication barriers, difficulties related to the establishment of successful breastfeeding, insufficient human resources and poor links between hospital and community-based resources. Facilitators included the availability of social aids for vulnerable families, 24-hour telephone access to the neonatal units, tailored educational materials and group sessions, continuing education for staff and the community-based Kangaroo Program available to parents post-discharge. Adolescent mothers, indigenous parent and working fathers were identified as particularly challenging to reach and engage in discharge preparation. Neonatal HCPs identified numerous challenges as well as helpful strategies for preparing families for hospital discharge. Additional studies are needed on the experience of neonatal discharge from the perspective of parents of premature infants in Colombia, to help inform optimal interventions for supporting families during the transition from hospital to home.

  14. Barriers and facilitators to preparing families with premature infants for discharge home from the neonatal unit. Perceptions of health care providers

    Directory of Open Access Journals (Sweden)

    Marie Raffray

    2014-12-01

    Full Text Available Objective. To explore Colombian health care provider perceptions of barriers and facilitators to preparing families with premature infants for discharge home from the neonatal intensive care unit (NICU. Methodology. Using a qualitative descriptive design, in-depth semi-structured interviews were conducted with fifteen neonatal health care providers (HCPs in Colombia. Data were analyzed using qualitative content analysis. Results. Participant responses centered on three main themes: 1 establishment of the parent-infant bond, 2 acquisition of parenting skills, and 3 getting ready for the transition from hospital to home. Barreirs to preparing parents for NICU discharge included obstacles to parental visiting in the NICU, communication barriers, difficulties related to the establishment of successful breastfeeding, insufficient human resources and poor links between hospital and community-based resources. Facilitators included the availability of social aids for vulnerable families, 24-hour telephone access to the neonatal units, tailored educational materials and group sessions, continuing education for staff and the community-based Kangaroo Program available to parents post-discharge. Adolescent mothers, indigenous parent and working fathers were identified as particularly challenging to reach and engage in discharge preparation. Conclusion. Neonatal HCPs identified numerous challenges as well as helpful strategies for preparing families for hospital discharge. Additional studies are needed on the experience of neonatal discharge from the perspective of parents of premature infants in Colombia, to help inform optimal interventions for supporting families during the transition from hospital to home.

  15. Muscle-tendon units localization and activation level analysis based on high-density surface EMG array and NMF algorithm

    Science.gov (United States)

    Huang, Chengjun; Chen, Xiang; Cao, Shuai; Zhang, Xu

    2016-12-01

    Objective. Some skeletal muscles can be subdivided into smaller segments called muscle-tendon units (MTUs). The purpose of this paper is to propose a framework to locate the active region of the corresponding MTUs within a single skeletal muscle and to analyze the activation level varieties of different MTUs during a dynamic motion task. Approach. Biceps brachii and gastrocnemius were selected as targeted muscles and three dynamic motion tasks were designed and studied. Eight healthy male subjects participated in the data collection experiments, and 128-channel surface electromyographic (sEMG) signals were collected with a high-density sEMG electrode grid (a grid consists of 8 rows and 16 columns). Then the sEMG envelopes matrix was factorized into a matrix of weighting vectors and a matrix of time-varying coefficients by nonnegative matrix factorization algorithm. Main results. The experimental results demonstrated that the weightings vectors, which represent invariant pattern of muscle activity across all channels, could be used to estimate the location of MTUs and the time-varying coefficients could be used to depict the variation of MTUs activation level during dynamic motion task. Significance. The proposed method provides one way to analyze in-depth the functional state of MTUs during dynamic tasks and thus can be employed on multiple noteworthy sEMG-based applications such as muscle force estimation, muscle fatigue research and the control of myoelectric prostheses. This work was supported by the National Nature Science Foundation of China under Grant 61431017 and 61271138.

  16. Firstborn offspring sex ratio is skewed towards female offspring in anesthesia care providers: A questionnaire-based nationwide study from United States

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    Deepak Gupta

    2013-01-01

    Objectives: The objective was to conduct a nation-wide survey to observe (a whether firstborn offspring sex ratio (OSR in anesthesia providers is skewed towards increased female offspring, and (b to identify potential factors influencing firstborn OSR, particularly those relating to the peri-conceptional practice of inhalational anesthesia induction among anesthesia providers. Materials and Methods: After institutional review board approval, a questionnaire was uploaded on SurveyMonkey and sent to anesthesia providers through their program coordinators in United States (US to complete the survey. Results: The current US national total-population sex ratio is 0.97 male (s/female with an at-birth sex ratio of 1.05 male (s/female; comparatively, the results from anesthesia providers′ survey respondents (n = 314 were a total OSR of 0.93 male (s/female ( P = 0.61 with firstborn OSR 0.82 male (s/female (a 6% increase in female offspring; P = 0.03, respectively. The only significant peri-conceptional factor related to anesthesia providers′ firstborn OSR′s skew was inhalational induction practice by anesthesia care provider favoring female offspring ( P < 0.01. Conclusion: Based on the results of this limited survey, it can be concluded that anesthesia care providers who practice inhalation induction of anesthesia during the peri-conceptional period are significantly more likely to have firstborn female offspring.

  17. Foraminifera in elevated Bermudian caves provide further evidence for +21 m eustatic sea level during Marine Isotope Stage 11

    Science.gov (United States)

    van Hengstum, Peter J.; Scott, David B.; Javaux, Emmanuelle J.

    2009-09-01

    Two hypotheses have been proposed to explain the origin of marine isotope stage (MIS) 11 deposits in small Bermudian caves at +21 m above modern sea level: (1) a +21 m MIS 11 eustatic sea-level highstand, and (2) a MIS 11 mega-tsunami event. Importantly, the foraminifera reported in these caves have yet to be critically evaluated within a framework of coastal cave environments. After statistically comparing foraminifera in modern Bermudian littoral caves and the MIS 11 Calonectris Pocket A (+21 m cave) to the largest available database of Bermudian coastal foraminifera, the assemblages found in modern littoral caves - and Calonectris Pocket A - cannot be statistically differentiated from lagoons. This observation is expected considering littoral caves are simply sheltered extensions of a lagoon environment in the littoral zone, where typical coastal processes (waves, storms) homogenize and rework lagoonal, reefal, and occasional planktic taxa. Fossil protoconchs of the Bermudian cave stygobite Caecum caverna were also associated with the foraminifera. These results indicate that the MIS 11 Bermudian caves are fossil littoral caves (breached flank margin caves), where the total MIS 11 microfossil assemblage is preserving a signature of coeval sea level at +21 m. Brackish foraminifera ( Polysaccammina, Pseudothurammina) and anchialine gastropods (˜95%, >300 individuals) indicate a brackish anchialine habitat developed in the elevated caves after the prolonged littoral environmental phase. The onset of sea-level regression following the +21 m highstand would first lower the ancient brackish Ghyben-Herzberg lens (<0.5 m) and flood the cave with brackish water, followed by drainage of the cave to create a permanent vadose environment. These interpretations of the MIS 11 microfossils (considering both taphonomy and paleoecology) are congruent with the micropaleontological, hydrogeological and physical mechanisms influencing modern Bermudian coastal cave environments. In

  18. Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume.

    NARCIS (Netherlands)

    Bech, A.; Blans, M.; Raaijmakers, M.; Mulkens, C.; Telting, D.; Boer, H. de

    2013-01-01

    BACKGROUND: Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. OBJECTIVE: To evaluate an individualized phosphate replacement regimen. DESIGN: Fifty consecutive intensive care unit patie

  19. Managing Highway Maintenance: Standards for Maintenance Work, Part 3, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit explains various uses of maintenance standards and how standards should be interpreted and communicated to formen and crew leaders. Several examples are given of the decisions made when applying the standards to routine work. The preceding units on standards (parts 1 and 2)…

  20. Problem Based Learning: Does It Provide Appropriate Levels of Guidance and Flexibility for Use in Police Recruit Education?

    Science.gov (United States)

    Shipton, Brett

    2009-01-01

    Education programs for police recruits have often been criticised for their over-reliance on teacher-centred approaches that are less than ideal for promoting functional knowledge and critical thinking skills. Problem-Based Learning (PBL), which is suggested as an alternative, has been criticised for not providing novice learners with appropriate…

  1. Sales of Forestry-Related Specialty License Plates in the Southern United States: A County Level Empirical Analysis

    Directory of Open Access Journals (Sweden)

    Shaun M. Tanger

    2016-07-01

    Full Text Available In recent years, specialty license plates have become an increasingly popular way to raise awareness and show support for a myriad of issues with which the plate is linked. Several states and various organizations that provide forestry education have developed forestry license plates. Vehicle owners can purchase the plates to show their support towards forestry by buying the forestry license plates, which generates revenue for the provider organization. Using county-level data from five states in the Southeastern United States, a statistical model was developed to examine explanatory factors of forestry-based specialty license plate sales in 2014. Using linear count regression modeling, we observed that the significant predictor variables of plate sales were income per capita, population density, the percentage of acres that are forested in the county, acres of forest in the county that are privately owned, percentage of people who are 65 or older, and presence of the forest industry in the county. Plate sales were positively correlated with the presence of the forest industry in the county.

  2. Dysregulation of serum gamma interferon levels in vascular chronic Q Fever patients provides insights into disease pathogenesis.

    Science.gov (United States)

    Pennings, Jeroen L A; Kremers, Marjolein N T; Hodemaekers, Hennie M; Hagenaars, Julia C J P; Koning, Olivier H J; Renders, Nicole H M; Hermans, Mirjam H A; de Klerk, Arja; Notermans, Daan W; Wever, Peter C; Janssen, Riny

    2015-06-01

    A large community outbreak of Q fever occurred in the Netherlands in the period 2007 to 2010. Some of the infected patients developed chronic Q fever, which typically includes pathogen dissemination to predisposed cardiovascular sites, with potentially fatal consequences. To identify the immune mechanisms responsible for ineffective clearance of Coxiella burnetii in patients who developed chronic Q fever, we compared serum concentrations of 47 inflammation-associated markers among patients with acute Q fever, vascular chronic Q fever, and past resolved Q fever. Serum levels of gamma interferon were strongly increased in acute but not in vascular chronic Q fever patients, compared to past resolved Q fever patients. Interleukin-18 levels showed a comparable increase in acute as well as vascular chronic Q fever patients. Additionally, vascular chronic Q fever patients had lower serum levels of gamma interferon-inducible protein 10 (IP-10) and transforming growth factor β (TGF-β) than did acute Q fever patients. Serum responses for these and other markers indicate that type I immune responses to C. burnetii are affected in chronic Q fever patients. This may be attributed to an affected immune system in cardiovascular patients, which enables local C. burnetii replication at affected cardiovascular sites.

  3. Neonatal pleural effusions in a Level III Neonatal Intensive Care Unit

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    Mariana Barbosa

    2015-04-01

    Full Text Available Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.The authors performed a retrospective study in the Neonatal Intensive Care Unit of "Hospital de São João", Porto (Portugal, between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN.Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2% newborns and acquired in 63 (76.8%. Fetal hydrops was the most frequent cause (15 cases, 78.9% of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9% of acquired effusions, followed by leakage of TPN (13 cases, 20.6%. Chylothorax was the most common type of effusion (41.5% of cases. Pleural effusions after intrathoracic surgery were mainly (64.1% chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9% newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.

  4. [Stress level assessment of the nursing staff in the Intensive Care Unit of a university hospital].

    Science.gov (United States)

    Carrillo-García, C; Ríos-Rísquez, M I; Martínez-Hurtado, R; Noguera-Villaescusa, P

    2016-01-01

    The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N=89). The mean of the Social support dimension was 3.13±0.397, for the Psychological demands at work dimension it was 3.10±0.384, with a mean of 2.96±0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample.

  5. Does Semi-Rigid Instrumentation Using Both Flexion and Extension Dampening Spacers Truly Provide an Intermediate Level of Stabilization?

    Directory of Open Access Journals (Sweden)

    Dilip Sengupta

    2013-01-01

    Full Text Available Conventional posterior dynamic stabilization devices demonstrated a tendency towards highly rigid stabilization approximating that of titanium rods in flexion. In extension, they excessively offload the index segment, making the device as the sole load-bearing structure, with concerns of device failure. The goal of this study was to compare the kinematics and intradiscal pressure of monosegmental stabilization utilizing a new device that incorporates both a flexion and extension dampening spacer to that of rigid internal fixation and a conventional posterior dynamic stabilization device. The hypothesis was the new device would minimize the overloading of adjacent levels compared to rigid and conventional devices which can only bend but not stretch. The biomechanics were compared following injury in a human cadaveric lumbosacral spine under simulated physiological loading conditions. The stabilization with the new posterior dynamic stabilization device significantly reduced motion uniformly in all loading directions, but less so than rigid fixation. The evaluation of adjacent level motion and pressure showed some benefit of the new device when compared to rigid fixation. Posterior dynamic stabilization designs which both bend and stretch showed improved kinematic and load-sharing properties when compared to rigid fixation and when indirectly compared to existing conventional devices without a bumper.

  6. Electronic coherence provides a direct proof for energy-level crossing in photoexcited lutein and beta-carotene.

    Science.gov (United States)

    Ostroumov, Evgeny; Müller, Marc G; Marian, Christel M; Kleinschmidt, Martin; Holzwarth, Alfred R

    2009-09-04

    We investigate femtosecond transient absorption dynamics of lutein and beta-carotene. Strong oscillations up to about 400 fs are observed, depending on excitation or detection wavelength and solvent. We propose electronic quantum beats as the origin of these oscillations. They provide direct proof for strong coupling of the 1B(u)(+) with another electronic "dark" state predicted by quantum chemical calculations to be the 1B(u)(-) state resulting in a crossing within a dynamic relaxation model. The overall dynamics can be described well by an optical Bloch equation approach.

  7. Chromosome-level genome map provides insights into diverse defense mechanisms in the medicinal fungus Ganoderma sinense.

    Science.gov (United States)

    Zhu, Yingjie; Xu, Jiang; Sun, Chao; Zhou, Shiguo; Xu, Haibin; Nelson, David R; Qian, Jun; Song, Jingyuan; Luo, Hongmei; Xiang, Li; Li, Ying; Xu, Zhichao; Ji, Aijia; Wang, Lizhi; Lu, Shanfa; Hayward, Alice; Sun, Wei; Li, Xiwen; Schwartz, David C; Wang, Yitao; Chen, Shilin

    2015-06-05

    Fungi have evolved powerful genomic and chemical defense systems to protect themselves against genetic destabilization and other organisms. However, the precise molecular basis involved in fungal defense remain largely unknown in Basidiomycetes. Here the complete genome sequence, as well as DNA methylation patterns and small RNA transcriptomes, was analyzed to provide a holistic overview of secondary metabolism and defense processes in the model medicinal fungus, Ganoderma sinense. We reported the 48.96 Mb genome sequence of G. sinense, consisting of 12 chromosomes and encoding 15,688 genes. More than thirty gene clusters involved in the biosynthesis of secondary metabolites, as well as a large array of genes responsible for their transport and regulation were highlighted. In addition, components of genome defense mechanisms, namely repeat-induced point mutation (RIP), DNA methylation and small RNA-mediated gene silencing, were revealed in G. sinense. Systematic bioinformatic investigation of the genome and methylome suggested that RIP and DNA methylation combinatorially maintain G. sinense genome stability by inactivating invasive genetic material and transposable elements. The elucidation of the G. sinense genome and epigenome provides an unparalleled opportunity to advance our understanding of secondary metabolism and fungal defense mechanisms.

  8. Derelict fishing line provides a useful proxy for estimating levels of non-compliance with no-take marine reserves.

    Directory of Open Access Journals (Sweden)

    David H Williamson

    Full Text Available No-take marine reserves (NTMRs are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching. Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas with limited or non-existent resources for conducting surveillance and enforcement. Here we assess the utility of density estimates and re-accumulation rates of derelict (lost and abandoned fishing line as a proxy for fishing effort and NTMR non-compliance on fringing coral reefs in three island groups of the Great Barrier Reef Marine Park (GBRMP, Australia. Densities of derelict fishing line were consistently lower on reefs within old (>20 year NTMRs than on non-NTMR reefs (significantly in the Palm and Whitsunday Islands, whereas line densities did not differ significantly between reefs in new NTMRs (5 years of protection and non-NTMR reefs. A manipulative experiment in which derelict fishing lines were removed from a subset of the monitoring sites demonstrated that lines re-accumulated on NTMR reefs at approximately one third (32.4% of the rate observed on non-NTMR reefs over a thirty-two month period. Although these inshore NTMRs have long been considered some of the best protected within the GBRMP, evidence presented here suggests that the level of non-compliance with NTMR regulations is higher than previously assumed.

  9. Derelict fishing line provides a useful proxy for estimating levels of non-compliance with no-take marine reserves.

    Science.gov (United States)

    Williamson, David H; Ceccarelli, Daniela M; Evans, Richard D; Hill, Jos K; Russ, Garry R

    2014-01-01

    No-take marine reserves (NTMRs) are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching). Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas with limited or non-existent resources for conducting surveillance and enforcement. Here we assess the utility of density estimates and re-accumulation rates of derelict (lost and abandoned) fishing line as a proxy for fishing effort and NTMR non-compliance on fringing coral reefs in three island groups of the Great Barrier Reef Marine Park (GBRMP), Australia. Densities of derelict fishing line were consistently lower on reefs within old (>20 year) NTMRs than on non-NTMR reefs (significantly in the Palm and Whitsunday Islands), whereas line densities did not differ significantly between reefs in new NTMRs (5 years of protection) and non-NTMR reefs. A manipulative experiment in which derelict fishing lines were removed from a subset of the monitoring sites demonstrated that lines re-accumulated on NTMR reefs at approximately one third (32.4%) of the rate observed on non-NTMR reefs over a thirty-two month period. Although these inshore NTMRs have long been considered some of the best protected within the GBRMP, evidence presented here suggests that the level of non-compliance with NTMR regulations is higher than previously assumed.

  10. The status of metal levels in common loons (Gavia immer) in the northeast United states

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — From 1989-1993, 178 common loons found dead or moribund throughout the northeastern United States were examined by personnel from Tufts University School of...

  11. Developing a United States Marine Corps Organizational and Intermediate Level Maintenance Performance Cost Model

    Science.gov (United States)

    2009-12-01

    Marine Corps Integrated Maintenance Management System MIPR Military Interdepartmental Purchase Request MLG Marine Corps Logistics Unit MOSIS ...D. (1997). An examination of the Marine Operating and Support Information System ( MOSIS ) as a mechanism for linking resources to readiness for

  12. Using Machine Learning to Determine United States Army Readiness at the Battalion Level

    Science.gov (United States)

    2012-02-16

    Unit Performance. US Army Research Institute for the Behavioral and Social Sciences, Alexandria, VA, July, 1994. Norvig , Peter, Paradigms of...Russell, Stuart, and Norvig , Peter, Artificial Intelligence, A Modern Approach, Prentice Hall, Upper Saddle River, New Jersey, 1995. Schaffer

  13. Satisfaction of health-care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates.

    Science.gov (United States)

    Bani-Issa, Wegdan; Al Yateem, Nabeel; Al Makhzoomy, Ibtihal Khalaf; Ibrahim, Ali

    2016-08-01

    The integration of electronic health records (EHRs) has shown promise in improving health-care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross-sectional survey of 680 health-care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes.

  14. Mid-level Providers Working in a Low-acuity Area are More Productive than in a High-acuity Area.

    Science.gov (United States)

    Silberman, Michael; Jeanmonod, Donald; Hamden, Khalief; Reiter, Mark; Jeanmonod, Rebecca

    2013-11-01

    Mid-level providers (MLP) are extensively used in staffing emergency departments (ED). We sought to compare the productivity of MLPs staffing a low-acuity and high-acuity area of a community ED. This is a retrospective review of MLP productivity at a single center 42,000-volume community ED from July 2009 to September 2010. MLPs staffed day shifts (8AM-6PM or 10AM-10PM) in high- and low-acuity sections of the ED. We used two-tailed T-test to compare patients/hour, relative value units (RVUs)/hour, and RVUs/patient between the 2 MLP groups. We included 49 low-acuity and 55 high-acuity shifts in this study. During the study period, MLPs staffing low-acuity shifts treated a mean of 2.7 patients/hour (confidence interval [CI] +/- 0.23), while those staffing high-acuity shifts treated a mean of 1.56 patients/hour (CI +/- 0.14, p<0.0001). MLPs staffing low-acuity shifts generated a mean of 4.45 RVUs/hour (CI +/- 0.34) compared to 3.19 RVUs/hour (CI +/- 0.29) for those staffing high-acuity shifts (p<0.0001). MLPs staffing low-acuity shifts generated a mean of 1.68 RVUs/patient (CI +/- 0.06) while those staffing high-acuity shifts generated a mean RVUs/patient of 2.05 (CI +/- 0.09, p<0.0001). MLPs staffing a low-acuity area treated more patients/hour and generated more RVUs/hour than when staffing a high-acuity area.

  15. Mid-level Providers Working in a Low-acuity Area are More Productive than in a High-acuity Area

    Directory of Open Access Journals (Sweden)

    Silberman, Michael

    2013-11-01

    Full Text Available Introduction: Mid-level providers (MLP are extensively used in staffing emergency departments (ED. We sought to compare the productivity of MLPs staffing a low-acuity and high-acuity area of a community ED.Methods: This is a retrospective review of MLP productivity at a single center 42,000-volume community ED from July 2009 to September 2010. MLPs staffed day shifts (8AM-6PM or 10AM-10PM in high- and low-acuity sections of the ED. We used two-tailed T-test to compare patients/hour, relative value units (RVUs/hour, and RVUs/patient between the 2 MLP groups. Results: We included 49 low-acuity and 55 high-acuity shifts in this study. During the study period, MLPs staffing low-acuity shifts treated a mean of 2.7 patients/hour (confidence interval [CI] +/- 0.23, while those staffing high-acuity shifts treated a mean of 1.56 patients/hour (CI +/- 0.14, P < 0.0001. MLPs staffing low-acuity shifts generated a mean of 4.45 RVUs/hour (CI +/- 0.34 compared to 3.19 RVUs/hour (CI +/-0.29 for those staffing high-acuity shifts (P < 0.0001. MLPs staffing low-acuity shifts generated a mean of 1.68 RVUs/patient (CI +/- 0.06 while those staffing high-acuity shifts generated a mean RVUs/patient of 2.05 (CI +/- 0.09, P < 0.0001. Conclusion: MLPs staffing a low-acuity area treated more patients/hour and generated more RVUs/hour than when staffing a high-acuity area. [West J Emerg Med.2013;14(6:598–601.

  16. Succinate receptor GPR91 provides a direct link between high glucose levels and renin release in murine and rabbit kidney.

    Science.gov (United States)

    Toma, Ildikó; Kang, Jung Julie; Sipos, Arnold; Vargas, Sarah; Bansal, Eric; Hanner, Fiona; Meer, Elliott; Peti-Peterdi, János

    2008-07-01

    Diabetes mellitus is the most common and rapidly growing cause of end-stage renal disease in developed countries. A classic hallmark of early diabetes mellitus includes activation of the renin-angiotensin system (RAS), which may lead to hypertension and renal tissue injury, but the mechanism of RAS activation is elusive. Here we identified a paracrine signaling pathway in the kidney in which high levels of glucose directly triggered the release of the prohypertensive hormone renin. The signaling cascade involved the local accumulation of succinate and activation of the kidney-specific G protein-coupled metabolic receptor, GPR91, in the glomerular endothelium as observed in rat, mouse, and rabbit kidney sections. Elements of signal transduction included endothelial Ca2+, the production of NO and prostaglandin (PGE2), and their paracrine actions on adjacent renin-producing cells. This GPR91 signaling cascade may serve to modulate kidney function and help remove metabolic waste products through renal hyperfiltration, and it could also link metabolic diseases, such as diabetes, or metabolic syndrome with RAS overactivation, systemic hypertension, and organ injury.

  17. Molecular-level evidence provided by ultrahigh resolution mass spectrometry for oil-derived doc in groundwater at Bemidji, Minnesota.

    Science.gov (United States)

    Islam, Ananna; Ahmed, Arif; Hur, Manhoi; Thorn, Kevin; Kim, Sunghwan

    2016-12-15

    Dissolved organic matter samples extracted from ground water at the USGS Bemidji oil spill site in Minnesota were investigated by ultrahigh resolution mass spectrometry. Principle component analysis (PCA) of the elemental composition assignments of the samples showed that the score plots for the contaminated sites were well separated from those for the uncontaminated sites. Additionally, spectra obtained from the same sampling site 7 and 19 years after the spill were grouped together in the score plot, strongly suggesting a steady state of contamination within the 12year interval. The double bond equivalence (DBE) of Ox class compounds was broader for the samples from the contaminated sites, because of the complex nature of oil and the consequent formation of compounds with saturated and/or aromatic structures from the oxygenated products of oil. In addition, Ox class compounds with a relatively smaller number of x (x<8; x=number of oxygen) and OxS1 class compounds were more abundant in the samples from the contaminated sites, because of the lower oxygen and higher sulfur contents of the oil compared to humic substances. The molecular-level signatures presented here can be a fundamental basis for in-depth analysis of oil contamination. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Evaluation of noise level at intensive care units in selected hospitals of Sanandaj

    Directory of Open Access Journals (Sweden)

    Nammam Ali Azadi

    2015-08-01

    Conclusion: We found the noise levels were always above the EPA thresholds at all three hospitals both during the day and night. It is recommended to train hospital officials and staffs for keeping noise levels to an acceptable level.

  19. Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States.

    Science.gov (United States)

    Guerra-Reyes, Lucia; Hamilton, Lydia J

    2017-02-01

    Midwifery care has been linked to positive birth outcomes. Despite the broad racial disparities in maternal and infant outcomes in the United States (US), little is known about the role of minority women in either providing or receiving this type of care. A vibrant community of minority women, who self-identify as providing these services, exists online. In this exploratory study we ask how they describe their role; view their practice; and position themselves in the broader discussions of racial health disparities in the US. Using an internet mediated qualitative design we analyse online narratives from self-described African-American nurse-midwives, lay midwives and birth assistants; we found 28 unique websites. We collected and analysed narrative material from each site. We used a thematic analysis approach to identify recurrent and emergent themes in relation to the study question. Narratives identified a strong link to the past, as providers viewed their practice in a historical perspective linking African roots, to the diaspora, and to current African-American struggles. Providers engaged both in direct clinical work, and in activist roles. Advocacy efforts sought to expand numbers of minority birth care workers and to extend the benefits of woman-centred birth care to underserved communities. Results demonstrate the continued existence and important role of diverse types of African-American birth care providers in minority communities in the US. Recognition, support, and increasing the number of midwives of colour is important in tackling racial inequalities in health. Further research should explore minority access to woman-centred care. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Optimal level of Au nanoparticles on Pd nanostructures providing remarkable electro-catalysis in direct ethanol fuel cell

    Science.gov (United States)

    Dutta, Abhijit; Mondal, Achintya; Broekmann, Peter; Datta, Jayati

    2017-09-01

    The designing and fabrication of economically viable electro-catalysts for ethanol oxidation reaction (EOR) in direct ethanol fuel cell (DEFC) has been one of the challenging issues over the decades. The present work deals with controlled synthesis of Pd coupled Au nano structure, as the non Pt group of catalysts for DEFC. The catalytic proficiency of bimetallic NPs (2-10 nm) are found to be strongly dependent on the Pd:Au ratio. The over voltage of EOR is considerably reduced by ∼260 mV with 33% of Au content in PdAu composition compared to Pd alone, demonstrating the beneficial role of Au and/or its surface oxides providing oxygen species at much lower potentials compared to Pd. The catalysts are further subjected to electrochemical analysis through voltammetry along with the temperature study on activation parameters. The quantitative determination of EOR products during the electrolysis is carried out by ion chromatographic analysis; vis-a-vis the coulombic efficiency of the product yield were derived from each of the compositions. Furthermore, a strong correlation among catalytic performances and bimetallic composition is established by screening the catalysts in an in-house fabricated direct ethanol anion exchange membrane fuel cell, DE(AEM)FC. The performance testing demonstrates outstanding increase of peak power density (∼40 mWcm-2, 93%) for the best accomplishment Au (33%) covered Pd (67%) catalyst in comparison with the monometallic Pd.

  1. Noninvasive Measurement of Ear Cartilage Elasticity on the Cellular Level: A New Method to Provide Biomechanical Information for Tissue Engineering

    Science.gov (United States)

    Bos, Ernst Jan; van der Laan, Koen; Helder, Marco N.; Mullender, Margriet G.; Iannuzzi, Davide

    2017-01-01

    Background: An important feature of auricular cartilage is its stiffness. To tissue engineer new cartilage, we need objective tools to provide us with the essential biomechanical information to mimic optimal conditions for chondrogenesis and extracellular matrix (ECM) development. In this study, we used an optomechanical sensor to investigate the elasticity of auricular cartilage ECM and tested whether sensitivity and measurement reproducibility of the sensor would be sufficient to accurately detect (subtle) differences in matrix compositions in healthy, diseased, or regenerated cartilage. Methods: As a surrogate model to different cartilage ECM compositions, goat ears (n = 9) were subjected to different degradation processes to remove the matrix components elastin and glycosaminoglycans. Individual ear samples were cut and divided into 3 groups. Group 1 served as control and was measured within 2 hours after animal death and at 24 and 48 hours, and groups 2 and 3 were measured after 24- and 48-h hyaluronidase or elastase digestion. Per sample, 9 consecutive measurements were taken ±300 μm apart. Results: Good reproducibility was seen between consecutive measurements with an overall interclass correlation coefficient average of 0.9 (0.81–0.98). Although degradation led to variable results, overall, a significant difference was seen between treatment groups after 48 hours (control, 4.2 MPa [±0.5] vs hyaluronidase, 2.0 MPa [±0.3], and elastase, 3.0 MPa [±0.4]; both P development of tissue-engineered auricular cartilage.

  2. Genome-wide association study for circulating levels of PAI-1 provides novel insights into its regulation

    Science.gov (United States)

    Huang, Jie; Sabater-Lleal, Maria; Asselbergs, Folkert W.; Tregouet, David; Shin, So-Youn; Ding, Jingzhong; Baumert, Jens; Oudot-Mellakh, Tiphaine; Folkersen, Lasse; Johnson, Andrew D.; Smith, Nicholas L.; Williams, Scott M.; Ikram, Mohammad A.; Kleber, Marcus E.; Becker, Diane M.; Truong, Vinh; Mychaleckyj, Josyf C.; Tang, Weihong; Yang, Qiong; Sennblad, Bengt; Moore, Jason H.; Williams, Frances M. K.; Dehghan, Abbas; Silbernagel, Günther; Schrijvers, Elisabeth M. C.; Smith, Shelly; Karakas, Mahir; Tofler, Geoffrey H.; Silveira, Angela; Navis, Gerjan J.; Lohman, Kurt; Chen, Ming-Huei; Peters, Annette; Goel, Anuj; Hopewell, Jemma C.; Chambers, John C.; Saleheen, Danish; Lundmark, Per; Psaty, Bruce M.; Strawbridge, Rona J.; Boehm, Bernhard O.; Carter, Angela M.; Meisinger, Christa; Peden, John F.; Bis, Joshua C.; McKnight, Barbara; Öhrvik, John; Taylor, Kent; Franzosi, Maria Grazia; Seedorf, Udo; Collins, Rory; Franco-Cereceda, Anders; Syvänen, Ann-Christine; Goodall, Alison H.; Yanek, Lisa R.; Cushman, Mary; Müller-Nurasyid, Martina; Folsom, Aaron R.; Basu, Saonli; Matijevic, Nena; van Gilst, Wiek H.; Kooner, Jaspal S.; Hofman, Albert; Danesh, John; Clarke, Robert; Meigs, James B.; Kathiresan, Sekar; Reilly, Muredach P.; Klopp, Norman; Harris, Tamara B.; Winkelmann, Bernhard R.; Grant, Peter J.; Hillege, Hans L.; Watkins, Hugh; Spector, Timothy D.; Becker, Lewis C.; Tracy, Russell P.; März, Winfried; Uitterlinden, Andre G.; Eriksson, Per; Cambien, Francois; Morange, Pierre-Emmanuel; Koenig, Wolfgang; Soranzo, Nicole; van der Harst, Pim; Liu, Yongmei

    2012-01-01

    We conducted a genome-wide association study to identify novel associations between genetic variants and circulating plasminogen activator inhibitor-1 (PAI-1) concentration, and examined functional implications of variants and genes that were discovered. A discovery meta-analysis was performed in 19 599 subjects, followed by replication analysis of genome-wide significant (P < 5 × 10−8) single nucleotide polymorphisms (SNPs) in 10 796 independent samples. We further examined associations with type 2 diabetes and coronary artery disease, assessed the functional significance of the SNPs for gene expression in human tissues, and conducted RNA-silencing experiments for one novel association. We confirmed the association of the 4G/5G proxy SNP rs2227631 in the promoter region of SERPINE1 (7q22.1) and discovered genome-wide significant associations at 3 additional loci: chromosome 7q22.1 close to SERPINE1 (rs6976053, discovery P = 3.4 × 10−10); chromosome 11p15.2 within ARNTL (rs6486122, discovery P = 3.0 × 10−8); and chromosome 3p25.2 within PPARG (rs11128603, discovery P = 2.9 × 10−8). Replication was achieved for the 7q22.1 and 11p15.2 loci. There was nominal association with type 2 diabetes and coronary artery disease at ARNTL (P < .05). Functional studies identified MUC3 as a candidate gene for the second association signal on 7q22.1. In summary, SNPs in SERPINE1 and ARNTL and an SNP associated with the expression of MUC3 were robustly associated with circulating levels of PAI-1. PMID:22990020

  3. An Examination of Individual Level Factors in Stress and Coping Processes: Perspectives of Chinese International Students in the United States

    Science.gov (United States)

    Yan, Kun; Berliner, David C.

    2011-01-01

    No empirical research has focused solely upon understanding the stress and coping processes of Chinese international students in the United States. This qualitative inquiry examines the individual-level variables that affect the stress-coping process of Chinese international students and how they conceptualize and adapt to their stress at an…

  4. Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice

    Science.gov (United States)

    2015-03-24

    experiencing significant change . It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure...culture, readiness, beliefs, and implementation. 15. SUBJECT TERMS Evidence-based practice, culture, mentor, organizational change 16. SECURITY...Medical Command; her areas of interest include staffing, acuity, nursing workload, change management, organizational culture and empowering junior

  5. An Examination of Individual Level Factors in Stress and Coping Processes: Perspectives of Chinese International Students in the United States

    Science.gov (United States)

    Yan, Kun; Berliner, David C.

    2011-01-01

    No empirical research has focused solely upon understanding the stress and coping processes of Chinese international students in the United States. This qualitative inquiry examines the individual-level variables that affect the stress-coping process of Chinese international students and how they conceptualize and adapt to their stress at an…

  6. The Classification of the Probability Unit Ability Levels of the Eleventh Grade Turkish Students by Cluster Analysis

    Science.gov (United States)

    Ozyurt, Ozcan

    2014-01-01

    In this study, the probability unit ability levels of the eleventh grade Turkish students were classified through cluster analysis. The study was carried out in a high school located in Trabzon, Turkey during the fall semester of the 2011-2012 academic years. A total of 84 eleventh grade students participated. Students were taught about…

  7. 75 FR 24755 - DTE ENERGY; Enrico Fermi Atomic Power Plant Unit 1; Exemption From Certain Low-Level Waste...

    Science.gov (United States)

    2010-05-05

    ... COMMISSION DTE ENERGY; Enrico Fermi Atomic Power Plant Unit 1; Exemption From Certain Low-Level Waste Shipment Tracking Requirements In 10 CFR Part 20 Appendix G 1.0 Background DTE Energy (DTE) is the licensee.... DTE is in the process of decommissioning Fermi-1 and radioactive waste shipments from the site are...

  8. Enhancing quality and safety competency development at the unit level: an initial evaluation of student learning and clinical teaching on dedicated education units.

    Science.gov (United States)

    Mulready-Shick, Joann; Kafel, Kathleen W; Banister, Gaurdia; Mylott, Laura

    2009-12-01

    The need to attend to quality and safety competency development, increase capacity in nursing education programs, address the faculty and nursing shortages, and find new ways to keep step with an ever-changing health care environment has brought forth numerous creative curricular responses and collaborative efforts. To tackle these multiple needs and challenges simultaneously, a new academic-service partnership was created to collaboratively develop an innovative clinical education delivery model. The designed dedicated education unit model not only promoted student learning about quality and safety competencies via unit-based projects but also supported quality improvements in nursing care delivery. Following the initial semester of the model's implementation, a pilot study was conducted. The findings generated the evidence required to take this innovation to the next level. Moreover, the education-practice partnership, which was created to implement the clinical education delivery model, was strengthened as a result of this preliminary evaluation.

  9. INSTALLATION OF A POST-ACCIDENT CONFINEMENT HIGH-LEVEL RADIATION MONITORING SYSTEM IN THE KOLA NUCLEAR POWER STATION (UNIT 2) IN RUSSIA

    Energy Technology Data Exchange (ETDEWEB)

    GREENE,G.A.; GUPPY,J.G.

    1998-09-01

    This is the final report on the INSP project entitled, ``Post-Accident Confinement High-Level Radiation Monitoring System'' conducted by BNL under the authorization of Project Work Plan WBS 1.2.2.6 (Attachment 1). This project was initiated in February 1993 to assist the Russians in reducing risks associated with the continued operation of older Soviet-designed nuclear power plants, specifically the Kola VVER-440/230 Unit 2, through improved accident detection capability, specifically by the installation of a dual train high-level radiation detection system in the confinement of Unit 2 of the Kola NPP. The major technical objective of this project was to provide, install and make operational the necessary hardware inside the confinement of the Kola NPP Unit 2 to provide early and reliable warning of the release of radionuclides from the reactor into the confinement air space as an indication of the occurrence of a severe accident at the plant. In addition, it was intended to provide hands-on experience and training to the Russian plant workers in the installation, operation, calibration and maintenance of the equipment in order that they may use the equipment without continued US assistance as an effective measure to improve reactor safety at the plant.

  10. Genome-Wide Association Identifies Nine Common Variants Associated With Fasting Proinsulin Levels and Provides New Insights Into the Pathophysiology of Type 2 Diabetes

    NARCIS (Netherlands)

    Strawbridge, Rona J.; Dupuis, Josee; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R.; Travers, Mary E.; Bouatia-Naji, Nabila; Dimas, Antigone S.; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F.; Taneera, Jalal; Kanoni, Stavroula; Peden, John F.; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J. P.; Barnes, Daniel; Dennison, Elaine M.; Eriksson, Johan G.; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S.; Frayling, Timothy M.; Goel, Anuj; Gu, Harvest F.; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U.; Jameson, Karen A.; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J. F.; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K.; Teresa Martinez-Larrad, Maria; Narisu, Narisu; Mannila, Maria Nastase; Ohrvik, John; Osmond, Clive; Pascoe, Laura; Payne, Felicity; Sayer, Avan A.; Sennblad, Bengt; Silveira, Angela; Stancakova, Alena; Stirrups, Kathy; Swift, Amy J.; Syvanen, Ann-Christine; Tuomi, Tiinamaija; van 't Hooft, Ferdinand M.; Walker, Mark; Weedon, Michael N.; Xie, Weijia; Zethelius, Bjorn; Ongen, Halit; Malarstig, Anders; Hopewell, Jemma C.; Saleheen, Danish; Chambers, John; Parish, Sarah; Danesh, John; Kooner, Jaspal; Ostenson, Claes-Goran; Lind, Lars; Cooper, Cyrus C.; Serrano-Rios, Manuel; Ferrannini, Ele; Forsen, Tom J.; Clarke, Robert; Franzosi, Maria Grazia; Seedorf, Udo; Watkins, Hugh; Froguel, Philippe; Johnson, Paul; Deloukas, Panos; Collins, Francis S.; Laakso, Markku; Dermitzakis, Emmanouil T.; Boehnke, Michael; McCarthy, Mark I.; Wareham, Nicholas J.; Groop, Leif; Pattou, Francois; Gloyn, Anna L.; Dedoussis, George V.; Lyssenko, Valeriya; Meigs, James B.; Barroso, Ines; Watanabe, Richard M.; Ingelsson, Erik; Langenberg, Claudia; Hamsten, Anders; Florez, Jose C.

    2011-01-01

    OBJECTIVE-Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired beta-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about

  11. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    R.J. Strawbridge (Rona); J. Dupuis (Josée); I. Prokopenko (Inga); A.M. Barker (Adam); E. Ahlqvist (Emma); D. Rybin (Denis); J.R. Petrie (John); N. Bouatia-Naji (Nabila); A.S. Dimas (Antigone); E. Wheeler (Eleanor); H. Chen (Han); B.F. Voight (Benjamin); J. Taneera (Jalal); S. Kanoni (Stavroula); J. Peden (John); F. Turrini (Fabiola); S. Gustafsson (Stefan); C. Zabena (Carina); P. Almgren (Peter); G.V. Dedoussis (George); D. Barnes (Daniel); E.M. Dennison (Elaine); K. Hagen (Knut); P. Eriksson (Per); E. Eury (Elodie); L. Folkersen (Lasse); C.S. Fox (Caroline); T.M. Frayling (Timothy); A. Goel (Anuj); M. Horikoshi (Momoko); B. Isomaa (Bo); A.U. Jackson (Anne); K. Jameson (Karen); E. Kajantie (Eero); J. Kerr-Conte (Julie); L. Groop (Leif); J. Kuusisto (Johanna); R.J.F. Loos (Ruth); J. Luan; K. Makrilakis (Konstantinos); A.K. Manning (Alisa); M.T. Martinez-Larrad (Maria Teresa); N. Narisu (Narisu); J. Öhrvik (John); C. Osmond (Clive); L. Pascoe (Laura); F. Payne (Felicity); A.A. Sayer; B. Sennblad (Bengt); C. Cooper (Charles); K. Stirrups (Kathy); A.J. Swift (Amy); A.C. Syvänen; T. Tuomi (Tiinamaija); F. van't Hooft (Ferdinand); M. Walker (Mark); M.N. Weedon (Michael); W. Xie (Weijia); B. Zethelius (Björn); L.J. Scott (Laura); V. Steinthorsdottir (Valgerdur); A.P. Morris (Andrew); C. Dina (Christian); R.P. Welch (Ryan); E. Zeggini (Eleftheria); C. Huth (Cornelia); Y.S. Aulchenko (Yurii); G. Thorleifsson (Gudmar); L.J. McCulloch (Laura); T. Ferreira (Teresa); H. Grallert (Harald); N. Amin (Najaf); G. Wu (Guanming); C.J. Willer (Cristen); S. Raychaudhuri (Soumya); S.A. McCarroll (Steven); O.M. Hofmann (Oliver); L. Qi (Lu); A.V. Segrè (Ayellet); M. van Hoek (Mandy); P. Navarro (Pau); K.G. Ardlie (Kristin); B. Balkau (Beverley); N. Narisu (Narisu); A.J. Bennett (Amanda); R. Blagieva (Roza); E.A. Boerwinkle (Eric); L.L. Bonnycastle (Lori); K.B. Boström (Kristina Bengtsson); B. Bravenboer (Bert); S. Bumpstead (Suzannah); N.P. Burtt (Noël); G. Charpentier (Guillaume); P.S. Chines (Peter); M. Cornelis (Marilyn); D.J. Couper (David); G. Crawford (Gabe); A.S.F. Doney (Alex); K.S. Elliott (Katherine); A.L. Elliott (Amanda); M.R. Erdos (Michael); C.S. Franklin (Christopher); M. Ganser (Martha); C. Gieger (Christian); N. Grarup (Niels); T. Green (Todd); S. Griffin (Simon); C.J. Groves (Christopher); C. Guiducci (Candace); S. Hadjadj (Samy); N. Hassanali (Neelam); C. Herder (Christian); T. Jorgensen (Torben); W.H.L. Kao (Wen); N. Klopp (Norman); A. Kong (Augustine); P. Kraft (Peter); T. Lauritzen (Torsten); M. Li (Man); A. Lieverse (Aloysius); M.N. Weedon (Michael); V. Lyssenko (Valeriya); M. Marre (Michel); T. Meitinger (Thomas); K. Midthjell (Kristian); M.A. Morken (Mario); P. Nilsson (Peter); K.R. Owen (Katharine); J.R.B. Perry (John); A.K. Petersen; C. Platou (Carl); C. Proença (Christine); W. Rathmann (Wolfgang); R.R. Frants (Rune); G. Rocheleau (Ghislain); M. Roden (Michael); M.J. Sampson (Michael); R. Saxena (Richa); B.M. Shields (Beverley); P. Shrader (Peter); T. Sparsø (Thomas); K. Strassburger (Klaus); H.M. Stringham (Heather); Q. Sun (Qi); B. Thorand (Barbara); J. Tichet (Jean); T.W. van Haeften (Timon); T.W. van Herpt (Thijs); J.V. van Vliet-Ostaptchouk (Jana); G.B. Walters (Bragi); C. Wijmenga (Cisca); S. Cauchi (Stephane); A.L. Gloyn (Anna); U. Gyllensten (Ulf); T. Hansen (T.); W.A. Hide (Winston); G.A. Hitman (Graham); A. Hofman (Albert); K. Hveem (Kristian); M. Laakso (Markku); K.L. Mohlke (Karen L.); A.D. Morris (Andrew); C.N.A. Palmer (Colin); L.D. Stein (Lincoln); J. Tuomilehto (Jaakko); A.G. Uitterlinden (André); R.M. Watanabe (Richard); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); H. Campbell (Harry); M.J. Daly (Mark); A.T. Hattersley (Andrew); F.B. Hu (Frank B.); J.B. Meigs (James); J.S. Pankow (James); O. Pedersen (Oluf); I. Barroso (Inês); L. Groop (Leif); R. Sladek (Rob); U. Thorsteinsdottir (Unnur); J.F. Wilson (James F.); T. Illig (Thomas); P. Froguel (Philippe); C.M. van Duijn (Cock); J-A. Zwart (John-Anker); D. Altshuler (David); M. Boehnke (Michael); M.I. McCarthy (Mark I.); E.K. Speliotes (Elizabeth); S.I. Berndt (Sonja); K.L. Monda (Keri); H.L. Allen; R. Mägi (Reedik); J.C. Randall (Joshua); S. Vedantam (Sailaja); T.W. Winkler (Thomas W.); T. Workalemahu (Tsegaselassie); I.M. Heid (Iris); A.R. Wood (Andrew); R.J. Weyant (Robert); K. Estrada Gil (Karol); L. Liang (Liming); J. Nemesh (James); J.H. Park; T.O. Kilpeläinen (Tuomas); J. Yang (Jian); M.F. Feitosa (Mary Furlan); Z. Kutalik (Zoltán)

    2011-01-01

    textabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new

  12. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    R.J. Strawbridge (Rona); J.R. Petrie (John); T. Forsen (Tom); C. Cooper (Cyrus); M. Franzosi; A. Hamsten (Anders); E. Ferrannini (Ele); M.S. Rios; C.-G. Östenson (Claes-Göran); K. Makrilakis (Konstantinos); T.J. Forsen (Tom); C. Osmond (Clive); C. Cooper (Charles); E.M. Dennison (Elaine); K. Jameson (Karen); A.A. Sayer; T. Kuulasmaa (Teemu); A. Stancáková (Alena); L. Lind (Lars); M.N. Mannila (Maria Nastase); H. Gu (Harvest); B. Zethelius (Björn); F. Turrini (Fabiola); R.J.F. Loos (Ruth); L. Pascoe (Laura); A.C. Syvanen; E. Ahlqvist (Emma); M. Horikoshi (Momoko); D. Barnes (Daniel); C. Han (Chen); A.K. Manning (Alisa); D. Rybin (Denis); S. Kanoni (Stavroula); A.M. Barker (Adam); W. Xie (Weijia); E. Eury (Elodie); J. Kerr-Conte (Julie); F. Pattou (François); P.R.V. Johnson (Paul); M. Travers (Mary); R.R. Frants (Rune); P. Eriksson (Per); L. Folkersen (Lasse); F.M. van't Hooft (Ferdinand); L.J. Scott (Laura); V. Steinthorsdottir (Valgerdur); A.D. Morris (Andrew); C. Dina (Christian); E. Zeggini (Eleftheria); C. Huth (Cornelia); Y.S. Aulchenko (Yurii); G. Thorleifsson (Gudmar); L.J. McCulloch (Laura); T. Ferreira (Teresa); H. Grallert (Harald); G. Wu (Guanming); C.J. Willer (Cristen); S. Raychaudhuri (Soumya); S.A. McCarroll (Steve); C. Langenberg (Claudia); O.M. Hofmann (Oliver); J. Dupuis (Josée); L. Qi (Lu); M. van Hoek (Mandy); P. Navarro (Pau); K.G. Ardlie (Kristin); R. Benediktsson (Rafn); A.J. Bennett (Amanda); R. Blagieva (Roza); E.A. Boerwinkle (Eric); K.B. Boström (Kristina Bengtsson); B. Bravenboer (Bert); S. Bumpstead (Suzannah); N.P. Burtt (Noisël); G. Charpentier (Guillaume); P.S. Chines (Peter); M. Cornelis (Marilyn); D.J. Couper (David); G. Crawford (Gabe); A.S.F. Doney (Alex); K.S. Elliott (Katherine); A.L. Elliott (Amanda); C. Fox (Craig); C.S. Franklin (Christopher); M. Ganser (Martha); N. Grarup (Niels); T. Green (Todd); S. Griffin (Simon); C. Guiducci (Candace); S. Hadjadj (Samy); N. Hassanali (Neelam); C. Herder (Christian); A.U. Jackson (Anne); P.R.V. Johnson (Paul R.); W.H.L. Kao (Wen); N. Klopp (Norman); A. Kong (Augustine); P. Kraft (Peter); J. Kuusisto (Johanna); T. Lauritzen (Torsten); M. Li (Man); A. Lieverse (Aloysius); C.M. Lindgren (Cecilia); V. Lyssenko (Valeriya); M. Marre (Michel); T. Meitinger (Thomas); K. Midthjell (Kristian); M.A. Morken (Mario); P. Nilsson (Peter); K.R. Owen (Katharine); F. Payne (Felicity); J.R.B. Perry (John R.); A.K. Petersen; C.P. Platou (Carl); C. Proença (Christine); I. Prokopenko (Inga); W. Rathmann (Wolfgang); N.R. Robertson (Neil); G. Rocheleau (Ghislain); M. Roden (Michael); M.J. Sampson (Michael); R. Saxena (Richa); B.M. Shields (Beverley); P. Shrader (Peter); G. Sigurdsson (Gunnar); T. Sparsø (Thomas); K. Strassburger (Klaus); H.M. Stringham (Heather); Q. Sun (Qi); B. Thorand (Barbara); J. Tichet (Jean); T. Tuomi (Tiinamaija); R.M. van Dam (Rob); T.W. van Haeften (Timon); T.W. van Herpt (Thijs); J.V. van Vliet-Ostaptchouk (Jana); G. Bragi Walters (G.); M.N. Weedon (Michael); C. Wijmenga (Cisca); R.N. Bergman (Richard); S. Cauchi (Stephane); A.L. Gloyn (Anna); U. Gyllensten (Ulf); T. Hansen (Torben); W.A. Hide (Winston); G.A. Hitman (Graham); D. Hunter (David); K. Hveem (Kristian); K.L. Mohlke (Karen); A.D. Morris (Andrew); C.N.A. Palmer (Colin); P.P. Pramstaller (Peter Paul); I. Rudan (Igor); E.J.G. Sijbrands (Eric); L.D. Stein (Lincoln); M. Walker (Mark); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); M.J. Daly (Mark); A.T. Hattersley (Andrew); F. Hu; J.B. Meigs (James); J.S. Pankow (James); O. Pedersen (Oluf); J.C. Florez (Jose); R. Sladek (Rob); U. Thorsteinsdottir (Unnur); J.F. Wilson (James F); T. Illig (Thomas); J-A. Zwart (John-Anker); D. Altshuler (David); M. Boehnke (Michael); M.I. McCarthy (Mark); E.K. Speliote (Elizabeth); C.J. Wille (Cristen); S.I. Bernd (Sonja); K.L. Mond (Keri); G. Thorleifsso (Gudmar); H. Lango Allen (Hana); C.M. Lindgre (Cecilia); J. Lua (Jian'an); R. Mäg (Reedik); J.C. Randal (Joshua); S. Vedanta (Sailaja); T.W. Winkle (Thomas); T. Workalemah (Tsegaselassie); I.M. Hei (Iris); V. Steinthorsdotti (Valgerdur); H.M. Stringha (Heather); M.N. Weedo (Michael); E. Wheeler (Eleanor); M.M. Woo (Margaret M.); T. Ferreir (Teresa); R.J. Weyan (Robert); A.V. Segrè (Ayellet); K. Estrad (Karol); J. Luan; J. Nemes (James); J.-H. Par (Ju-Hyun); S. Gustafsson (Stefan); T.O. Kilpeläine (Tuomas); J. Yang (Joanna); N. Bouatia-Naji (Nabila); T. Esko (Tõnu); M.F. Feitosa (Mary Furlan); Z. Kutalik (Zoltán); M. Mangino (Massimo); S. Raychaudhuri (Soumya); R.P. Welch (Ryan); J.H. Zhao; K.K.H. Aben (Katja); D. Absher (Devin); N. Amin (Najaf); A.L. Dixon (Anna); E. Fisher (Eva); N.L. Glazer (Nicole); M.E. Goddard (Michael); N.L. Heard-Costa (Nancy); V. Hoesel (Volker); J.J. Hottenga (Jouke Jan); A. Johansson (Åsa); T. Johnson (Toby); S. Ketkar (Shamika); C. Lamina (Claudia); S. Li (Shengxu); M.F. Moffatt (Miriam); R.H. Myers (Richard); N. Narisu (Narisu); J.R.B. Perry (John); M.J. Peters (Marjolein); S. Ripatti (Samuli); F. Rivadeneira Ramirez (Fernando); C. Sandholt (Camilla); L.J. Scott (Laura); N. Timpson (Nicholas); J.P. Tyrer (Jonathan); S. van Wingerden (Sophie); R.M. Watanabe (Richard); C.C. White (Charles); F. Wiklund (Fredrik); C. Barlassina (Christina); D.I. Chasman (Daniel); M.N. Cooper (Matthew); J.-O. Jansson (John-Olov); R.W. Lawrence (Robert); N. Pellikka (Niina); J. Shi (Jianxin); E. Thiering (Eelisabeth); H. Alavere (Helene); M.T.S. Alibrandi (Maria); P. Almgren (Peter); A.M. Arnold (Alice); T. Aspelund (Thor); L.D. Atwood (Larry); B. Balkau (Beverley); A.J. Balmforth (Anthony); Y. Ben-Shlomo; R.N. Bergman (Richard); S.M. Bergmann (Sven); H. Biebermann (Heike); A.I.F. Blakemore (Alexandra); T. Boes (Tanja); L.L. Bonnycastle (Lori); S.R. Bornstein (Stefan); T.A. Buchanan (Thomas); F. Busonero; H. Campbell (Harry); F.P. Cappuccio (Francesco); C. Cavalcanti-Proença (Christine); Y.D. Ida Chen; C.-M. Chen (Chih-Mei); R. Clarke; L. Coin (Lachlan); J. Connell (John); I.N.M. Day (Ian); M. den Heijer (Martin); J. Duan (Jubao); S. Ebrahim (Shanil); R. Elosua (Roberto); G. Eiriksdottir (Gudny); M.R. Erdos (Michael); K. Hagen (Knut); M.F. Facheris (Maurizio); S.B. Felix (Stephan); P. Fischer-Posovszky (Pamela); N. Friedrich (Nele); N.B. Freimer (Nelson); M. Fu (Mao); S. Gaget (Stefan); P.V. Gejman (Pablo); E.J. Geus (Eeco); A.P. Gjesing (Anette); P. Goyette (Philippe); J. Gräßler (Jürgen); D. Greenawalt (Danielle); C.J. Groves (Christopher); A.L. Hartikainen; N. Hassanali (Neelam); A.S. Hall (Alistair); A.S. Havulinna (Aki); C. Hayward (Caroline); A.C. Heath (Andrew); A.A. Hicks (Andrew); A. Hinney (Anke); G. Homuth (Georg); J. Hui (Jennie); W. Igl (Wilmar); B. Isomaa (Bo); K.B. Jacobs (Kevin); I. Jarick (Ivonne); E. Jewell (Eelizabeth); U. John (Ulrich); T. Jorgensen (Torben); P. Jousilahti (Pekka); A. Jula (Antti); M. Kaakinen (Marika); E. Kajantie (Eero); L. Kaplan (Lee); S. Kathiresan (Sekar); J. Kettunen (Johannes); L. Kinnunen (Leena); I. Kolcic (Ivana); I.R. König (Inke); S. Koskinen (Seppo); P. Kovacs (Peter); J. Kuusisto (Johanna); P. Kraft (Peter); K. Kvaløy (Kirsti); J. Laitinen (Jaana); O. Lantieri (Olivier); C. Lanzani (Chiara); L.J. Launer (Lenore); C. Lecoeur (Cécile); T. Lehtimäki (Terho); J. Liu (Jianjun); M.L. Lokki; M. Lorentzon (Mattias); R.N. Luben (Robert); B. Ludwig (Barbara); P. Manunta (Paolo); D. Marek (Diana); M. Marre (Michel); N.G. Martin (Nicholas); W.L. McArdle (Wendy); A. McCarthy (Anne); B. McKnight (Barbara); T. Meitinger (Thomas); O. Melander (Olle); D. Meyre (David); K. Midthjell (Kristian); G.W. Montgomery (Grant); M.A. Morken (Mario); A.P. Morris (Andrew); R. Mulic (Rosanda); J.S. Ngwa; M. Nelis (Mari); M.J. Neville (Matthew); D.R. Nyholt (Dale); C.J. O'Donnel (Christopher); S. O'Rahilly (Stephen); K.K. Ong (Ken); B.A. Oostra (Ben); G. Paré (Guillaume); A.N. Parker (Alex); M. Perola (Markus); I. Pichler (Irene); K.H. Pietilainen (Kirsi Hannele); C. Platou (Carl); O. Polasek (Ozren); A. Pouta (Anneli); S. Rafelt (Suzanne); O. Raitakari (Olli); N.W. Rayner (Nigel William); M. Ridderstråel (Martin); W. Rief (Winfried); A. Ruokonen (Aimo); N.R. Robertson (Neil); P. Rzehak (Peter); V. Salomaa (Veikko); A.R. Sanders (Alan); M.S. Sandhu (Manjinder); S. Sanna (Serena); J. Saramies (Jouko); M.J. Savolainen (Markku); A. Scherag (Andre); S. Schipf (Sabine); S. Schreiber (Stefan); H. Schunkert (Heribert); K. Silander (Kaisa); J. Sinisalo (Juha); J.H. Smit (Jan); N. Soranzo (Nicole); U. Sovio (Ulla); J. Stephens (Jonathan); I. Surakka (Ida); A.J. Swift (Amy); M.L. Tammesoo; J.-C. Tardif (Jean-Claude); M. Teder-Laving (Maris); T.M. Teslovich (Tanya); J.R. Thompson (John); B. Thomson (Brian); A. Tönjes (Anke); J.B.J. van Meurs (Joyce); G.J.B. van Ommen; V. Vatin (Vincent); J. Viikari (Jorma); S. Visvikis-Siest (Sophie); V. Vitart (Veronique); C.I. Vogel (Carla); B.F. Voight (Benjamin); L. Waite (Lindsay); H. Wallaschofski (Henri); E. Widen (Elisabeth); S. Wiegand (Susanna); S.H. Wild (Sarah); G.A.H.M. Willemsen (Gonneke); D.R. Witte (Deniel); J.C.M. Witteman (Jacqueline); J. Xu (Jianfeng); Q. Zhang (Qunyuan); L. Zgaga (Lina); A. Ziegler (Andreas); P. Zitting (Paavo); J.P. Beilby (John); I.S. Farooqi (Sadaf); J. Hebebrand (Johannes); H.V. Huikuri (Heikki); A.L. James (Alan); M. Kähönen (Mika); D.F. Levinson (Douglas); F. MacCiardi (Fabio); M.S. Nieminen (Markku); C. Ohlsson (Claes); C. Palmer (Cameron); P.M. Ridker (Paul); M. Stumvoll (Michael); J.S. Beckmann (Jacques); H. Boeing (Heiner); E.A. Boerwinkle (Eric); D.I. Boomsma (Dorret); S.J. Chanock (Stephen); G.D. Smith; J. Erdmann (Jeanette); H. Grönberg (Henrik); A.S. Hall (Alistair); T. Hansen (Torben); T.B. Harris (Tamara); R.B. Hayes (Richard); J. Heinrich (Joachim); F.B. Hu (Frank); T. Illig (Thomas); M.-R. Jarvelin (Marjo-Riitta); J. Kaprio (Jaakko); F. Karpe (Fredrik); L.A.L.M. Kiemeney (Bart); H. Krude; M. Laakso (Markku); D.A. Lawlor (Debbie); A. Metspalu (Andres); P. Munroe (Patricia); B.W.J.H. Penninx (Brenda); A. Peters (Annette); T. Reinehr (Thomas); A. Rissanen (Aila); N.J. Samani (Nilesh); P.E.H. Schwarz (Peter); A.R. Shuldiner (Alan); J. Tuomilehto (Jaakko); M. Uda (Manuela); A.G. Uitterlinden (André); T.T. Valle (Timo); M. Wabitsch (Martin); G. Waeber (Gérard); J.F. Wilson (James); A.F. Wright (Alan); M.C. Zillikens (Carola); N. Chatterjee (Nilanjan); S.A. McCarroll (Steven); S. Purcell (Shaun); P.M. Visscher (Peter); I.B. Borecki (Ingrid); C.S. Fox (Caroline); L. Groop (Leif); T. Haritunians (Talin); D.J. Hunter (David); R.C. Kaplan (Robert); J.R. O´Connell; L. Peltonen (Leena Johanna); D. Schlessinger (David); D.P. Strachan (David); C.M. van Duijn (Cock); H.E. Wichmann (Heinz Erich); T.M. Frayling (Timothy); U. Thorsteinsdottir (Unnur); I. Barroso (Inês); M. Boehnke (Michael); K. Stefansson (Kari); K.E. North (Kari); M.I. McCarthy (Mark); J.N. Hirschhorn (Joel); E. Ingelsson (Erik); R.J.F. Loos (Ruth); A. Nica (Alexandra); L. Parts (Leopold); D. Glass (Daniel); J. Nisbet (James); A. Barrett (Angela); M. Sekowska (Magdalena); M. Travers (Mary); S.C. Potter (Simon); E. Grundberg (Elin); K.S. Small (Kerrin); A.K. Hedman (Asa); V. Bataille (Veronique); J. Tzenova Bell (Jordana); G. Surdulescu (Gabriela); A.S. Dimas (Antigone); C. Ingle (Catherine); F.O. Nestle (Frank); P. di Meglio (Paola); J. Min (Josine); A. Wilk (Alicja); C.J. Hammond (Christopher); N. Hassanali (Neelam); T.-P. Yang (Tsun-Po); S.B. Montgomery (Stephen); S. O'Rahilly (Steve); K.T. Zondervan (Krina); N. Soranzo (Nicole); R. Durbin (Richard); K.R. Ahmadi (Kourosh); M.I. McCarthy (Mark I); E.T. Dermitzakis (Emmanouil); T.D. Spector (Timothy); H. Schunkert (Heribert); I.R. König (Inke); S. Kathiresan (Sekar); M.P. Reilly (Muredach); T.L. Assimes (Themistocles); H. Holm (Hilma); M. Preuss (Michael); A.F.R. Stewart (Alexandre); M. Barbalic (maja); C. Gieger (Christian); Z. Aherrahrou (Zouhair); H. Allayee (Hooman); S.S. Anand (Sonia); K. Andersen (Karl); J.L. Anderson (Jeffrey); D. Ardissino (Diego); S.G. Ball (Stephen); T.A. Barnes (Timothy); D.M. Becker (Diane); L.C. Becker (Lewis); K. Berger (Klaus); J.C. Bis (Joshua); S.M. Boekholdt (Matthijs); E.A. Boerwinkle (Eric); P.S. Braund (Peter); M.J. Brown (Morris); M.S. Burnett; I. Buysschaert (Ian); J.F. Carlquist (John); L. Chen (Li); S. Cichon (Sven); V. Codd (Veryan); R.W. Davies (Robert); G.V. Dedoussis (George); A. Dehghan (Abbas); S. Demissie (Serkalem); J. Devaney (Joseph); P. Diemert (Patrick); R. Do (Ron); A. Doering (Angela); S. Eifert (Sandra); N. El Mokhtari (NourEddine); S.G. Ellis (Stephen); J. Engert; S.E. Epstein (Stephen); U. de Faire (Ulf); M. Fischer (Marcus); A.R. Folsom (Aaron); J. Freyer (Jennifer); B. Gigante (Bruna); D. Girelli (Domenico); S. Gretarsdottir (Solveig); V. Gudnason (Vilmundur); J.R. Gulcher (Jeffrey); E. Halperin (Eran); N. Hammond (Naomi); S.L. Hazen (Stanley); A. Hofman (Albert); B.D. Horne (Benjamin); T. Illig (Thomas); C. Iribarren (Carlos); G.T. Jones (Gregory); J.W. Jukema (Jan Wouter); M.A. Kaiser (Michael); L.M. Kaplan (Lee); J.J.P. Kastelein (John); K-T. Khaw (Kay-Tee); J.W. Knowles (Joshua); G. Kolovou (Genovefa); A. Kong (Augustine); R. Laaksonen (Reijo); D. Lambrechts (Diether); K. Leander (Karin); G. Lettre (Guillaume); X. Li (Xiaohui); W. Lieb (Wolfgang); C. Loley (Christina); A.J. Lotery (Andrew); P.M. Mannucci (Pier); S. Maouche (Seraya); N. Martinelli (Nicola); P.P. McKeown (Pascal); C. Meisinger (Christa); T. Meitinger (Thomas); P.A. Merlini (Pier Angelica); V. Mooser (Vincent); T. Morgan (Thomas); T.W. Mühleisen (Thomas); J.B. Muhlestein (Joseph); T. Munzel (Thomas); K. Musunuru (Kiran); J. Nahrstaedt (Janja); C.P. Nelson (Christopher P.); M.M. Nöthen (Markus); O. Olivieri (Oliviero); R.S. Patel (Riyaz); C.C. Patterson (Chris); F. Peyvandi (Flora); L. Qu (Liming); A.A. Quyyumi (Arshed); D.J. Rader (Daniel); L.S. Rallidis (Loukianos); C. Rice (Catherine); F.R. Rosendaal (Frits); D. Rubin (Diana); M.L. Sampietro (Maria Lourdes); M.S. Sandhu (Manjinder); E.E. Schadt (Eric); A. Schäfer (Arne); A. Schillert (Arne); J. Schrezenmeir (Jürgen); S.M. Schwartz (Stephen); D.S. Siscovick (David); M. Sivananthan (Mohan); S. Sivapalaratnam (Suthesh); A.V. Smith (Albert Vernon); T.B. Smith (Tamara); J.D. Snoep (Jaapjan); N. Soranzo (Nicole); J.A. Spertus (John); K. Stark (Klaus); K. Stirrups (Kathy); M. Stoll (Monika); W.H.W. Tang (Wilson); S. Tennstedt (Stephanie); G. Thorgeirsson (Gudmundur); G. Thorleifsson (Gudmar); M. Tomaszewski (Maciej); A.M. van Rij (Andre); B.F. Voight (Benjamin); N.J. Wareham (Nick); G.A. Wells (George); P.S. Wild (Philipp); C. Willenborg (Christina); B.J. Wright (Benjamin); S. Ye (Shu); T. Zeller (Tanja); A. Ziegler (Andreas); F. Cambien (François); A.H. Goodall (Alison); L.A. Cupples (Adrienne); T. Quertermous (Thomas); W. März (Winfried); C. Hengstenberg (Christian); S. Blankenberg (Stefan); W.H. Ouwehand (Willem); A. Hall (Anne); J.R. Thompson (John); K. Stefansson (Kari); R. Roberts (Robert); U. Thorsteinsdottir (Unnur); C.J. O'Donnell (Christopher); R. McPherson (Ruth); N.J. Samani (Nilesh); J. Hopewell; S. Parish (Sharon); A. Offer (Alison); L. Bowman; P. Sleight (Peter); S. Armitage (Shane); R. Peto (R.); R. Collins (Rory); J.C. Chambers (John); N. Ahmed (Nabeel); M. Caulfield (Mark); P. Donnelly (Peter); P. Elliott (Paul); P. Froguel (Philippe); M.I. McCarthy (Mark); N.J. Samani (Nilesh); J. Scott (James); J.S. Sehmi (Joban); W. Zhang (Weihua); J.S. Kooner (Jaspal); R.J. Strawbridge (Rona); M. Sabater-Lleal (Maria); A. Mälarstig (Anders); B. Sennblad (Bengt); J. Öhrvik (John); A. Silveira (Angela); F. van't Hooft (Ferdinand); P. Eriksson (Per); A. Hamsten (Anders); M.-L. Hellénius (Mai-Lis); G. Olsson; S. Rust (Stephan); G. Assmann (Gerd); U. Seedorf (Udo); S. Barlera (Simona); M.G. Franzosi; G. Tognoni; R. Clarke (Robert); P. Linksted (Pamela); J. Hopewell; F.S. Collins (Francis); J. Peden (John); A. Goel (Anuj); H. Ongen (Halit); T. Kyriakou (Theodosios); F. Green (Fiona); M. Farrall (Martin); H. Watkins (Hugh); D. Saleheen; A. Rasheed (Asif); M.A. Zaidi (Aghar); N. Shah (Nisha); M. Samuel (Maria); C.B. Mallick (Chandana Basu); M. Azhar (Muhammad); K.S. Zaman (Khan Shah); A. Samad (Adbus); M. Ishaq (Muhammad); A. Gardezi (Ali); F.-R. Memon (Fazal-ur-Rehman); N.J. Samani (Nilesh); R. Frossard; P. Deloukas (Panagiotis); J. Danesh (John)

    2011-01-01

    markdownabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new

  13. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    R.J. Strawbridge (Rona); J.R. Petrie (John); T. Forsen (Tom); C. Cooper (Cyrus); M. Franzosi; A. Hamsten (Anders); E. Ferrannini (Ele); M.S. Rios; C.-G. Östenson (Claes-Göran); K. Makrilakis (Konstantinos); T.J. Forsen (Tom); C. Osmond (Clive); C. Cooper (Charles); E.M. Dennison (Elaine); K. Jameson (Karen); A.A. Sayer; T. Kuulasmaa (Teemu); A. Stancáková (Alena); L. Lind (Lars); M.N. Mannila (Maria Nastase); H. Gu (Harvest); B. Zethelius (Björn); F. Turrini (Fabiola); R.J.F. Loos (Ruth); L. Pascoe (Laura); A.C. Syvanen; E. Ahlqvist (Emma); M. Horikoshi (Momoko); D. Barnes (Daniel); C. Han (Chen); A.K. Manning (Alisa); D. Rybin (Denis); S. Kanoni (Stavroula); A.M. Barker (Adam); W. Xie (Weijia); E. Eury (Elodie); J. Kerr-Conte (Julie); F. Pattou (François); P.R.V. Johnson (Paul); M. Travers (Mary); R.R. Frants (Rune); P. Eriksson (Per); L. Folkersen (Lasse); F.M. van't Hooft (Ferdinand); L.J. Scott (Laura); V. Steinthorsdottir (Valgerdur); A.D. Morris (Andrew); C. Dina (Christian); E. Zeggini (Eleftheria); C. Huth (Cornelia); Y.S. Aulchenko (Yurii); G. Thorleifsson (Gudmar); L.J. McCulloch (Laura); T. Ferreira (Teresa); H. Grallert (Harald); G. Wu (Guanming); C.J. Willer (Cristen); S. Raychaudhuri (Soumya); S.A. McCarroll (Steve); C. Langenberg (Claudia); O.M. Hofmann (Oliver); J. Dupuis (Josée); L. Qi (Lu); M. van Hoek (Mandy); P. Navarro (Pau); K.G. Ardlie (Kristin); R. Benediktsson (Rafn); A.J. Bennett (Amanda); R. Blagieva (Roza); E.A. Boerwinkle (Eric); K.B. Boström (Kristina Bengtsson); B. Bravenboer (Bert); S. Bumpstead (Suzannah); N.P. Burtt (Noisël); G. Charpentier (Guillaume); P.S. Chines (Peter); M. Cornelis (Marilyn); D.J. Couper (David); G. Crawford (Gabe); A.S.F. Doney (Alex); K.S. Elliott (Katherine); A.L. Elliott (Amanda); C. Fox (Craig); C.S. Franklin (Christopher); M. Ganser (Martha); N. Grarup (Niels); T. Green (Todd); S. Griffin (Simon); C. Guiducci (Candace); S. Hadjadj (Samy); N. Hassanali (Neelam); C. Herder (Christian); A.U. Jackson (Anne); P.R.V. Johnson (Paul R.); W.H.L. Kao (Wen); N. Klopp (Norman); A. Kong (Augustine); P. Kraft (Peter); J. Kuusisto (Johanna); T. Lauritzen (Torsten); M. Li (Man); A. Lieverse (Aloysius); C.M. Lindgren (Cecilia); V. Lyssenko (Valeriya); M. Marre (Michel); T. Meitinger (Thomas); K. Midthjell (Kristian); M.A. Morken (Mario); P. Nilsson (Peter); K.R. Owen (Katharine); F. Payne (Felicity); J.R.B. Perry (John R.); A.K. Petersen; C.P. Platou (Carl); C. Proença (Christine); I. Prokopenko (Inga); W. Rathmann (Wolfgang); N.R. Robertson (Neil); G. Rocheleau (Ghislain); M. Roden (Michael); M.J. Sampson (Michael); R. Saxena (Richa); B.M. Shields (Beverley); P. Shrader (Peter); G. Sigurdsson (Gunnar); T. Sparsø (Thomas); K. Strassburger (Klaus); H.M. Stringham (Heather); Q. Sun (Qi); B. Thorand (Barbara); J. Tichet (Jean); T. Tuomi (Tiinamaija); R.M. van Dam (Rob); T.W. van Haeften (Timon); T.W. van Herpt (Thijs); J.V. van Vliet-Ostaptchouk (Jana); G. Bragi Walters (G.); M.N. Weedon (Michael); C. Wijmenga (Cisca); R.N. Bergman (Richard); S. Cauchi (Stephane); A.L. Gloyn (Anna); U. Gyllensten (Ulf); T. Hansen (Torben); W.A. Hide (Winston); G.A. Hitman (Graham); D. Hunter (David); K. Hveem (Kristian); K.L. Mohlke (Karen); A.D. Morris (Andrew); C.N.A. Palmer (Colin); P.P. Pramstaller (Peter Paul); I. Rudan (Igor); E.J.G. Sijbrands (Eric); L.D. Stein (Lincoln); M. Walker (Mark); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); M.J. Daly (Mark); A.T. Hattersley (Andrew); F. Hu; J.B. Meigs (James); J.S. Pankow (James); O. Pedersen (Oluf); J.C. Florez (Jose); R. Sladek (Rob); U. Thorsteinsdottir (Unnur); J.F. Wilson (James F); T. Illig (Thomas); J-A. Zwart (John-Anker); D. Altshuler (David); M. Boehnke (Michael); M.I. McCarthy (Mark); E.K. Speliote (Elizabeth); C.J. Wille (Cristen); S.I. Bernd (Sonja); K.L. Mond (Keri); G. Thorleifsso (Gudmar); H. Lango Allen (Hana); C.M. Lindgre (Cecilia); J. Lua (Jian'an); R. Mäg (Reedik); J.C. 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Loos (Ruth); A. Nica (Alexandra); L. Parts (Leopold); D. Glass (Daniel); J. Nisbet (James); A. Barrett (Angela); M. Sekowska (Magdalena); M. Travers (Mary); S.C. Potter (Simon); E. Grundberg (Elin); K.S. Small (Kerrin); A.K. Hedman (Asa); V. Bataille (Veronique); J. Tzenova Bell (Jordana); G. Surdulescu (Gabriela); A.S. Dimas (Antigone); C. Ingle (Catherine); F.O. Nestle (Frank); P. di Meglio (Paola); J. Min (Josine); A. Wilk (Alicja); C.J. Hammond (Christopher); N. Hassanali (Neelam); T.-P. Yang (Tsun-Po); S.B. Montgomery (Stephen); S. O'Rahilly (Steve); K.T. Zondervan (Krina); N. Soranzo (Nicole); R. Durbin (Richard); K.R. Ahmadi (Kourosh); M.I. McCarthy (Mark I); E.T. Dermitzakis (Emmanouil); T.D. Spector (Timothy); H. Schunkert (Heribert); I.R. König (Inke); S. Kathiresan (Sekar); M.P. Reilly (Muredach); T.L. Assimes (Themistocles); H. Holm (Hilma); M. Preuss (Michael); A.F.R. Stewart (Alexandre); M. Barbalic (maja); C. Gieger (Christian); Z. Aherrahrou (Zouhair); H. Allayee (Hooman); S.S. Anand (Sonia); K. Andersen (Karl); J.L. Anderson (Jeffrey); D. Ardissino (Diego); S.G. Ball (Stephen); T.A. Barnes (Timothy); D.M. Becker (Diane); L.C. Becker (Lewis); K. Berger (Klaus); J.C. Bis (Joshua); S.M. Boekholdt (Matthijs); E.A. Boerwinkle (Eric); P.S. Braund (Peter); M.J. Brown (Morris); M.S. Burnett; I. Buysschaert (Ian); J.F. Carlquist (John); L. Chen (Li); S. Cichon (Sven); V. Codd (Veryan); R.W. Davies (Robert); G.V. Dedoussis (George); A. Dehghan (Abbas); S. Demissie (Serkalem); J. Devaney (Joseph); P. Diemert (Patrick); R. Do (Ron); A. Doering (Angela); S. Eifert (Sandra); N. El Mokhtari (NourEddine); S.G. Ellis (Stephen); J. Engert; S.E. Epstein (Stephen); U. de Faire (Ulf); M. Fischer (Marcus); A.R. Folsom (Aaron); J. Freyer (Jennifer); B. Gigante (Bruna); D. Girelli (Domenico); S. Gretarsdottir (Solveig); V. Gudnason (Vilmundur); J.R. Gulcher (Jeffrey); E. Halperin (Eran); N. Hammond (Naomi); S.L. Hazen (Stanley); A. Hofman (Albert); B.D. Horne (Benjamin); T. Illig (Thomas); C. Iribarren (Carlos); G.T. Jones (Gregory); J.W. Jukema (Jan Wouter); M.A. Kaiser (Michael); L.M. Kaplan (Lee); J.J.P. Kastelein (John); K-T. Khaw (Kay-Tee); J.W. Knowles (Joshua); G. Kolovou (Genovefa); A. Kong (Augustine); R. Laaksonen (Reijo); D. Lambrechts (Diether); K. Leander (Karin); G. Lettre (Guillaume); X. Li (Xiaohui); W. Lieb (Wolfgang); C. Loley (Christina); A.J. Lotery (Andrew); P.M. Mannucci (Pier); S. Maouche (Seraya); N. Martinelli (Nicola); P.P. McKeown (Pascal); C. Meisinger (Christa); T. Meitinger (Thomas); P.A. Merlini (Pier Angelica); V. Mooser (Vincent); T. Morgan (Thomas); T.W. Mühleisen (Thomas); J.B. Muhlestein (Joseph); T. Munzel (Thomas); K. Musunuru (Kiran); J. Nahrstaedt (Janja); C.P. Nelson (Christopher P.); M.M. Nöthen (Markus); O. Olivieri (Oliviero); R.S. Patel (Riyaz); C.C. Patterson (Chris); F. Peyvandi (Flora); L. Qu (Liming); A.A. Quyyumi (Arshed); D.J. Rader (Daniel); L.S. Rallidis (Loukianos); C. Rice (Catherine); F.R. Rosendaal (Frits); D. Rubin (Diana); M.L. Sampietro (Maria Lourdes); M.S. Sandhu (Manjinder); E.E. Schadt (Eric); A. Schäfer (Arne); A. Schillert (Arne); J. Schrezenmeir (Jürgen); S.M. Schwartz (Stephen); D.S. Siscovick (David); M. Sivananthan (Mohan); S. Sivapalaratnam (Suthesh); A.V. Smith (Albert Vernon); T.B. Smith (Tamara); J.D. Snoep (Jaapjan); N. Soranzo (Nicole); J.A. Spertus (John); K. Stark (Klaus); K. Stirrups (Kathy); M. Stoll (Monika); W.H.W. Tang (Wilson); S. Tennstedt (Stephanie); G. Thorgeirsson (Gudmundur); G. Thorleifsson (Gudmar); M. Tomaszewski (Maciej); A.M. van Rij (Andre); B.F. Voight (Benjamin); N.J. Wareham (Nick); G.A. Wells (George); P.S. Wild (Philipp); C. Willenborg (Christina); B.J. Wright (Benjamin); S. Ye (Shu); T. Zeller (Tanja); A. Ziegler (Andreas); F. Cambien (François); A.H. Goodall (Alison); L.A. Cupples (Adrienne); T. Quertermous (Thomas); W. März (Winfried); C. Hengstenberg (Christian); S. Blankenberg (Stefan); W.H. Ouwehand (Willem); A. Hall (Anne); J.R. Thompson (John); K. Stefansson (Kari); R. Roberts (Robert); U. Thorsteinsdottir (Unnur); C.J. O'Donnell (Christopher); R. McPherson (Ruth); N.J. Samani (Nilesh); J. Hopewell; S. Parish (Sharon); A. Offer (Alison); L. Bowman; P. Sleight (Peter); S. Armitage (Shane); R. Peto (R.); R. Collins (Rory); J.C. Chambers (John); N. Ahmed (Nabeel); M. Caulfield (Mark); P. Donnelly (Peter); P. Elliott (Paul); P. Froguel (Philippe); M.I. McCarthy (Mark); N.J. Samani (Nilesh); J. Scott (James); J.S. Sehmi (Joban); W. Zhang (Weihua); J.S. Kooner (Jaspal); R.J. Strawbridge (Rona); M. Sabater-Lleal (Maria); A. Mälarstig (Anders); B. Sennblad (Bengt); J. Öhrvik (John); A. Silveira (Angela); F. van't Hooft (Ferdinand); P. Eriksson (Per); A. Hamsten (Anders); M.-L. Hellénius (Mai-Lis); G. Olsson; S. Rust (Stephan); G. Assmann (Gerd); U. Seedorf (Udo); S. Barlera (Simona); M.G. Franzosi; G. Tognoni; R. Clarke (Robert); P. Linksted (Pamela); J. Hopewell; F.S. Collins (Francis); J. Peden (John); A. Goel (Anuj); H. Ongen (Halit); T. Kyriakou (Theodosios); F. Green (Fiona); M. Farrall (Martin); H. Watkins (Hugh); D. Saleheen; A. Rasheed (Asif); M.A. Zaidi (Aghar); N. Shah (Nisha); M. Samuel (Maria); C.B. Mallick (Chandana Basu); M. Azhar (Muhammad); K.S. Zaman (Khan Shah); A. Samad (Adbus); M. Ishaq (Muhammad); A. Gardezi (Ali); F.-R. Memon (Fazal-ur-Rehman); N.J. Samani (Nilesh); R. Frossard; P. Deloukas (Panagiotis); J. Danesh (John)

    2011-01-01

    markdownabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new

  14. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    R.J. Strawbridge (Rona); J. Dupuis (Josée); I. Prokopenko (Inga); A.M. Barker (Adam); E. Ahlqvist (Emma); D. Rybin (Denis); J.R. Petrie (John); N. Bouatia-Naji (Nabila); A.S. Dimas (Antigone); E. Wheeler (Eleanor); H. Chen (Han); B.F. Voight (Benjamin); J. Taneera (Jalal); S. Kanoni (Stavroula); J. Peden (John); F. Turrini (Fabiola); S. Gustafsson (Stefan); C. Zabena (Carina); P. Almgren (Peter); G.V. Dedoussis (George); D. Barnes (Daniel); E.M. Dennison (Elaine); K. Hagen (Knut); P. Eriksson (Per); E. Eury (Elodie); L. Folkersen (Lasse); C.S. Fox (Caroline); T.M. Frayling (Timothy); A. Goel (Anuj); M. Horikoshi (Momoko); B. Isomaa (Bo); A.U. Jackson (Anne); K. Jameson (Karen); E. Kajantie (Eero); J. Kerr-Conte (Julie); L. Groop (Leif); J. Kuusisto (Johanna); R.J.F. Loos (Ruth); J. Luan; K. Makrilakis (Konstantinos); A.K. Manning (Alisa); M.T. Martinez-Larrad (Maria Teresa); N. Narisu (Narisu); J. Öhrvik (John); C. Osmond (Clive); L. Pascoe (Laura); F. Payne (Felicity); A.A. Sayer; B. Sennblad (Bengt); C. Cooper (Charles); K. Stirrups (Kathy); A.J. Swift (Amy); A.C. Syvänen; T. Tuomi (Tiinamaija); F. van't Hooft (Ferdinand); M. Walker (Mark); M.N. Weedon (Michael); W. Xie (Weijia); B. Zethelius (Björn); L.J. Scott (Laura); V. Steinthorsdottir (Valgerdur); A.P. Morris (Andrew); C. Dina (Christian); R.P. Welch (Ryan); E. Zeggini (Eleftheria); C. Huth (Cornelia); Y.S. Aulchenko (Yurii); G. Thorleifsson (Gudmar); L.J. McCulloch (Laura); T. Ferreira (Teresa); H. Grallert (Harald); N. Amin (Najaf); G. Wu (Guanming); C.J. Willer (Cristen); S. Raychaudhuri (Soumya); S.A. McCarroll (Steven); O.M. Hofmann (Oliver); L. Qi (Lu); A.V. Segrè (Ayellet); M. van Hoek (Mandy); P. Navarro (Pau); K.G. Ardlie (Kristin); B. Balkau (Beverley); N. Narisu (Narisu); A.J. Bennett (Amanda); R. Blagieva (Roza); E.A. Boerwinkle (Eric); L.L. Bonnycastle (Lori); K.B. Boström (Kristina Bengtsson); B. Bravenboer (Bert); S. Bumpstead (Suzannah); N.P. Burtt (Noël); G. 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Gigante (Bruna); D. Girelli (Domenico); D.R. Witte (Deniel); J.R. Gulcher (Jeffrey); E. Halperin (Eran); N. Hammond (Naomi); S.L. Hazen (Stanley); A. Ziegler (Andreas); G.T. Jones (Gregory); J.W. Jukema (Jan Wouter); I.S. Farooqi (Sadaf); J.J.P. Kastelein (John); R. Laaksonen (Reijo); D. Lambrechts (Diether); D.F. Levinson (Douglas); X. Li (Xiaohui); W. Lieb (Wolfgang); C. Loley (Christina); A.J. Lotery (Andrew); P.M. Mannucci (Pier); S. Maouche (Seraya); J.S. Beckmann (Jacques); H. Boeing (Heiner); C. Meisinger (Christa); V. Mooser (Vincent); T. Morgan (Thomas); F.S. Collins (Francis); J.B. Muhlestein (Joseph); T. Munzel (Thomas); K. Musunuru (Kiran); J. Nahrstaedt (Janja); C.P. Nelson (Christopher P.); M.M. Nöthen (Markus); R.S. Patel (Riyaz); F. Peyvandi (Flora); R.B. Hayes (Richard); A.A. Quyyumi (Arshed); D.J. Rader (Daniel); L.S. Rallidis (Loukianos); F. Karpe (Fredrik); J. Kaprio (Jaakko); M.L. Sampietro (Maria Lourdes); M.S. Sandhu (Manjinder); E.E. Schadt (Eric); A. Schäfer (Arne); A. Schillert (Arne); S.M. Schwartz (Stephen); P. Munroe (Patricia); S. Sivapalaratnam (Suthesh); A.V. Smith (Albert Vernon); J.D. Snoep (Jaapjan); J.A. Spertus (John); K. Stark (Klaus); M. Stoll (Monika); W. Tang (W.); S. Tennstedt (Stephanie); G. Thorgeirsson (Gudmundur); A.R. Shuldiner (Alan); A.M. van Rij (Andre); N.J. Wareham (Nick); G.A. Wells (George); P.S. Wild (Philipp); C. Willenborg (Christina); B.J. Wright (Benjamin); T. Zeller (Tanja); F. Cambien (François); A.H. Goodall (Alison); W. März (Winfried); S. Blankenberg (Stefan); R. Roberts (Robert); R. McPherson (Ruth); J. Hopewell; P.M. Visscher (Peter); A. Offer (Alison); L. Bowman; P. Sleight (Peter); R. Peto (R.); F.S. Collins (Francis); J.C. Chambers (John C.); N. Ahmed (Nabeel); J.R. O´Connell; P. Donnelly (Peter); J.S. Kooner (Jaspal); N.J. Samani (Nilesh); J. Scott (James); J.S. Sehmi (Joban); W. Zhang (Weihua); R.J. Strawbridge (Rona); Sabater-Lleal, M. (Maria); A. Mälarstig (Anders); M.-L. Hellénius (Mai-Lis); G. Olsson; S. Rust (Stephan); G. Assmann (Gerd); U. Seedorf (Udo); G. Tognoni; M. Franzosi; P. Linksted (Pamela); H. Ongen (Halit); T. Kyriakou (Theodosios); M. Farrall (Martin); A. Rasheed (Asif); M.A. Zaidi (Aghar); N. Shah (Nisha); M. Samuel (Maria); C.B. Mallick (Chandana Basu); M. Azhar (Muhammad); K.S. Zaman (Khan Shah); M. Ishaq (Muhammad); A. Gardezi (Ali); C.J. Hammond (Christopher); R. Frossard; J. Danesh (John); J.C. Chambers (John); J.S. Kooner (Jaspal S.); C.-G. Östenson (Claes-Göran); K.T. Zondervan (Krina); M. Serrano-Ríos (Manuel); E. Ferrannini (Ele); T. Forsen (Tom); M.I. McCarthy (Mark); G.V. Dedoussis (George); C. Langenberg (Claudia); A. Hamsten (Anders); J.C. Florez (Jose)

    2011-01-01

    textabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insi

  15. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    Strawbridge, R.J.; Dupuis, J.; Prokopenko, I.; Barker, A.; Ahlqvist, E.; Rybin, D.; Petrie, J.R.; Travers, M.E.; Bouatia-Naji, N.; Dimas, A.S.; Nica, A.; Wheeler, E.; Chen, H.; Voight, B.F.; Taneera, J.; Kanoni, S.; Peden, J.F.; Turrini, F.; Gustafsson, S.; Zabena, C.; Almgren, P.; Barker, D.J.; Barnes, D.; Dennison, E.M.; Eriksson, J.G.; Eriksson, P.; Eury, E.; Folkersen, L.; Fox, C.S.; Frayling, T.M.; Goel, A.; Gu, H.F.; Horikoshi, M.; Isomaa, B.; Jackson, A.U.; Jameson, K.A.; Kajantie, E.; Kerr-Conte, J.; Kuulasmaa, T.; Kuusisto, J.; Loos, R.J.; Luan, J.; Makrilakis, K.; Manning, A.K.; Martinez-Larrad, M.T.; Narisu, N.; Nastase Mannila, M.; Ohrvik, J.; Osmond, C.; Pascoe, L.; Payne, F.; Sayer, A.A.; Sennblad, B.; Silveira, A.; Stancakova, A.; Stirrups, K.; Swift, A.J.; Syvanen, A.C.; Tuomi, T.; Hooft, F. van 't; Walker, M.; Weedon, M.N.; Xie, W.; Zethelius, B.; Ongen, H.; Malarstig, A.; Hopewell, J.C.; Saleheen, D.; Chambers, J.; Parish, S.; Danesh, J.; Kooner, J.; Ostenson, C.G.; Lind, L.; Cooper, C.C.; Serrano-Rios, M.; Ferrannini, E.; Forsen, T.J.; Clarke, R.; Franzosi, M.G.; Seedorf, U.; Watkins, H.; Froguel, P.; Johnson, P.; Deloukas, P.; Collins, F.S.; Laakso, M.; Dermitzakis, E.T.; Boehnke, M.; McCarthy, M.I.; Wareham, N.J.; Groop, L.; Pattou, F.; Gloyn, A.L.; Dedoussis, G.V.; Lyssenko, V.; Meigs, J.B.; Barroso, I.; Watanabe, R.M.; Heijer, M. den; Kiemeney, L.A.L.M.

    2011-01-01

    OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired beta-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about

  16. Genome-Wide Association Identifies Nine Common Variants Associated With Fasting Proinsulin Levels and Provides New Insights Into the Pathophysiology of Type 2 Diabetes

    NARCIS (Netherlands)

    Strawbridge, Rona J.; Dupuis, Josee; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R.; Travers, Mary E.; Bouatia-Naji, Nabila; Dimas, Antigone S.; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F.; Taneera, Jalal; Kanoni, Stavroula; Peden, John F.; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J. P.; Barnes, Daniel; Dennison, Elaine M.; Eriksson, Johan G.; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S.; Frayling, Timothy M.; Goel, Anuj; Gu, Harvest F.; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U.; Jameson, Karen A.; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J. F.; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K.; Teresa Martinez-Larrad, Maria; Narisu, Narisu; Mannila, Maria Nastase; Ohrvik, John; Osmond, Clive; Pascoe, Laura; Payne, Felicity; Sayer, Avan A.; Sennblad, Bengt; Silveira, Angela; Stancakova, Alena; Stirrups, Kathy; Swift, Amy J.; Syvanen, Ann-Christine; Tuomi, Tiinamaija; van 't Hooft, Ferdinand M.; Walker, Mark; Weedon, Michael N.; Xie, Weijia; Zethelius, Bjorn; Ongen, Halit; Malarstig, Anders; Hopewell, Jemma C.; Saleheen, Danish; Chambers, John; Parish, Sarah; Danesh, John; Kooner, Jaspal; Ostenson, Claes-Goran; Lind, Lars; Cooper, Cyrus C.; Serrano-Rios, Manuel; Ferrannini, Ele; Forsen, Tom J.; Clarke, Robert; Franzosi, Maria Grazia; Seedorf, Udo; Watkins, Hugh; Froguel, Philippe; Johnson, Paul; Deloukas, Panos; Collins, Francis S.; Laakso, Markku; Dermitzakis, Emmanouil T.; Boehnke, Michael; McCarthy, Mark I.; Wareham, Nicholas J.; Groop, Leif; Pattou, Francois; Gloyn, Anna L.; Dedoussis, George V.; Lyssenko, Valeriya; Meigs, James B.; Barroso, Ines; Watanabe, Richard M.; Ingelsson, Erik; Langenberg, Claudia; Hamsten, Anders; Florez, Jose C.

    2011-01-01

    OBJECTIVE-Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired beta-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about

  17. Construct validity test of evaluation tool for professional behaviors of entry-level occupational therapy students in the United States

    Directory of Open Access Journals (Sweden)

    Hon K. Yuen

    2016-06-01

    Full Text Available Purpose: This study aimed to test the construct validity of an instrument to measure student professional behaviors in entry-level occupational therapy (OT students in the academic setting. Methods: A total of 718 students from 37 OT programs across the United States answered a self-assessment survey of professional behavior that we developed. The survey consisted of ranking 28 attributes, each on a 5-point Likert scale. A split-sample approach was used for exploratory and then confirmatory factor analysis. Results: A three-factor solution with nine items was extracted using exploratory factor analysis [EFA] (n=430, 60%. The factors were ‘Commitment to Learning’ (2 items, ‘Skills for Learning’ (4 items, and ‘Cultural Competence’ (3 items. Confirmatory factor analysis (CFA on the validation split (n=288, 40% indicated fair fit for this three-factor model (fit indices: CFI=0.96, RMSEA=0.06, and SRMR=0.05. Internal consistency reliability estimates of each factor and the instrument ranged from 0.63 to 0.79. Conclusion: Results of the CFA in a separate validation dataset provided robust measures of goodness-of-fit for the three-factor solution developed in the EFA, and indicated that the three-factor model fitted the data well enough. Therefore, we can conclude that this student professional behavior evaluation instrument is a structurally validated tool to measure professional behaviors reported by entry-level OT students. The internal consistency reliability of each individual factor and the whole instrument was considered to be adequate to good.

  18. Human Language, Unit II: Language Curriculum, Level C [Grade Three]; Teacher's Guide.

    Science.gov (United States)

    Oregon Univ., Eugene. Oregon Elementary English Project.

    Developed by the Oregon Elementary English Project, the lessons in this second of a two-part unit on the human language intended for grades three and four revolve around the character Sad Sam, who gets lost in the woods and happens to observe four animals (bears, raccoons, geese, and robins). Having been introduced to Sad Sam in lesson 1, the…

  19. Process methods and levels of automation of wood pallet repair in the United States

    Science.gov (United States)

    Jonghun Park; Laszlo Horvath; Robert J. Bush

    2016-01-01

    This study documented the current status of wood pallet repair in the United States by identifying the types of processing and equipment usage in repair operations from an automation prespective. The wood pallet repair firms included in the sudy received an average of approximately 1.28 million cores (i.e., used pallets) for recovery in 2012. A majority of the cores...

  20. Communication Systems, Unit II: Language Curriculum, Level D [Grade Four]; Teacher's Guide.

    Science.gov (United States)

    Oregon Univ., Eugene. Oregon Elementary English Project.

    Developed by the Oregon Elementary English Project for grades three and four, this second of two units on communication systems begins with a lesson which reinforces the concept that in order to communicate we must all have the same meaning for the signals used. Lessons 1 through 3 deal with the various kinds of communication signals used by…

  1. Managing Highway Maintenance: Maintenance Management--by Objectives, Unit 10, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit deals with management by objectives--its definition, how it works, and necessary steps for application. It is designed for maintenance supervisors who are familiar with maintenance management systems. The format is a programed, self-instructional approach in which questions are…

  2. Managing Highway Maintenance: Instructor's Manual for Work Programs and Budgets, Unit 9, Levels 1 and 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit covers the purpose of developing work programs and budgets; a review of the program and budget development process (activity descriptions, feature inventories and quality standards, estimated work quantities, and dollar requirements); and typical calculations for work programs,…

  3. Managing Highway Maintenance: Standards for Maintenance Work, Part 1, Unit 8, Level 2.

    Science.gov (United States)

    Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

    Part of the series "Managing Highway Maintenance," the unit is about maintenance standards and is designed for superintendents and senior foremen who are responsible for scheduling and controlling routine maintenance. It describes different kinds of standards, why and how standards are developed, and how standards are to be used and…

  4. Biomass Feedstock Availability in the United States: 1999 State Level Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, Marie E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Perlack, Robert L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Turhollow, Anthony [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); de la Torre Ugarte, Daniel [Univ. of Tennessee, Knoxville, TN (United States); Becker, Denny A. [Science Applications International Corporation, Oak Ridge, TN (United States); Graham, Robin L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Slinsky, Stephen E. [Univ. of Tennessee, Knoxville, TN (United States); Ray, Daryll E. [Univ. of Tennessee, Knoxville, TN (United States)

    2000-01-01

    Interest in using biomass feedstocks to produce power, liquid fuels, and chemicals in the U.S. is increasing. Central to determining the potential for these industries to develop is an understanding of the location, quantities, and prices of biomass resources. This paper describes the methodology used to estimate biomass quantities and prices for each state in the continental United States.

  5. Experiences of health care providers managing sexual assault victims in the emergency unit Part 2: Discussion of results and literature control

    Directory of Open Access Journals (Sweden)

    Rebecca M. Skhosana

    2009-04-01

    Full Text Available The objective of this study was to explore and describe the experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select participants from health care providers who were working in the emergency unit and had managed more than four sexual assault victims. Data were collected by means of individual interviews and analysed according to the Tesch method of data analysis by the researcher and the independent co-coder. Main categories, subcategories and themes were identified. Participants expressed their emotions, challenges and police attitudes and behaviours, as well as inconsistencies in guidelines and needs identification. It was recommended that members of the multidisciplinary team engage in community activities and that the community participate in matters pertaining to sexual assault. Government should develop clear guidelines that are applicable to rural and urban South Africa. Health care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents.

    Opsomming

    Die doel van hierdie studie was om die ervaringe van gesondheidsorgverskaffers wat slagoffers van seksuele aanranding in die ongevalle-eenheid van 'n gemeenskapshospitaal in die Nkangala-distrik in die provinsie van Mpumalanga hanteer, te ontgin en te beskryf. ’n Kwalitatiewe fenomenologiese ontwerp is toegepas. Doelbewuste steekproefneming is gebruik om deelnemers te selekteer uit die groep gesondheidsorgverskaffers wat in die ongevalle-eenheid werksaam was en meer as vier slagoffers van seksuele aanranding hanteer het. Data is by wyse van individuele onderhoude ingesamel en volgens die Tesch-metode van data-analise deur die navorser en die onafhanklike

  6. Motor unit recruitment pattern during low-level static and dynamic contractions.

    Science.gov (United States)

    Søgaard, K

    1995-03-01

    Motor unit (MU) recruitment patterns were studied during dynamic and static contractions at workloads corresponding to 10% of maximal voluntary contraction force. The dynamic contraction consisted of a 20 degrees flexion and extension of the elbow performed with a velocity of 10 degrees/s. Motor unit potential trains were recorded from the brachial biceps muscle of 6 healthy females using a quadripolar needle electrode and a computerized decomposition program. Properties of the identified MUs were derived from concentric needle EMG. A total of 119 MUs were identified during dynamic contractions, 107 MUs during static anisotonic contractions, and 96 MUs during static isotonic contractions. The main result was that MUs recruited during different contractions showed similar properties and may belong to the same part of the motoneuron pool. This indicates that MU recruitment patterns during dynamic contractions may be almost as stereotypical as during static contractions and may even activate the same MUs.

  7. MODEL MEKANISME ADMINISTRATIF TERINTEGRASIPADA IMPLEMENTASI STRATEGI DI LEVEL UNIT BISNIS STRATEGIS

    Directory of Open Access Journals (Sweden)

    Dwi Sulistiani

    2014-11-01

    Full Text Available Tulisan ini menindaklanjuti pandangan terpadu tentang elemen penting dari tiga mekanisme administratif: struktur organisasi, sistem kontrol dan manajer yang berkaitan dengan perbedaan dalam strategi kompetitif SBU (strategic business unit.Tulisan ini berdasarkan penelitian Govindarajan (1988 yang mencoba menemukan model untuk implementasi beragam strategi SBU yang dijalankan oleh korporasi berbeda. Hasilnya ditemukan bahwa lokus kontrol internal manajerial yang tinggi dan emphasis yang rendah pada pemenuhan sebuah budget berhubungan dengan kinerja tinggi dalam SBU yang menjalankan strategi diferensiasi. Hasil berbasis analisis sistem menunjukkan bahwa ketika gaya evaluatif budget, desentralisasi dan lokus kontrol berhubungan untuk memenuhi kebutuhan strategi SBU, maka dihasilkan kinerja superior. Kesesuaian sistem ini adalah sangat kuat antar SBU diferensiasi, tapi tidak begitu kuat antar unit low cost

  8. State-Level Comparison of Processes and Timelines for Distributed Photovoltaic Interconnection in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Ardani, K.; Davidson, C.; Margolis, R.; Nobler, E.

    2015-01-01

    This report presents results from an analysis of distributed photovoltaic (PV) interconnection and deployment processes in the United States. Using data from more than 30,000 residential (up to 10 kilowatts) and small commercial (10-50 kilowatts) PV systems, installed from 2012 to 2014, we assess the range in project completion timelines nationally (across 87 utilities in 16 states) and in five states with active solar markets (Arizona, California, New Jersey, New York, and Colorado).

  9. The Prosecution of State-Level Human Trafficking Cases in the United States

    OpenAIRE

    Amy Farrell; Monica J DeLateur; Colleen Owens; Stephanie Fahy

    2016-01-01

    In an effort to combat human trafficking, the United States federal government and all fifty states passed new laws that criminalise human trafficking and support the identification and prosecution of human trafficking perpetrators. Despite the passage of these laws, only a small number of human trafficking cases have been prosecuted in the last fifteen years. Guided by the notion that prosecutors seek to avoid uncertainty when making decisions to pursue criminal prosecution, we explore how h...

  10. Platoon-Level After Action Review Aids in the SIMNET Unit Performance Assessment System

    Science.gov (United States)

    1992-07-01

    EXERCISE AS A FUNCTION OF UNIT SIDE, TIME, RESULT, AND RANGE TIME FIRING SIDE RESULT RANGE 06:45:00 Red Near Miss 1430 07:03:00 Blue Hit 1860 07:04:00 Blue...Hit 1781 Near Miss 1612 Red Near Miss 2263 Hit 1856 07:05:00 Blue Near Miss 1563 Near Miss 1836 Kill 1132 Hit 1894 Red Near Miss 1900 Hit 1918 11

  11. A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit.

    Science.gov (United States)

    Holms, Natalie; Milligan, Stuart; Kydd, Angela

    2014-11-01

    End-of-life care (EOLC) in the intensive care unit (ICU) has received little attention in the literature in comparison to the considerable amount of existing literature available on EOLC in other areas of nursing. The ethos of the ICU is to preserve life, but as many patients die in this environment, EOLC should be an integral part of the ICU nurse's role. This qualitative study explored the experiences of ICU nurses who had provided EOLC to patients and their families. Participants were purposively recruited within one local ICU (n=5). A semi-structured interview format was used to guide in-depth interviews. The themes identified from the interview analysis were; use of integrated care systems, communication, the environment, education and training, staff distress. The findings suggest that ICU nurses do not feel adequately prepared to give proficient EOLC. Those who felt more confident in EOLC had learned what to do over time. Appropriate training, support and improved communication between staff, patients and families is necessary for good EOLC in ICUs.

  12. On the Implementation of Variable Speed in Pump-Turbine Units Providing Primary and Secondary Load-Frequency Control in Generating Mode

    Directory of Open Access Journals (Sweden)

    José Ignacio Sarasúa

    2015-12-01

    Full Text Available This paper analyses different control strategies for the speed control loop of a variable-speed pump-turbine unit equipped with a doubly fed induction generator, operating in generating mode in an isolated power system with high penetration of intermittent renewable energy. The control strategies are evaluated and compared to each other in terms of the amount of water discharged through the pump-turbine and of the wicket gates fatigue while providing primary and secondary load-frequency control. The influence of the penstock length and the initial operating point on the performance of each control strategy is studied in detail. For these purposes, several simulations have been performed with a suitable dynamic model of the pumped-storage hydropower plant and the power system. The results of the paper indicate that a proper control strategy would consist in updating the reference speed according to the power generation schedule and keeping it constant within each scheduling period (typically 1 h.

  13. Semimanufacture intended to be mounted on a vibrating wall or a vibrating panel for actively damping vibrations of the wall, wall or panel provided with such semimanufacture, system provided with a semimanufacture and a control unit, wall or panel provided with a control unit and method for damping audible vibrations of a wall or panel

    NARCIS (Netherlands)

    Goeje, de Marius; Overbeek, van Michiel Wilbert R.M.; Waal, van der Adri; Berkhoff, Arthur P.; Nederveen, Peter J.

    2006-01-01

    A semimanufacture intended to be mounted on a vibrating wall or a vibrating panel for actively damping the vibrations in the wall or the panel with frequencies which are at least partly audible, wherein the semimanufacture is provided with a plate wherein the plate is integrated with: at least one v

  14. [Prevention of ventilator-associated pneumonia: a comparison of level of knowledge in three critical care units].

    Science.gov (United States)

    Pujante-Palazón, I; Rodríguez-Mondéjar, J J; Armero-Barranco, D; Sáez-Paredes, P

    2016-01-01

    To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  15. Assessment of ambient noise levels in the intensive care unit of a university hospital

    Directory of Open Access Journals (Sweden)

    Hatem O Qutub

    2009-01-01

    Conclusion : Some sources of environmental noise, such as the use of oxygen, suction equipment or respirators are unavoidable. Nevertheless, hospital ICUs should have measures to minimize the level of exposure to noise in the ICU. Further research in this area might focus on the noise level and other modifiable environmental stress factors in the ICU that affect patients as well as the staff.

  16. Short hours, long hours: Hour levels and trends in the retail industry in the United States, Canada, and Mexico

    OpenAIRE

    Carré, Françoise; Tilly, Chris

    2012-01-01

    In settings where most workers have full-time schedules, hourly wages are appropriate primary indicators of job quality and worker outcomes. However, in sectors where full-time schedules do not dominate - primarily service-producing activities - total hours matter, in addition to hourly wages, for job quality and worker outcomes. In this paper we employ a sector-focused, comparative framework to further examine hours levels - measured as average weekly hours - and trends in Canada, the United...

  17. Individual, unit and vocal clan level identity cues in sperm whale codas

    DEFF Research Database (Denmark)

    Gero, Shane; Whitehead, Hal; Rendell, Luke

    2016-01-01

    The ‘social complexity hypothesis’ suggests that complex social structure is a driver of diversity in animal communication systems. Sperm whales have a hierarchically structured society in which the largest affiliative structures, the vocal clans, are marked on ocean-basin scales by culturally...... transmitted dialects of acoustic signals known as ‘codas’. We examined variation in coda repertoires among both individual whales and social units—the basic element of sperm whale society—using data from nine Caribbean social units across six years. Codas were assigned to individuals using photo...

  18. Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

    Science.gov (United States)

    Shaefer, H Luke; Miller, Matthew

    2011-08-01

    Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

  19. Energy Efficiency Policy in the United States. Overview of Trends at Different Levels of Government

    Energy Technology Data Exchange (ETDEWEB)

    Doris, Elizabeth [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cochran, Jaquelin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Vorum, Martin [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2009-12-01

    This report catalogs by sector--buildings, transportation, industrial, and power--energy efficiency policies at the federal, state, and local levels, and identifies some prominent policy trends. Four key findings emerged from this report: 1) leadership on energy efficiency is necessary--and is found--at each level of government; 2) there is no widely accepted methodology for evaluating energy efficiency policies; 3) coordination among the three levels of government--and across sectors--is increasingly important, and there are opportunities to significantly improve policy performance through a unified strategy; and 4) there are efficiencies to be gained by informing policies in one sector with experience from others.

  20. Energy Efficiency Policy in the United States: Overview of Trends at Different Levels of Government

    Energy Technology Data Exchange (ETDEWEB)

    Doris, E.; Cochran, J.; Vorum, M.

    2009-12-01

    This report catalogs by sector--buildings, transportation, industrial, and power--energy efficiency policies at the federal, state, and local levels, and identifies some prominent policy trends. Four key findings emerged from this report: 1) leadership on energy efficiency is necessary--and is found--at each level of government; 2) there is no widely accepted methodology for evaluating energy efficiency policies; 3) coordination among the three levels of government--and across sectors--is increasingly important, and there are opportunities to significantly improve policy performance through a unified strategy; and 4) there are efficiencies to be gained by informing policies in one sector with experience from others.

  1. District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

    Science.gov (United States)

    Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

    2016-08-08

    In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs

  2. Attributes for NHDPlus Catchments (Version 1.1) for the Conterminous United States: Level 3 Ecoregions

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set represents the estimated area of level 3 ecological landscape regions (ecoregions), as defined by Omernik (1987), compiled for every catchment of...

  3. The Use of Twitter to Predict the Level of Influenza Activity in the United States

    Science.gov (United States)

    2014-09-01

    forecast the level of influenza activity. The rise in the popularity of social media websites such as Flickr, Twitter and Facebook has transformed...The CDC requires a tool that can forecast the level of influenza activity. The rise in the popularity of social media websites such as Flickr... impacted world societies, economies and tourism . In order to prevent such influenza pandemics, U.S. health agencies need to be alerted of the danger

  4. Effective inundation of continental United States communities with 21st century sea level rise

    Directory of Open Access Journals (Sweden)

    Kristina A. Dahl

    2017-07-01

    Full Text Available Recurrent, tidally driven coastal flooding is one of the most visible signs of sea level rise. Recent studies have shown that such flooding will become more frequent and extensive as sea level continues to rise, potentially altering the landscape and livability of coastal communities decades before sea level rise causes coastal land to be permanently inundated. In this study, we identify US communities that will face effective inundation—defined as having 10% or more of livable land area flooded at least 26 times per year—with three localized sea level rise scenarios based on projections for the 3rd US National Climate Assessment. We present these results in a new, online interactive tool that allows users to explore when and how effective inundation will impact their communities. In addition, we identify communities facing effective inundation within the next 30 years that contain areas of high socioeconomic vulnerability today using a previously published vulnerability index. With the Intermediate-High and Highest sea level rise scenarios, 489 and 668 communities, respectively, would face effective inundation by the year 2100. With these two scenarios, more than half of communities facing effective inundation by 2045 contain areas of current high socioeconomic vulnerability. These results highlight the timeframes that US coastal communities have to respond to disruptive future inundation. The results also underscore the importance of limiting future warming and sea level rise: under the Intermediate-Low scenario, used as a proxy for sea level rise under the Paris Climate Agreement, 199 fewer communities would be effectively inundated by 2100.

  5. The Prosecution of State-Level Human Trafficking Cases in the United States

    Directory of Open Access Journals (Sweden)

    Amy Farrell

    2016-05-01

    Full Text Available In an effort to combat human trafficking, the United States federal government and all fifty states passed new laws that criminalise human trafficking and support the identification and prosecution of human trafficking perpetrators. Despite the passage of these laws, only a small number of human trafficking cases have been prosecuted in the last fifteen years. Guided by the notion that prosecutors seek to avoid uncertainty when making decisions to pursue criminal prosecution, we explore how human trafficking crimes are indicted under these newly defined state laws. Using a sample of cases from twelve US counties and interviews with police, prosecutors and court personnel, we examine the factors that influence the decision to prosecute crimes investigated as human trafficking in state court. This research informs our understanding of why so few human trafficking cases are prosecuted and why human trafficking suspects are rarely convicted of trafficking offenses.

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

    Science.gov (United States)

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

    2013-04-01

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

  7. Comparability of nurse staffing measures in examining the relationship between RN staffing and unit-acquired pressure ulcers: a unit-level descriptive, correlational study.

    Science.gov (United States)

    Choi, JiSun; Staggs, Vincent S

    2014-10-01

    Various staffing measures have been used in examining the relationship between nurse staffing and patient outcomes. Little research has been conducted to compare these measures based on their explanatory power as predictors of nursing-sensitive outcomes. In this study, both administrative and nurse-reported measures were examined. Administrative measures included registered nurse (RN) skill mix and three versions of nursing hours per patient day (HPPD); nurse-reported measures included RN-reported number of assigned patients and RN-perceived staffing adequacy. To examine correlations among six nurse staffing measures and to compare their explanatory power in relation to unit-acquired pressure ulcers (UAPUs). Descriptive, correlational study. 2397 nursing units in 409 U.S. acute care hospitals. Random-intercept logistic regression analyses were performed using 2011 data from a national database. Relationships between nurse staffing measures and UAPU occurrences were examined in eight models, each with one or more staffing measures as predictors. Characteristics of nursing units (RN workgroup education level and RN workgroup unit tenure) and hospitals (size, teaching status, and Magnet status) were included as control variables. Two versions of HPPD (total nursing HPPD and RN HPPD) and RN skill mix were significantly correlated with RN-reported number of assigned patients (r range=-0.87 to -0.75). These staffing measures had weaker correlations with RN-perceived staffing adequacy (r range=0.16 to 0.23). Of the six staffing variables, only RN-perceived staffing adequacy and RN skill mix were significantly associated with UAPU odds, the former being the better predictor. Although RN-perceived staffing adequacy was not highly correlated with administrative measures of HPPD and RN skill mix, it was the strongest predictor of UAPU occurrences. RN-perceived staffing adequacy can serve as a more appropriate measure of staffing for nursing-sensitive outcomes research than

  8. Confronting commercial sexual exploitation and sex trafficking of minors in the United States: a guide for providers of victim and support services

    National Research Council Canada - National Science Library

    Briere, Rona; Simon, Patti

    2014-01-01

    .... However, much of this attention has focused internationally. This international focus has overshadowed the reality that commercial sexual exploitation and sex trafficking of minors also occur every day within the United States...

  9. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure - United States, 2016.

    Science.gov (United States)

    Oduyebo, Titilope; Petersen, Emily E; Rasmussen, Sonja A; Mead, Paul S; Meaney-Delman, Dana; Renquist, Christina M; Ellington, Sascha R; Fischer, Marc; Staples, J Erin; Powers, Ann M; Villanueva, Julie; Galang, Romeo R; Dieke, Ada; Muñoz, Jorge L; Honein, Margaret A; Jamieson, Denise J

    2016-02-12

    CDC has updated its interim guidelines for U.S. health care providers caring for pregnant women during a Zika virus outbreak (1). Updated guidelines include a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2-12 weeks after pregnant women return from travel. This update also expands guidance to women who reside in areas with ongoing Zika virus transmission, and includes recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15-44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout their pregnancy. For pregnant women with clinical illness consistent with Zika virus disease,* testing is recommended during the first week of illness. For asymptomatic pregnant women residing in areas with ongoing Zika virus transmission, testing is recommended at the initiation of prenatal care with follow-up testing mid-second trimester. Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.

  10. Historical temperature and salinity data collected from 1896-04-22 to 1961-03-26 from the World Ocean and provided by United Kingdom hydrographic office (NODC Accession 0073673)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Historical temperature and salinity data collected from 1896-04-22 to 1961-03-26 from the World Ocean. Data were digitized from cards provided by United Kingdom...

  11. The Relationship Between Sound Levels In the Postanesthesia Care Unit and Use of Analgesics

    Science.gov (United States)

    1999-10-01

    the physiological and psychological mechanisms behind the phenomena, Florence Nightingale noticed an association between noise and patient discomfort...is interesting that the relationship between sound levels and the use of analgesics remains so similar. Going back even further, Florence Nightingale s

  12. Global and regional sea level rise scenarios for the United States

    Science.gov (United States)

    Sweet, W.; Kopp, R.E.; Weaver, C.P.; Obeysekera, J; Horton, Radley M.; Thieler, E. Robert; Zervas, C.

    2017-01-01

    The Sea Level Rise and Coastal Flood Hazard Scenarios and Tools Interagency Task Force, jointly convened by the U.S. Global Change Research Program (USGCRP) and the National Ocean Council (NOC), began its work in August 2015. The Task Force has focused its efforts on three primary tasks:

  13. The Application of VARK Learning Styles in Introductory Level Economics Units

    Science.gov (United States)

    Wright, Sarah; Stokes, Anthony

    2015-01-01

    The issues of developing strategies and approaches to teaching introductory level economics courses at university have been long standing. With the development of economics learning standards in Australia, this is a time to consider teaching and learning approaches to engage students and develop skills in economics. This paper considers that to…

  14. Omernik's Level III Ecoregions of the Continental United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows Omernik's Level III ecoregions, derived from a 1:7,500,000 map created by J.M. Omernik in 1987 and from refinements of Omernik's framework that...

  15. The Application of VARK Learning Styles in Introductory Level Economics Units

    Science.gov (United States)

    Wright, Sarah; Stokes, Anthony

    2015-01-01

    The issues of developing strategies and approaches to teaching introductory level economics courses at university have been long standing. With the development of economics learning standards in Australia, this is a time to consider teaching and learning approaches to engage students and develop skills in economics. This paper considers that to…

  16. Short-term bulk energy storage system scheduling for load leveling in unit commitment: modeling, optimization, and sensitivity analysis.

    Science.gov (United States)

    Hemmati, Reza; Saboori, Hedayat

    2016-05-01

    Energy storage systems (ESSs) have experienced a very rapid growth in recent years and are expected to be a promising tool in order to improving power system reliability and being economically efficient. The ESSs possess many potential benefits in various areas in the electric power systems. One of the main benefits of an ESS, especially a bulk unit, relies on smoothing the load pattern by decreasing on-peak and increasing off-peak loads, known as load leveling. These devices require new methods and tools in order to model and optimize their effects in the power system studies. In this respect, this paper will model bulk ESSs based on the several technical characteristics, introduce the proposed model in the thermal unit commitment (UC) problem, and analyze it with respect to the various sensitive parameters. The technical limitations of the thermal units and transmission network constraints are also considered in the model. The proposed model is a Mixed Integer Linear Programming (MILP) which can be easily solved by strong commercial solvers (for instance CPLEX) and it is appropriate to be used in the practical large scale networks. The results of implementing the proposed model on a test system reveal that proper load leveling through optimum storage scheduling leads to considerable operation cost reduction with respect to the storage system characteristics.

  17. [Levels of state-trait anxiety between mothers and fathers who have children in an intensive care unit.

    Science.gov (United States)

    Rojas-Carrasco, Karmina Elena

    2013-01-01

    Background: when there is a child patient in the family, it is frequent that parents get upset. Anxiety in the mother and father could be different depending on the way each one lives the critical situation of the child patient. The purpose was to measure levels of anxiety in fathers and mothers who had a hospitalized child in an intensive care unit. Methods: the State-Trait Anxiety Inventory (STAI) was applied to a group of 50 pairs of parents who had a hospitalized child in the intensive care unit in a pediatric hospital. A no probabilistic intentional sample was used. Differences between groups were analyzed by Student's t test. Results: no significant differences were obtained between mothers and fathers for both state-anxiety and trait-anxiety. Significant differences were obtained intra-groups between both kinds of anxiety. Conclusions: having a child who is chronically sick or hospitalized for intensive therapy causes similar levels of anxiety in both parents. Anxiety is significantly increased in both parents when their child is hospitalized in an intensive therapy unit.

  18. Grasslands and Croplands Have Different Microbial Biomass Carbon Levels per Unit of Soil Organic Carbon

    Directory of Open Access Journals (Sweden)

    Terence P. McGonigle

    2017-07-01

    Full Text Available Primarily using cropped systems, previous studies have reported a positive linear relationship between microbial biomass carbon (MBC and soil organic carbon (SOC. We conducted a meta-analysis to explore this relationship separately for grasslands and croplands using available literature. Studies were limited to those using fumigation–extraction for MBC for field samples. Trials were noted separately where records were distinct in space or time. Grasslands were naturally occurring, restored, or seeded. Cropping systems were typical of the temperate zone. MBC had a positive linear response to increasing SOC that was significant in both grasslands (p < 0.001; r2 = 0.76 and croplands (p < 0.001; r2 = 0.48. However, MBC increased 2.5-fold more steeply per unit of increasing SOC for grassland soils, as compared to the corresponding response in cropland soils. Expressing MBC as a proportion of SOC across the regression overall, slopes corresponded to 2.7% for grasslands and 1.1% for croplands. The slope of the linear relationship for grasslands was significantly (p = 0.0013 steeper than for croplands. The difference between the two systems is possibly caused by a greater proportion of SOC in grasslands being active rather than passive, relative to that in croplands, with that active fraction promoting the formation of MBC.

  19. Interior characteristics at mid-levels of thunderstorms in the southeastern United States

    Science.gov (United States)

    Musil, Dennis J.; Smith, Paul L.

    1988-01-01

    Data characterizing the vertical wind structure and hydrometeors within cumulonimbus clouds in the southeastern United States were collected by the armored T-28 aircraft during the 1986 Cooperative Huntsville Meteorological Experiment (COHMEX). Data analysis concentrated on the hydrometeor character and development, as well as the general microphysical and kinematic structure of the clouds penetrated. The high reflectivities which sometimes exceeded the usual 55 dBz limit set for the T-28, are not necessarily related to hail in the COHMEX storms. Instead, large numbers of millimeter-size particles were found, while the hail infrequently encountered was generally small. The fact that the larger hydrometeors were usually found in narrow and weak updrafts that appeared to be well mixed suggests that a coalescence mechanism was active in many of the storms. The depth of warm cloud (typically about 3.5 km) present in these storms apparently allows ample time for particles to reach the observed millimeter sizes. The presence of cloud droplets in the largest sizes measured supports this mechanism. Ice processes play a role in the precipitation, but hail was unable to grow very large in these storms probably because the high concentrations of observed growth centers suggest a natural beneficial competition process.

  20. Multi­-Threaded Algorithms for General purpose Graphics Processor Units in the ATLAS High Level Trigger

    CERN Document Server

    Conde Mui\\~no, Patricia; The ATLAS collaboration

    2016-01-01

    General purpose Graphics Processor Units (GPGPU) are being evaluated for possible future inclusion in an upgraded ATLAS High Level Trigger farm. We have developed a demonstrator including GPGPU implementations of Inner Detector and Muon tracking and Calorimeter clustering within the ATLAS software framework. ATLAS is a general purpose particle physics experiment located on the LHC collider at CERN. The ATLAS Trigger system consists of two levels, with level 1 implemented in hardware and the High Level Trigger implemented in software running on a farm of commodity CPU. The High Level Trigger reduces the trigger rate from the 100 kHz level 1 acceptance rate to 1 kHz for recording, requiring an average per­-event processing time of ~250 ms for this task. The selection in the high level trigger is based on reconstructing tracks in the Inner Detector and Muon Spectrometer and clusters of energy deposited in the Calorimeter. Performing this reconstruction within the available farm resources presents a significant ...

  1. Lifelong Learning Experience and Level of Social Exclusion or Inclusion of Asian Communities Living in Denmark and the United Kingdom

    DEFF Research Database (Denmark)

    Singla, Rashmi; Klein, Sonia; Panesar, Jasbir

    2005-01-01

    This article reflects the situation of Asian communities in Denmark and the United Kingdom which is influenced by global trends, the patterns of differing learning they participate in which are influenced by the concept of LifeLong Learning within each country, educational opportunities, socio......-economic positions of this target group and entrepreneurship activities taking place. Global trends influence disadvantaged learners level of participation in learning within Europe. The Asian communities in Denmark and the United Kingdom, despite the differences in migration period, have made the decision to live......, including Asian communities, have been negatively affected in the recent years due to the increased political restrictions and media coverage. In comparison, despite the recent immigration policies in the UK, many members of the Asian communities have embraced the opportunities LifeLong Learning has...

  2. Late spring ultraviolet levels over the United Kingdom and the link to ozone

    Directory of Open Access Journals (Sweden)

    J. Austin

    Full Text Available Erythemally-weighted ultraviolet (UVery levels measured over southern England, during anticyclonic weather between 30 April and 2 May, 1997, were almost 50 higher than normally expected for clear skies and were similar to mid-summer values for the first time since measurements began in 1990. Investigation of this episode suggests that a combination of both meteorological and chemical effects were responsible for generating record low ozone amounts for the time of year. Further, comparisons between the A band ultraviolet (315 to 400 nm wavelength amounts, and radiative calculations confirm that the high UVery was primarily due to the reduction in total ozone. These results are contrasted with a similar period for 1998, in which near climatological ozone amounts were measured. The prospects for enhanced UVery levels in future years are briefly reviewed in the light of expected increases in stratospheric halogen levels and greenhouse gases.

    Key words. Atmospheric composition and structure (middle atmosphere · composition and chemistry · Meterology and atmospheric dynamics (middle atmosphere dynamics; radiative processes

  3. A study of changes in foundation insulation levels in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Christian, J.E. [Oak Ridge National Lab., TN (United States); Voss, M.K. [Saint Mary`s Coll., Winona, MN (United States)

    1992-10-01

    For almost 10 years the US Department of Energy (DOE) has sponsored a small research effort with. the objective of working with the building industry to see that cost-effective foundation insulation levels are installed in all US buildings. One of the first discoveries in 1983--1984 was that less than 5% of the existing buildings had foundation insulation and less than 30% of new construction included foundation insulation. After producing foundation handbooks, actively working with energy code and standards groups (ASHRAE and Council of American Building Officials: Model Energy Code Committee) conducting told experiments, and developing computer models for predicting energy savings has any measurable progress been made toward the fulfillment of this DOE objective? Also, in order to derive maximum energy savings impact for this ongoing research activity, market feedback of progress toward attainment of the objective is needed. Using the network of building experts available to the Building Thermal Envelope Systems and Materials program, a short mail survey was developed, administered, and results analyzed. This study concludes that foundation insulation usage on new residential buildings has increased from 1982 levels of around 25% to 1992 levels of around 50%. Government handbooks and recent changes in local enforced codes and standards are identified as major contributors to this improvement. Progress has been made but more is needed to capture the remaining 40% of the foundations that should be insulated. Several issues are reported as obstacles that need to be overcome to capture the remainder of the foundation market.

  4. A study of changes in foundation insulation levels in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Christian, J.E. (Oak Ridge National Lab., TN (United States)); Voss, M.K. (Saint Mary' s Coll., Winona, MN (United States))

    1992-10-01

    For almost 10 years the US Department of Energy (DOE) has sponsored a small research effort with. the objective of working with the building industry to see that cost-effective foundation insulation levels are installed in all US buildings. One of the first discoveries in 1983--1984 was that less than 5% of the existing buildings had foundation insulation and less than 30% of new construction included foundation insulation. After producing foundation handbooks, actively working with energy code and standards groups (ASHRAE and Council of American Building Officials: Model Energy Code Committee) conducting told experiments, and developing computer models for predicting energy savings has any measurable progress been made toward the fulfillment of this DOE objective Also, in order to derive maximum energy savings impact for this ongoing research activity, market feedback of progress toward attainment of the objective is needed. Using the network of building experts available to the Building Thermal Envelope Systems and Materials program, a short mail survey was developed, administered, and results analyzed. This study concludes that foundation insulation usage on new residential buildings has increased from 1982 levels of around 25% to 1992 levels of around 50%. Government handbooks and recent changes in local enforced codes and standards are identified as major contributors to this improvement. Progress has been made but more is needed to capture the remaining 40% of the foundations that should be insulated. Several issues are reported as obstacles that need to be overcome to capture the remainder of the foundation market.

  5. Landscape-level influences of terrestrial snake occupancy within the southeastern United States.

    Science.gov (United States)

    Steen, David A; McClure, Christopher J W; Brock, Jean C; Rudolph, D Craig; Pierce, Josh B; Lee, James R; Humphries, W Jeffrey; Gregory, Beau B; Sutton, William B; Smith, Lora L; Baxley, Danna L; Stevenson, Dirk J; Guyer, Craig

    2012-06-01

    Habitat loss and degradation are thought to be the primary drivers of species extirpations, but for many species we have little information regarding specific habitats that influence occupancy. Snakes are of conservation concern throughout North America, but effective management and conservation are hindered by a lack of basic natural history information and the small number of large-scale studies designed to assess general population trends. To address this information gap, we compiled detection/nondetection data for 13 large terrestrial species from 449 traps located across the southeastern United States, and we characterized the land cover surrounding each trap at multiple spatial scales (250-, 500-, and 1000-m buffers). We used occupancy modeling, while accounting for heterogeneity in detection probability, to identify habitat variables that were influential in determining the presence of a particular species. We evaluated 12 competing models for each species, representing various hypotheses pertaining to important habitat features for terrestrial snakes. Overall, considerable interspecific variation existed in important habitat variables and relevant spatial scales. For example, kingsnakes (Lampropeltis getula) were negatively associated with evergreen forests, whereas Louisiana pinesnake (Pituophis ruthveni) occupancy increased with increasing coverage of this forest type. Some species were positively associated with grassland and scrub/shrub (e.g., Slowinski's cornsnake, Elaphe slowinskii) whereas others, (e.g., copperhead, Agkistrodon contortrix, and eastern diamond-backed rattlesnake, Crotalus adamanteus) were positively associated with forested habitats. Although the species that we studied may persist in varied landscapes other than those we identified as important, our data were collected in relatively undeveloped areas. Thus, our findings may be relevant when generating conservation plans or restoration goals. Maintaining or restoring landscapes that

  6. Intrinsic component of resilience among entry level medical students in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Mehzabin Ahmed

    2011-10-01

    Full Text Available BackgroundResilience is the capacity to recover and to cope successfullywith everyday challenges. Resilience has intrinsic andextrinsic components and an effort has been made to studythe intrinsic component and its association with sociodemographicfactors, among the entry level students of theIntegrated Bachelor of Medicine and Bachelor of Surgery(MBBS course.MethodThe present study was conducted in Gulf MedicalUniversity, using a self-administered questionnaire,comprising of two parts, distributed to all the students whoconsented to participate. The first part contained questionson socio-demographic details while the second partcontained questions on the intrinsic and extrinsiccomponents of resilience of the students. The datacollected was analysed using Predictive Analytic Software(PASW 18.0 using frequency, mean, SD and median.ResultsAmong the 58 students who participated 24 (41.4% weremales and 34 (58.6% females, of which 70.7% were 20years. The mean score for the intrinsiccomponent of resilience was 48.9 (SD, 5 and range 35–60.The median scores showed no significant variation (p<0.05with age, gender, religion, nationality, family structure,highest education among parents, the person they sharetheir feelings with or the number of friends. However,minimally higher scores were noted in the median scores ofstudents from nuclear families, with Western nationalityand those whose parents had a university level education,who shared their feelings with people of their owngeneration or outside their family and who have 5–9friends.ConclusionThe intrinsic component of resilience was found to bealmost uniform for the study group and the level is high. Astudy has to further look into its effect on coping with thestresses encountered during the academic year.

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

    Science.gov (United States)

    Al-Hilal, Mohamed; Aissa, Mosa

    2015-02-01

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

  8. Pneumothorax in neonates: a level III Neonatal Intensive Care Unit experience

    Directory of Open Access Journals (Sweden)

    Íris Santos Silva

    2016-09-01

    Full Text Available Introduction: Pneumothorax occurs more frequently in the neonatal period than in any other period of life and is associated with increased mortality and morbidity. Several risk factors for pneumothorax, including respiratory pathology, invasive and non-invasive respiratory support, and predictors of mortality have been described.Objective: To evaluate the prevalence of pneumothorax, to assess risk factors and to describe the clinical characteristics, management and outcome of newborn infants with pneumothorax, as well as to identify predictors of mortality in these newborns.Methods: This retrospective case-control study included all newborns hospitalized in the Neonatal Intensive Care Unit (NICU of “Centro Hospitalar São João”, Porto, Portugal, between 2003 and 2014, with the diagnosis of pneumothorax. A control group was selected among the newborns without pneumothoraces, admitted to the same NICU during the same period. The collected data included: demographics and perinatal data, pneumothorax characteristics, classification, treatment and clinical outcomes.Results: Our study included 240 neonates (80 with pneumothoraces and 160 controls, of whom 145 were male (60.4%. Median gestational age was 37 (24-40 weeks and median birthweight 2,613 (360-4,324 grams. The prevalence in our NICU was 1.5%. Pneumothorax was significantly associated with respiratory distress syndrome (RDS (p = 0.010 and transient tachypnea of the newborn (TTN (p < 0.001. Invasive mechanical ventilation (MV (p = 0.016 and FiO2 ≥ 0.4 (p = 0.003, were independent risk factors for the development of pneumothoraces. The mortality rate was 13.8%. Hypotension, MV and thoracentesis followed by a chest tube insertion were found to be predictors of mortality in newborns with pneumothoraces, but pneumothorax per se was not a predictor of mortality.Conclusion: Pneumothorax is relatively frequent in the NICU. Its risk factors and predictors of mortality should be known in order to

  9. Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment.

    Science.gov (United States)

    Yousif, Sami; Machan, Jason T; Alaska, Yasser; Suner, Selim

    2017-03-20

    Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.

  10. CREATION A MATHEMATICAL MODEL, THAT PROVIDES A SUFFICIENT LEVEL OF ANONYMITY IN E-VOTING SYSTEM WITH THE INTEGRITY AND PRIVACY OF TRANSMITTED DATA

    Directory of Open Access Journals (Sweden)

    Ugryumov D. V.

    2013-11-01

    Full Text Available The article presents the results of an analytical review of existing methods to ensure anonymity, the study of the system architecture of the electronic voting, and presented the author’s idea to improve the client's anonymity in such systems. The result is a mathematical model, that provides a sufficient level of anonymity in electronic voting system to preserve the integrity and confidentiality of transmitted data

  11. 放射性物位计在连续重整装置的应用%Application of Radioactive Material Level Meter in Continuous Reforming Unit

    Institute of Scientific and Technical Information of China (English)

    杨霄

    2015-01-01

    Catalyst regeneration system is the core part of reaction and regeneration of continuous reforming unit. To provide reliable parameters for control system, the catalyst should be accurately detected in the process of catalyst regeneration and recycling. Radioactive material level meter is an instrument which can accurately detect the catalyst material level. This paper introduces the radioactive material level meter's working principle, configu-rations and protection matters, and meanwhile, introduces the setting and calibration of the meter in continuous re-forming unit with the domestic continuous reforming process.%催化剂再生系统是连续重整装置反再部分的核心环节。在催化剂再生和循环的过程中需要准确检测催化剂的物位,为控制系统提供可靠参数。放射性物位计就是一种能准确检测设备中催化剂物位的仪表。本文介绍了放射性物位计的工作原理、配置方法和防护事项。同时,结合国产连续重整工艺,介绍了放射性物位计在连续重整中的设置和标定。

  12. Estimated Impacts of Sequestration-Level Funding: United States Department of Defense Fiscal Year 1015 Budget Request

    Science.gov (United States)

    2014-04-01

    3) (7)   Budget Line Items = "CH‐53K (Heavy Lift)" and "CH‐53K RDTE" Amphibious Combat Vehicle ACV ...investments are shown in Figure 4-9. At the PB15 funding level the Marine Corps begins development of the follow-on ACV program to replace the 40-year old...legacy vehicle. At BCA funding, only initial scoping and research efforts could be started. Figure 4-9. ACV Position Units FY 2015 FY 2016 FY

  13. Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review.

    Science.gov (United States)

    Lovink, Marleen H; Persoon, Anke; van Vught, Anneke J A H; Koopmans, Raymond T C M; Schoonhoven, Lisette; Laurant, Miranda G H

    2015-12-01

    This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking. A quantitative systematic literature review using Cochrane methods. The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands. This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people. © 2015 John Wiley & Sons Ltd.

  14. An assessment of dioxin levels in processed ball clay from the United States

    Energy Technology Data Exchange (ETDEWEB)

    Ferrario, J.; Byrne, C. [USEPA, Stennis Space Ctr. Mississippi (United States); Schaum, J. [USEPA, Washington, DC (United States)

    2004-09-15

    Introduction The presence of dioxin-like compounds in ball clay was discovered in 1996 as a result of an investigation to determine the sources of elevated levels of dioxin found in two chicken fat samples from a national survey of poultry. The investigation indicated that soybean meal added to chicken feed was the source of dioxin contamination. Further investigation showed that the dioxin contamination came from the mixing of a natural clay known as ''ball clay'' with the soybean meal as an anti-caking agent. The FDA subsequently discontinued the use of contaminated ball clay as an anti-caking agent in animal feeds. The source of the dioxins found in ball clay has yet to be established. A comparison of the characteristic dioxin profile found in ball clay to those of known anthropogenic sources from the U.S.EPA Source Inventory has been undertaken, and none of those examined match the features found in the clays. These characteristic features together with the fact that the geologic formations in which the clays are found are ancient suggest a natural origin for the dioxins. The plasticity of ball clays makes them an important commercial resource for a variety of commercial uses. The percentage of commercial uses of ball clay in 2000 included: 29% for floor and wall tile, 24% for sanitary ware, 10% pottery, and 37% for other industrial and commercial uses. The total mining of ball clay in the U.S. for 2003 was 1.12 million metric tons. EPA is examining the potential for the environmental release of dioxins from the processing/use of ball clays and evaluating potential exposure pathways. Part of this overall effort and the subject of this study includes the analysis of dioxin levels found in commercially available ball clays commonly used in ceramic art studios.

  15. A comparative study of allowable pesticide residue levels on produce in the United States

    Directory of Open Access Journals (Sweden)

    Neff Roni A

    2012-01-01

    Full Text Available Abstract Background The U.S. imports a substantial and increasing portion of its fruits and vegetables. The U.S. Food and Drug Administration currently inspects less than one percent of import shipments. While countries exporting to the U.S. are expected to comply with U.S. tolerances, including allowable pesticide residue levels, there is a low rate of import inspections and few other incentives for compliance. Methods This analysis estimates the quantity of excess pesticide residue that could enter the U.S. if exporters followed originating country requirements but not U.S. pesticide tolerances, for the top 20 imported produce items based on quantities imported and U.S. consumption levels. Pesticide health effects data are also shown. Results The model estimates that for the identified items, 120 439 kg of pesticides in excess of U.S. tolerances could potentially be imported to the U.S., in cases where U.S. regulations are more protective than those of originating countries. This figure is in addition to residues allowed on domestic produce. In the modeling, the top produce item, market, and pesticide of concern were oranges, Chile, and Zeta-Cypermethrin. Pesticides in this review are associated with health effects on 13 body systems, and some are associated with carcinogenic effects. Conclusions There is a critical information gap regarding pesticide residues on produce imported to the U.S. Without a more thorough sampling program, it is not possible accurately to characterize risks introduced by produce importation. The scenario presented herein relies on assumptions, and should be considered illustrative. The analysis highlights the need for additional investigation and resources for monitoring, enforcement, and other interventions, to improve import food safety and reduce pesticide exposures in originating countries.

  16. The Responses of Kuwaiti Special Educators to American Approaches to the Care and Treatment Provided Individuals with Mental Retardation in the United States Today.

    Science.gov (United States)

    Nelson, William R.; McDaniel, Elizabeth A.; Miller, Regina

    1997-01-01

    Twenty-five special educators from Kuwait who had participated in a six-week special education enrichment program in the United States were surveyed. A description of the program is combined with discussion of participants' sociocultural background and a report on their impressions and reactions. Lessons learned regarding international training…

  17. An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

    Science.gov (United States)

    Weaver, Shannon; Gull, Bethany; Ashby, Jeanie; Kamimura, Akiko

    2017-01-01

    The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire's controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S.…

  18. Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients

    Institute of Scientific and Technical Information of China (English)

    Tao Wang; Yun-Liang Cui; Zhao-Fen Lin; De-Chang Chen

    2016-01-01

    Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis ofbacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia.The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis ofbacteremia in Intensive Care Unit (ICU).Methods: The medical records of 420 patients in ICU were retrospectively reviewed.Patients (n =241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels.The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors.Patients' BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups.The PCT and plasma endotoxin levels were compared in the different groups.Results: A total of 241 patients with 505 episodes of BC were analyzed.The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups.GN bacteremia was more prevalent than Gram-positive bacteremia.The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups.The plasma endotoxin significantly differed among different groups and was bacterial species dependent.Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia.Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China.And PCT is a more valuable biomarker than endotoxin

  19. Market-level assessment of the economic benefits of atrazine in the United States.

    Science.gov (United States)

    Mitchell, Paul D

    2014-11-01

    Atrazine and other triazine herbicides are widely used in US maize and sorghum production, yet the most recent market-level assessment of the economic benefits of atrazine is for market conditions prevalent in the early 1990s, before commercialization of transgenic crops. Grain markets have changed substantially since that time; for example, the size of the US maize market increased by 170% from 1990-1992 to 2007-2009. This paper reports a current assessment of the economic benefits of atrazine. Yield increases and cost changes implied by triazine herbicides are projected to reduce maize prices by 7-8% and sorghum prices by 19-20%. Projected consumer benefits from lower prices range from $US 3.6 to 4.4 × 10(9) annually, with the net projected economic benefit for triazine herbicides to the US economy ranging from $US 2.9 to 3.4 × 10(9) annually because lower prices imply reduced producer income. Productivity gains from triazine herbicides maintain an estimated 270 000-390 000 ha of land in non-crop uses that generate environmental benefits not accounted for in this analysis. Even in the current era, with transgenic varieties dominating crop production, atrazine and the other triazine herbicides continue to be a key part of maize and sorghum production and generate substantial economic benefits. © 2013 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

  20. Market-level assessment of the economic benefits of atrazine in the United States

    Science.gov (United States)

    Mitchell, Paul D

    2014-01-01

    BACKGROUND Atrazine and other triazine herbicides are widely used in US maize and sorghum production, yet the most recent market-level assessment of the economic benefits of atrazine is for market conditions prevalent in the early 1990s, before commercialization of transgenic crops. Grain markets have changed substantially since that time; for example, the size of the US maize market increased by 170% from 1990–1992 to 2007–2009. This paper reports a current assessment of the economic benefits of atrazine. RESULTS Yield increases and cost changes implied by triazine herbicides are projected to reduce maize prices by 7–8% and sorghum prices by 19–20%. Projected consumer benefits from lower prices range from $US 3.6 to 4.4 × 109 annually, with the net projected economic benefit for triazine herbicides to the US economy ranging from $US 2.9 to 3.4 × 109 annually because lower prices imply reduced producer income. Productivity gains from triazine herbicides maintain an estimated 270 000–390 000 ha of land in non-crop uses that generate environmental benefits not accounted for in this analysis. CONCLUSION Even in the current era, with transgenic varieties dominating crop production, atrazine and the other triazine herbicides continue to be a key part of maize and sorghum production and generate substantial economic benefits. © 2013 The Authors. PestManagement Science published by JohnWiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:24318916

  1. The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania

    Science.gov (United States)

    Prytherch, Helen; Leshabari, Melkidezek T.; Wiskow, Christiane; Aninanya, Gifty A.; Kakoko, Deodatus C.V.; Kagoné, Moubassira; Burghardt, Juliane; Kynast-Wolf, Gisela; Marx, Michael; Sauerborn, Rainer

    2012-01-01

    Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. PMID

  2. Android and gynoid fat percentages and serum lipid levels in United States adults.

    Science.gov (United States)

    Min, Kyoung-Bok; Min, Jin-Young

    2015-03-01

    Accumulating evidence suggests that fat distribution is a better predictor of cardiovascular disease than body mass index (BMI). The aim of this study was to investigate the association of android and gynoid fat percentages with lipid profiles to determine whether android and/or gynoid fat percentages are associated with serum lipid levels. A population-based cross-sectional study. Five thousand six hundred and ninety-six adults (20 years and older) who participated in the National Health and Nutrition Examination Survey 2003-2006. The regional body composition in the android and gynoid regions was defined by dual energy X-ray absorptiometry (DXA). The estimation of lipid risk profiles included total cholesterol, high-density lipoprotein (HDL) -cholesterol, low-density lipoprotein (LDL) -cholesterol and triglycerides (TG). Regardless of gender, android and gynoid body fat percentages were positively and significantly correlated with BMI and waist circumference. After adjustment for age, ethnicity, education, smoking, alcohol consumption, dyslipidaemia and BMI, increases in android fat percentage were significantly associated with total cholesterol, TG and HDL cholesterol in males, and total cholesterol, HDL cholesterol and LDL cholesterol in females. The gynoid fat percentages showed a positive correlation with total cholesterol in males, whereas gynoid fat accumulation in females showed a favourable association with TG and HDL cholesterol. The observed associations differed according to ethnic groups. Our results suggest that regional fat distribution in the android and gynoid regions have different effects on lipid profiles, and that fat in the android region, rather than the gynoid region, may be an important factor in determining the risk of cardiovascular disease. © 2014 John Wiley & Sons Ltd.

  3. Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.

    Science.gov (United States)

    Tsai, Jaw-Shiun; Chen, Chao-Hsien; Wu, Chih-Hsun; Chiu, Tai-Yuan; Morita, Tatsuya; Chang, Chin-Hao; Hung, Shou-Hung; Lee, Ya-Ping; Chen, Ching-Yu

    2015-02-01

    Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients. This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired. The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, pconsciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, pconsciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively. Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.

  4. An analysis of United States Marine Corps Enlisted Entry-Level Training using supply chain and operations management

    OpenAIRE

    Alfonso, Steven; Oh, Dingjin; Younger, Larry M.

    2010-01-01

    MBA Professional Report Approved for public release; distribution is unlimited The Enlisted Entry-Level Training (EELT) pipeline is a complex network that is of vital importance to the U.S. Marine Corps' ability to maintain a balanced force and serve as the nation's force in readiness. This report provides an all-inclusive description of the EELT pipeline by identifying the fundamental steps in the supply chain, analyzing the supply chain's critical characteristics, and providing in...

  5. MACHINE LEARNING APPROACHES IN IMPROVING SERVICE LEVEL AGREEMENT-BASED ADMISSION CONTROL FOR A SOFTWARE-AS-A-SERVICE PROVIDER IN CLOUD

    Directory of Open Access Journals (Sweden)

    R. S. Mohana

    2013-01-01

    Full Text Available Software as a Service (SaaS offers reliable access to software applications to the end users over the Internet without direct investment in infrastructure and software. SaaS providers utilize resources of internal data centres or rent resources from a public Infrastructure as a Service (IaaS provider in order to serve their customers. Internal hosting can ample cost of administration and maintenance whereas hiring from an IaaS provider can impact the service quality due to its variable performance. To surmount these drawbacks, we propose pioneering admission control and scheduling algorithms for SaaS providers to effectively utilize public Cloud resources to maximize profit by minimizing cost and improving customer satisfaction level. There is a drawback in this method is strength of the algorithms by handling errors in dynamic scenario of cloud environment, also there is a need of machine learning method to predict the strategies and produce the according resources. The admission control provided by trust model that is based on SLA uses different strategies to decide upon accepting user requests so that there is minimal performance impact, avoiding SLA penalties that are giving higher profit. Machine learning method aims at building a distributed system for cloud resource monitoring and prediction that includes learning-based methodologies for modelling and optimization of resource prediction models. The learning methods are Artificial Neural Network (ANN and Support Vector Machine (SVM are two typical machine learning strategies in the category of regression computation. These two methods can be employed for modelling resource state prediction. In addition, we conduct a widespread evaluation study to analyze which solution matches best in which scenario to maximize SaaS provider’s profit. Results obtained through our extensive simulation shows that our proposed algorithms provide significant improvement (up to 40% cost saving over

  6. Scales for evaluating self-perceived anxiety levels in patients admitted to intensive care units: a review.

    Science.gov (United States)

    Perpiñá-Galvañ, Juana; Richart-Martínez, Miguel

    2009-11-01

    To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación mecánica for the Spanish-language databases. Information was extracted from 18 selected articles on the level of anxiety experienced by patients and the psychometric properties of the instruments used to measure anxiety. Moderate levels of anxiety were reported. Levels were higher in women than in men, and higher in patients undergoing positive pressure ventilation regardless of sex. Most multi-item instruments had high coefficients of internal consistency. The reliability of instruments with only a single item was not demonstrated, even though the instruments had moderate-to-high correlations with other measurements. Midlength scales, such the anxiety subscale of the Brief Symptom Inventory or the shortened state version of the State-Trait Anxiety Inventory are best for measuring anxiety in critical care patients.

  7. Changes in Disparity in County-Level Diagnosed Diabetes Prevalence and Incidence in the United States, between 2004 and 2012

    Science.gov (United States)

    Gregg, Edward W.; Beckles, Gloria L.; Luman, Elizabeth T.; Barker, Lawrence E.; Geiss, Linda S.

    2016-01-01

    Background In recent decades, the United States experienced increasing prevalence and incidence of diabetes, accompanied by large disparities in county-level diabetes prevalence and incidence. However, whether these disparities are widening, narrowing, or staying the same has not been studied. We examined changes in disparity among U.S. counties in diagnosed diabetes prevalence and incidence between 2004 and 2012. Methods We used 2004 and 2012 county-level diabetes (type 1 and type 2) prevalence and incidence data, along with demographic, socio-economic, and risk factor data from various sources. To determine whether disparities widened or narrowed over the time period, we used a regression-based β-convergence approach, accounting for spatial autocorrelation. We calculated diabetes prevalence/incidence percentage point (ppt) changes between 2004 and 2012 and modeled these changes as a function of baseline diabetes prevalence/incidence in 2004. Covariates included county-level demographic and, socio-economic data, and known type 2 diabetes risk factors (obesity and leisure-time physical inactivity). Results For each county-level ppt increase in diabetes prevalence in 2004 there was an annual average increase of 0.02 ppt (p<0.001) in diabetes prevalence between 2004 and 2012, indicating a widening of disparities. However, after accounting for covariates, diabetes prevalence decreased by an annual average of 0.04 ppt (p<0.001). In contrast, changes in diabetes incidence decreased by an average of 0.04 ppt (unadjusted) and 0.09 ppt (adjusted) for each ppt increase in diabetes incidence in 2004, indicating a narrowing of county-level disparities. Conclusions County-level disparities in diagnosed diabetes prevalence in the United States widened between 2004 and 2012, while disparities in incidence narrowed. Accounting for demographic and, socio-economic characteristics and risk factors for type 2 diabetes narrowed the disparities, suggesting that these factors are

  8. Continual Decrease in Blood Lead Level in Americans: United States National Health Nutrition and Examination Survey 1999-2014.

    Science.gov (United States)

    Tsoi, Man-Fung; Cheung, Ching-Lung; Cheung, Tommy Tsang; Cheung, Bernard Man Yung

    2016-11-01

    Lead is toxic and affects neurodevelopment in children even at low levels. There has been a long-term effort in the United States to reduce exposure to lead in the environment. We studied the latest US population blood lead levels and analyzed its trend. Blood lead levels in 63,890 participants of the National Health Nutrition and Examination Survey 1999-2014 were analyzed using SPSS Complex Samples v22.0 (IBM Corp, Armonk, NY). Mean blood lead levels and 95% confidence intervals (CIs) were 1.65 μg/dL (1.62-1.68), 1.44 μg/dL (1.42-1.47), 1.43 μg/dL (1.40-1.45), 1.29 μg/dL (1.27-1.32), 1.27 μg/dL (1.25-1.29), 1.12 μg/dL (1.10-1.14), 0.97 μg/dL (0.95-0.99), and 0.84 μg/dL (0.82-0.86) in 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014, respectively. Blood lead levels decreased significantly (P lead level ≥5 μg/dL were 9.9% (95% CI, 7.5-12.9), 7.4% (95% CI, 5.9-9.4), 5.3% (95% CI, 4.1-6.9), 2.9% (95% CI, 2.1-3.9), 3.1% (95% CI, 2.0-4.8), 2.1% (95% CI, 1.5-3.1), 2.0% (95% CI, 1.0-3.6), and 0.5% (95% CI, 0.3-1.0) in 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014, respectively. The decreasing trend was significant (P lead level was 3.48 μg/dL. Blood lead levels have been decreasing in the US population. The reference level also should decrease. It is still important to monitor blood lead levels in the population, especially among pregnant women and children aged 1 to 5 years. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Managers' perception regarding information systems that provide decision making support: a case study in an organizational unit of a petroleum derivatives company

    Directory of Open Access Journals (Sweden)

    Fabiano Raldi

    2016-07-01

    Full Text Available In a globalization scenario, uncertainty and high competitive edge between the companies, every manager needs to make decisions that bring competitive advantage to his/her organization. These decisions are increasingly complex, which demands more rapid and precise information to allow efficient decision-making. It is in this scenario that Information Systems (IS have gained importance in the decision-making process. Yet, many of these IS may not be adequate to the manager’s needs. This study aims to identify the perception of the managers of an Organizational Unit at an oil and derivatives company about the support given by ISs regarding their decision making. To obtain the expected results, a questionnaire based on the critical factors involved in IS quality and directed to the managers of the Organizational Unit. Results of this study will enable professionals responsible for developing ISs, as well as managers and those working with these systems to identify strengths and weaknesses of existing systems.

  10. Individuality and adaptation across levels of selection: How shall we name and generalize the unit of Darwinism?

    Science.gov (United States)

    Gould, Stephen Jay; Lloyd, Elisabeth A.

    1999-01-01

    Two major clarifications have greatly abetted the understanding and fruitful expansion of the theory of natural selection in recent years: the acknowledgment that interactors, not replicators, constitute the causal unit of selection; and the recognition that interactors are Darwinian individuals, and that such individuals exist with potency at several levels of organization (genes, organisms, demes, and species in particular), thus engendering a rich hierarchical theory of selection in contrast with Darwin’s own emphasis on the organismic level. But a piece of the argument has been missing, and individuals at levels distinct from organisms have been denied potency (although granted existence within the undeniable logic of the theory), because they do not achieve individuality with the same devices used by organisms and therefore seem weak by comparison. We show here that different features define Darwinian individuality across scales of size and time. In particular, species-individuals may develop few emergent features as direct adaptations. The interactor approach works with emergent fitnesses, not with emergent features; and species, as a consequence of their different mechanism for achieving individuality (reproductive exclusivity among subparts, that is, among organisms), express many effects from other levels. Organisms, by contrast, suppress upwardly cascading effects, because the organismic style of individuality (by functional integration of subparts) does not permit much competition or differential reproduction of parts from within. Species do not suppress the operation of lower levels; such effects therefore become available as exaptations conferring emergent fitness—a primary source of the different strength that species achieve as effective Darwinian individuals in evolution. PMID:10518549

  11. A Case Study of the Librarian-Initiated Publications Discovery Activities in State Level Digital Depositories in the United States

    Directory of Open Access Journals (Sweden)

    Chi-Shiou Lin

    2008-12-01

    Full Text Available This article describes the novel phenomenon of librarian-initiated publications discovery (LIPD in state-level digital depositories in the United States. LIPD is a series of actions taken by digital depository librarians to discover and inspect government Web sites and select Web content qualifying as government publications for inclusion in the state depositories. In a current popular model in which states employ OCLC Digital Archive™ for the depositories, the power of content selection has shifted from government agencies (content producers to digital depositories. This study systematically documented and compared the LIPD actions in four case states and developed a LIPD process model for descriptive and analytic purposes. It also discusses the impacts and challenges facing the changing practices in preserving government information as historical record. [Article content in Chinese

  12. A fuzzy multi-objective model for capacity allocation and pricing policy of provider in data communication service with different QoS levels

    Science.gov (United States)

    Pan, Wei; Wang, Xianjia; Zhong, Yong-guang; Yu, Lean; Jie, Cao; Ran, Lun; Qiao, Han; Wang, Shouyang; Xu, Xianhao

    2012-06-01

    Data communication service has an important influence on e-commerce. The key challenge for the users is, ultimately, to select a suitable provider. However, in this article, we do not focus on this aspect but the viewpoint and decision-making of providers for order allocation and pricing policy when orders exceed service capacity. It is a multiple criteria decision-making problem such as profit and cancellation ratio. Meanwhile, we know realistic situations in which much of the input information is uncertain. Thus, it becomes very complex in a real-life environment. In this situation, fuzzy sets theory is the best tool for solving this problem. Our fuzzy model is formulated in such a way as to simultaneously consider the imprecision of information, price sensitive demand, stochastic variables, cancellation fee and the general membership function. For solving the problem, a new fuzzy programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the suitable order set and pricing policy of provider in data communication service with different quality of service (QoS) levels.

  13. “I Want to be There When He Graduates:” Foster Parents Show Higher Levels of Commitment than Group Care Providers

    Science.gov (United States)

    Lo, Albert; Roben, Caroline K.P.; Maier, Collin; Fabian, Kim; Shauffer, Carole; Dozier, Mary

    2015-01-01

    Group care is a frequent placement for adolescents placed in out of home care when their birth parents’ care is deemed unsafe. In the present study, we assessed whether foster parents show greater commitment to children than group care providers. Given that group care represents a number of living arrangements, we considered both shift care (where staff work shifts and do not live with the children) and cottage care (where staff live for extended periods of time with the children in a group living context). Commitment was assessed using the This Is My Child Interview (adapted for adolescents). Thirty-one foster parents, 18 shift workers, and 28 cottage care providers were interviewed. As predicted, foster parents showed higher levels of commitment than both shift care workers and cottage care providers, and the associations held when children’s externalizing behaviors and the number of children the caregivers had cared for were controlled. The results suggest that foster care promotes greater commitment among caregivers than other out of home placements, and add to other findings that favor foster care as the out of home placement of choice for adolescents. PMID:25937687

  14. The 1999 international emergency humanitarian evacuation of the Kosovars to Canada: A qualitative study of service providers' perspectives at the international, national and local levels

    Directory of Open Access Journals (Sweden)

    Jafarpour Morteza

    2005-01-01

    Full Text Available Abstract Background In response to the Kosovo crisis, Canada received 5,500 Albanian Kosovar refugees in 1999 as part of the emergency humanitarian evacuation and settlement effort. This study attempts to describe the experiences of service providers at the international, national, and local levels, involved in the organization and delivery of health and settlement services in Canada for the Kosovar refugees. Methods A qualitative case study design using key informant interviews was used. Nominated sampling was used to identify 17 individuals involved in the organization and delivery of health and settlement. Key themes were identified and recommendations made to provide a framework for the development of policy to guide response to future humanitarian emergencies. Results Six themes emerged: (1 A sense of being overwhelmed, (2 A multitude of health issues, (3 critical challenges in providing health care, (4 access to health and settlement services, (5 overall successes and (6 need for a coordinated approach to migration health. Conclusions For those involved, the experience was overwhelming but rewarding. Interviewees' major concerns were the need for a more comprehensive and coordinated approach to the flow of medical information and handling of specific health problems.

  15. The 1999 international emergency humanitarian evacuation of the Kosovars to Canada: A qualitative study of service providers' perspectives at the international, national and local levels.

    Science.gov (United States)

    Fowler, Nancy; Redwood-Campbell, Lynda; Molinaro, Elizabeth; Howard, Michelle; Kaczorowski, Janusz; Jafarpour, Morteza; Robinson, Susan

    2005-01-12

    BACKGROUND: In response to the Kosovo crisis, Canada received 5,500 Albanian Kosovar refugees in 1999 as part of the emergency humanitarian evacuation and settlement effort. This study attempts to describe the experiences of service providers at the international, national, and local levels, involved in the organization and delivery of health and settlement services in Canada for the Kosovar refugees. METHODS: A qualitative case study design using key informant interviews was used. Nominated sampling was used to identify 17 individuals involved in the organization and delivery of health and settlement. Key themes were identified and recommendations made to provide a framework for the development of policy to guide response to future humanitarian emergencies. RESULTS: Six themes emerged: (1) A sense of being overwhelmed, (2) A multitude of health issues, (3) critical challenges in providing health care, (4) access to health and settlement services, (5) overall successes and (6) need for a coordinated approach to migration health. CONCLUSIONS: For those involved, the experience was overwhelming but rewarding. Interviewees' major concerns were the need for a more comprehensive and coordinated approach to the flow of medical information and handling of specific health problems.

  16. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

    Science.gov (United States)

    Strawbridge, Rona J; Dupuis, Josée; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R; Travers, Mary E; Bouatia-Naji, Nabila; Dimas, Antigone S; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F; Taneera, Jalal; Kanoni, Stavroula; Peden, John F; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J P; Barnes, Daniel; Dennison, Elaine M; Eriksson, Johan G; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S; Frayling, Timothy M; Goel, Anuj; Gu, Harvest F; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U; Jameson, Karen A; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J F; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K; Martínez-Larrad, María Teresa; Narisu, Narisu; Nastase Mannila, Maria; Ohrvik, John; Osmond, Clive; Pascoe, Laura; Payne, Felicity; Sayer, Avan A; Sennblad, Bengt; Silveira, Angela; Stancáková, Alena; Stirrups, Kathy; Swift, Amy J; Syvänen, Ann-Christine; Tuomi, Tiinamaija; van 't Hooft, Ferdinand M; Walker, Mark; Weedon, Michael N; Xie, Weijia; Zethelius, Björn; Ongen, Halit; Mälarstig, Anders; Hopewell, Jemma C; Saleheen, Danish; Chambers, John; Parish, Sarah; Danesh, John; Kooner, Jaspal; Ostenson, Claes-Göran; Lind, Lars; Cooper, Cyrus C; Serrano-Ríos, Manuel; Ferrannini, Ele; Forsen, Tom J; Clarke, Robert; Franzosi, Maria Grazia; Seedorf, Udo; Watkins, Hugh; Froguel, Philippe; Johnson, Paul; Deloukas, Panos; Collins, Francis S; Laakso, Markku; Dermitzakis, Emmanouil T; Boehnke, Michael; McCarthy, Mark I; Wareham, Nicholas J; Groop, Leif; Pattou, François; Gloyn, Anna L; Dedoussis, George V; Lyssenko, Valeriya; Meigs, James B; Barroso, Inês; Watanabe, Richard M; Ingelsson, Erik; Langenberg, Claudia; Hamsten, Anders; Florez, Jose C

    2011-10-01

    Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis.

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

    Directory of Open Access Journals (Sweden)

    Chacham

    2016-07-01

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

  18. The results of a survey highlighting issues with feedback on medical training in the United Kingdom and how a Smartphone App could provide a solution.

    Science.gov (United States)

    Gray, Thomas G; Hood, Gill; Farrell, Tom

    2015-11-06

    Feedback drives learning in medical education. Healthcare Supervision Logbook (HSL) is a Smartphone App developed at Sheffield Teaching Hospitals for providing feedback on medical training, from both a trainee's and a supervisor's perspective. In order to establish a mandate for the role of HSL in clinical practice, a large survey was carried out. Two surveys (one for doctors undertaking specialty training and a second for consultants supervising their training) were designed. The survey for doctors-in-training was distributed to all specialty trainees in the South and West localities of the Health Education Yorkshire and the Humber UK region. The survey for supervisors was distributed to all consultants involved in educational and clinical supervision of specialty trainees at Sheffield Teaching Hospitals. The results confirm that specialty trainees provide feedback on their training infrequently-66 % do so only annually. 96 % of the specialty trainees owned a Smartphone and 45 % said that they would be willing to use a Smartphone App to provide daily feedback on the clinical and educational supervision they receive. Consultant supervisors do not receive regular feedback on the educational and clinical supervision they provide to trainees-56 % said they never received such feedback and 33 % said it was only on an annual basis. 86 % of consultants surveyed owned a Smartphone and 41 % said they would be willing to use a Smartphone App to provide feedback on the performance of trainees they were supervising. Feedback on medical training is recorded by specialty trainees infrequently and consultants providing educational and clinical supervision often do not receive any feedback on their performance in this area. HSL is a simple, quick and efficient way to collect and collate feedback on medical training to improve this situation. Good support and education needs to be provided when implementing this new technology.

  19. Prevalence and Level of Listeria monocytogenes in Ice Cream Linked to a Listeriosis Outbreak in the United States.

    Science.gov (United States)

    Chen, Y I; Burall, Laurel S; Macarisin, Dumitru; Pouillot, Régis; Strain, Errol; DE Jesus, Antonio J; Laasri, Anna; Wang, Hua; Ali, Laila; Tatavarthy, Aparna; Zhang, Guodong; Hu, Lijun; Day, James; Kang, Jihun; Sahu, Surasri; Srinivasan, Devayani; Klontz, Karl; Parish, Mickey; Evans, Peter S; Brown, Eric W; Hammack, Thomas S; Zink, Donald L; Datta, Atin R

    2016-11-01

    A most-probable-number (MPN) method was used to enumerate Listeria monocytogenes in 2,320 commercial ice cream scoops manufactured on a production line that was implicated in a 2015 listeriosis outbreak in the United States. The analyzed samples were collected from seven lots produced in November 2014, December 2014, January 2015, and March 2015. L. monocytogenes was detected in 99% (2,307 of 2,320) of the tested samples (lower limit of detection, 0.03 MPN/g), 92% of which were contaminated at ice cream products linked to a listeriosis outbreak provided a unique data set for further understanding the risk associated with L. monocytogenes contamination for highly susceptible populations.

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

    Science.gov (United States)

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

    2014-08-01

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

  1. A Multi-Level Bayesian Analysis of Racial Bias in Police Shootings at the County-Level in the United States, 2011-2014.

    Directory of Open Access Journals (Sweden)

    Cody T Ross

    Full Text Available A geographically-resolved, multi-level Bayesian model is used to analyze the data presented in the U.S. Police-Shooting Database (USPSD in order to investigate the extent of racial bias in the shooting of American civilians by police officers in recent years. In contrast to previous work that relied on the FBI's Supplemental Homicide Reports that were constructed from self-reported cases of police-involved homicide, this data set is less likely to be biased by police reporting practices. County-specific relative risk outcomes of being shot by police are estimated as a function of the interaction of: 1 whether suspects/civilians were armed or unarmed, and 2 the race/ethnicity of the suspects/civilians. The results provide evidence of a significant bias in the killing of unarmed black Americans relative to unarmed white Americans, in that the probability of being {black, unarmed, and shot by police} is about 3.49 times the probability of being {white, unarmed, and shot by police} on average. Furthermore, the results of multi-level modeling show that there exists significant heterogeneity across counties in the extent of racial bias in police shootings, with some counties showing relative risk ratios of 20 to 1 or more. Finally, analysis of police shooting data as a function of county-level predictors suggests that racial bias in police shootings is most likely to emerge in police departments in larger metropolitan counties with low median incomes and a sizable portion of black residents, especially when there is high financial inequality in that county. There is no relationship between county-level racial bias in police shootings and crime rates (even race-specific crime rates, meaning that the racial bias observed in police shootings in this data set is not explainable as a response to local-level crime rates.

  2. A Multi-Level Bayesian Analysis of Racial Bias in Police Shootings at the County-Level in the United States, 2011-2014.

    Science.gov (United States)

    Ross, Cody T

    2015-01-01

    A geographically-resolved, multi-level Bayesian model is used to analyze the data presented in the U.S. Police-Shooting Database (USPSD) in order to investigate the extent of racial bias in the shooting of American civilians by police officers in recent years. In contrast to previous work that relied on the FBI's Supplemental Homicide Reports that were constructed from self-reported cases of police-involved homicide, this data set is less likely to be biased by police reporting practices. County-specific relative risk outcomes of being shot by police are estimated as a function of the interaction of: 1) whether suspects/civilians were armed or unarmed, and 2) the race/ethnicity of the suspects/civilians. The results provide evidence of a significant bias in the killing of unarmed black Americans relative to unarmed white Americans, in that the probability of being {black, unarmed, and shot by police} is about 3.49 times the probability of being {white, unarmed, and shot by police} on average. Furthermore, the results of multi-level modeling show that there exists significant heterogeneity across counties in the extent of racial bias in police shootings, with some counties showing relative risk ratios of 20 to 1 or more. Finally, analysis of police shooting data as a function of county-level predictors suggests that racial bias in police shootings is most likely to emerge in police departments in larger metropolitan counties with low median incomes and a sizable portion of black residents, especially when there is high financial inequality in that county. There is no relationship between county-level racial bias in police shootings and crime rates (even race-specific crime rates), meaning that the racial bias observed in police shootings in this data set is not explainable as a response to local-level crime rates.

  3. Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme.

    Science.gov (United States)

    Skinner, Henry; Skoyles, Julian; Redfearn, Sue; Jutley, Raj; Mitchell, Ian; Richens, David

    2013-01-01

    There are significant pressures on resident medical rotas on intensive care. We have evaluated the safety and feasibility of nurse practitioners (NPs) delivering first-line care on an intensive care unit with all doctors becoming non-resident. Previously, resident doctors on a 1:8 full-shift rota supported by NPs delivered first-line care to patients after cardiac surgery. Subsequently, junior doctors changed to a 1:5 non-resident rota and NPs onto a 1:7 full-shift rota provided first-line care. A single centre before-and-after service evaluation on cardiac intensive care. mortality rates, surgical trainee attendance in theatre and cost before and after the change. After-hour calls by NPs to doctors and subsequent actions were also audited after the change. The overall mortality rates in the 12 months before the change were 2.8 and 2.2% in the 12 months after (P = 0.43). The median [range] logistic EuroSCORE was 5.3 [0.9-84] before and 5.0 [0.9-85] after the change (P = 0.16). After accounting for the risk profile, the odds ratio for death after the change relative to before was 0.83, 95% confidence interval 0.41-1.69. Before the change, a surgical trainee attended theatre 467 of 702 (68%) cases. This increased to 539 of 677 (80%) cases after the change (P cardiac intensive care. Training opportunities for junior surgeons increased and costs were reduced.

  4. Inclusivity and dementia: health services planning with individuals with dementia: effective inclusion requires action at multiple levels by individuals with dementia, care partners, service providers and funding organizations.

    Science.gov (United States)

    Whitfield, Kyle; Wismer, Susan

    2006-01-01

    Historically, Alzheimer societies have identified the care partners of persons with dementia as their central clients. This focus is broadening to include the person with the disease, as well. This paper presents the results of a Canadian research study addressing organizational considerations related to effective inclusion of persons with dementia in planning and decision-making about health services and programs. Our findings suggest that effective inclusion requires action at multiple levels by individuals with dementia, care partners and friends; service organizations and providers; and funding organizations. Additional research is needed to explore the applicability of these findings to other organizations in different localities and to examine emergent themes further. Of these, one that has received little attention to date concerns the potential risks associated with effective inclusion.

  5. A Study of Teacher Opinions and Evaluations Concerning Selected Free Printed Materials Provided by the American Iron and Steel Institute to Individuals Throughout the United States.

    Science.gov (United States)

    DuVall, Charles R.; And Others

    The focus of this study was teacher assessment of several factors relating to selected materials provided by the American Iron and Steel Institute. The design and rationale, instrumentation, methodology, and questionnaire mailing are discussed in Chapter I. Chapter II reviews the related literature, including the historic nature of free and…

  6. A Study of Teacher Opinions Concerning Selected Free Filmstrips Provided by the American Iron and Steel Institute to Schools Throughout the United States.

    Science.gov (United States)

    DuVall, Charles R.; And Others

    This study analyzed teacher assessment of several factors related to selected filmstrips provided to teachers by the American Iron and Steel Institute. Main concerns of the study related to applicability of the filmstrip to instructional programs, assessment of accuracy of information contained, effectiveness of content, effectiveness of…

  7. Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers.

    Science.gov (United States)

    Fisher, A D; Castellini, G; Ristori, J; Casale, H; Giovanardi, G; Carone, N; Fanni, E; Mosconi, M; Ciocca, G; Jannini, E A; Ricca, V; Lingiardi, V; Maggi, M

    2017-03-01

    To date, few studies have addressed attitudes toward transgender individuals. In addition, little is known about health care providers' (HCP) attitudes toward sexual minorities. The aim of the present study is to compare attitudes toward homosexual and transgender individuals between gender dysphoric individuals (GDs), general population controls (C) and HCP. A total of 310 subjects were considered, including 122 GDs (63 transwomen and 59 transmen), 53 heterosexual HCP (26 males and 27 females) and 135 C. Participants completed the Modern Homophobia Scale (MHS) and the Attitudes Toward Transgendered Individuals Scale (ATTI) in order to assess attitudes toward gay men and lesbian women and toward transgender individuals, respectively. In addition, GDs completed the Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA) and ATTI to measure, respectively, gender dysphoria levels and internalized transphobia. Religious attitudes were evaluated by means of the Religious Fundamentalism Scale (RFS), and Discrimination and Stigma Scale (DISC-12) was used to measure perceived discrimination. (1) Men showed significantly higher levels of homophobia and transphobia when compared to women (p homophobia and transphobia (both p < 0.001). Our results underline the need to promote awareness and acceptance of the sexual minorities, who are more at risk of discriminatory attitudes, which are strongly dependent on religious precepts and dogma.

  8. The WRF Model Forecast-Derived Low-Level Wind Shear Climatology over the United States Great Plains

    Directory of Open Access Journals (Sweden)

    Sukanta Basu

    2010-02-01

    Full Text Available For wind resource assessment projects, it is common practice to use a power-law relationship (U(z ~ zα and a fixed shear exponent (α = 1=7 to extrapolate the observed wind speed from a low measurement level to high turbine hub-heights. However, recent studies using tall-tower observations have found that the annual average shear exponents at several locations over the United States Great Plains (USGP are significantly higher than 1=7. These findings highlight the critical need for detailed spatio-temporal characterizations of wind shear climatology over the USGP, where numerous large wind farms will be constructed in the foreseeable future. In this paper, a new generation numerical weather prediction model—the Weather Research and Forecasting (WRF model, a fast and relatively inexpensive alternative to time-consuming and costly tall-tower projects, is utilized to determine whether it can reliably estimate the shear exponent and the magnitude of the directional shear at any arbitrary location over the USGP. Our results indicate that the WRF model qualitatively captures several low-level wind shear characteristics. However, there is definitely room for physics parameterization improvements for the WRF model to reliably represent the lower part of the atmospheric boundary layer.

  9. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  10. Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: an observational cross-sectional study.

    Science.gov (United States)

    Staggs, Vincent S; Dunton, Nancy

    2012-09-01

    Nursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix. To explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix. Observational cross-sectional study of longitudinal data. 1884 nursing units in 306 U.S. acute care hospitals. During a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet(®) status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation). Government ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant. Several hospital and unit characteristic variables have significant associations with nursing turnover; these associations

  11. Family medicine residents’ perceived level of comfort in treating common sports injuries across residency programs in the United States

    Directory of Open Access Journals (Sweden)

    Amoako AO

    2015-03-01

    Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort

  12. Cross (Unit)-Level Effects of Cohesion on Relationships of Suicide Thoughts to Combat Exposure, Postdeployment Stressors, and Postdeployment Social Support.

    Science.gov (United States)

    Griffith, James

    2015-01-01

    A behavioral health concern for the US military has been suicide, largely due to its increased prevalence in the last several years during US involvement in the Iraq and Afghanistan wars. Using hierarchical linear modeling (HLM), the present study examined relationships among combat exposure, postdeployment stressors, social support, and unit cohesion. Survey data were obtained from 4,567 soldiers who were members of 50 company-sized units. At the individual level, combat exposure and postdeployment stressors were associated with suicidal thoughts. Postdeployment social support was associated with fewer suicidal thoughts. There was no evidence of the stress-buffering effect of social support. At the group level, reduced risk for suicidal thoughts was associated with units having higher than average cohesion. Reduced risk for suicidal thoughts in conjunction with combat experiences was observed in units having higher than average cohesion, though not reaching a traditional level of statistical significance.

  13. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure--United States, 2016.

    Science.gov (United States)

    Petersen, Emily E; Polen, Kara N D; Meaney-Delman, Dana; Ellington, Sascha R; Oduyebo, Titilope; Cohn, Amanda; Oster, Alexandra M; Russell, Kate; Kawwass, Jennifer F; Karwowski, Mateusz P; Powers, Ann M; Bertolli, Jeanne; Brooks, John T; Kissin, Dmitry; Villanueva, Julie; Muñoz-Jordan, Jorge; Kuehnert, Matthew; Olson, Christine K; Honein, Margaret A; Rivera, Maria; Jamieson, Denise J; Rasmussen, Sonja A

    2016-04-01

    CDC has updated its interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure to include recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving. This guidance is based on limited available data on persistence of Zika virus RNA in blood and semen. Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission ( http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission. Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception. This guidance also provides updated recommendations on testing of pregnant women with possible Zika virus exposure. These recommendations will be updated when additional data become available.

  14. A study to evaluate the levels of dioxin-like compounds in dairy feeds in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Lorber, M.; Ferrario, J.; Byrne, C. [United States Environmental Protection Agency, WA, DC (United States); Greene, C.; Cyrus, A. [Versar, Inc., Springfield, VA (United States)

    2004-09-15

    The primary route for general population exposure to dioxin-like compounds is through the consumption of animal fats, with bovine-derived meat, milk and dairy products comprising over 50% of total exposure in the United States. The primary route of exposure hypothesized for cattle is airborne deposition of dioxins onto the leaves of feed crops. Over the last few years additional pathways of exposure have been identified associated with contaminated feed additives such as ball clay, mineral supplements, and animal byproducts. Studies by the United States Department of Agriculture (USDA) have shown that incidental contact with pentachlorophenol (PCP)-treated wood by cattle have resulted in elevated tissue levels. Although the air-to-leaf pathway is still considered by most researchers to be the dominant pathway of exposure, the lack of any systematic examination of animal feeds to quantify the contribution of the air-to-leaf pathway has been a major gap in our empirical understanding of dioxin exposure. The Environmental Protection Agency (EPA), in cooperation with USDA and the US Food and Drug Administration (FDA), has undertaken a program to study the presence of dioxin-like compounds in animal feeds. Two phases of this program have been completed, and this paper reports on the third phase. The first phase was a study on the mass balance of dioxins in lactating cows. The objective of that study was to quantify the role feeds play in total dairy cow exposure. The second phase of the program involved the collection and measurement of dioxins in minor feed components. Dioxins in specific targeted animal feed components of interest, including animal byproducts (beef, pork, poultry by-products, fish meal) and plant byproducts (deodorizer distillates from corn, soybean, peanut, cottonseed, and canola processers; cane and beet molasses), were measured. The third phase of the project, reported here, involved component sampling of dairy feeds around the US.

  15. Genome-Wide Association Identifies Nine Common Variants Associated With Fasting Proinsulin Levels and Provides New Insights Into the Pathophysiology of Type 2 Diabetes

    Science.gov (United States)

    Strawbridge, Rona J.; Dupuis, Josée; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R.; Travers, Mary E.; Bouatia-Naji, Nabila; Dimas, Antigone S.; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F.; Taneera, Jalal; Kanoni, Stavroula; Peden, John F.; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J.P.; Barnes, Daniel; Dennison, Elaine M.; Eriksson, Johan G.; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S.; Frayling, Timothy M.; Goel, Anuj; Gu, Harvest F.; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U.; Jameson, Karen A.; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J.F.; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K.; Martínez-Larrad, María Teresa; Narisu, Narisu; Nastase Mannila, Maria; Öhrvik, John; Osmond, Clive; Pascoe, Laura; Payne, Felicity; Sayer, Avan A.; Sennblad, Bengt; Silveira, Angela; Stančáková, Alena; Stirrups, Kathy; Swift, Amy J.; Syvänen, Ann-Christine; Tuomi, Tiinamaija; van 't Hooft, Ferdinand M.; Walker, Mark; Weedon, Michael N.; Xie, Weijia; Zethelius, Björn; Ongen, Halit; Mälarstig, Anders; Hopewell, Jemma C.; Saleheen, Danish; Chambers, John; Parish, Sarah; Danesh, John; Kooner, Jaspal; Östenson, Claes-Göran; Lind, Lars; Cooper, Cyrus C.; Serrano-Ríos, Manuel; Ferrannini, Ele; Forsen, Tom J.; Clarke, Robert; Franzosi, Maria Grazia; Seedorf, Udo; Watkins, Hugh; Froguel, Philippe; Johnson, Paul; Deloukas, Panos; Collins, Francis S.; Laakso, Markku; Dermitzakis, Emmanouil T.; Boehnke, Michael; McCarthy, Mark I.; Wareham, Nicholas J.; Groop, Leif; Pattou, François; Gloyn, Anna L.; Dedoussis, George V.; Lyssenko, Valeriya; Meigs, James B.; Barroso, Inês; Watanabe, Richard M.; Ingelsson, Erik; Langenberg, Claudia; Hamsten, Anders; Florez, Jose C.

    2011-01-01

    OBJECTIVE Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10−8). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10−4), improved β-cell function (P = 1.1 × 10−5), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10−6). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis. PMID:21873549

  16. Update: Interim Guidelines for Health Care Providers Caring for Infants and Children with Possible Zika Virus Infection--United States, February 2016.

    Science.gov (United States)

    Fleming-Dutra, Katherine E; Nelson, Jennifer M; Fischer, Marc; Staples, J Erin; Karwowski, Mateusz P; Mead, Paul; Villanueva, Julie; Renquist, Christina M; Minta, Anna A; Jamieson, Denise J; Honein, Margaret A; Moore, Cynthia A; Rasmussen, Sonja A

    2016-02-26

    CDC has updated its interim guidelines for U.S. health care providers caring for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy and expanded guidelines to include infants and children with possible acute Zika virus disease. This update contains a new recommendation for routine care for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, when the infant has a normal head circumference, normal prenatal and postnatal ultrasounds (if performed), and normal physical examination. Acute Zika virus disease should be suspected in an infant or child aged Zika virus during delivery is possible, acute Zika virus disease should also be suspected in an infant during the first 2 weeks of life 1) whose mother traveled to or resided in an affected area within 2 weeks of delivery and 2) who has ≥2 of the following manifestations: fever, rash, conjunctivitis, or arthralgia. Evidence suggests that Zika virus illness in children is usually mild. As an arboviral disease, Zika virus disease is nationally notifiable. Health care providers should report suspected cases of Zika virus disease to their local, state, or territorial health departments to arrange testing and so that action can be taken to reduce the risk for local Zika virus transmission. As new information becomes available, these guidelines will be updated: http://www.cdc.gov/zika/.

  17. The record of major quaternary sea-level changes in a large coastal plain estuary, Chesapeake Bay, Eastern United States

    Science.gov (United States)

    Colman, Steven M.; Mixon, R.B.

    1988-01-01

    Seismic-reflection surveys of the Chesapeake Bay, combined with geologic mapping and analysis of boreholes on the Delmarva Peninsula, provide evidence of at least three generations of the Susquehanna River system and three generations of the Chesapeake Bay. The evidence for ancient courses of the Susquehanna River is preserved as three distinct paleochannels, and evidence for ancient versions of the Chesapeake Bay is preserved as three sets of paleochannel fill beneath the bay and three generations of barrier-spit deposits on the southern Delmarva Peninsula. The paleochannels represent relative sea-level minima and the channel-fill and barrier-spit deposits represents relative sea-level maxima. A history of three major marine transgressions is recorded in the stratigraphy preserved in the filled paleochannels and in the overlying barrier-spit complexes: three systematic progressions from fluvial to estuarine to bay or nearshore marine environments. This sea-level record seems to be compatible with the saw-toothed pattern of the marine oxygen-isotope record and with the concept of glacial-interglacial terminations. It also seems to have a climax character in which most of the preserved evidence is related to the largest terminations and to the extreme sea-level positions that bound those terminations. The three paleochannel-fill and barrier-spit complexes appear to correspond to oxygen-isotope stages 1,5, and either 7 or 11; the three related paleochannels correspond to stages 2, 6, and either 8 or 12. ?? 1988.

  18. County-level estimates of nitrogen and phosphorus from commercial fertilizer for the Conterminous United States, 1987–2006

    Science.gov (United States)

    Gronberg, Jo Ann M.; Spahr, Norman E.

    2012-01-01

    The U.S. Geological Survey’s National Water-Quality Assessment program requires nutrient input for analysis of the national and regional assessment of water quality. Detailed information on nutrient inputs to the environment are needed to understand and address the many serious problems that arise from excess nutrients in the streams and groundwater of the Nation. This report updates estimated county-level farm and nonfarm nitrogen and phosphorus input from commercial fertilizer sales for the conterminous United States for 1987 through 2006. Estimates were calculated from the Association of American Plant Food Control Officials fertilizer sales data, Census of Agriculture fertilizer expenditures, and U.S. Census Bureau county population. A previous national approach for deriving farm and nonfarm fertilizer nutrient estimates was evaluated, and a revised method for selecting representative states to calculate national farm and nonfarm proportions was developed. A national approach was used to estimate farm and nonfarm fertilizer inputs because not all states distinguish between farm and nonfarm use, and the quality of fertilizer reporting varies from year to year. For states that distinguish between farm and nonfarm use, the spatial distribution of the ratios of nonfarm-to-total fertilizer estimates for nitrogen and phosphorus calculated using the national-based farm and nonfarm proportions were similar to the spatial distribution of the ratios generated using state-based farm and nonfarm proportions. In addition, the relative highs and lows in the temporal distribution of farm and nonfarm nitrogen and phosphorus input at the state level were maintained—the periods of high and low usage coincide between national- and state-based values. With a few exceptions, nonfarm nitrogen estimates were found to be reasonable when compared to the amounts that would result if the lawn application rates recommended by state and university agricultural agencies were used. Also

  19. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

    Science.gov (United States)

    Blick, Kenneth E

    2013-08-01

    To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

  20. Effect of Teaching Protein Synthesis Unit Based On Multiple Intelligence Theory, To the Student Level of Retaining

    Directory of Open Access Journals (Sweden)

    İsmet HASENEKOĞLU

    2009-12-01

    Full Text Available In this study, Protein Synthesis Unit was presented through Multiple Intelligence Theory based activities. The purpose of this study was to investigate Multiple Intelligence Theory’s impacts on student’s retention of knowledge acquired about Protein Synthesis. This research was conducted with Sophomores from Primary Science Education Department in Kafkas University Faculty of Education and lasted three weeks in the spring term of 2007–2008 academic year. In this study, within context of quasi-experimental method, which is based on impartially selected groups, nonequivalent control groups pretest-posttest method was used. Two classes from Primary Science Education Department were randomly selected. While the traditionalapproach was used in the control group, the teaching activities based on Multiple Intelligences Theory were used in the experimental group. The Protein Syntheses achievement test which had an reliability coefficient Cronbach Alpha of 0,8 prepared by the researcher were used to collect data.The data obtained, t test and A nova test was evaluated by using SPSS 12.0 package program. As a result of research was found that teaching based on Multiple Intelligence has been more effective in increasing student’s achievement and their levels of retention compared to teaching based on Traditional Approach.

  1. The Effectiveness of Cooperative Learning Methods on 7th Level “The Structure of Matter and Properties” Unit

    Directory of Open Access Journals (Sweden)

    Yasemin KOÇ

    2016-04-01

    Full Text Available The aim of this research are to determine the effectiveness of Student Teams-Achievement Division (STAD and Reading-Writing-Application (RWA methods of cooperative learning model on academic achievement at the unit of 7th Level “The Structure of Matter and Properties” and students’ views related to methods. The sample of this research are 102 students from two different secondary school in Ağrı. As data collecting tools, Pre-Knowledge Test (PKT, Academic Achievement Test (AAT and Scale Methods Views (SMV is used. For the analysis of the obtained data, one-way variance analysis (ANOVA was used for pre- test and analysis covariance (ANCOVA for academic achievement test because of significant differences in the groups’ pre- test. Descriptive statistics for students’ views about methods are used. It was found that RWA and STAD have similar effects on students’ academic achievement and students instructed with these techniques are more successful than students instructed with teacher centered instruction.

  2. Auditing of Monitoring and Respiratory Support Equipment in a Level III-C Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Elena Bergon-Sendin

    2015-01-01

    Full Text Available Background. Random safety audits (RSAs are a safety tool but have not been widely used in hospitals. Objectives. To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. Methods. A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. Results. A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12–3.06, p=0.01, and during the late shift (3 pm to 10 pm, OR 1.59 (1.03–2.4, p=0.03. Conclusions. Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

  3. County-level estimates of nutrient inputs to the landsurface of the conterminous United States, 1982-2001

    Science.gov (United States)

    Ruddy, Barbara C.; Lorenz, David L.; Mueller, David K.

    2006-01-01

    Nutrient input data for fertilizer use, livestock manure, and atmospheric deposition from various sources were estimated and allocated to counties in the conterminous United States for the years 1982 through 2001. These nationally consistent nutrient input data are needed by the National Water-Quality Assessment Program for investigations of stream- and ground-water quality. For nitrogen, the largest source was farm fertilizer; for phosphorus, the largest sources were farm fertilizer and livestock manure. Nutrient inputs from fertilizer use in nonfarm areas, while locally important, were an order of magnitude smaller than inputs from other sources. Nutrient inputs from all sources increased between 1987 and 1997, but the relative proportions of nutrients from each source were constant. Farm-fertilizer inputs were highest in the upper Midwest, along eastern coastal areas, and in irrigated areas of the West. Nonfarm-fertilizer use was similar in major metropolitan areas throughout the Nation, but was more extensive in the more populated Eastern and Central States and in California. Areas of greater manure inputs were located throughout the South-central and Southeastern States and in scattered areas of the West. Nitrogen deposition from the atmosphere generally increased from west to east and is related to the location of major sources and the effects of precipitation and prevailing winds. These nutrient-loading data at the county level are expected to be the fundamental basis for national and regional assessments of water quality for the National Water-Quality Assessment Program and other large-scale programs.

  4. Nosocomial sepsis: evaluation of the efficacy of preventive measures in a level-III neonatal intensive care unit.

    Science.gov (United States)

    Almeida, Catarina Cardoso de; Pissarra da Silva, Susana Maria Saraiva; Flor de Lima Caldas de Oliveira, Filipa Silveira Dias; Guimarães Pereira Areias, Maria Hercília Ferreira

    2017-09-01

    To evaluate nosocomial infections preventive bundle, implemented in April 2010 in Centro Hospitalar de São João (CHSJ) Neonatal Intensive Care Unit (NICU) effectiveness. Newborns admitted to level-III NICU of CHSJ, between 1 April 2007 and 31 March 2013, with sepsis as discharge diagnosis, were selected and divided into two periods (Period 1 and 2, before and after new preventive bundle introduction). Data from the two periods were compared. Nosocomial sepsis incidence density decreased significantly from 8.6 to 4.8 per 1000 patient days from Period 1 to 2. Nosocomial infections preventive bundle implementation led to a significant decrease in central line-associated bloodstream infections (CLABSI) rates from 14.1 to 10.4 per 1000 catheter days. Nosocomial infections preventive bundle implemented revealed efficient in decreasing the incidence density of nosocomial sepsis. However, CLABSI rates remain high. Physicians should be alert to the need to adhere to strict infection control protocols and institute effective measures for nosocomial infection surveillance.

  5. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States.

    Science.gov (United States)

    Durham, David P; Ndeffo-Mbah, Martial L; Skrip, Laura A; Jones, Forrest K; Bauch, Chris T; Galvani, Alison P

    2016-05-03

    Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

  6. Cardiovascular Diseases on the Global Agenda: The United Nations High Level Meeting, Sustainable Development Goals, and the Way Forward.

    Science.gov (United States)

    Ralston, Johanna; Reddy, K Srinath; Fuster, Valentin; Narula, Jagat

    2016-12-01

    In 2011, the United Nations (UN) organized the first ever meeting for heads of state to discuss the problem of noncommunicable diseases (NCD), including cardiovascular disease (CVD), cancer, chronic respiratory disease, and diabetes mellitus. Recognizing that these had emerged as leading causes of morbidity and mortality in the world, including in many low- and middle-income countries, advocates from government and civil society had called for increased attention and a UN response. Earlier, NCD including CVD were absent from the global health agenda in part because of their omission from the Millennium Development Goals. The UN meeting and the global advocacy response offered a game-changing opportunity to redress this omission. The World Heart Federation (WHF) played an instrumental role in the UN meeting and follow up, including inclusion of CVD in the Sustainable Development Goals. The next phase of the global CVD movement is expected through national action, including CVD roadmaps and partnering with the World Health Organization. The WHF is heavily committed to these goals and the other nongovernmental organizations invested in the mission must help take this historical mandate forward. Instrumental to this will be the engagement of people affected by or at risk of developing CVD, to draw more attention and resources to NCD and to ensure that successes to date in global policy translate into action at the national level.

  7. Walk the Line: The Development of Route Selection Standards for Spent Nuclear Fuel and High-level Radioactive Waste in the United States - 13519

    Energy Technology Data Exchange (ETDEWEB)

    Dilger, Fred [Black Mountain Research, Henderson, NV 81012 (United States); Halstead, Robert J. [State of Nevada Agency for Nuclear Projects, Carson City, NV 80906 (United States); Ballard, James D. [Department of Sociology, California State University, Northridge, CA 91330 (United States)

    2013-07-01

    Although storage facilities for spent nuclear fuel (SNF) and high-level radioactive waste (HLRW) are widely dispersed throughout the United States, these materials are also relatively concentrated in terms of geographic area. That is, the impacts of storage occur in a very small geographic space. Once shipments begin to a national repository or centralized interim storage facility, the impacts of SNF and HLRW will become more geographically distributed, more publicly visible, and almost certainly more contentious. The selection of shipping routes will likely be a major source of controversy. This paper describes the development of procedures, regulations, and standards for the selection of routes used to ship spent nuclear fuel and high-level radioactive waste in the United States. The paper begins by reviewing the circumstances around the development of HM-164 routing guidelines. The paper discusses the significance of New York City versus the Department of Transportation and application of HM-164. The paper describes the methods used to implement those regulations. The paper will also describe the current HM-164 designated routes and will provide a summary data analysis of their characteristics. This analysis will reveal the relatively small spatial scale of the effects of HM 164. The paper will then describe subsequent developments that have affected route selection for these materials. These developments include the use of 'representative routes' found in the Department of Energy (DOE) 2008 Supplemental Environmental Impact Statement for the formerly proposed Yucca Mountain geologic repository. The paper will describe recommendations related to route selection found in the National Academy of Sciences 2006 report Going the Distance, as well as recommendations found in the 2012 Final Report of the Blue Ribbon Commission on America's Nuclear Future. The paper will examine recently promulgated federal regulations (HM-232) for selection of rail

  8. The topography of poverty in the United States: a spatial analysis using county-level data from the Community Health Status Indicators project.

    Science.gov (United States)

    Holt, James B

    2007-10-01

    Socioeconomic and health-related data at the county level are now available through the Community Health Status Indicators (CHSI) database. These data are useful for assessing the health of communities and regions. Users of the CHSI data can access online reports and an online mapping application for visualizing patterns in various community-related measures. It also is possible to download these data to conduct local analyses. This paper describes a spatial analysis of poverty in the United States at the county level for 2000. Spatial statistical techniques in a geographic information system were used to quantify significant spatial patterns, such as concentrated poverty rates and spatial outliers. The analysis revealed significant and stark patterns of poverty. A distinctive north-south demarcation of low versus high poverty concentrations was found, along with isolated pockets of high and low poverty within areas in which the predominant poverty rates were opposite. This pattern can be described as following a continental poverty divide. These insights can be useful in explicating the underlying processes involved in forming such spatial patterns that result in concentrated wealth and poverty. The spatial analytic techniques are broadly applicable to socioeconomic and health-related data and can provide important information about the spatial structure of datasets, which is important for choosing appropriate analysis methods.

  9. Phraseological units in Italian textbooks: an analysis of Italian textbooks ranked by the levels of language proficiency of the Common European Framework of Reference for Languages (CEFR

    Directory of Open Access Journals (Sweden)

    Daša Stanič

    2014-12-01

    Full Text Available This paper investigates the treatment given to phraseological units in the teaching/learning of Italian as a foreign language. For this purpose, some textbooks of Italian based on the CEFR were analysed to determine when, how and in what contexts phraseological units are introduced and studied, and to determine to what extent the selected textbooks represent an effective support in the process of teaching/learning Italian as a foreign language. Because of their characteristics, phraseological units represent a stumbling-block for non-native speakers, especially if their L1 is not one of the Romance Languages. Until the advent of the communicative approach – but also later – phraseology received only little attention in the teaching and learning of foreign languages; it was assumed that a student would develop a phraseological competence through imitation, and it seemed that phraseological units were to be treated only at higher levels of language proficiency. On the contrary, as many recent studies convincingly suggest, phraseological units should be systematically and explicitly taught/learnt from  level A1 on.  In the CEFR phraseological units are presented as an important element of lexical competence, while they are mostly neglected in the level descriptors. This approach seems to leave no objective criteria for textbook authors who consider whether and how to incorporate phraseology in their textbooks.

  10. Effects of Selection and Training on Unit-Level Performance over Time: A Latent Growth Modeling Approach

    Science.gov (United States)

    Van Iddekinge, Chad H.; Ferris, Gerald R.; Perrewe, Pamela L.; Perryman, Alexa A.; Blass, Fred R.; Heetderks, Thomas D.

    2009-01-01

    Surprisingly few data exist concerning whether and how utilization of job-related selection and training procedures affects different aspects of unit or organizational performance over time. The authors used longitudinal data from a large fast-food organization (N = 861 units) to examine how change in use of selection and training relates to…

  11. Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit

    Directory of Open Access Journals (Sweden)

    Ashu S Mathai

    2011-01-01

    Full Text Available Context: The role of hand hygiene in preventing health care associated infections (HCAIs has been clearly established. However, compliance rates remain poor among health care personnel. Aims: a To investigate the health care workers′ hand hygiene compliance rates in the intensive care unit (ICU, b to assess reasons for non-compliance and c to study the efficacy of a multimodal intervention strategy at improving compliance. Settings: A mixed medical-surgical ICU of a tertiary level hospital. Design: A before-after prospective, observational, intervention study. Materials and Methods: All health care personnel who came in contact with patients in the ICU were observed for their hand hygiene compliance before and after a multimodal intervention strategy (education, posters, verbal reminders and easy availability of products. A self-report questionnaire was also circulated to assess perceptions regarding compliance. Statistical analysis was done using c2 test or Fisher exact test (Epi info software. Results: Hand hygiene compliance among medical personnel working in the ICU was 26% and the most common reason cited for non-compliance was lack of time (37%. The overall compliance improved significantly following the intervention to 57.36% (P<0.000. All health care worker groups showed significant improvements: staff nurses (21.48-61.59%, P<0.0000, nursing students (9.86-33.33%, P<0.0000, resident trainees (21.62-60.71%, P<0.0000, visiting consultants (22-57.14%, P=0.0001, physiotherapists (70-75.95%, P=0.413 and paramedical staff (10.71-55.45%, P< 0.0000. Conclusions: Hand hygiene compliance among health care workers in the ICU is poor; however, intervention strategies, such as the one used, can be useful in improving the compliance rates significantly.

  12. The management in the sphere of physical culture and sport at the level of administrative and territorial units: traditions and innovations

    Directory of Open Access Journals (Sweden)

    Viktor Savchenko

    2016-02-01

    Full Text Available Purpose: to analyze the activity of subjects of management in the sphere of physical culture and sport at the level of territorial administrative units. Material & Methods: the legal analysis of a feature of management in the sphere of physical culture and sport of administrative and territorial units of the various level. Results: the main activities of administrative structures of the governmental authorities and the local governments are allocated. Conclusions: it is revealed that the sphere of physical culture and sport needs the improvement in the conditions of decentralization, offers on its reforming are considered.

  13. Action Tweets Linked to Reduced County-Level HIV Prevalence in the United States: Online Messages and Structural Determinants.

    Science.gov (United States)

    Ireland, Molly E; Chen, Qijia; Schwartz, H Andrew; Ungar, Lyle H; Albarracin, Dolores

    2016-06-01

    HIV is uncommon in most US counties but travels quickly through vulnerable communities when it strikes. Tracking behavior through social media may provide an unobtrusive, naturalistic means of predicting HIV outbreaks and understanding the behavioral and psychological factors that increase communities' risk. General action goals, or the motivation to engage in cognitive and motor activity, may support protective health behavior (e.g., using condoms) or encourage activity indiscriminately (e.g., risky sex), resulting in mixed health effects. We explored these opposing hypotheses by regressing county-level HIV prevalence on action language (e.g., work, plan) in over 150 million tweets mapped to US counties. Controlling for demographic and structural predictors of HIV, more active language was associated with lower HIV rates. By leveraging language used on social media to improve existing predictive models of geographic variation in HIV, future targeted HIV-prevention interventions may have a better chance of reaching high-risk communities before outbreaks occur.

  14. Current European corn borer, Ostrinia nubilalis, injury levels in the northeastern United States and the value of Bt field corn.

    Science.gov (United States)

    Bohnenblust, Eric W; Breining, James A; Shaffer, John A; Fleischer, Shelby J; Roth, Gregory W; Tooker, John F

    2014-11-01

    Recent evidence indicates that some populations of European corn borer (ECB), Ostrinia nubilalis (Hübner), have declined to historic lows owing to widespread adoption of Bt corn hybrids. To understand current ECB populations in Pennsylvania field corn, the authors assessed larval damage in Bt and non-Bt corn hybrids at 29 sites over 3 years. The influence of Bt adoption rates, land cover types and moth activity on levels of ECB damage was also considered. Bt hybrids reduced ECB damage when compared with non-Bt, but these differences inconsistently translated to higher yields and, because of higher seed costs, rarely improved profits. No relationships were detected between land use or Bt adoption and ECB damage rates, but positive relationships were found between plant damage and captures of Z-race ECB moths in pheromone traps in the PestWatch network. ECB damage levels were generally low and appear to be declining across Pennsylvania. In many locations, farmers may gain greater profits by planting competitive non-Bt hybrids; however, Bt hybrids remain valuable control options, particularly in the parts of Pennsylvania where ECB populations persist. Moth captures from PestWatch appear to provide insight into where Bt hybrids are most valuable. © 2013 Society of Chemical Industry.

  15. Automatic chemical monitoring in the composition of functions performed by the unit level control system in the new projects of nuclear power plant units

    Science.gov (United States)

    Denisova, L. G.; Khrennikov, N. N.

    2014-08-01

    The article presents information on the state of regulatory framework and development of a subsystem for automated chemical monitoring of water chemistries in the primary and secondary coolant circuits used as part of the automatic process control system in new projects of VVER reactor-based nuclear power plant units. For the strategy of developing and putting in use the water chemistry-related part of the automated process control system within the standard AES-2006 nuclear power plant project to be implemented, it is necessary to develop regulatory documents dealing with certain requirements imposed on automatic water chemistry monitoring systems in accordance with the requirements of federal codes and regulations in the field of using atomic energy.

  16. Geologic and hydrologic considerations for various concepts of high-level radioactive waste disposal in conterminous United States

    Science.gov (United States)

    Ekren, E.B.; Dinwiddie, G.A.; Mytton, J.W.; Thordarson, William; Weir, J.E.; Hinrichs, E.N.; Schroder, L.J.

    1974-01-01

    The purpose of this investigation is to evaluate and identify which geohydrologic environments in conterminous United States are best suited for various concepts or methods of underground disposal of high-level radioactive wastes and to establish geologic and hydrologic criteria that are pertinent to high-level waste disposal. The unproven methods of disposal include (1) a very deep drill hole (30,000-50,000 ft or 9,140-15,240 m), (2) a matrix of (an array of multiple) drill holes (1,000-20,000 ft or 305-6,100 m), (3) a mined chamber (1,000-10,000 ft or 305-3,050 m), (4) a cavity with separate manmade structures (1,000-10,000 ft or 305-3,050 m), and (5) an exploded cavity (2,000-20,000 ft or 610-6,100 m) o The geohydrologic investigation is made on the presumption that the concepts or methods of disposal are technically feasible. Field and laboratory experiments in the future may demonstrate whether or not any of the methods are practical and safe. All the conclusions drawn are tentative pending experimental confirmation. The investigation focuses principally on the geohydrologic possibilities of several methods of disposal in rocks other than salt. Disposal in mined chambers in salt is currently under field investigation, and this disposal method has been intensely investigated and evaluated by various workers under the sponsorship of the Atomic Energy Commission. Of the various geohydrologic factors that must be considered in the selection of optimum waste-disposal sites, the most important is hydrologic isolation to assure that the wastes will be safely contained within a small radius of the emplacement zone. To achieve this degree of hydrologic isolation, the host rock for the wastes must have very low permeability and the site must be virtually free of faults. In addition, the locality should be in (1) an area of low seismic risk where the possibility of large earthquakes rupturing the emplacement zone is very low, (2) where the possibility- of flooding by

  17. County-Level Estimates of Nitrogen and Phosphorus from Animal Manure for the Conterminous United States, 2002

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set consists of county estimates of nitrogen and phosphorus in kilograms from animal manure in the conterminous United States for 2002. These estimates...

  18. Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2008-12-01

    Epidemiologic studies of physical activity among patients with end-stage renal disease (ESRD) are lacking. The aim of this study was to describe the patterns of physical activity among new dialysis patients in the United States.

  19. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.

    Science.gov (United States)

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E

    1996-10-01

    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

  20. Improving the quality of health care in the United States of America: the need for a multi-level approach.

    Science.gov (United States)

    Mechanic, David

    2002-07-01

    Serious efforts to address quality require coordinated, multi-faceted, multi-level strategies that address the organisational environments and cultures that affect how care is provided. Most efforts over the past 50 years to improve the care provided by physicians and other clinicians have been individually rather than system based. Such individual interventions to modify physician behaviour typically have only modest effects whether considering the recognition and treatment of depression in primary care, following established practice guidelines, carrying out preventive interventions, monitoring and managing chronic illness appropriately, or managing pain and end-of-life care. It is increasingly recognised that quality of care is a property of health systems. Internal efforts to shape clinical routines, such as performance incentives and disease-management approaches, and external inducements and constraints that shape how clinical contexts are organised and function are equally relevant. Internal factors include the skills training of clinical personnel, organisational procedures and mechanisms to coordinate care and prevent errors, implementation of best practices, effective use of informational technologies and appropriate incentives. External factors include broader financial and reimbursement mechanisms, regulatory arrangements that protect access and patient rights in situations of vulnerability and performance-based contracts. The mobilisation of effective advocacy, independent and non-profit statutory watchdog organisations, and good consumer information can facilitate and reinforce quality efforts. System integration is admittedly difficult, and always incomplete, but movement toward this goal is an essential strategic objective.

  1. Synthesis and spectral investigations of a new dyad with spiropyran and fluorescein units: toward information processing at the single molecular level.

    Science.gov (United States)

    Guo, Xuefeng; Zhang, Deqing; Zhou, Yucheng; Zhu, Daoben

    2003-07-11

    A new dyad 1 with two spiropyran units as the photochromic acceptors and one fluorescein unit as the fluorescent donor was synthesized and characterized. External inputs (ultraviolet light, visible light, and proton) induce the reversible changes of the structure and, concomitantly, the absorption spectrum of dyad 1 due to the presence of two spiropyran units. Only the absorption spectrum of the ME form of the spiropyran units in dyad 1 has large spectral overlap with the fluorescence spectrum of the fluorescein unit. Thus, the fluorescence intensity of dyad 1 is modulated by reversible conversion among the three states of the photochromic spiropyran units and the fluorescence resonance energy transfer (FRET) between the ME form and the fluorescein unit. Based on the fact that dyad 1 could "read out" three external input signals (ultraviolet light, visible ligh,t and proton) and "write" a compatible specific output signal (fluorescence intensity), dyad 1 described here can be considered to perform an integrated circuit function with one OR and one AND interconnected logic gates. The present results demonstrate an efficient strategy for elaborating and transmitting information at the single molecular level.

  2. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

    Directory of Open Access Journals (Sweden)

    Penelope A Mcnulty

    2014-07-01

    Full Text Available Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface EMG in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded from 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p< 0.001 with no between-side differences for controls. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p< 0.001. Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p< 0.05. The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p< 0.05 but not ankle dorsiflexion. However, the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.

  3. ISS EPS Orbital Replacement Unit Block Diagrams

    Science.gov (United States)

    Schmitz, Gregory V.

    2001-01-01

    The attached documents are being provided to Switching Power Magazine for information purposes. This magazine is writing a feature article on the International Space Station Electrical Power System, focusing on the switching power processors. These units include the DC-DC Converter Unit (DDCU), the Bi-directional Charge/Discharge Unit (BCDU), and the Sequential Shunt Unit (SSU). These diagrams are high-level schematics/block diagrams depicting the overall functionality of each unit.

  4. Quantitative Detection of Hepatitis A Virus and Enteroviruses Near the United States-Mexico Border and Correlation with Levels of Fecal Indicator Bacteria▿

    OpenAIRE

    Gersberg, Richard M.; Rose, Michael A.; Robles-Sikisaka, Refugio; Dhar, Arun K.

    2006-01-01

    For decades, untreated sewage flowing northward from Tijuana, Mexico, via the Tijuana River has adversely affected the water quality of the recreational beaches of San Diego, California. We used quantitative reverse transcription-PCR to measure the levels of hepatitis A virus (HAV) and enteroviruses in coastal waters near the United States-Mexico border and compared these levels to those of the conventional fecal indicators, Escherichia coli and enterococci. Over a 2-year period from 2003 to ...

  5. Optical coherence tomography: an assessment of current training across all levels of seniority in 8 ophthalmic units in the united kingdom

    Directory of Open Access Journals (Sweden)

    Shilling John S

    2006-10-01

    Full Text Available Abstract Background Optical Coherence Tomography (OCT is becoming an increasingly integral part of ophthalmological clinical practice. The accurate interpretation of OCT images is important both in terms of diagnosis and in directing subsequent management. The aim of this study was to determine the clinical competence in OCT image interpretation of ophthalmologists in different subspecialties and grades. Methods Eight OCT images demonstrating a single macular pathology and two normal scans were selected by case notes review. These ten images were shown to thirty doctors and 10 non-medical staff from eight units. They were asked to identify each lesion, the average thickness of the lesion, and the axis at which the OCT was taken. One point was awarded for each correct answer. Results The mean scores for the correct qualitative identification of the OCT lesion (with a maximum score of 10 for different grades of doctors and non-medical staff were as follows: medical retinal consultants (MRC, 9 (range, 8–10; vitreoretinal consultants (VRC, 7 (range, 6–9; non-retinal consultants (NRC, 4 (range, 2–6; vitreoretinal fellows (VRF, 4 (range, 3–7; specialist registrars (SpR, 3 (range, 2–5; senior house officers (SHO, 4 (range, 3–6; orthoptists, 1 (range, 0–1; ancillary staff, 2 (range, 0–3. Conclusion A wide range in the ability to accurately interpret OCT images has been demonstrated. All doctors would thereby benefit from further training in the interpretation of OCT scans.

  6. Risk Management. Unit 20. Level 3. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 303-20.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on risk management in the PACE (Program for Acquiring Competence in Entrepreneurship) curriculum includes the full text of the student module and lesson plans, instructional suggestions, and other teacher resources. The competencies that are incorporated into this module are at Level 3 of learning--starting and…

  7. Pricing Strategy. Unit 10. Level 2. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 302-10.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on pricing strategy in the PACE (Program for Acquiring Competence in Entrepreneurship) curriculum includes the full text of the student module and lesson plans, instructional suggestions, and other teacher resources. The competencies that are incorporated into this module are at Level 2 of learning--planning for a…

  8. Pricing Strategy. Unit 10. Level 3. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 303-10.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on pricing strategy in the PACE (Program for Acquiring Competence in Entrepreneurship) curriculum includes the full text of the student module and lesson plans, instructional suggestions, and other teacher resources. The competencies that are incorporated into this module are at Level 3 of learning--starting and…

  9. Pricing Strategy. Unit 10. Level 1. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 301-10.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on pricing strategy in the PACE (Program for Acquiring Competence in Entrepreneurship) curriculum includes the full text of the student module and lesson plans, instructional suggestions, and other teacher resources. The competencies that are incorporated into this module are at Level 1 of learning--understanding…

  10. Adaptation and implementation of HoMBReS: a community-level, evidence-based HIV behavioral intervention for heterosexual Latino men in the midwestern United States.

    Science.gov (United States)

    Martinez, Omar; Roth, Alexis M; Kelle, Guadalupe; Downs, Mario; Rhodes, Scott D

    2014-02-01

    Over the past decade, the midwestern United States has witnessed a dramatic increase in its Latino population. The lack of culturally and linguistically congruent resources coupled with high incidence and prevalence rates of HIV among Latinos living in the Midwest merits attention. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) is a community-level social network intervention designed for Latino men. We describe the adaptation and implementation of HoMBReS for Latino men living in Indianapolis, Indiana, the second largest city in the Midwest. Five Navegantes (lay health educators) were trained; they provided a total of 34 educational charlas (small group didactic sessions). A total of 270 Latino men attended the charlas and were offered no-cost screening for HIV and sexually transmitted infections (STI). Three participants tested HIV positive and 15 screened positive for STI. The charlas coupled with the testing initiative, served as a successful method to increase sexual health knowledge among Latino men and to link newly-diagnosed HIV/STI-positive individuals to treatment and care. The adaptation and implementation of HoMBReS respond to the CDC and NIH call to increase HIV testing and service provision among vulnerable populations.

  11. A detection-level hazardous waste ground-water monitoring compliance plan for the 200 areas low-level burial grounds and retrievable storage units

    Energy Technology Data Exchange (ETDEWEB)

    1987-02-01

    This plan defines the actions needed to achieve detection-level monitoring compliance at the Hanford Site 200 Areas Low-Level Burial Grounds (LLBG) in accordance with the Resource Conservation and Recovery Act (RCRA). Compliance will be achieved through characterization of the hydrogeology and monitoring of the ground water beneath the LLBG located in the Hanford Site 200 Areas. 13 refs., 20 figs.

  12. Providing Retraining and Advancement Training for Primary/Elementary School Teachers at the State Level in Great Britain and the USA

    Science.gov (United States)

    Chychuk, Antonina

    2017-01-01

    In Great Britain and the USA the normative basis of primary/elementary school teachers' qualification advancement is being actively developed, i. e. this issue is considered at the state level. For a long time the development of retraining and advancement training system for primary/elementary school teachers has been grounded on conceptual…

  13. Glucose homeostasis and metabolic adaptation in the pregnant and lactating sheep are affected by the level of nutrition previously provided during her late fetal life

    DEFF Research Database (Denmark)

    Husted, Sanne Munch; Nielsen, Mette Benedicte Olaf; Blache, D.

    2008-01-01

    This study investigated whether undernutrition (UN) during late fetal life can programme the subsequent adult life adaptation of glucose homeostasis and metabolism during pregnancy and lactation. Twenty-four primiparous experimental ewes were used. Twelve had been exposed to a prenatal NORM level...

  14. The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels.

    Science.gov (United States)

    Diya, Luwis; Van den Heede, Koen; Sermeus, Walter; Lesaffre, Emmanuel

    2012-05-01

      The aim of this article was to assess the relationship between (1) in-hospital mortality and/or (2) unplanned readmission to intensive care units or operating theatre and nurse staffing variables.   Adverse events are used as surrogates for patient safety in nurse staffing and patient safety research. A single adverse event cannot adequately capture the multi-dimensional attributes of patient safety; hence, there is a need to consider composite measures. Unplanned readmission into the postoperative Intensive Care nursing unit and/or operating Theatre and in-hospital mortality can be viewed as measures that incorporate the effects of several adverse events.   We conducted a Bayesian multilevel analysis on a subset of the 2003 Belgian Hospital Discharge and Nursing Minimum Data sets. The sample included 9054 patients who underwent coronary artery bypass surgery or heart valve procedures from 28 Belgian acute hospitals. Two proxies of patient safety were considered, namely postoperative in-hospital mortality in the first postoperative intensive care unit and unplanned readmission into the intensive care and/or operating theatre (including mortality beyond the first postoperative intensive care unit) after the first-operative intensive care nursing unit.   There is an association between in-hospital mortality and/or unplanned readmissions and nurse staffing levels, but the relationship is moderated by volume and severity of illness respectively. In addition, the relationship differs between the two endpoints.   Higher nurse staffing levels on postoperative general nursing cardiac surgery units protected patients from unplanned readmission to intensive care units or operating theatre and in-hospital mortality. © 2011 Blackwell Publishing Ltd.

  15. Using field data to assess the effects of pesticides on crustacea in freshwater aquatic ecosystems and verifying the level of protection provided by water quality guidelines.

    Science.gov (United States)

    Guy, Martha; Singh, Lucina; Mineau, Pierre

    2011-07-01

    The purpose of this study was to investigate how well single-species laboratory data predict real-world pesticide toxicity effects on Crustacea. Data from field pesticide exposures from experimental mesocosm and small pond studies were converted into toxicity units (TUs) by dividing measured pesticide concentrations by the L(E)C50 for Daphnia or acute 5% hazard concentration for Crustacea (HC5-C). The proportion of crustacean taxa significantly affected by the pesticide treatment, called the count ratio of effect, was used in logistic regression models. Of 200 possible logistic model combinations of the TUs, fate, physicochemical variables, and structural variables versus the count ratio of effect for the mesocosm data, the best model was found to incorporate log(TU HC5-C). This model was used to convert pesticide water quality guidelines from around the world into estimates of the proportion of crustacean taxa predicted to be impacted by exposure to a pesticide at the water quality guideline concentration. This analysis suggests 64% of long-term water quality guidelines and 88% of short-term pesticide water quality guidelines are not protective of the aquatic life they are designed to protect. We conclude that empirically derived data from mesocosm studies should be incorporated into water quality guideline derivation for pesticides where available. Also, interspecific differences in susceptibility should be accounted for more accurately to ensure water quality guidelines are adequately protective against the adverse effects of pesticide exposure. Copyright © 2011 SETAC.

  16. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing

    Directory of Open Access Journals (Sweden)

    Nikoo Yamani

    2014-01-01

    Conclusion: It seems that inter-professional education can improve the quality of health care to some extent through influencing knowledge and collaborative performance of health care teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.

  17. Investigating the Practice of Providing Written Corrective Feedback Types by ESL Teachers at the Upper Secondary Level in High Performance Schools

    Science.gov (United States)

    Mahmud, Norasyikin

    2016-01-01

    The past few decades has seen the rapid development of WCF (written corrective feedback) study. The present study examined the practice of providing WCF by teachers. The aim of this study was to determine the types of WCF used by English teachers. The study is an explanatory sequential mixed-methods design using open-ended and close-ended survey…

  18. The Effect of an Instructional Unit Incorporating Live Animals on Knowledge of Nutrition for Different Age Levels.

    Science.gov (United States)

    Roth, Anne I.; Wunderlich, Kenneth W.

    A nutrition education unit, Rat Pak, developed by Dairy Council, Inc., is an attempt to influence students to make wise food choices. It consists of eleven lessons in an instructional sequence which incorporates the use of white rats as a means of illustrating the effect of improper diet while teaching proper diet. The purpose of this…

  19. Cardiorespiratory Fitness Levels among U.S. Youth Aged 12-15 Years: United States, 1999-2004 and 2012

    Science.gov (United States)

    ... aerobic work and power on a rope-braked cycle ergometer by direct measurement. Appl Physiol Nutr Metab 31(4):392–7. 2006. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311( ...

  20. Assessment of variation in the alberta context tool: the contribution of unit level contextual factors and specialty in Canadian pediatric acute care settings

    Directory of Open Access Journals (Sweden)

    Cummings Greta G

    2011-10-01

    Full Text Available Abstract Background There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1 examine the extent to which the 10 ACT concepts discriminate between patient care units and (2 identify variables that significantly contribute to between-unit variation for each of the 10 concepts. Methods 859 professional nurses (844 valid responses working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT's ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts in which we systematically assessed the unique contribution (i.e., error variance reduction of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1. In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3. Results The null model (unadjusted baseline HLM model established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units. When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the

  1. Newly incident cannabis use in the United States, 2002–2011: a regional and state level benchmark

    Directory of Open Access Journals (Sweden)

    Jacob P. Leinweber

    2017-07-01

    Full Text Available Background Cannabis use and cannabis regulatory policies recently re-surfaced as noteworthy global research and social media topics, including claims that Mexicans have been sending cannabis and other drug supplies through a porous border into the United States. These circumstances prompted us to conduct an epidemiological test of whether the states bordering Mexico had exceptionally large cannabis incidence rates for 2002–2011. The resulting range of cannabis incidence rates disclosed here can serve as 2002–2011 benchmark values against which estimates from later years can be compared. Methods The population under study is 12-to-24-year-old non-institutionalized civilian community residents of the US, sampled and assessed with confidential audio computer-assisted self-interviews (ACASI during National Surveys on Drug Use and Health, 2002–2011 (aggregate n ∼ 420,000 for which public use datasets were available. We estimated state-specific cannabis incidence rates based on independent replication sample surveys across these years, and derived meta-analysis estimates for 10 pre-specified regions, including the Mexico border region. Results From meta-analysis, the estimated annual incidence rate for cannabis use in the Mexico Border Region is 5% (95% CI [4%–7%], which is not an exceptional value relative to the overall US estimate of 6% (95% CI [5%–6%]. Geographically quite distant from Mexico and from states of the western US with liberalized cannabis policies, the North Atlantic Region population has the numerically largest incidence estimate at 7% (95% CI [6%–8%], while the Gulf of Mexico Border Region population has the lowest incidence rate at 5% (95% CI [4%–6%]. Within the set of state-specific estimates, Vermont’s and Utah’s populations have the largest and smallest incidence rates, respectively (VT: 9%; 95% CI [8%–10%]; UT: 3%; 95% CI [3%–4%]. Discussion Based on this study’s estimates, among 12-to-24-year-old US

  2. Analysis of the nicotinamide phosphoribosyltransferase family provides insight into vertebrate adaptation to different oxygen levels during the water-to-land transition.

    Science.gov (United States)

    Fang, Chengchi; Guan, Lihong; Zhong, Zaixuan; Gan, Xiaoni; He, Shunping

    2015-08-01

    One of the most important events in vertebrate evolutionary history is the water-to-land transition, during which some morphological and physiological changes occurred in concert with the loss of specific genes in tetrapods. However, the molecular mechanisms underlying this transition have not been well explored. To explore vertebrate adaptation to different oxygen levels during the water-to-land transition, we performed comprehensive bioinformatics and experimental analysis aiming to investigate the NAMPT family in vertebrates. NAMPT, a rate-limiting enzyme in the salvage pathway of NAD+ biosynthesis, is critical for cell survival in a hypoxic environment, and a high level of NAMPT significantly augments oxidative stress in normoxic environments. Phylogenetic analysis showed that NAMPT duplicates arose from a second round whole-genome duplication event. NAMPTA existed in all classes of vertebrates, whereas NAMPTB was only found in fishes and not tetrapods. Asymmetric evolutionary rates and purifying selection were the main evolutionary forces involved. Although functional analysis identified several functionally divergent sites during NAMPT family evolution, in vitro experimental data demonstrated that NAMPTA and NAMPTB were functionally conserved for NAMPT enzymatic function in the NAD+ salvage pathway. In situ hybridization revealed broad NAMPTA and NAMPTB expression patterns, implying regulatory functions over a wide range of developmental processes. The morpholino-mediated knockdown data demonstrated that NAMPTA was more essential than NAMPTB for vertebrate embryo development. We propose that the retention of NAMPTB in water-breathing fishes and its loss in air-breathing tetrapods resulted from vertebrate adaptation to different oxygen levels during the water-to-land transition. © 2015 FEBS.

  3. ACTUAL REQUIREMENTS REGARDING THE INTELLECTUAL CAPITAL AT AN EUROPEAN AND INTERNATIONAL LEVEL. THE ASSESSMENT OF QUALITY MANAGEMENT SYSTEMS IN ORGANISATIONS PROVIDING INSTRUCTION SERVICES

    Directory of Open Access Journals (Sweden)

    Danut Neacsu

    2012-12-01

    Full Text Available The European Union Council had and still has in view the profound changes taking place in society: globalization represents for Europe a competitors intensification in all the economical sectors, while the developing and the diversification of the information technologies can lead to a radical change of the whole learning and educational system, opening the perspectives for learning possibilities and accumulating knowledge during all one’s life. The topic actuality of this article consist from the fact that, due to the globalization and the international competition intensification the request for workers with a low qualification level decreases; the new jobs presuppose high performances, flexibility, stress on qualities such as: high level of performance, creativity, openness to change, initiative. People will be obliged to possess much more knowledge, competences and they will have to work in multi spheres teams. Of course that not all the people can become conceptual analysts, something like this cannot be required, but an adaptation to the new system, to the new economy is required. At present, more and more people work in domains in which information is created. In the future this percent will grow. The utilizing on a large scale of machines and installations will determine that even workers from the basic domains to be better and better prepared. In the countries OECD the unemployment rate is higher for the persons with a second education, unlike the persons with a higher education, the manpower being in this way forced to become more qualified. On the other hand, as more and more work is taking place at an intellectual level, the detaining and manipulating of information becomes an essential quality for each employee. This article has as a main objective the highlighting of actual requirements regarding the quality assurance in instruction services at an European and international level. Thus, the permanent learning strategies from the

  4. Vaccination coverage by race/ethnicity and poverty level among children aged 19-35 months--United States, 1997.

    Science.gov (United States)

    1998-11-13

    The goals of the Childhood Immunization Initiative (CII) for 1996 were to have > or =90% of children receive three or more doses of diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids (DTP/DT), poliovirus vaccine, and Haemophilus influenzae type b vaccine (Hib) and one dose of measles-mumps-rubella vaccine, and for > or =70% of children to receive three or more doses of hepatitis B vaccine. The National Immunization Survey (NIS) was undertaken as part of the CII to monitor vaccination coverage levels for each state and for 28 urban areas. This report presents coverage estimates by race/ethnicity and poverty level for 1997 and compares coverage estimates for 1995 and 1997; the findings indicate improvements in vaccination coverage levels among children living below poverty level although these levels were lower than levels among children living at or above poverty level.

  5. Impact of an educational intervention on provider knowledge, attitudes, and comfort level regarding counseling women ages 40–49 about breast cancer screening

    Directory of Open Access Journals (Sweden)

    Bryan TJ

    2015-05-01

    Full Text Available Teresa J Bryan,1,2 Carlos A Estrada,1,2 Analia Castiglioni,3 Erin D Snyder1,2 1University of Alabama at Birmingham, Birmingham, AL, USA; 2Birmingham Veterans Administration Medical Center, Birmingham, AL, USA; 3University of Central Florida College of Medicine, Orlando, FL, USA Background: Mammography screening for women under the age of 50 is controversial. Groups such as the US Preventive Services Task Force recommend counseling women 40–49 years of age about mammography risks and benefits in order to incorporate the individual patient's values in decisions regarding screening. We assessed the impact of a brief educational intervention on the knowledge and attitudes of clinicians regarding breast cancer screening. Methods: The educational intervention included a review of the risks and benefits of screening, individual risk assessment, and counseling methods. Sessions were led by a physician expert in breast cancer screening. Participants were physicians and nurses in 13 US Department of Veterans Affairs primary care clinics in Alabama. Outcomes were as follows: 1 knowledge assessment of mammogram screening recommendations; 2 counseling practices on the risks and benefits of screening; and 3 comfort level with counseling about screening. Outcomes were assessed by survey before and after the intervention. Results: After the intervention, significant changes in attitudes about breast cancer screening were seen. There was a decrease in the percentage of participants who reported that they would screen all women ages 40–49 years (82% before the intervention, 9% afterward. There was an increase in the percentage of participants who reported that they would wait until the patient was 50 years old before beginning to screen (12% before the intervention, 38% afterward. More participants (5% before, 53% after; P<0.001 said that they would discuss the patient's preferences. Attitudes favoring discussion of screening benefits increased, though not

  6. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

    DEFF Research Database (Denmark)

    Matzen, Lars E; Jepsen, Ditte B; Ryg, Jesper

    2012-01-01

    ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS...... to an acute geriatricunit. These data suggest that assessment of ADL may have a potential role in decisionmaking for the clinical management of frail geriatric inpatients....

  7. The Knowledge Level of United States Air Force Flight Nurses Regarding the Injuries of Conventional Warfare Casualties

    Science.gov (United States)

    1989-01-01

    penetrating wound of brain " (United States Department of Defense, 1987, p. 182). Since it was virtually impossible to construct one question covering...exhaustion is characterized by which of the following? a. Euphoria, sharpened skills and senses b. Insomnia, anorexia , and malaise c. Unrelenting fatigue... malnutrition d. Don’t know 11. An external fixation device to immobilize a fractured extremity is best described by which of the following? a. A special cast

  8. Monolithically integrated enhancement/depletion-mode AlGaN/GaN HEMTs SRAM unit and voltage level shifter using fluorine plasma treatment

    Science.gov (United States)

    Yonghe, Chen; Xuefeng, Zheng; Jincheng, Zhang; Xiaohua, Ma; Yue, Hao

    2016-05-01

    A GaN-based E/D mode direct-couple logic 6 transistors SRAM unit and a voltage level shifter were designed and fabricated. E-mode and D-mode AlGaN/GaN HEMTs were integrated in one wafer using fluorine plasma treatment and using a moderate AlGaN barrier layer heterojunction structure. The 6 transistors SRAM unit consists of two symmetrical E/D mode inverters and two E-mode switch HEMTs. The output low and high voltage of the SRAM unit are 0.95 and 0.07 V at a voltage supply of 1 V. The voltage level shifter lowers the supply voltage using four Ni-AlGaN Schottky diodes in a series at a positive supply voltage of 6 V and a negative supply voltage of -6 V. By controlling the states of inverter modules of the level shifter in turn, the level shifter offers two channel voltage outputs of -0.5 and -5 V. The flip voltage of the level shifter is 0.76 V. Both the SRAM unit and voltage shifter operate correctly, demonstrating the promising potential for GaN-based E/D mode digital and analog integrated circuits. Several considerations are proposed to avoid the influence of threshold voltage degradation of D-mode and E-mode HEMT on the operation of the circuit. Project supported by the National Natural Science Foundation of China (No. 61334002), the Opening Project of Science and Technology on Reliability Physics and Application Technology of Electronic Component Laboratory (No. ZHD201206), and the Program for New Century Excellent Talents in University (No. NCET-12-0915).

  9. Low cost electronic ultracapacitor interface technique to provide load leveling of a battery for pulsed load or motor traction drive applications

    Science.gov (United States)

    King, Robert Dean; DeDoncker, Rik Wivina Anna Adelson

    1998-01-01

    A battery load leveling arrangement for an electrically powered system in which battery loading is subject to intermittent high current loading utilizes a passive energy storage device and a diode connected in series with the storage device to conduct current from the storage device to the load when current demand forces a drop in battery voltage. A current limiting circuit is connected in parallel with the diode for recharging the passive energy storage device. The current limiting circuit functions to limit the average magnitude of recharge current supplied to the storage device. Various forms of current limiting circuits are disclosed, including a PTC resistor coupled in parallel with a fixed resistor. The current limit circuit may also include an SCR for switching regenerative braking current to the device when the system is connected to power an electric motor.

  10. Proton pump inhibitors drastically modify triosephosphate isomerase from Giardia lamblia at functional and structural levels, providing molecular leads in the design of new antigiardiasic drugs.

    Science.gov (United States)

    García-Torres, Itzhel; de la Mora-de la Mora, Ignacio; Marcial-Quino, Jaime; Gómez-Manzo, Saúl; Vanoye-Carlo, América; Navarrete-Vázquez, Gabriel; Colín-Lozano, Blanca; Gutiérrez-Castrellón, Pedro; Sierra-Palacios, Edgar; López-Velázquez, Gabriel; Enríquez-Flores, Sergio

    2016-01-01

    Proton pump inhibitors (PPIs) are extensively used in clinical practice because of their effectiveness and safety. Omeprazole is one of the best-selling drugs worldwide and, with other PPIs, has been proposed to be potential drugs for the treatment of several diseases. We demonstrated that omeprazole shows cytotoxic effects in Giardia and concomitantly inactivates giardial triosephosphate isomerase (GlTIM). Therefore, we evaluated the efficiency of commercially available PPIs to inactivate this enzyme. We assayed the effect of PPIs on the GlTIM WT, single Cys mutants, and the human counterpart, following enzyme activity, thermal stability, exposure of hydrophobic regions, and susceptibility to limited proteolysis. PPIs efficiently inactivated GlTIM; however, rabeprazole was the best inactivating drug and was nearly ten times more effective. The mechanism of inactivation by PPIs was through the modification of the Cys 222 residue. Moreover, there are important changes at the structural level, the thermal stability of inactivated-GlTIM was drastically diminished and the structural rigidity was lost, as observed by the exposure of hydrophobic regions and their susceptibility to limited proteolysis. Our results demonstrate that rabeprazole is the most potent PPI for GlTIM inactivation and that all PPIs tested have substantial abilities to alter GITIM at the structural level, causing serious damage. This is the first report demonstrating the effectiveness of commercial PPIs on a glycolytic parasitic enzyme, with structural features well known. This study is a step forward in the use and understanding the implicated mechanisms of new antigiardiasic drugs safe in humans. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Glucose homeostasis and metabolic adaptation in the pregnant and lactating sheep are affected by the level of nutrition previously provided during her late fetal life.

    Science.gov (United States)

    Husted, S M; Nielsen, M O; Blache, D; Ingvartsen, K L

    2008-05-01

    This study investigated whether undernutrition (UN) during late fetal life can programme the subsequent adult life adaptation of glucose homeostasis and metabolism during pregnancy and lactation. Twenty-four primiparous experimental ewes were used. Twelve had been exposed to a prenatal NORM level of nutrition (maternal diet approximately 15 MJME/d) and 12 to a LOW level of nutrition (maternal diet approximately 7 MJME/d) during the last 6 weeks pre-partum. The experimental ewes were subjected to two intravenous glucose tolerance tests (IGTT) in late gestation (one prior to (G-IGTT) and one by the end of a feed restriction period (RG-IGTT)), and a third around peak lactation (L-IGTT). LOW had lower basal insulin concentrations during lactation, and significantly decreased absolute insulin secretion during the L-IGTT in spite of similar glucose tolerance, indicating increased insulin sensitivity in LOW during lactation. There was no effect of prenatal UN on glucose tolerance during G-IGTT, however, during RG-IGTT LOW was more glucose intolerant and apparently more insulin resistant compared to NORM. In conclusion, UN during late fetal life in sheep impairs subsequent pancreatic insulin secretory capacity during adult life, and reduces plasticity of down-regulation of insulin secretion in response to a metabolic challenge. Furthermore, prenatal UN appears to programme mechanisms, which in young adult females can shift the insulin hypersensitivity observed during early lactation into an insulin resistance observed during late gestation and feed restriction. Early postnatal UN caused by lowered milk intake in early postnatal life may have contributed to these phenomena.

  12. Simulating partially illegal markets of private tanker water providers on the country level: A multi-agent, hydroeconomic case-study of Jordan

    Science.gov (United States)

    Klassert, C. J. A.; Yoon, J.; Gawel, E.; Klauer, B.; Sigel, K.; Talozi, S.; Lachaut, T.; Selby, P. D.; Knox, S.; Gorelick, S.; Tilmant, A.; Harou, J. J.; Mustafa, D.; Medellin-Azuara, J.; Rajsekhar, D.; Avisse, N.; Zhang, H.

    2016-12-01

    In arid countries around the world, markets of private small-scale water providers, mostly delivering water via tanker trucks, have emerged to balance the shortcomings of public water supply systems. While these markets can provide substantial contributions to meeting customers' water demands, they often partially rely on illegal water abstractions, thus imposing an unregulated and unmonitored strain on ground and surface water resources. Despite their important impacts on water users' welfare and resource sustainability, these markets are still poorly understood. We use a multi-agent, hydroeconomic simulation model, developed as part of the Jordan Water Project, to investigate the role of these markets in a country-wide case-study of Jordan. Jordan's water sector is characterized by a severe and growing scarcity of water resources, high intermittency in the public water network, and a strongly increasing demand due to an unprecedented refugee crisis. The tanker water market serves an important role in providing water from rural wells to households and commercial enterprises, especially during supply interruptions. In order to overcome the lack of direct data about this partially illegal market, we simulate demand and supply for tanker water. The demand for tanker water is conceptualized as a residual demand, remaining after a water user has depleted all available cheap and qualitatively reliable piped water. It is derived from residential and commercial demand functions on the basis of survey data. Tanker water supply is determined by farm simulation models calculating the groundwater pumping cost and the agricultural opportunity cost of tanker water. A market algorithm is then used to match rural supplies with users' demands, accounting for survey data on tanker operators' transport costs and profit expectations. The model is used to gain insights into the size of the tanker markets in all 89 subdistricts of Jordan and their responsiveness to various policy

  13. Comparison of Fluoride Levels in Tap and Bottled Water and Reported Use of Fluoride Supplementation in a United States–Mexico Border Community

    Directory of Open Access Journals (Sweden)

    Paloma I. Beamer

    2017-04-01

    Full Text Available BackgroundCompared to the general United States (U.S. population, Arizona counties along the U.S.–Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health.ObjectiveTo evaluate the levels of fluoride in tap and bottled water as well as the use of fluoride supplements in an Arizona border community.MethodsLow-income Latino households (n = 90 who report use of bottled water as their primary source of water intake were recruited. Participants completed a questionnaire about their and their children’s dental histories and use of fluoride supplements. Water samples (bottled and tap were collected from a subset of households (n = 30 for analysis of fluoride.ResultsFluoride detection levels were significantly greater (p = 0.02, Fisher’s exact test in tap water (average = 0.49 mg/dL than in bottled water, yet, the majority (22/30 were below the range for optimal dental health (0.7–1.2 mg/L. Concentration of fluoride in the majority (29/30 of bottled water samples was below the quantitative detection limit of 0.4 mg/L. Children were significantly less likely to have dental caries if they received fluoride varnishing treatments (p = 0.01, Fisher’s exact test, lived in households that reported using fluoridated mouthwash (p < 0.001, Fisher’s exact test, their parents received fluoride education (p = 0.01, Fisher’s exact test, and their parents reported visiting a dentist yearly (p < 0.001, Fisher’s exact test. Furthermore, none of the participants reported receiving recommendations from health-care providers about fluoride supplementation or variance in content by the type of water consumed.ConclusionAlthough fluoride was significantly more

  14. Providing instrumental social support is more beneficial to reduce mortality risk among the elderly with low educational level in Taiwan: a 12-year follow-up national longitudinal study.

    Science.gov (United States)

    Liao, C C; Yeh, C J; Lee, S H; Liao, W C; Liao, M Y; Lee, M C

    2015-04-01

    To evaluate whether the effects of providing or receiving social support are more beneficial to reduce mortality risk among the elderly with different educational levels. In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 1492 males and 1177 females aged ≥67 years were retrieved. Participants received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others and involved in social engagement. Education attainment was divided into two levels: high and low. The low education level included illiterate and elementary school. The high education level included junior high school to senior high school and above college. Cox regression analysis was used to examine the association between providing or receiving social support on mortality with different educational levels. The average age of the participants in 1996 was 73.0 (IQR=8.0) years, and the median survival following years (1996-2007) of participants was 10.3 (IQR=6.7) years. Most participants were low educational level including illiterate (39.3%) and elementary school (41.2%). Participants with high educational level tend to be younger and more male significantly. On the contrary, participants with low educational level tend to have significant more poor income, more depression, more cognition impairment, more with IADL and ADL disability than high educational level. Most participants received instrumental support from others (95.5%) and also provided emotional support to others (97.7%). Providing instrumental support can reduce 17% of mortality risk among the elderly with a low level of education after adjusting several covariates [Hazard ratio (HR) = 0.83; 95% confidence interval (CI) = 0.70-0.99; p = 0.036]. Providing instrumental social support to others confer benefits to the giver and prolong life expectancy among the

  15. Providing a diet containing only maintenance levels of energy and protein during the latter stages of pregnancy resulted in a prolonged delivery time during parturition in rats.

    Science.gov (United States)

    Tanaka, Y; Kadokawa, H

    2012-01-01

    In mammals, a prolonged delivery time during parturition is dangerous for both mother and fetus, although the mechanisms that prolong delivery are unclear. To investigate whether nutrition affects delivery time, we administered two feeds containing maintenance (L-feed) or higher (H-feed) levels of energy and protein at different points during the latter half of pregnancy and compared the effects of the various treatments on delivery time in rats. After the rats had been maintained on the L-feed and then copulated on pro-oestrus (Day 0), pregnant females were randomly allocated to one of three groups: (1) the no-improvement group, which was fed L-feed throughout gestation; (2) the early group, which was fed L-feed until Day 11 of gestation and then switched to H-feed; and (3) the late group, which was fed L-feed until Day 16 of gestation and then switched to H-feed. There was no significant difference in the number of pups among the three groups. However, delivery time was significantly longer in the no-improvement group (73.7±5.2 min) than the early (46.9±5.6 min) and late (55.4±5.5 min) groups. Consuming a maintenance diet during the latter half of pregnancy resulted in a prolonged delivery time.

  16. Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2016-01-01

    Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia. Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China. And PCT is a more valuable biomarker than endotoxin in the diagnosis of bacteremia.

  17. Cost effectiveness of universal umbilical cord blood gas and lactate analysis in a tertiary level maternity unit.

    Science.gov (United States)

    White, Christopher R H; Doherty, Dorota A; Cannon, Jeffrey W; Kohan, Rolland; Newnham, John P; Pennell, Craig E

    2016-07-01

    There is an increasing body of literature supporting universal umbilical cord blood gas analysis (UCBGA) into all maternity units. A significant impediment to UCBGA's introduction is the perceived expense of the introduction and associated ongoing costs. Consequently, this study set out to conduct the first cost-effectiveness analysis of introducing universal UCBGA. Analysis was based on 42,100 consecutive deliveries ≥23 weeks of gestation at a single tertiary obstetric unit. Within 4 years of UCBGA's introduction there was a 45% reduction in term special care nursery (SCN) admissions >2499 g. Incurred costs included initial and ongoing costs associated with universal UCBGA. Averted costs were based on local diagnosis-related grouping costs for reduction in term SCN admissions. Incremental cost-effectiveness ratio (ICER) and sensitivity analysis results were reported. Under the base-case scenario, the adoption of universal UCBGA was less costly and more effective than selective UCBGA over 4 years and resulted in saving of AU$641,532 while adverting 376 SCN admissions. Sensitivity analysis showed that UCBGA was cost-effective in 51.8%, 83.3%, 99.6% and 100% of simulations in years 1, 2, 3 and 4. These conclusions were not sensitive to wide, clinically possible variations in parameter values for neonatal intensive care unit and SCN admissions, magnitude of averted SCN admissions, cumulative delivery numbers, and SCN admission costs. Universal UCBGA is associated with significant initial and ongoing costs; however, potential averted costs (due to reduced SCN admissions) exceed incurred costs in most scenarios.

  18. Evaluation of the Submerged Demineralizer System (SDS) flowsheet for decontamination of high-activity-level water at the Three Mile Island Unit 2 Nuclear Power Station

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, D. O.; Collins, E. D.; King, L. J.; Knauer, J. B.

    1980-07-01

    This report discusses the Submerged Demineralizer System (SDS) flowsheet for decontamination of the high-activity-level water at the Three Mile Island Unit 2 Nuclear Power Station was evaluated at Oak Ridge National Laboratory in a study that included filtration tests, ion exchange column tests, and ion exchange distribution tests. The contaminated waters, the SDS flowsheet, and the experiments made are described. The experimental results were used to predict the SDS performance and to indicate potential improvements.

  19. Gaharu Leaf Extract Water Reduce MDA and 8-OHdG Levels and Increase Activities SOD and Catalase in Wistar Rats Provided Maximum Physical Activity

    Directory of Open Access Journals (Sweden)

    I Made Oka Adi Parwata

    2016-09-01

    Full Text Available Background: Oxidative stress occurs due to an imbalance of the number of free radicals by the number of endogenous antioxidant produced by the body i.e. Superoxide Dismutase (SOD, Gluthathione Peroxidase (GPx, and Catalase. The imbalance between the number of free radicals and antioxidants can be overcome with the endogenous antioxidant intake that exogenous oxidative stress can be reduced. One of exogenous antioxidants is natural Gaharu leaf water extract. Objective: This research focus on the effect of Gaharu leaf water extract in reducing MDA and 8-OHdG and increase the activity of SOD and Catalase. Methods: This study was an experimental with post only controls group design. Experiment was divided  into 5 groups of wistar rats, each consisting of 5 animals, i.e. negative control group without extract [K (-], treatment 1 treated 50 mg/kg BW/day of the extract (T1, treatment 2 treated 100 mg/kg BW/day of the extract (T2, treatment 3 treated 200 mg/ kg BW/day of the extract (T3, and positive control group [K (+] treated with vitamin Cat a dose 50 mg/kg BW/day. All groups treated for 10 weeks. Every day, before treatment, each group was given a maximum swimming activity for 1.5 hours for 10 weeks. ELISA was used to measure MDA, 8-OHdG, SOD, and Catalase activities. Result: The research results showed that treatment of extract of  leaves of Gaharu with an higher dose from 50 mg/kg BW up to 200 mg/ kg BW significantly decline (p <0.05 levels of MDA with the average ranging from 6.37±0.23, 5,56±0.27 and 4.32±0.27, 8-OHdG with a mean of 1.64±0.11, 1.26±0.46, and 1.09±0.17. On the other hand the treatment also increase SOD activity with less ranging from 12.15±1.04, 15.70±2.02, and 18.84±1.51, and Catalase ranging from 6,68±0.63, 8.20±1.14 and 9.29±0,79 in the blood of Wistar rats were given a maximum activity compared to the negative control group. This is probably higher phenol compounds (bioflavonoids quantity content of the extract

  20. Grid-Level Application of Electrical Energy Storage: Example Use Cases in the United States and China

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yingchen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Yang, Rui [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhou, Shengru [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Wang, Caixia [State Grid Corporation of China; Lei, Xuejiao [State Grid Corporation of China; Li, Qionghui [State Grid Corporation of China; Jiang, Liping [State Grid Corporation of China

    2017-08-16

    Electrical energy storage (EES) systems are expected to play an increasing role in helping the United States and China-the world's largest economies with the two largest power systems-meet the challenges of integrating more variable renewable resources and enhancing the reliability of power systems by improving the operating capabilities of the electric grid. EES systems are becoming integral components of a resilient and efficient grid through a diverse set of applications that include energy management, load shifting, frequency regulation, grid stabilization, and voltage support.

  1. The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2010-06-01

    Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making.

  2. Tanzanian farmers' knowledge and attitudes to GM biotechnology and the potential use of GM crops to provide improved levels of food security. A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Herron Caroline M

    2010-07-01

    believe use of GM biotechnology is an appropriate way in which to tackle issues of food security, provide improved health and drive development.

  3. Tanzanian farmers' knowledge and attitudes to GM biotechnology and the potential use of GM crops to provide improved levels of food security. A Qualitative Study.

    Science.gov (United States)

    Lewis, Christopher P; Newell, James N; Herron, Caroline M; Nawabu, Haidari

    2010-07-12

    to tackle issues of food security, provide improved health and drive development.

  4. Prevalence and level of Listeria monocytogenes and other Listeria species in selected retail ready-to-eat foods in the United Kingdom.

    Science.gov (United States)

    Little, C L; Sagoo, S K; Gillespie, I A; Grant, K; McLauchlin, J

    2009-09-01

    Although listeriosis is a rare cause of human disease in the United Kingdom, an increase in the number of cases has been observed since 2001, almost exclusively in persons older than 60 years. This increase prompted this study on the microbiological safety of ready-to-eat (RTE) foods, which included those types potentially linked to cases of listeriosis. Between May 2006 and April 2007, 6,984 RTE foods were sampled (2,168 sliced meats, 1,242 hard cheese, 1,088 sandwiches, 878 butter, 725 spreadable cheese, 515 confectionery products containing cream, and 368 probiotic drinks). The food types with the highest prevalence of Listeria monocytogenes were sandwiches (7.0%) and sliced meats (3.7% within shelf life, 4.2% end of shelf life). L. monocytogenes at > 100 CFU/g (exceeding the European Commission's food safety criteria limit) only occurred in sandwiches (0.4%) and sliced meats (0.7% within shelf life, 1.0% end of shelf life). Contamination with L. monocytogenes at >100 CFU/g was more frequent in meats that were prepacked and/or of pack size > or = 300 g and in sandwiches that were supplied prepacked that contained salad vegetables as an ingredient. Satisfactory microbiological quality was associated with premises on which the management was trained in food hygiene and those that complied with hazard analysis and critical control point principles. This study provides important information about the microbiological safety of RTE foods and demonstrates that the control of L. monocytogenes in such foods, and in particular sandwiches and sliced meats, is essential in order to minimize the risk of this bacterium being present at levels hazardous to health at the point of consumption.

  5. An integrated assessment of energy-water nexus at the state level in the United States: Projections and analyses under different scenarios through 2095

    Science.gov (United States)

    Liu, L.; Patel, P. L.; Hejazi, M. I.; Kyle, P.; Davies, E. G.; Zhou, Y.; Clarke, L.; Edmonds, J.

    2013-12-01

    Water withdrawals for thermoelectric power plants account for approximately half of the total water use in the United States. With growing electricity demands in the future and limited water supplies in many water-scarce states in the U.S., grasping the trade-off between energy and water requires an integrated modeling approach that can capture the interactions among energy, water availability, climate, technology, and economic factors at various scales. In this study, the Global Change Assessment Model (GCAM), a technologically-detailed integrated model of the economy, energy, agriculture and land use, water, and climate systems, with 14 geopolitical regions that are further dissaggregated into up to 18 agro-ecological zones, was extended to model the electricity and water systems at the state level in the U.S. More specifically, GCAM was employed to estimate future state-level electricity generation and demands, and the associated water withdrawals and consumptions under a set of six scenarios with extensive levels of details on generation fuel portfolio, cooling technology mix, and water use intensities. The state-level estimates were compared against available inventories where good agreement was achieved on national and regional levels. We then explored the electric-sector water use up to 2095, focusing on implications from: 1) socioeconomics and growing demands, 2) the adoption of climate mitigation policy (e.g., RCP4.5 W/m2 vs. a reference scenario), 3) the transition of cooling systems, 4) constraints on electricity trading across states (full trading vs. limited trading), and 5) the adoption of water saving technologies. Overall, the fast retirement of once-through cooling, together with the gradual transition from fossil fuels dominant to a mixture of different fuels, accelerate the decline of water withdrawals and correspondingly compensate consumptive water use. Results reveal that U.S. electricity generation expands significantly as population grows

  6. The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study.

    Science.gov (United States)

    Odetola, Folafoluwa O; Miller, William C; Davis, Matthew M; Bratton, Susan L

    2005-07-01

    To describe the relationship between the location of Pediatric Intensive Care Unit (PICU) facilities and county-level child death from trauma in the contiguous USA. We conducted a cross-sectional ecologic study using county-level data on death due to trauma in children 0 to 14 years of age from 1996 to 1998. These data were linked to 1997 county-level data on availability of PICU facilities. In 1997, PICU facilities were present in 9% of USA counties. There were 18,337 childhood deaths from trauma in the study period. The presence of PICU facilities in a county was associated with lower mortality from trauma (incidence rate ratio [IRR] = 0.72; 95% CI 0.67-0.78) compared to counties without PICU facilities. After controlling for residence in rural and low-income counties, and the presence of adult medicosurgical intensive care units, the presence of PICU facilities in a county remained associated with lower rates of death from trauma (IRR = 0.82; 95% CI 0.75-0.89). The presence of PICU facilities is related to lower mortality rates due to traumatic injuries at the county level. This finding may reflect the concentration of pediatric subspecialty care in counties with PICUs. This association merits further study with individual-level observations.

  7. INTERNET CONNECTIVITY FOR MASS PRODUCED UNITS WITHOUT USER INTERFACE

    DEFF Research Database (Denmark)

    2000-01-01

    To the manufacturer of mass produced units without a user interface, typically field level units, connection of these units to a communications network for enabling servicing, control and trackability is of interest. To provide this connection, a solution is described in which an interface...... comprising an ASIC is built into a mass produced unit, whereby the ASIC is incorporating selected portions of selected layers of the Internet Protocol. The mass produced unit is then allocated a unit address....

  8. Evaluating coastal landscape response to sea-level rise in the northeastern United States: approach and methods

    Science.gov (United States)

    Lentz, Erika E.; Stippa, Sawyer R.; Thieler, E. Robert; Plant, Nathaniel G.; Gesch, Dean B.; Horton, Radley M.

    2014-02-13

    The U.S. Geological Survey is examining effects of future sea-level rise on the coastal landscape from Maine to Virginia by producing spatially explicit, probabilistic predictions using sea-level projections, vertical land movement rates (due to isostacy), elevation data, and land-cover data. Sea-level-rise scenarios used as model inputs are generated by using multiple sources of information, including Coupled Model Intercomparison Project Phase 5 models following representative concentration pathways 4.5 and 8.5 in the Intergovernmental Panel on Climate Change Fifth Assessment Report. A Bayesian network is used to develop a predictive coastal response model that integrates the sea-level, elevation, and land-cover data with assigned probabilities that account for interactions with coastal geomorphology as well as the corresponding ecological and societal systems it supports. The effects of sea-level rise are presented as (1) level of landscape submergence and (2) coastal response type characterized as either static (that is, inundation) or dynamic (that is, landform or landscape change). Results are produced at a spatial scale of 30 meters for four decades (the 2020s, 2030s, 2050s, and 2080s). The probabilistic predictions can be applied to landscape management decisions based on sea-level-rise effects as well as on assessments of the prediction uncertainty and need for improved data or fundamental understanding. This report describes the methods used to produce predictions, including information on input datasets; the modeling approach; model outputs; data-quality-control procedures; and information on how to access the data and metadata online.

  9. Evaluating Coastal Landscape Response to Sea-Level Rise in the Northeastern United States - Approach and Methods

    Science.gov (United States)

    Lentz, Erika E.; Stippa, Sawyer R.; Thieler, E. Robert; Plant, Nathaniel G.; Gesch, Dean B.; Horton, Radley M.

    2015-01-01

    The U.S. Geological Survey is examining effects of future sea-level rise on the coastal landscape from Maine to Virginia by producing spatially explicit, probabilistic predictions using sea-level projections, vertical land movement rates (due to isostacy), elevation data, and land-cover data. Sea-level-rise scenarios used as model inputs are generated by using multiple sources of information, including Coupled Model Intercomparison Project Phase 5 models following representative concentration pathways 4.5 and 8.5 in the Intergovernmental Panel on Climate Change Fifth Assessment Report. A Bayesian network is used to develop a predictive coastal response model that integrates the sea-level, elevation, and land-cover data with assigned probabilities that account for interactions with coastal geomorphology as well as the corresponding ecological and societal systems it supports. The effects of sea-level rise are presented as (1) level of landscape submergence and (2) coastal response type characterized as either static (that is, inundation) or dynamic (that is, landform or landscape change). Results are produced at a spatial scale of 30 meters for four decades (the 2020s, 2030s, 2050s, and 2080s). The probabilistic predictions can be applied to landscape management decisions based on sea-level-rise effects as well as on assessments of the prediction uncertainty and need for improved data or fundamental understanding. This report describes the methods used to produce predictions, including information on input datasets; the modeling approach; model outputs; data-quality-control procedures; and information on how to access the data and metadata online.

  10. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach.

    Science.gov (United States)

    Molter, G; Seifert, H; Mandraka, F; Kasper, G; Weidmann, B; Hornei, B; Öhler, M; Schwimmbeck, P; Kröschel, P; Higgins, P G; Reuter, S

    2016-02-01

    An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAb) occurred in an interdisciplinary intensive care unit, affecting 10 patients. Within hours of recognition of the spread of CRAb an intervention team was instituted for collection of available data, decision-making, communication and monitoring of all interventions performed, including cohorting, temporary stop of admissions, staff education, and enforcement of infection control measures. An area was defined for cohortation of patients colonized with CRAb, with a separate nursing team and a second set of mobile equipment. New transmissions were no longer observed after only four days into the institution of enhanced infection control measures. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  11. Internet Use Patterns, Acceptance Levels. and Policy Recommendations: An Information Technology Infusion Approach to the Internet and the United States Air Force.

    Science.gov (United States)

    1996-12-01

    well as policy recommendations regarding Internet use in the Air Force. The research provides substantial evidence that Internet technology is not being...highly infused at the headquaners-level than it is at base-level. This research also demonstrates that supervisory support for Internet use positively

  12. Educational Level and Illiteracy Rates of Mothers and Step-Fathers of Vietnamese Amerasians Enroute to the United States.

    Science.gov (United States)

    Ronk, Donald E.

    A study compared demographic and test data on the Vietnamese mothers or primary caregivers of Amerasian offspring (hereafter, Amerasian mothers) with those of non-Amerasian peers at the Philippine Refugee Processing Center. Eight hypotheses concerning the educational level, illiteracy rate, English language skills, husband's education, and…

  13. Training Level, Acculturation, Role Ambiguity, and Multicultural Discussions in Training and Supervising International Counseling Students in the United States

    Science.gov (United States)

    Ng, Kok-Mun; Smith, Shannon D.

    2012-01-01

    This research partially replicated Nilsson and Anderson's "Professional Psychology: Research and Practice" (2004) study on training and supervising international students. It investigated the relationships among international counseling students' training level, acculturation, supervisory working alliance (SWA), counseling self-efficacy (COSE),…

  14. School- and Family-Level Socioeconomic Status and Health Behaviors: Multilevel Analysis of a National Survey in Wales, United Kingdom

    Science.gov (United States)

    Moore, Graham F.; Littlecott, Hannah J.

    2015-01-01

    Background: Interventions to address inequalities in adolescent health behaviors often target children from less affluent families, or schools in poorer areas. Few studies have examined whether school- or family-level affluence predicts health behaviors independently, or in combination. Methods: This article reports secondary analysis of the Welsh…

  15. Training Level, Acculturation, Role Ambiguity, and Multicultural Discussions in Training and Supervising International Counseling Students in the United States

    Science.gov (United States)

    Ng, Kok-Mun; Smith, Shannon D.

    2012-01-01

    This research partially replicated Nilsson and Anderson's "Professional Psychology: Research and Practice" (2004) study on training and supervising international students. It investigated the relationships among international counseling students' training level, acculturation, supervisory working alliance (SWA), counseling self-efficacy (COSE),…

  16. The Haiku Moment: Seeing the World in a Grain of Sand. A Curriculum Unit for Elementary Levels. Revised.

    Science.gov (United States)

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    In recent years, haiku has become a widely adopted part of the language arts, social studies, and multicultural studies curriculum, particularly at the elementary level. Haiku became popular in the 17th and 18th centuries in Japan. Haiku remains popular because these poems describe nature and human experiences, as well as being simple and short.…

  17. The Haiku Moment: Seeing the World in a Grain of Sand. A Curriculum Unit for Secondary Levels. Revised.

    Science.gov (United States)

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    In recent years, haiku has become a widely adopted part of the language arts curriculum, particularly at the elementary level. Educators appreciate the simplicity and brevity of haiku as a poetic form that young students can grasp fairly easily and therefore express themselves readily. However, this focus on form has often been to the exclusion of…

  18. Low level technology tool (LLTT) in screening for blindness: test qualities in the outpatients department of a tertiary eye unit using the Snellen chart.

    Science.gov (United States)

    Masanganise, R; Rusakaniko, S; Manjonjori, N

    2010-01-01

    To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to reach parts of the country where the conventional visual acuity charts are not available. Aperformance evaluation of counting fingers (LLTT) in screening for blindness against the standard test (Snellen chart). Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Zimbabwe. Patients presenting to the Eye Outpatient Department at Sekuru Kaguvi Eye Unit with various eye problems. Sensitivity of low level technology tool (LLTT) in identifying blind people. Sensitivity and specificity of LLTT in detecting blindness in all age groups combined was 100% and 88.5% respectively. Although sensitivity was not affected by patient age, specificity decreased with increasing age. The overall positive predictive value for the test was 53.3% and the prevalence of blindness among outpatient attendees was 11.6%. Finger counting is an effective tool that can be employed in screening for blindness in communities which are hard to reach, have low literacy rate and when conventional methods of testing visual acuity are not available.

  19. Using a Geospatial Model to Relate Fluvial Geomorphology to Macroinvertebrate Habitat in a Prairie River—Part 2: Matching Family-Level Indices to Geomorphological Response Units (GRUs

    Directory of Open Access Journals (Sweden)

    Anna Grace Nostbakken Meissner

    2016-03-01

    Full Text Available Many rivers are intensely managed due to anthropogenic influences such as dams, channelization, and water provision for municipalities, agriculture, and industry. With this growing pressure on fluvial systems comes a greater need to evaluate the state of their ecosystems. The purpose of this research is to use a geospatial model of the Qu’Appelle River in Saskatchewan to distinguish instream macroinvertebrate habitats at the family level. River geomorphology was assessed through the use of ArcGIS and digital elevation models; with these tools, the sinuosity, slope, fractal dimension, and stream width of the river were processed. Subsequently, Principal Component Analysis, a clustering technique, revealed areas with similar sets of geomorphological characteristics. These similar typology sequences were then grouped into geomorphological response units (GRUs, designated a color, and mapped into a geospatial model. Macroinvertebrate data was then incorporated to reveal several relationships to the model. For instance, certain GRUs contained more highly sensitive species and healthier diversity levels than others. Future possibilities for expanding on this project include incorporating stable isotope data to evaluate the food-web structure within the river basin. Although GRUs have been very successful in identifying fish habitats in other studies, the macroinvertebrates may be too sessile and their habitat too localized to be identified by such large river units. Units may need to be much shorter (250 m to better identify macroinvertebrate habitat.

  20. Outbreak of Streptococcus pyogenes emm type 58 in a high dependency unit of a level-1 trauma center of India

    Directory of Open Access Journals (Sweden)

    Purva Mathur

    2014-01-01

    Full Text Available Background and Aims: Group A Streptococcus (GAS can cause illnesses ranging from self-limited to severe, life-threatening, invasive infections. The objective of the following study was to investigate a suspected Streptococcus pyogenes outbreak in a high dependency unit (HDU of our trauma center. Materials and Methods: All the isolates of beta hemolytic Streptococci were identified by standard microbiological methods, Vitek 2 system and latex agglutination tests. Antimicrobial susceptibility testing was performed as recommended by Clinical Laboratory Standards Institute. Exotoxin genes, including speA, speB, speC, speF, smeZ, ssa, speG, speH, speJ, speL, speM and speI were detected by polymerase chain reaction (PCR. The emm types of isolates of S. pyogenes were determined by sequencing the variable 5′ end of emm gene after amplification by PCR. Results: In a 28 bedded poly-trauma ward with a four bedded HDU three out of four patients developed S. pyogenes emm type 58 infection. The strain was macrolide and tetracycline resistant and produced the Streptococcal pyrogenic exotoxins speB, speC, speG, speF and smeZ. Surveillance sampling was done for investigation from patients, health-care workers and environmental samples. Conclusion: An outbreak of GAS infections was established caused by the uncommonly reported emm type 58. The outbreak was controlled by prompt treatment, intensive surveillance, feedback and training.

  1. Free protein S level as a risk factor for coronary heart disease and stroke in a prospective cohort study of healthy United Kingdom men.

    Science.gov (United States)

    Ken-Dror, Gie; Cooper, Jackie A; Humphries, Steve E; Drenos, Fotios; Ireland, Helen A

    2011-10-15

    Plasma protein S (PS) levels are reportedly low in patients with venous thrombosis but high in coronary heart disease (CHD) patients. The authors examined the association between free PS concentration and CHD or stroke risk and assessed risk in combination with C-reactive protein (CRP) levels. Free PS concentration was determined in 6 annual visits among 3,052 middle-aged (49-64 years) United Kingdom men from the Second Northwick Park Heart Study, with 297 CHD events from 1989 to 2005. The highest (vs. first) quintile was associated with a significantly increased CHD risk after adjustment for all other risk factors and correction for regression dilution bias (hazard ratio = 1.85, 95% confidence interval: 1.08, 3.16; P = 0.024). Models that included all well-known risk factors plus PS quintiles improved prediction of CHD (net reclassification improvement (NRI) = 7.0% (P = 0.007), category-less NRI (>0) = 22.1% (P < 0.001)), and the likelihood ratio statistic increased significantly (P = 0.018). The increase in CHD risk was particularly strong when subjects also had high CRP levels. There was no association between free PS level and stroke risk. This study confirms the independent association of elevated free PS levels with future risk of CHD, although elevated PS levels added only modestly to prediction metrics. The novel finding of increased CHD risk, particularly when CRP and PS levels are high, requires further study.

  2. A factors influencing applicant selection of entry-level physical therapist education programs in the United States.

    Science.gov (United States)

    Wilcox, Kim Curbow; Weber, Mark

    2005-01-01

    Physical therapist education programs must compete for qualified applicants due to a nationwide reduction in the applicant pool. To develop successful recruitment strategies, faculty members need information on factors influencing applicant selection of a program. The purpose of this study was to analyze factors influencing selection of an entry-level physical therapist education program. Survey subjects were students enrolled in the first professional year of an accredited entry-level physical therapist education program. A survey instrument was developed based on the literature and interviews with physical therapist students and faculty members. Results of pilot studies to determine face and content validity were acceptable. Stratified random cluster sampling was applied to select 66 entry-level physical therapy programs from an available population of 150 of the 199 accredited programs. Forty-nine programs were not included in the population for various reasons. Using a five-point Likert scale, subjects rated the influence of 51 items on their selection of a specific physical therapist education program. The overall return rate was 70.4% (1,250 surveys returned). Data were analyzed by response frequency. Four factors were selected as "very influential" by 50% or more of the subjects: degree offered, accreditation status, perception of educational quality, and program atmosphere. Additional factors selected by 45% or more of respondents as "very influential" were pass rate on licensing examination, marketability of degree, student/faculty ratio, and small class size. Factors rated "not influential" by 50% or more of subjects included ethnic, cultural, and gender issues. Since 1998, the physical therapy profession has experienced changes in entry-level degree requirements, practice requirements, and employment opportunities, resulting in increased competition for qualified applicants to education programs. The information gained in this study may assist faculty in

  3. Urinary cadmium levels and tobacco smoke exposure in women age 20-69 years in the United States.

    Science.gov (United States)

    McElroy, J A; Shafer, M M; Trentham-Dietz, A; Hampton, J M; Newcomb, P A

    2007-10-01

    Cadmium is a toxic, bioaccumulated heavy metal with a half-life of one to four decades in humans (CDC, 2005). Primary exposure sources include food and tobacco smoke. In our population-based study, a risk-factor interview was conducted as part of a breast cancer study for 251 randomly selected women living in Wisconsin (USA), aged 20-69 yr, and spot-urine specimens were also obtained. Urine collection kits were carefully designed to minimize trace element contamination during specimen collection and handling in each participant's home. Urine cadmium concentrations were quantified using inductively coupled plasma-mass spectrometry, and creatinine levels and specific gravity were also determined. Statistically significant increasing creatinine-adjusted urinary cadmium mean levels relative to smoking status (never, former, and current respectively) were observed. A difference in mean cadmium levels for nonsmokers who reported environmental tobacco smoke exposure during childhood or the recent past (approximately 2 yr prior to the interview) for exposure at home, at work, or in social settings compared to those who reported no exposure was not found.

  4. Serum penicillin G levels are lower than expected in adults within two weeks of administration of 1.2 million units.

    Directory of Open Access Journals (Sweden)

    Michael P Broderick

    Full Text Available When introduced in the 1950s, benzathine penicillin G (BPG was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90 of 0.016 µg/ml. We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 µg/ml, and by day 15<0.01 µg/ml. Levels in more than 50% of the subjects were below 0.02 µg/ml on day 9, and <.01 µg/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2½ weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.

  5. Pre-Study of Off-site Consequence Analysis in Level 3 PSA of Wolsong Unit 1

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won-Jik; Yang, Ho-Chang; Choi, Seong-Soo [ACT, Daejeon (Korea, Republic of)

    2015-10-15

    In order to perform level 3 PSA, MACCS II (MELCOR Accident Consequence Code System 2) is needed. MACCS II is used in PSA for plants in order to evaluate population dose that is the effects on health and environment caused by released radioisotopes after an accident. In this study, Steam Generator Tube Rupture (SGTR) event in CANDU-6 plants is evaluated population dose that is the effects on health and environment caused by released radioisotopes after an accident. In this study, Steam Generator Tube Rupture (SGTR) event has been evaluated by using Level 1 PSA result and Level 2 PSA result(ISSAC) and MACCS II. As a result, We are obtained the following conclusion. - Early maximum early fatalities is 5.35E+02 equal to latent maximum early fatalities.(99.5%) - Early and latent maximum cancer fatalities are 2.33E+03 and 1.11E+04, respectively. (99.5%) - Early and latent maximum population doses are 1.25 and 5.00 person-rem/yr, respectively. (99.5%) Other study has shown that MACCS II was performed evaluation for Wolsong NPP. Small Break Loss of Coolant Accident(SBLOCA) event is selected by other study. The results of early and cancer fatalities applied similar assumption were 3.02E+00 and 1.89E+03, respectively. This study's results are higher than other study's result. Because, basis input data is different each studies, and event frequency are different (This study : 2.10E-07/ Other study : 4.93E-09)

  6. Cadmium levels in soils and plants from some long-term soil fertility experiments in the United States of America

    Energy Technology Data Exchange (ETDEWEB)

    Mortvedt, J.J.

    Phosphate fertilizers contain varying amounts of Cd and other heavy metals as contaminants from phosphate rock (PR). To determine whether periodic applications of P fertilizers resulted in measurable accumulations of Cd in soils and in harvested crops, soil and plant tissue samples from nine long-term (>50 yr) soil fertility experiments in the USA were analyzed for Cd, as well as P and other elements. Annual Cd rates were estimated to range from 0.3 to 1.2 g ha/sup -1/ in these experiments. Plant tissues analyzed were corn (Zea mays L.), soybean (Glycine max L. Merr.), and wheat (Triticum aestivum L.) leaves or grain, and timothy (Phleum pratense L.) forage. Results from these long-term experiments have shown that plant uptake of Cd contaminants in P fertilizers containing < 10 mg Cd kg/sup -1/ is negligible. While the Cd accumulations in soil in these experiments could not be calculated, they would approximate that accumulated in most agricultural soils in the USA at this time. About 70% of the P fertilizers is produced from Florida PR, which contains <10 mg kg/sup -1/ of Cd, as compared with about 10% from the western USA, which contains higher Cd levels. Therefore, adding Cd to soils as a contaminant in P fertilizers at rates ranging from 0.3 to 1.2 g Cd ha/sup -1/ does not appear to result in increased Cd levels in plants as a result of long-term P fertilization.

  7. Implementation of a Sage-Based Stirling Model Into a System-Level Numerical Model of the Fission Power System Technology Demonstration Unit

    Science.gov (United States)

    Briggs, Maxwell H.

    2011-01-01

    The Fission Power System (FPS) project is developing a Technology Demonstration Unit (TDU) to verify the performance and functionality of a subscale version of the FPS reference concept in a relevant environment, and to verify component and system models. As hardware is developed for the TDU, component and system models must be refined to include the details of specific component designs. This paper describes the development of a Sage-based pseudo-steady-state Stirling convertor model and its implementation into a system-level model of the TDU.

  8. Forest cover change in the upper Midwestern United States results from both climate and land use change following European settlement: Historical survey and weather records provide robust support for modeling applications

    Science.gov (United States)

    Goring, S. J.; Williams, J. W.; McLachlan, J. S.; Dawson, A.; Dietze, M.; Paciorek, C. J.; Mladenoff, D. J.; Record, S.; Cogbill, C. V.; Hooten, M.; Ruid, M.; Jackson, S. T.

    2013-12-01

    Since European settlement, both climate and human land use have acted on forests in the upper Midwestern United States resulting in changes in forest structure and composition. The extent of these changes has been examined locally and at the state level by examining forest records from the Public Lands Survey System (PLSS), but here we bring together records of changing forest composition with weather records from the mid to late 19th century from the 19th Century Forts and Observer's Database. We are able to assign attribution for taxon range and composition shifts in the region to either land use, climate or both. We see that much of the range contraction in the region seen when comparing Forest Inventory and Analysis data with Public Land Survey System data occurs along the prairie margin, with northern forests showing greater stability in both range and composition suggesting a dominant role for land use in structuring regional vegetation. Modern forests are often less diverse than PLSS forests and the mean minimum dissimilarity between modern and PLSS-era forests is significantly higher than the minimum dissimilarity within either the PLSS-era forests or the modern (FIA) forests, indicating the possiblity that our modern forests have already become 'no-analogue' ecosystems.

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

    Science.gov (United States)

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

    2012-10-15

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

  10. High Pdr12 levels in spoilage yeast (Saccharomyces cerevisiae) correlate directly with sorbic acid levels in the culture medium but are not sufficient to provide cells with acquired resistance to the food preservative.

    Science.gov (United States)

    Papadimitriou, Minas N B; Resende, Catarina; Kuchler, Karl; Brul, Stanley

    2007-01-25

    Sorbic acid is a commonly used food preservative against yeast and fungal food spoilage. Understanding its effect on the molecular physiology of yeast cells will allow the food industry to develop knowledge-based strategies to make more optimal use of its preservative action. Here we show that the yeast membrane protein Pdr12, previously shown to be prominently involved in sorbic acid resistance development in laboratory strains, was strongly induced by the presence of sorbic acid in the culture medium in Saccharomyces strains isolated from spoiled foods. Induction of Pdr12 expression was seen both under laboratory conditions and upon growth in a commercial soft drink. Induction was rapid and maintained for the duration of the stress. No Pdr12-like protein induction was seen in Zygosaccharomyces bailii or Zygosaccharomyces lentus, two well-known beverages spoilage organisms. Finally, unexpectedly, our studies showed for the first time that pre-inducing Pdr12p to maximal levels by subjecting cells to a mild sorbic acid stress did not lead to cells with an acquired resistance. Neither more rapid growth in the presence of the acid nor growth at higher sorbic acid concentrations at a given environmental pH was observed. Thus we have shown that while important in resistance development against sorbic acid, by itself induction of the pump is not sufficient to acquire resistance to the preservative.

  11. Assessment of the Level of Satisfaction and Unmet Data Needs for Specialty Drug Formulary Decisions in the United States.

    Science.gov (United States)

    Choi, Yoonyoung; Navarro, Robert P

    2016-04-01

    Formulary management within a limited budget is critical, especially for specialty drugs, which are used for serious medical conditions and are very expensive. Despite attempts to summarize the pertinent evidence, it is uncertain whether data needs of formulary decision makers for specialty drugs are satisfied. To assess the level of satisfaction of specialty drug formulary decision makers with regards to the strength of current available data sources and unmet needs regarding clinical, economic, and unpublished evidence. This study targeted pharmacists and physicians involved with formulary decision making at health plans or pharmacy benefit management companies at the national, large regional, and local levels. 95 individuals were invited to participate (without compensation) in a 21-item, web-based survey (Qualtrics), which was open from June 14 to July 31, 2014. The responses were coded for descriptive and statistical analysis. Statistical analyses included the Kruskal-Wallis test, analysis of variance, and the Mann-Whitney-Wilcoxon test. Of 95 pharmacists or physicians, 40 respondents initiated the survey, and 33 respondents completed the survey (response rate = 34.7%). Drug formulary decision makers infrequently rated data evidence strength (17.1% "always"). Clinical data evidence strength was rated highest with published randomized controlled trials (RCTs; mean [SD] = 4.06 [0.87] of 5.0), while participant organizations' internal data were rated highest for economic data evidence strength (mean [SD] = 3.91 [1.07] of 5.0). Decision makers rated the highest unmet need as more data generated from head-to-head RCTs (mean [SD] = 2.94 [0.25] of 3.0) and cost-effectiveness analyses (mean [SD] = 2.53 [0.67] of 3.0). The participants believed manufacturers might be in the best position to satisfy their desire for head-to-head RCTs (mean [SD] = 4.31 [1.09] of 5.0). Despite a variety of data sources, drug formulary decision makers continue to rely on published RCTs or

  12. Complications of Trauma Patients Admitted to the ICU in Level I Academic Trauma Centers in the United States

    Directory of Open Access Journals (Sweden)

    Stefania Mondello

    2014-01-01

    Full Text Available Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality. Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications. Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%. Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications (R=0.435,P<0.0001. The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR of developing complication for patients over age 75 versus young adults was 0.7 (P<0.0001. Among males, traumatic central nervous system (CNS injury was an important predictor for complications (adjusted OR 1.24. Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.

  13. Quantitative Detection of Hepatitis A Virus and Enteroviruses Near the United States-Mexico Border and Correlation with Levels of Fecal Indicator Bacteria▿

    Science.gov (United States)

    Gersberg, Richard M.; Rose, Michael A.; Robles-Sikisaka, Refugio; Dhar, Arun K.

    2006-01-01

    For decades, untreated sewage flowing northward from Tijuana, Mexico, via the Tijuana River has adversely affected the water quality of the recreational beaches of San Diego, California. We used quantitative reverse transcription-PCR to measure the levels of hepatitis A virus (HAV) and enteroviruses in coastal waters near the United States-Mexico border and compared these levels to those of the conventional fecal indicators, Escherichia coli and enterococci. Over a 2-year period from 2003 to 2005, a total of 20 samples were assayed at two sites during both wet and dry weather: the surfzone at the mouth of the Tijuana River and the surfzone near the pier at Imperial Beach (IB), California (about 2 km north of the mouth of the Tijuana River). HAV and enterovirus were detected in 79 and 93% of the wet-weather samples, respectively. HAV concentrations in these samples ranged from 105 to 30,771 viral particles/liter, and enterovirus levels ranged from 7 to 4,417 viral particles/liter. The concentrations of HAV and enterovirus were below the limit of detection for all dry weather samples collected at IB. Regression analyses showed a significant correlation between the densities of both fecal bacterial indicators and the levels of HAV (R2 > 0.61, P 0.70, P < 0.0001), a finding that supports the use of conventional bacterial indicators to predict the levels of these viruses in recreational marine waters. PMID:16980430

  14. Quantitative detection of hepatitis a virus and enteroviruses near the United States-Mexico border and correlation with levels of fecal indicator bacteria.

    Science.gov (United States)

    Gersberg, Richard M; Rose, Michael A; Robles-Sikisaka, Refugio; Dhar, Arun K

    2006-12-01

    For decades, untreated sewage flowing northward from Tijuana, Mexico, via the Tijuana River has adversely affected the water quality of the recreational beaches of San Diego, California. We used quantitative reverse transcription-PCR to measure the levels of hepatitis A virus (HAV) and enteroviruses in coastal waters near the United States-Mexico border and compared these levels to those of the conventional fecal indicators, Escherichia coli and enterococci. Over a 2-year period from 2003 to 2005, a total of 20 samples were assayed at two sites during both wet and dry weather: the surfzone at the mouth of the Tijuana River and the surfzone near the pier at Imperial Beach (IB), California (about 2 km north of the mouth of the Tijuana River). HAV and enterovirus were detected in 79 and 93% of the wet-weather samples, respectively. HAV concentrations in these samples ranged from 105 to 30,771 viral particles/liter, and enterovirus levels ranged from 7 to 4,417 viral particles/liter. The concentrations of HAV and enterovirus were below the limit of detection for all dry weather samples collected at IB. Regression analyses showed a significant correlation between the densities of both fecal bacterial indicators and the levels of HAV (R2>0.61, P0.70, P<0.0001), a finding that supports the use of conventional bacterial indicators to predict the levels of these viruses in recreational marine waters.

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

    Directory of Open Access Journals (Sweden)

    Mahore RK

    2015-04-01

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

  16. Multi-level multi-criteria analysis of alternative fuels for waste collection vehicles in the United States.

    Science.gov (United States)

    Maimoun, Mousa; Madani, Kaveh; Reinhart, Debra

    2016-04-15

    Historically, the U.S. waste collection fleet was dominated by diesel-fueled waste collection vehicles (WCVs); the growing need for sustainable waste collection has urged decision makers to incorporate economically efficient alternative fuels, while mitigating environmental impacts. The pros and cons of alternative fuels complicate the decisions making process, calling for a comprehensive study that assesses the multiple factors involved. Multi-criteria decision analysis (MCDA) methods allow decision makers to select the best alternatives with respect to selection criteria. In this study, two MCDA methods, Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) and Simple Additive Weighting (SAW), were used to rank fuel alternatives for the U.S. waste collection industry with respect to a multi-level environmental and financial decision matrix. The environmental criteria consisted of life-cycle emissions, tail-pipe emissions, water footprint (WFP), and power density, while the financial criteria comprised of vehicle cost, fuel price, fuel price stability, and fueling station availability. The overall analysis showed that conventional diesel is still the best option, followed by hydraulic-hybrid WCVs, landfill gas (LFG) sourced natural gas, fossil natural gas, and biodiesel. The elimination of the WFP and power density criteria from the environmental criteria ranked biodiesel 100 (BD100) as an environmentally better alternative compared to other fossil fuels (diesel and natural gas). This result showed that considering the WFP and power density as environmental criteria can make a difference in the decision process. The elimination of the fueling station and fuel price stability criteria from the decision matrix ranked fossil natural gas second after LFG-sourced natural gas. This scenario was found to represent the status quo of the waste collection industry. A sensitivity analysis for the status quo scenario showed the overall ranking of diesel and

  17. Niveles de estrés en el personal de enfermería de unidades de cuidados paliativos Stress levels on nursing staff of palliative care units

    Directory of Open Access Journals (Sweden)

    Cristina Gómez Cantorna

    2012-06-01

    Full Text Available Mediante este estudio, nos gustaría saber cuál es el nivel de estrés que padecen las enfermeras, que trabajan en unidades de cuidados paliativos. Para ello hemos elegido una muestra de 94 enfermeras del SERGAS (Servicio Galego de Saúde, de las distintas unidades de cuidados paliativos, utilizando un cuestionario de datos sociodemográficos y organizacionales junto con el Maslach Burnout Inventory, como instrumentos evaluatorios. Después del análisis de los datos observamos que el personal de enfermería que trabaja en dichas unidades de cuidados paliativos, no presenta un nivel de estrés tan elevado como el que nosotros planteábamos al principio de nuestro estudio.Through this study, we would like to know what level of stress experienced by nurses working in palliative care units. We have chosen a sample of 94 nurses of SERGAS (Servicio Galego de las Saúde of the different palliative care units, using a questionnaire on demographic and organizational data with the Maslach Burnout Inventory, for assessment tools. After analyzin the dat we note that the nursing staff working in this departament of palliative care, no estres levels as high as we posed at the beginning of our study.

  18. Impact of the 2008 Global Recession on air quality over the United States: Implications for surface ozone levels from changes in NOx emissions

    Science.gov (United States)

    Tong, Daniel; Pan, Li; Chen, Weiwei; Lamsal, Lok; Lee, Pius; Tang, Youhua; Kim, Hyuncheol; Kondragunta, Shobha; Stajner, Ivanka

    2016-09-01

    Satellite and ground observations detected large variability in nitrogen oxides (NOx) during the 2008 economic recession, but the impact of the recession on air quality has not been quantified. This study combines observed NOx trends and a regional chemical transport model to quantify the impact of the recession on surface ozone (O3) levels over the continental United States. The impact is quantified by simulating O3 concentrations under two emission scenarios: business-as-usual (BAU) and recession. In the BAU case, the emission projection from the Cross-State Air Pollution Rule is used to estimate the "would-be" NOx emission level in 2011. In the recession case, the actual NO2 trends observed from Air Quality System ground monitors and the Ozone Monitoring Instrument on the Aura satellite are used to obtain "realistic" changes in NOx emissions. The model prediction with the recession effect agrees better with ground O3 observations over time and space than the prediction with the BAU emission. The results show that the recession caused a 1-2 ppbv decrease in surface O3 concentration over the eastern United States, a slight increase (0.5-1 ppbv) over the Rocky Mountain region, and mixed changes in the Pacific West. The gain in air quality benefits during the recession, however, could be quickly offset by the much slower emission reduction rate during the post-recession period.

  19. A Descriptive Study to Determine the Level of Crisis Preparedness Frontline Leaders Are Trained to Perform during an Exploding Crisis in Los Angeles County Healthcare Facilities, Providing Emergency Services

    Science.gov (United States)

    Corbaley, Salomay Rose

    2010-01-01

    Purpose: The purpose of this study was to determine the level of crisis leadership preparedness facility administrators report frontline healthcare leaders are trained to perform during an exploding crisis in Los Angeles County healthcare facilities, providing emergency services. Methodology: This was a mixed method descriptive study. The…

  20. Effect of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit.

    Science.gov (United States)

    Sugisaki, Norihide; Kawakami, Yasuo; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2011-07-28

    Findings from animal experiments are sometimes contradictory to the idea that the tendon structure is a simple elastic spring in series with muscle fibers, and suggest influence of muscle contraction on the tendon mechanical properties. The purpose of the present study was to investigate the influence of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit. For seven subjects, ankle dorsiflexion was performed without (passive condition) and with contraction of plantar flexor muscles (eccentric conditions, at 3 contraction levels) on an isokinetic dynamometer. Deformation of the Achilles tendon during each trial was measured using ultrasonography. The Achilles tendon force corresponding to the tendon elongation of 10mm in the passive condition was significantly smaller than those in the eccentric conditions (p<0.05 or p<0.01). Within the eccentric conditions, the Achilles tendon force corresponding to the tendon elongation of 10mm was significantly greater in the maximal contraction level than those in submaximal eccentric conditions (p<0.05 or p<0.01). In addition, the tendon stiffness was greater in higher contraction levels (p<0.05 or p<0.01). Present results suggest that the human tendon structure is not a simple elastic spring in series with muscle fibers.

  1. Life Insurance for Consumers: A Teacher's Guide. A Teacher Inservice Module for Secondary Level Consumer Education Units in Home Economics, Business Education, Social Studies and Related Areas.

    Science.gov (United States)

    Thelen, Judith

    This teacher-oriented learning module for secondary level consumer education teachers, the first in a series of three, was developed to provide information on life insurance and ideas for conveying this content to students. The module begins with a definition and general goals of consumer economics, an overview, a pre-test, a performance objective…

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

    Science.gov (United States)

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

    2011-02-01

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

  3. Lanreotide extended-release aqueous-gel formulation, injected by patient, partner or healthcare provider in patients with acromegaly in the United States: 1-year data from the SODA registry.

    Science.gov (United States)

    Salvatori, Roberto; Woodmansee, Whitney W; Molitch, Mark; Gordon, Murray B; Lomax, Kathleen G

    2014-02-01

    Lanreotide depot (LD; commercial name Somatuline(®) Depot) is an injectable, extended-release formulation of the synthetic somatostatin analog (SSA) lanreotide. In recent clinical trials, LD was found to be suitable for self or partner administration, avoiding the need to travel to a medical facility. The Somatuline(®) Depot for Acromegaly (SODA) study is an ongoing, multicenter, observational study in the US investigating the efficacy, safety, convenience and symptom relief provided by LD in patients with acromegaly. Sub-analyses explore outcomes according to who administered the injection: patient, partner, healthcare provider (HCP) or a combination. Data reported here reflect one year of patient experience. Patients are eligible for inclusion if they have a diagnosis of acromegaly, are treated with LD and can give signed informed consent. Baseline data include patient demographics, previous acromegaly treatment and investigations, GH and IGF-I levels, LD dose and dose adjustment frequency. Symptom frequency, injection pain and treatment convenience are assessed using patient-reported questionnaires. As of 18 April 2012, 166 patients had enrolled in SODA. Most (72 %) achieved normal IGF-I levels after 12 months of LD treatment. Disease control was similar in self or partner injectors and in patients who received injections from their HCP, although self or partner injecting was deemed more convenient. LD was well-tolerated irrespective of who performed the injection. Self injection led to more injection-site reactions, but this did not increase the rate of treatment interruption. Acromegaly symptoms remained stable. Biochemical, safety and convenience data support the clinical validity of injecting LD at home.

  4. Achieving Provider Engagement

    Science.gov (United States)

    Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew

    2014-01-01

    The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. PMID:25212855

  5. Using a Bayesian Network to predict shore-line change vulnerability to sea-level rise for the coasts of the United States

    Science.gov (United States)

    Gutierrez, Benjamin T.; Plant, Nathaniel G.; Pendleton, Elizabeth A.; Thieler, E. Robert

    2014-01-01

    Sea-level rise is an ongoing phenomenon that is expected to continue and is projected to have a wide range of effects on coastal environments and infrastructure during the 21st century and beyond. Consequently, there is a need to assemble relevant datasets and to develop modeling or other analytical approaches to evaluate the likelihood of particular sea-level rise impacts, such as coastal erosion, and to inform coastal management decisions with this information. This report builds on previous work that compiled oceanographic and geomorphic data as part of the U.S. Geological Survey’s Coastal Vulnerability Index (CVI) for the U.S. Atlantic coast, and developed a Bayesian Network to predict shoreline-change rates based on sea-level rise plus variables that describe the hydrodynamic and geologic setting. This report extends the previous analysis to include the Gulf and Pacific coasts of the continental United States and Alaska and Hawaii, which required using methods applied to the USGS CVI dataset to extract data for these regions. The Bayesian Network converts inputs that include observations of local rates of relative sea-level change, mean wave height, mean tide range, a geomorphic classification, coastal slope, and observed shoreline-change rates to calculate the probability of the shoreline-erosion rate exceeding a threshold level of 1 meter per year for the coasts of the United States. The calculated probabilities were compared to the historical observations of shoreline change to evaluate the hindcast success rate of the most likely probability of shoreline change. Highest accuracy was determined for the coast of Hawaii (98 percent success rate) and lowest accuracy was determined for the Gulf of Mexico (34 percent success rate). The minimum success rate rose to nearly 80 percent (Atlantic and Gulf coasts) when success included shoreline-change outcomes that were adjacent to the most likely outcome. Additionally, the probabilistic approach determines the

  6. A dynamic level IV multimedia environmental model: application to the fate of polychlorinated biphenyls in the United Kingdom over a 60-year period.

    Science.gov (United States)

    Sweetman, Andrew J; Cousins, Ian T; Seth, Rajesh; Jones, Kevin C; Mackay, Donald

    2002-05-01

    A dynamic or level IV multimedia model is described and illustrated by application to the fate of three polychlorinated biphenyl (PCB) congeners in the United Kingdom over a 60-year period from their introduction into commerce until the present. Models of this type are shown to be valuable for elucidating the time response of environmental systems to increasing, decreasing, or pulse inputs. The suggestion is made that in addition to the outputs of time-dependent concentrations (which can be compared with monitoring data for validation purposes), it is useful to examine masses, fugacities, and fugacity ratios between media? The relative importance of processes is best evaluated by compiling cumulative intermedia fluxes and quantities lost by reaction and advection and examining the corresponding process rate constants or their reciprocals, the characteristic times. The suggestion is made that uncertainty and sensitivity analyses are desirable, but it must be appreciated that relative sensitivities of input parameters may change during the simulation period, so a single sensitivity analysis conducted at one point in time can be misleading. The use of the model for forecasting future trends in concentration is illustrated. Given the uncertainties in emission and advective inflow rates, the simulation of PCB fate in the United Kingdom is regarded as showing time trends that are in satisfactory agreement with monitoring data.

  7. Consumers' segmentation based on the acceptability of meat from entire male pigs with different boar taint levels in four European countries: France, Italy, Spain and United Kingdom.

    Science.gov (United States)

    Panella-Riera, N; Blanch, M; Kallas, Z; Chevillon, P; Garavaldi, A; Gil, M; Gil, J M; Font-i-Furnols, M; Oliver, M A

    2016-04-01

    Two consumer studies were conducted to know the acceptability of pork with different boar taint levels: test 1 performed in Spain (n=126) and United Kingdom (n=146), and test 2 performed in France (n=139) and Italy (n=140). Each test had 3 types of pork: 'Female meat', 'Low boar tainted meat', and a third type was 'Medium boar tainted meat' or 'High boar tainted meat'. Three main clusters were identified on the basis of 'How delicious do you find this meat?': 1-Pork lovers, 2-Boar meat lovers, 3-Reject boar tainted meat. Additionally, in test 2, a fourth cluster was identified: 'Reject low tainted meat'. A group of 16.2-38.2% of consumers rejected meat from boars, and another group of 12.4-21.7% rated the meat with medium or high levels of boar taint better than the meat from females, identifying a niche for meat from medium and high levels of boar taint, and suggesting the need to select carcasses on the basis of boar taint.

  8. Improvement of the performances of a tandem simulated moving bed chromatography by controlling the yield level of a key product of the first simulated moving bed unit.

    Science.gov (United States)

    Mun, Sungyong; Wang, Nien-Hwa Linda

    2017-03-10

    One of the trustworthy processes for ternary separation is a tandem simulated moving bed (SMB) process, which consists of two subordinate four-zone SMB units (Ring I and Ring II). To take full advantage of a tandem SMB as a means of recovering all three products with high purities and high economical efficiency, it is important to understand how the separation condition in Ring II is affected by that in Ring I, and further to reflect such point in the stage of designing a tandem SMB. In regard to such issue, it was clarified in this study that the Ring I factors affecting the Ring II condition could be represented by the yield level of a key product of Ring I (Ykey(RingI)). As the Ykey(RingI) level became higher, the amount of the Ring I key-product that was reloaded into Ring II was reduced, which affected favorably the Ring II separation condition. On the other hand, the higher Ykey(RingI) level caused a larger dilution for the stream from Ring I to Ring II, which affected adversely the Ring II separation condition. As a result, a minimum in the desorbent usage of a tandem SMB occurred at the Ykey(RingI) level where the two aforementioned factors could be balanced with each other. If such an optimal Ykey(RingI) level was adopted, the desorbent usage could be reduced by up to 25%. It was also found that as the throughput of a tandem SMB became higher, the factor related to the migration of the Ring I key-product into Ring II was more influential in the performances of a tandem SMB than the factor related to the dilution of the stream from Ring I to Ring II.

  9. County-level estimates of nitrogen and phosphorus from animal manure for the conterminous United States, 2007 and 2012

    Science.gov (United States)

    Gronberg, JoAnn M.; Arnold, Terri L.

    2017-03-24

    County-level estimates of nitrogen and phosphorus inputs from animal manure for the conterminous United States were calculated from animal population inventories in the 2007 and 2012 Census of Agriculture, using previously published methods. These estimates of non-point nitrogen and phosphorus inputs from animal manure were compiled in support of the U.S. Geological Survey’s National Water-Quality Assessment Project of the National Water Quality Program and are needed to support national-scale investigations of stream and groundwater water quality. The estimates published in this report are comparable with older estimates which can be compared to show changes in nitrogen and phosphorus inputs from manure over time.

  10. The 2011 United Nations high-level meeting on non-communicable diseases: the Africa agenda calls for a 5-by-5 approach.

    Science.gov (United States)

    Mensah, G A; Mayosi, B M

    2012-11-08

    The High Level Meeting of the 66th Session of the United Nations General Assembly was held in September 2011. The Political Declaration issued at the meeting focused the attention of world leaders and the global health community on the prevention and control of noncommunicable diseases (NCDs). The four major NCDs (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases) and their four risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol) constitute the target of the '4-by-4' approach, which is also supported by national and international health organisations. We argue that while preventing these eight NCDs and risk factors is also important in Africa, it will not be enough. A '5-by-5' strategy is needed, addressing neuropsychiatric disorders as the fifth NCD; and transmissible agents that underlie the neglected tropical diseases and other NCDs as the fifth risk factor. These phenomena cause substantial preventable death and disability, and must therefore be prioritised.

  11. Evaluation of accuracy of complete-arch multiple-unit abutment-level dental implant impressions using different impression and splinting materials.

    Science.gov (United States)

    Buzayan, Muaiyed; Baig, Mirza Rustum; Yunus, Norsiah

    2013-01-01

    This in vitro study evaluated the accuracy of multiple-unit dental implant casts obtained from splinted or nonsplinted direct impression techniques using various splinting materials by comparing the casts to the reference models. The effect of two different impression materials on the accuracy of the implant casts was also evaluated for abutment-level impressions. A reference model with six internal-connection implant replicas placed in the completely edentulous mandibular arch and connected to multi-base abutments was fabricated from heat-curing acrylic resin. Forty impressions of the reference model were made, 20 each with polyether (PE) and polyvinylsiloxane (PVS) impression materials using the open tray technique. The PE and PVS groups were further subdivided into four subgroups of five each on the bases of splinting type: no splinting, bite registration PE, bite registration addition silicone, or autopolymerizing acrylic resin. The positional accuracy of the implant replica heads was measured on the poured casts using a coordinate measuring machine to assess linear differences in interimplant distances in all three axes. The collected data (linear and three-dimensional [3D] displacement values) were compared with the measurements calculated on the reference resin model and analyzed with nonparametric tests (Kruskal-Wallis and Mann-Whitney). No significant differences were found between the various splinting groups for both PE and PVS impression materials in terms of linear and 3D distortions. However, small but significant differences were found between the two impression materials (PVS, 91 μm; PE, 103 μm) in terms of 3D discrepancies, irrespective of the splinting technique employed. Casts obtained from both impression materials exhibited differences from the reference model. The impression material influenced impression inaccuracy more than the splinting material for multiple-unit abutment-level impressions.

  12. Unit labour costs, productivity and international competitiveness

    NARCIS (Netherlands)

    Ark, Bart van; Stuivenwold, Edwin; Ypma, Gerard

    2005-01-01

    This paper provides international comparisons of relative levels of unit labour costs (ULC) for several OECD countries relative to the United States. The estimates are based on the Total Economy Database and the 60-Industry Database of the Groningen Growth and Development Centre (GGDC), and are also

  13. A look at state-level risk assessment in the United States: making decisions in the absence of federal risk values.

    Science.gov (United States)

    Effio, Diana G; Kroner, Oliver; Maier, Andrew; Hayes, William; Willis, Alison; Strawson, Joan

    2013-01-01

    State environmental agencies in the United States are charged with making risk management decisions that protect public health and the environment while managing limited technical, financial, and human resources. Meanwhile, the federal risk assessment community that provides risk assessment guidance to state agencies is challenged by the rapid growth of the global chemical inventory. When chemical toxicity profiles are unavailable on the U.S. Environmental Protection Agency's Integrated Risk Information System or other federal resources, each state agency must act independently to identify and select appropriate chemical risk values for application in human health risk assessment. This practice can lead to broad interstate variation in the toxicity values selected for any one chemical. Within this context, this article describes the decision-making process and resources used by the federal government and individual U.S. states. The risk management of trichloroethylene (TCE) in the United States is presented as a case study to demonstrate the need for a collaborative approach among U.S. states toward identification and selection of chemical risk values while awaiting federal risk values to be set. The regulatory experience with TCE is contrasted with collaborative risk science models, such as the European Union's efforts in risk assessment harmonization. Finally, we introduce State Environmental Agency Risk Collaboration for Harmonization, a free online interactive tool designed to help to create a collaborative network among state agencies to provide a vehicle for efficiently sharing information and resources, and for the advancement of harmonization in risk values used among U.S. states when federal guidance is unavailable. © 2012 Society for Risk Analysis.

  14. Provider Health and Wellness.

    Science.gov (United States)

    Nanda, Anil; Wasan, Anita; Sussman, James

    2017-07-19

    Provider health and wellness is a significant issue and can impact patient care, including patient satisfaction, quality of care, medical errors, malpractice risk, as well as provider and office staff turnover and early retirement. Health and wellness encompasses various areas including burnout, depression, divorce, and suicide and affects providers of all specialties and at all levels of training. Providers deal with many everyday stresses, including electronic health records, office politics, insurance and billing issues, dissatisfied patients, and their own personal and family issues. Approximately half of all physicians suffer from burnout, and the rate of burnout among physicians of all specialties is increasing. An important first step in dealing with burnout is recognition and then seeking assistance. Strategies to prevent and treat burnout include increasing provider resiliency as well as implementing practical changes in the everyday practice of medicine. There is currently very little data regarding health and wellness specifically in the field of allergy and immunology, and studies are necessary to determine the prevalence of burnout and related issues in this field. Many medical specialties as well as state and national medical associations have health and wellness committees and other resources, which are essential for providers. Health and wellness programs should be introduced early in a provider's training and continued throughout a provider's career. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  15. A Case Study of Semantic Annotation with Multi - Ontology by Upper- level Ontology Unitive Control%顶级本体统控的多本体语义标注实证研究

    Institute of Scientific and Technical Information of China (English)

    米杨; 曹锦丹

    2012-01-01

    The paper takes upper - level Ontology as the core technology, integrates domain Ontologies by upper - level Ontology unitive control, and annotates information semantically by integration Ontology with tools like Prot6g6 and GATE for empirical research. It integrates the Nasal Inflammation Disease Ontology and National Essential Drugs Ontology as one Ontology to annotate the Electronic Medical Record information resources, and the semantic annotation library can be saved as XML format. This research provides empirical evidence for semantic annotation schema with integration Ontology using upper- level Ontology unitive control, and the annotated resources can match the Ontology element in semantic re- trieval so as to realize the semantic applications like knowledge discovery.%以顶级本体作为本体工程的技术核心,通过顶级本体统控领域本体整合、整合本体语义标注等手段,利用Prot6g6、GATE等工具整合中文鼻部炎症疾病知识本体和国家基本药物知识本体,实现以整合本体标注电子病历信息资源,并保存为XML形式语义标注库。本研究实证顶级本体统控的整合本体语义标注模式,标注后的资源叮在语义检索阶段匹配本体元素,进而实现知识发现等语义应用。

  16. Interdependence between government levels in Brazilian health policy: the implementation of Emergency Care Units in the State of Rio de Janeiro, Brazil.

    Science.gov (United States)

    de Lima, Luciana Dias; Machado, Cristiani Veira; O'Dwyer, Gisele; Baptista, Tatiana Wargas de Faria; de Andrade, Carla Lourenço Tavares; Konder, Mariana Teixeira

    2015-02-01

    This article addresses policymaking related to Emergency Care Units (ECU) in the State of Rio de Janeiro between 2007 and 2013, duly identifying the relationships between the various levels of government in this process. It prioritized the context of policy formulation, the factors that motivated the inclusion and maintenance of ECUs on the state agenda and the process of how the policy was implemented in the state. The study was based on the literature that defines the agenda and implementation of public policies and on contributions from historic institutionalism. The research involved analysis of documents, secondary data, and 51 interviews with people in positions of authority in state and municipal governments. The priority given to ECUs in the government agenda was the result of a confluence of historical, structural, political and institutional factors, as well as the current context. The results of this study indicate the existence of interdependence between levels of government, however federal coordination problems have prejudiced the integration of the various components of emergency health care in the state.

  17. Flyway Habitat Management Unit Project report no. 5: A target waterfowl population model: estimates of populations for individual species at maximum foreseeable levels

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Complete estimates of waterfowl populations in each of 164 management units through the forty-eight coterminous United States were systematically developed for May...

  18. Effect of soil salinity and nutrient levels on the community structure of the root-associated bacteria of the facultative halophyte, Tamarix ramosissima, in southwestern United States.

    Science.gov (United States)

    Taniguchi, Takeshi; Imada, Shogo; Acharya, Kumud; Iwanaga, Fumiko; Yamanaka, Norikazu

    2015-01-01

    Tamarix ramosissima is a tree species that is highly resistant to salt and drought. The Tamarix species survives in a broad range of environmental salt levels, and invades major river systems in southwestern United States. It may affect root-associated bacteria (RB) by increasing soil salts and nutrients. The effects of RB on host plants may vary even under saline conditions, and the relationship may be important for T. ramosissima. However, to the best of our knowledge, there have been no reports relating to T. ramosissima RB and its association with salinity and nutrient levels. In this study, we have examined this association and the effect of arbuscular mycorrhizal colonization of T. ramosissima on RB because a previous study has reported that colonization of arbuscular mycorrhizal fungi affected the rhizobacterial community (Marschner et al., 2001). T. ramosissima roots were collected from five locations with varying soil salinity and nutrient levels. RB community structures were examined by terminal restriction fragment (T-RF) length polymorphism, cloning, and sequencing analyses. The results suggest that RB richness, or the diversity of T. ramosissima, have significant negative relationships with electrical conductivity (EC), sodium concentration (Na), and the colonization of arbuscular mycorrhizal fungi, but have a significant positive relationship with phosphorus in the soil. However, at each T-RF level, positive correlations between the emergence of some T-RFs and EC or Na were observed. These results indicate that high salinity decreased the total number of RB species, but some saline-tolerant RB species multiplied with increasing salinity levels. The ordination scores of nonmetric multidimensional scale analysis of RB community composition show significant relationships with water content, calcium concentration, available phosphorus, and total nitrogen. These results indicate that the RB diversity and community composition of T. ramosissima are affected

  19. Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

    Science.gov (United States)

    Johnson, Ralph Jay

    2015-01-01

    Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

  20. Research on functional logistics provider selection based on QFD and bi-level programming modeling%基于QFD和双层规划的物流服务供应商选择研究

    Institute of Scientific and Technical Information of China (English)

    陈虎

    2012-01-01

    For the service cost and logistics service quality, the bi-level programming model is designed to select functional logistics provider, the upper-level objective function determines service cost which should be minimized; the lower-level objective function is supplier's service quality which should be maximized. Through the method of QFD, comprehensive evaluating logistics suppliers by the evaluation index and customer needs, the synthetically expressive degree of each subcontract supplier is gained. The bi-level iterative algorithm is designed for the model, and through a case study, both the model and the algorithm are validated.%从物流服务成本和物流服务质量两个方面构建物流服务供应商选择的双层规划模型,上层规划以物流服务成本最小为目标,下层以选择的供应商的综合表现度最大为目标.通过改进QFD模型,将评价指标和客户需求相结合,对待选物流供应商进行综合评价,计算供应商的综合表现度.结合模型的特点设计分层迭代算法,算例验证了模型和算法的有效性.

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

    Science.gov (United States)

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

    2017-06-01

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

  2. RETINOPATHY OF PREMATURITY SCREENING OF 500 INFANTS IN A LEVEL II NEONATAL INTENSIVE CARE UNIT AT A MEDICAL COLLEGE HOSPITAL IN SOUTHERN KARNATAKA

    Directory of Open Access Journals (Sweden)

    Keerthi

    2014-09-01

    Full Text Available INTRODUCTION: Retinopathy of prematurity (ROP is the leading cause of infant blindness and predominantly affects premature, low birth weight babies.1 India and other middle-income countries are said to be suffering from the ‘third epidemic’. ROP is multi-factorial and early detection and treatment of threshold ROP with timely laser treatment results in excellent outcome.3-8 OBJECTIVES: 1. To determine the yield of ROP in a level II neonatal intensive care unit (NICU at a Government Medical College Hospital in Mandya district. 2. To determine disease characteristics and outcome of treatment. METHODOLOGY: The study is a prospective analysis of infants admitted during March 1st 2009 and November 30th, 2011(33 months at the NICU of Mandya Institute of Medical Sciences (MIMS Hospital. All infants weighing level III NICU’s in larger cities. With improving neonatal care, a collaborative, timely and appropriate screening strategy is necessary in the community to prevent ROP blindness in rural infants.

  3. End of FY10 report - used fuel disposition technical bases and lessons learned : legal and regulatory framework for high-level waste disposition in the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Weiner, Ruth F.; Blink, James A. (Lawrence Livermore National Laboratory, Livermore, CA); Rechard, Robert Paul; Perry, Frank (Los Alamos National Laboratory, Los Alamos, NM); Jenkins-Smith, Hank C. (University of Oklahoma, Norman, OK); Carter, Joe (Savannah River Nuclear Solutions, Aiken, SC); Nutt, Mark (Argonne National Laboratory, Argonne, IL); Cotton, Tom (Complex Systems Group, Washington DC)

    2010-09-01

    This report examines the current policy, legal, and regulatory framework pertaining to used nuclear fuel and high level waste management in the United States. The goal is to identify potential changes that if made could add flexibility and possibly improve the chances of successfully implementing technical aspects of a nuclear waste policy. Experience suggests that the regulatory framework should be established prior to initiating future repository development. Concerning specifics of the regulatory framework, reasonable expectation as the standard of proof was successfully implemented and could be retained in the future; yet, the current classification system for radioactive waste, including hazardous constituents, warrants reexamination. Whether or not consideration of multiple sites are considered simultaneously in the future, inclusion of mechanisms such as deliberate use of performance assessment to manage site characterization would be wise. Because of experience gained here and abroad, diversity of geologic media is not particularly necessary as a criterion in site selection guidelines for multiple sites. Stepwise development of the repository program that includes flexibility also warrants serious consideration. Furthermore, integration of the waste management system from storage, transportation, and disposition, should be examined and would be facilitated by integration of the legal and regulatory framework. Finally, in order to enhance acceptability of future repository development, the national policy should be cognizant of those policy and technical attributes that enhance initial acceptance, and those policy and technical attributes that maintain and broaden credibility.

  4. Effect of a multi-level intervention on nurse—patient communication in the intensive care unit: Results of the SPEACS trial

    Science.gov (United States)

    Happ, Mary Beth; Garrett, Kathryn L.; Tate, Judith A.; DiVirgilio, Dana; Houze, Martin P.; Demirci, Jill R.; George, Elisabeth; Sereika, Susan M.

    2014-01-01

    Objective To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients. Design Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurseepatient dyad for communication frequency, quality and success. Patients self-rated communication ease. Setting Two ICUs in a university-affiliated medical center. Participants 89 intubated patients awake, responsive and unable to speak and 30 ICU nurses. Main results Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p communication skills training, materials and SLP consultation intervention in the ICU. PMID:24495519

  5. A Critical Assessment of Sea-Level Rise Projections for the Northeast United States in the 21st Century: Discrepancies and Their Cost

    Science.gov (United States)

    Zhang, M.

    2015-12-01

    Several studies have projected the magnitudes of sea-level rise (SLR) in the Northeast United States for the 21th Century as a result of anthropogenic climate change. Among them are those by NOAA, the New York City Panel on Climate Change (NPCC), and the US Army Corps of Engineers (COE). The projected magnitudes of SLR from some of these sources are being used by policymakers to make difficult choices of investments on infrastructure that can be resilient against anticipated SLR. While there is no question that SLR will happen and resilience measures against SLR is very necessary, this presentation questions the rigor of science behind some of these projections that can have significant costs to the society. A critical assessment of available SLR projections for the northeast US and their discrepancies is presented. It is concluded from the current understanding of science that the mean values and upper bounds of SLR from NOAA, NPCC and COE are likely exaggerated for the region. It is also argued that scientists should treat the SLR projection as a separate problem from policies so that the best cost-benefit analysis can be performed in the decision process.

  6. 78 FR 14034 - Health Insurance Providers Fee

    Science.gov (United States)

    2013-03-04

    ... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee AGENCY: Internal... covered entities engaged in the business of providing health insurance for United States health risks... regulations affect persons engaged in the business of providing health insurance for United States health...

  7. Individualistic impact of unit operations of production, at household level, on some antinutritional factors in selected cowpea-based food products.

    Science.gov (United States)

    Bolade, Mathew K

    2016-05-01

    The individualistic effect of unit operations of production, at household level, on some antinutritional factors in selected cowpea-based food products (moin-moin, akara, and gbegiri) was investigated. Four cowpea types (IT93K-452-1, IT95K-499s-35, IT97K-568-18, and market sample) were used for the study, whereas the three traditional food products were produced from each of the cowpea types, respectively. The results revealed that every unit operation involved in the production of moin-moin, akara or gbegiri contributed to the overall reduction of trypsin inhibitor activity (TIA), phytic acid (PA), and tannin; though at varying degrees. In the production of moin-moin, the major contributions to the overall reduction in TIA were from steaming (64.2-72.0%), second-stage soaking (9.7-11.9%), and dehulling (9.4-10.2%). The contributions to the overall reduction in PA were from dehulling (34.0-40.4%), preliminary soaking (15.4-21.0%), and steaming (7.8-14.0%), whereas that of tannin were from dehulling (39.7-47.6%), steaming (19.6-24.7%), and preliminary soaking (9.8-15.9%). For akara production, the major contributions to TIA reduction were from deep frying (64.2-72.0%), second-stage soaking (9.7-11.9%), and dehulling (9.4-10.2%). The PA reduction was from dehulling (34.0-40.4%), preliminary soaking (15.4-21.0%), and deep frying (9.6-15.9%), whereas that of tannin reduction was from dehulling (39.7-47.6%), deep frying (20.7-25.3%), and preliminary soaking (9.8-15.9%). In the production of gbegiri, the overall reduction in TIA was contributed from pressure cooking (79.0-84.8%), preliminary soaking (5.8-11.3%), and dehulling (9.4-10.2%). The reduction in PA was contributed by dehulling (34.0-40.4%), pressure cooking (24.7-35.0%), and preliminary soaking (15.4-21.0%), whereas the overall reduction in tannin content was similarly contributed by dehulling (39.7-47.6%), pressure cooking (29.8-34.4%), and preliminary soaking (9.8-15.9%).

  8. Establishing the Intermediate Unit.

    Science.gov (United States)

    Pennsylvania State Dept. of Education, Harrisburg.

    The State of Pennsylvania Act 102 establishes a system of 29 intermediate units, creates intermediate unit boards of directors, spells out their duties and functions, and provides a system of financing their operations. This handbook has been prepared by the Pennsylvania Department of Education to provide intermediate unit boards of directors,…

  9. Units of measure in clinical information systems.

    Science.gov (United States)

    Schadow, G; McDonald, C J; Suico, J G; Föhring, U; Tolxdorff, T

    1999-01-01

    The authors surveyed existing standard codes for units of measures, such as ISO 2955, ANSI X3.50, and Health Level 7's ISO+. Because these standards specify only the character representation of units, the authors developed a semantic model for units based on dimensional analysis. Through this model, conversion between units and calculations with dimensioned quantities become as simple as calculating with numbers. All atomic symbols for prefixes and units are defined in one small table. Huge permutated conversion tables are not required. This method is also simple enough to be widely implementable in today's information systems. To promote the application of the method the authors provide an open-source implementation of this method in JAVA. All existing code standards for units, however, are incomplete for practical use and require substantial changes to correct their many ambiguities. The authors therefore developed a code for units that is much more complete and free from ambiguities.

  10. Compassion fatigue among pediatric healthcare providers.

    Science.gov (United States)

    Branch, Carole; Klinkenberg, Dean

    2015-01-01

    Compassion fatigue is a term used to describe the unique stressors affecting people in caregiving professions. For nurses and other direct care providers, the impact of compassion fatigue may result in stress-related symptoms, job dissatisfaction, decreased productivity, decreased patient satisfaction scores, safety issues, and job turnover. Those who care for seriously ill children and their families are at increased risk for compassion fatigue. Constant exposure to children who are suffering, in combination with work place stressors and personal issues, may contribute to the development of compassion fatigue. The Professional Quality of Life Scale Version 5 was used to determine the risk for compassion fatigue among 296 direct care providers at St. Louis Children's Hospital. Compassion satisfaction, burnout, and secondary traumatic stress scores did not differ by age, work category, level of education, or work experience. There were, however, significant differences in scores as a function of nursing unit. Nurses who work in the pediatric intensive care unit reported lower compassion satisfaction scores, and higher burnout and secondary traumatic stress scores. Results demonstrated the risk for compassion fatigue and provided data necessary to support development of a compassion fatigue program for direct care providers.

  11. Transport Reactor Development Unit Modification to Provide a Syngas Slipstream at Elevated Conditions to Enable Separation of 100 LB/D of Hydrogen by Hydrogen Separation Membranes Year - 6 Activity 1.15 - Development of a National Center for Hydrogen Technology

    Energy Technology Data Exchange (ETDEWEB)

    Schlasner, Steven

    2012-03-01

    Gasification of coal when associated with carbon dioxide capture and sequestration has the potential to provide low-cost as well as low-carbon hydrogen for electric power, fuels or chemicals production. The key element to the success of this concept is inexpensive, effective separation of hydrogen from carbon dioxide in synthesis gas. Many studies indicate that membrane technology is one of the most, if not the most, economical means of accomplishing separation; however, the advancement of hydrogen separation membrane technology is hampered by the absence of experience or demonstration that the technology is effective economically and environmentally at larger scales. While encouraging performance has been observed at bench scale (less than 12 lb/d hydrogen), it would be imprudent to pursue a largescale demonstration without testing at least one intermediate scale, such as 100 lb/d hydrogen. Among its many gasifiers, the Energy & Environmental Research Center is home to the transport reactor demonstration unit (TRDU), a unit capable of firing 200—500 lb/hr of coal to produce 400 scfm of synthesis gas containing more than 200 lb/d of hydrogen. The TRDU and associated downstream processing equipment has demonstrated the capability of producing a syngas over a wide range of temperatures and contaminant levels — some of which approximate conditions of commercial-scale gasifiers. Until this activity, however, the maximum pressure of the TRDU’ s product syngas was 120 psig, well below the 400+ psig pressures of existing large gasifiers. This activity installed a high-temperature compressor capable of accepting the range of TRDU products up to 450°F and compressing them to 500 psig, a pressure comparable to some large scale gasifiers. Thus, with heating or cooling downstream of the TRDU compressor, the unit is now able to present a near-raw to clean gasifier synthesis gas containing more than 100 lb/d of hydrogen at up to 500 psig over a wide range of temperatures

  12. United Cerebral Palsy

    Science.gov (United States)

    ... be sure to follow us on Twitter . United Cerebral Palsy UCP educates, advocates and provides support services to ... Partners Merz Logo Sprint Relay Copyright © 2015 United Cerebral Palsy 1825 K Street NW Suite 600 Washington, DC ...

  13. Unit Cost Compendium Calculations

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Unit Cost Compendium (UCC) Calculations raw data set was designed to provide for greater accuracy and consistency in the use of unit costs across the USEPA...

  14. Effectiveness of a parenting programme in a public health setting: a randomised controlled trial of the positive parenting programme (Triple P level 3 versus care as usual provided by the preventive child healthcare (PCH

    Directory of Open Access Journals (Sweden)

    Jansen Daniëlle EMC

    2010-03-01

    Full Text Available Abstract Background Considering the high burden of disease of psychosocial problems in children and adolescents, early intervention regarding problem behaviour of young children is very important. The Preventive Child Healthcare (PCH offers a good setting to detect such problem behaviour and to provide parenting support to the parents concerned. This paper aims to describe the design of an effectiveness study of a parenting programme for parents of children with mild psychosocial problems after an initial, evidence based screening in routine PCH. Methods/Design The effects of the intervention will be studied in a randomised controlled trial. Prior to a routine PCH health examination, parents complete a screening questionnaire on psychosocial problems. Parents of children with increased but still subclinical levels of psychosocial problems will be assigned at random to the experimental group (Triple P, level 3 or to the control group (care as usual. Outcome measures, such as problem behaviour in the child and parenting behaviour, will be assessed before, directly after and 6 and 12 months after the intervention. Discussion Parenting support may be an effective intervention to reduce psychosocial problems in children but evidence-based parenting programmes that fit the needs of the PCH are not available as yet. Although the Triple P programme seems promising and suitable for a universal population approach, evidence on its effectiveness in routine PCH still lacks. Trial registration NTR1338

  15. Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study

    Science.gov (United States)

    Folasayo, Adigun Temiloluwa; Oluwasegun, Afolayan John; Samsudin, Suhailah; Saudi, Siti Nor Sakinah; Osman, Malina; Hamat, Rukman Awang

    2017-01-01

    This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs) among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female) aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6%) had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6%) by the students, while chlamydia (26%) and trichomoniasis (21.0%) were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values aware that STD screening was important while use of condoms was protective (63.8%). The majority of them strongly felt that treatment should be sought immediately if they (85.5%) and their partners (87.4%) have symptoms. Among the sexually-active students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24–30 years old (an odds ratio (AOR) = 0.57, 95% confidence interval (CI) = 0.377–0.859) and faculty type (AOR = 5.69, 95% CI = 4.019–8.057) were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented. PMID:28208724

  16. Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Adigun Temiloluwa Folasayo

    2017-02-01

    Full Text Available This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6% had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6% by the students, while chlamydia (26% and trichomoniasis (21.0% were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values < 0.05. Most of them (88.8% were aware that STD screening was important while use of condoms was protective (63.8%. The majority of them strongly felt that treatment should be sought immediately if they (85.5% and their partners (87.4% have symptoms. Among the sexually-active students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24–30 years old (an odds ratio (AOR = 0.57, 95% confidence interval (CI = 0.377–0.859 and faculty type (AOR = 5.69, 95% CI = 4.019–8.057 were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented.

  17. Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study.

    Science.gov (United States)

    Folasayo, Adigun Temiloluwa; Oluwasegun, Afolayan John; Samsudin, Suhailah; Saudi, Siti Nor Sakinah; Osman, Malina; Hamat, Rukman Awang

    2017-02-08

    This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs) among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female) aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6%) had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6%) by the students, while chlamydia (26%) and trichomoniasis (21.0%) were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24-30 years old (an odds ratio (AOR) = 0.57, 95% confidence interval (CI) = 0.377-0.859) and faculty type (AOR = 5.69, 95% CI = 4.019-8.057) were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented.

  18. Sustaining a "culture of silence" in the neonatal intensive care unit during nonemergency situations: a grounded theory on ensuring adherence to behavioral modification to reduce noise levels.

    Science.gov (United States)

    Swathi, S; Ramesh, A; Nagapoornima, M; Fernandes, Lavina M; Jisina, C; Rao, P N Suman; Swarnarekha, A

    2014-01-01

    The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to "sustain a culture of silence in NICU during nonemergency situations" (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The "culture of silence" reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a "noisy culture" prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints.

  19. DEBATE ENTRE NIVELES ARTIFICIALES Y UNIDADES ESTRATIGRÁFICAS: EL ENTIERRO HUMANO POSTERIOR AL FUERTE SANCTI SPIRITUS (1527-1529, PUERTO GABOTO (SANTA FE / Artificial levels vs. stratigraphic units: the human burial subsequent to Sancti Spiritus Fort (15

    Directory of Open Access Journals (Sweden)

    Cristina Pasquali

    2014-12-01

    Full Text Available Se presenta el estudio y análisis de un entierro humano hallado dentro del alcance del proyecto de investigación del Fuerte Sancti Spiritus, en la localidad de Puerto Gaboto (provincia de Santa Fe. La recuperación del mismo se realizó en el año 2010, mediante la metodología de excavación por niveles artificiales. Dentro del marco del proyecto, a partir del año 2010, con la incorporación del equipo de arqueólogos pertenecientes a la Universidad del País Vasco se aplica una nueva metodología de intervención en el campo: excavación en extensión (open area por unidades estratigráficas. Este trabajo consta de una primera parte, en donde se presenta la recuperación de los restos óseos por niveles artificiales y su curaduría, así como, la clasificación y descripción de los materiales asociados al entierro. En una segunda etapa, se presenta la secuencia histórica del sitio determinada por las excavaciones estratigráficas y su relación con el entierro. A esto se le agrega el proceso de trabajo seguido para integrar el entierro dentro de la secuencia estratigráfica y para poder señalar a cuál de las fases de la secuencia histórica pertenece. Palabras clave: Esqueleto humano; Niveles artificiales; Unidades estratigráficas; Siglo XVI; Nordeste argentino   Abstract This study analyses a human burial found within the excavations of the Fort Sancti Spiritus (Puerto Gaboto, province of Santa Fe. Artificial levels excavation methodology was used to recover it in 2010. Subsequently a new excavation methodology was applied, open area through stratigraphic units. The recovery and treatment of the bones by artificial levels is initially presented, as well as the classification and description of materials linked to the burial. Secondly the historical sequence of the site deduced by the stratigraphic excavations and its relationship to the burial is provided. Additionally the process followed to integrate the burial into the

  20. Comparison of curves of units Hounsfields of planning and provided by the OBI cono beam CT; Comparacion de curvas de unidades hounsfields de planificacion y proporcionadas por el OBI cone beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Alarcon, C.; Vicent granado, D.; Gutierrez Ramos, S. M.; Sanchez Carmona, G.; Herrador Cordoba, M.

    2013-07-01

    Due to the possibility for dosimetric calculations with the images provided by the imaging system OBI has emerged the need to study the difference between the densities Hounsfield curve used in the TPS and the corresponding of the OBI. As well as the dosimetric differences that may occur as a result of the differences between the two. (Author)