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  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

    2017-09-01

    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. Ten ways for provider units to weather this economic downturn.

    Science.gov (United States)

    Bernard, Amy

    2009-05-01

    The current economic recession challenges all continuing nursing education provider units to review operational practices and explore ways to maintain and ensure financial viability. Adjustments in programs are likely, as nurses seek more cost-effective ways of meeting their continuing education requirements. Further, employers are reducing staff and budgets. As a result, provider units need to reassess operations and refocus outcomes.

  3. Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers.

    Science.gov (United States)

    Philbin, Morgan M; Tanner, Amanda E; Chambers, Brittany D; Ma, Alice; Ware, Samuella; Lee, Sonia; Fortenberry, J Dennis; The Adolescent Trials Network

    2017-10-01

    HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.

  4. Electronic circuit provides automatic level control for liquid nitrogen traps

    Science.gov (United States)

    Turvy, R. R.

    1968-01-01

    Electronic circuit, based on the principle of increased thermistor resistance corresponding to decreases in temperature provides an automatic level control for liquid nitrogen cold traps. The electronically controlled apparatus is practically service-free, requiring only occasional reliability checks.

  5. Optimal maintenance policy incorporating system level and unit level for mechanical systems

    Science.gov (United States)

    Duan, Chaoqun; Deng, Chao; Wang, Bingran

    2018-04-01

    The study works on a multi-level maintenance policy combining system level and unit level under soft and hard failure modes. The system experiences system-level preventive maintenance (SLPM) when the conditional reliability of entire system exceeds SLPM threshold, and also undergoes a two-level maintenance for each single unit, which is initiated when a single unit exceeds its preventive maintenance (PM) threshold, and the other is performed simultaneously the moment when any unit is going for maintenance. The units experience both periodic inspections and aperiodic inspections provided by failures of hard-type units. To model the practical situations, two types of economic dependence have been taken into account, which are set-up cost dependence and maintenance expertise dependence due to the same technology and tool/equipment can be utilised. The optimisation problem is formulated and solved in a semi-Markov decision process framework. The objective is to find the optimal system-level threshold and unit-level thresholds by minimising the long-run expected average cost per unit time. A formula for the mean residual life is derived for the proposed multi-level maintenance policy. The method is illustrated by a real case study of feed subsystem from a boring machine, and a comparison with other policies demonstrates the effectiveness of our approach.

  6. Levels of Interaction Provided by Online Distance Education Models

    Science.gov (United States)

    Alhih, Mohammed; Ossiannilsson, Ebba; Berigel, Muhammet

    2017-01-01

    Interaction plays a significant role to foster usability and quality in online education. It is one of the quality standard to reveal the evidence of practice in online distance education models. This research study aims to evaluate levels of interaction in the practices of distance education centres. It is aimed to provide online distance…

  7. Search for an Emergency Contraception Provider in the United States

    Science.gov (United States)

    ... emergency contraception provider. Concerned about cost? Click here . ---------- Emergency contraceptive pills are stocked by all major pharmacy chains, ... daily birth control pills you can use as emergency contraceptive pills. You can search for a provider in ...

  8. Providing Radiation Protection Experts in the United Kingdom

    International Nuclear Information System (INIS)

    Partington, C.; Owen, D.

    2004-01-01

    The EEC Directive on Qualified Experts in Radiation Protection has been implemented in the United Kingdom by the Ionising Radiations Regulations 1999 (IRR99). These Regulations require Radiation Employers to appoint suitable Radiation Protection Advisers (RPA) who must be consulted in certain circumstances when starting work with, or using ionising radiations. Radiation Protection Advisers have to have a current certificate of competence and, to gain one of these, must have demonstrated their competence in one of two ways either by achieving a National Vocational Qualification in Radiation Protection Practice or by being Certificated by an Assessing Body. Assessing Bodies have to be recognised by the Health and Safety Executive, who undertake a rigorous assessment process to determine whether the proposed Assessing Body is fit to undertake RPA Assessments. By July 2003, only two such Assessing Bodies had been approved in the UK. These two Assessing Bodies are ? RPA 2000 a company established by the four leading Radiation Protection Professional Societies in the UK for assessing anyone in the UK as Radiation Protection Advisers, And ? BNFL established by BNFL to assess the competence of BNFL's own Radiation Protection Advisers. This paper will describe the standards against which Radiation Protection Advisers are assessed, the manner in which each of these two Assessing Bodies carry out the assessment process and their experience to date. The way in which Radiation Employers carry out the appointment process will also be described. Potential future developments of the Assessment Process and standards will also be discussed. (Author)

  9. Early abortion services in the United States: a provider survey.

    Science.gov (United States)

    Benson, Janie; Clark, Kathryn Andersen; Gerhardt, Ann; Randall, Lynne; Dudley, Susan

    2003-04-01

    The objective of this study was to describe the availability of early surgical and medical abortion among members of the National Abortion Federation (NAF) and to identify factors affecting the integration of early abortion services into current services. Telephone interviews were conducted with staff at 113 Planned Parenthood affiliates and independent abortion providers between February and April 2000, prior to FDA approval of mifepristone. Early abortion services were available at 59% of sites, and establishing services was less difficult than or about what was anticipated. Sites generally found it easier to begin offering early surgical abortion than early medical abortion. Physician participation was found to be critical to implementing early services. At sites where some but not all providers offered early abortion, variations in service availability resulted. Given the option of reconsidering early services, virtually all sites would make the same decision again. These data suggest that developing mentoring relationships between experienced early abortion providers/sites and those not offering early services, and training physicians and other staff, are likely to be effective approaches to expanding service availability.

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

    African Journals Online (AJOL)

    Variations in levels of care within a hospital provided to acute trauma patients. ... A scoring system was devised to classify the quality of the observations that each patient received in the different ... Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the ... HOW TO USE AJOL.

  11. Measuring healthcare productivity - from unit to system level.

    Science.gov (United States)

    Kämäräinen, Vesa Johannes; Peltokorpi, Antti; Torkki, Paulus; Tallbacka, Kaj

    2016-04-18

    Purpose - Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. The purpose of this paper is to focus on healthcare production system productivity measurement. Design/methodology/approach - Traditionally, healthcare productivity has been studied and measured independently at the unit, organization and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical information for managers. Findings - The study introduces different approaches and methods to measure productivity in healthcare. Practical implications - A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical benefits for managers. Originality/value - The authors focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level and the system level.

  12. 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.   

  13. Should Master's Level Training To Provide Rural Services Survive?

    Science.gov (United States)

    Keller, Peter A.

    Despite recent efforts to encourage federal funding of psychological services for underserved populations such as the elderly and residents of rural areas, ample evidence suggests that rural areas are underserved by psychologists. Drawing on data from rural and urban areas in Pennsylvania, this paper argues that master's level training can provide…

  14. Providing policy information at the local level. [Dow Chemical Co

    Energy Technology Data Exchange (ETDEWEB)

    Vaughan, H W

    1977-01-01

    Dow Chemical's approach to plant waste management has enabled the company to conribute to a broader understanding of worldwide environmental problems at no net cost to the company. A Corporate Ecology Council was formed in 1970 in response to public concern over mercury in St. Claire River fish. The Council adopted an environmental policy dedicated to providing quality and leadership in environmental improvement. This was followed by steps to identify and monitor hazardous wastes and to improve waste treatment technology. A group of sub-councils and technology centers was established. The company increased employee responsibilities rather than expand the staff and incorporated environmental performance in the employee evaluation procedure. (DCK)

  15. A Mid-Level Dental Provider in Oregon: Dental hygienists' perceptions.

    Science.gov (United States)

    Coplen, Amy E; Bell, Kathryn; Aamodt, Gail L; Ironside, Lynn

    2017-10-01

    Purpose: Many states are exploring alternative provider models and examining the role of the dental hygienist to address access to care challenges as the United States continues to face increasing demands for oral healthcare services. The purpose of this study was to assess dental hygienists' opinions in the state of Oregon regarding the current limitations of dental hygienists' scope of practice, perceived need for a mid-level provider in Oregon, and personal interest in becoming a mid-level provider. Methods: In December 2013 a survey was mailed to a sample of 1,231 dental hygienists registered in Oregon representing 30% of the licentiates. All licentiates holding expanded practice permits (EPP) were included in the sample (n=351). The following categories were included in the 32-question survey: scope of practice, mid-level provider, current practice, and demographics. Results: A total of 440 surveys were returned for a response rate of 36%. Of the EPP holders, 51% responded to the survey. Over half of respondents (59%) believe that a mid-level provider is needed in the state. Respondents holding membership in the American Dental Hygienists' Association, as well as EPP holders, were significantly more likely to respond that a mid-level dental provider was needed in the state (plevel provider was introduced in Oregon, the new provider should be a registered dental hygienist model. Forty-three percent (n=186) of respondents were interested in becoming mid-level providers and 47% (n=203) of respondents believed that the minimum education for a mid-level provider should be a bachelor's degree. The majority, 74% (n=137), of those interested in becoming a mid-level provider indicated a preference in completing their education through online teaching combined with a clinical internship. Conclusion: There is strong support from dental hygienists in Oregon that a need exists for a mid-level dental provider and that this provider model should be dental hygiene based

  16. Providing Criminological Security of Minors at the National Level

    Directory of Open Access Journals (Sweden)

    Andrei I. Savelev

    2017-08-01

    Full Text Available The article discusses issues related to the provision of criminological security of minors at the national level. The Author analyzes the normative legal basis and main directions of activity of subjects of prevention of the violation of child rights in the Russian Federation. The Author believes that the current system of legal guarantees of criminological security of minors not fully meet modern requirements of protection of rights, freedoms and legitimate interests of adolescents. In particular, the legislation of the Russian Federation is largely focused on protecting the interests of disadvantaged segments of the population, including minors, being in socially dangerous position. It is proposed to improve the existing legislation through the adoption of a new federal law “The bases of the system of prevention of offences and security of minors”, which will be an important step towards building a legal state.

  17. Disparities in perceived patient-provider communication quality in the United States: Trends and correlates.

    Science.gov (United States)

    Spooner, Kiara K; Salemi, Jason L; Salihu, Hamisu M; Zoorob, Roger J

    2016-05-01

    This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ. A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations. PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors. Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health. These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Multi-Unit Initiating Event Analysis for a Single-Unit Internal Events Level 1 PSA

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong San; Park, Jin Hee; Lim, Ho Gon [KAERI, Daejeon (Korea, Republic of)

    2016-05-15

    The Fukushima nuclear accident in 2011 highlighted the importance of considering the risks from multi-unit accidents at a site. The ASME/ANS probabilistic risk assessment (PRA) standard also includes some requirements related to multi-unit aspects, one of which (IE-B5) is as follows: 'For multi-unit sites with shared systems, DO NOT SUBSUME multi-unit initiating events if they impact mitigation capability [1].' However, the existing single-unit PSA models do not explicitly consider multi-unit initiating events and hence systems shared by multiple units (e.g., alternate AC diesel generator) are fully credited for the single unit and ignores the need for the shared systems by other units at the same site [2]. This paper describes the results of the multi-unit initiating event (IE) analysis performed as a part of the at-power internal events Level 1 probabilistic safety assessment (PSA) for an OPR1000 single unit ('reference unit'). In this study, a multi-unit initiating event analysis for a single-unit PSA was performed, and using the results, dual-unit LOOP initiating event was added to the existing PSA model for the reference unit (OPR1000 type). Event trees were developed for dual-unit LOOP and dual-unit SBO which can be transferred from dual- unit LOOP. Moreover, CCF basic events for 5 diesel generators were modelled. In case of simultaneous SBO occurrences in both units, this study compared two different assumptions on the availability of the AAC D/G. As a result, when dual-unit LOOP initiating event was added to the existing single-unit PSA model, the total CDF increased by 1∼ 2% depending on the probability that the AAC D/G is available to a specific unit in case of simultaneous SBO in both units.

  19. 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

  20. Level III and IV Ecoregions of the Continental United States

    Science.gov (United States)

    Information and downloadable maps and datasets for Level III and IV ecoregions of the continental United States. Ecoregions are areas of general similarity in the type, quality, and quantity of environmental resources.

  1. Zika virus disease knowledge among the future health-care providers of the United Arab Emirates.

    Science.gov (United States)

    Rabbani, Syed Arman; Mustafa, Farhan; Shouqair, Tasneem; Mohamad, Itaf; Tahsin, Nada

    2018-01-01

    Zika virus (ZIKV) disease has become a major public health concern. Although there are no reported cases of ZIKV disease in the United Arab Emirates (UAE), there is a potential risk of transmission due to large expatriate population and high influx of international travelers. This cross-sectional study was conducted to assess the knowledge of ZIKV disease among the students of a medical and health sciences university in the UAE. Their knowledge of ZIKV disease was assessed using a specially designed, pretested, and validated questionnaire. Of the 500 respondents included in the final analysis, 314 (62.8%) respondents presented with poor knowledge of ZIKV disease. The mean knowledge score of the study population was 10.48 ± 2.48 out of a maximum of 17. Gender, college and year of study, nationality and attendance in lecture/conference/workshop on Zika were significantly associated with the level of knowledge. The males possessed significantly ( P = 0.046) better knowledge as compared to the females. Students of medical college had significantly ( P = 0.005) better knowledge as compared to students of other colleges. The level of knowledge improved significantly ( P = 0.026) as the year of study progressed. There is a need for medical and paramedical students to update their knowledge of ZIKV disease as they are the future health-care providers who will be responsible for creating awareness about such outbreaks and their preventive measures.

  2. Zika virus disease knowledge among the future health-care providers of the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Syed Arman Rabbani

    2018-01-01

    Full Text Available Zika virus (ZIKV disease has become a major public health concern. Although there are no reported cases of ZIKV disease in the United Arab Emirates (UAE, there is a potential risk of transmission due to large expatriate population and high influx of international travelers. This cross-sectional study was conducted to assess the knowledge of ZIKV disease among the students of a medical and health sciences university in the UAE. Their knowledge of ZIKV disease was assessed using a specially designed, pretested, and validated questionnaire. Of the 500 respondents included in the final analysis, 314 (62.8% respondents presented with poor knowledge of ZIKV disease. The mean knowledge score of the study population was 10.48 ± 2.48 out of a maximum of 17. Gender, college and year of study, nationality and attendance in lecture/conference/workshop on Zika were significantly associated with the level of knowledge. The males possessed significantly (P = 0.046 better knowledge as compared to the females. Students of medical college had significantly (P = 0.005 better knowledge as compared to students of other colleges. The level of knowledge improved significantly (P = 0.026 as the year of study progressed. There is a need for medical and paramedical students to update their knowledge of ZIKV disease as they are the future health-care providers who will be responsible for creating awareness about such outbreaks and their preventive measures.

  3. Motor-pump unit provided with a lifting appliance of the motor

    International Nuclear Information System (INIS)

    Veronesi, Luciano; Francis, W.R.

    1978-01-01

    This invention relates to lifting appliances and particularly concerns a 'pump and motor set' or motor-pump unit fitted with a lifting appliance enabling the motor to be separated from the pump. In nuclear power stations the reactor discharges heat that is carried by the coolant to a distant point away from the reactor to generate steam and electricity conventionally. In order to cause the reactor coolant to flow through the system, coolant motor-pump units are provided in the cooling system. These units are generally of the vertical type with an electric motor fitted vertically on the pump by means of a cylindrical or conical structure called motor support [fr

  4. Brayton Power Conversion Unit Tested: Provides a Path to Future High-Power Electric Propulsion Missions

    Science.gov (United States)

    Mason, Lee S.

    2003-01-01

    Closed-Brayton-cycle conversion technology has been identified as an excellent candidate for nuclear electric propulsion (NEP) power conversion systems. Advantages include high efficiency, long life, and high power density for power levels from about 10 kWe to 1 MWe, and beyond. An additional benefit for Brayton is the potential for the alternator to deliver very high voltage as required by the electric thrusters, minimizing the mass and power losses associated with the power management and distribution (PMAD). To accelerate Brayton technology development for NEP, the NASA Glenn Research Center is developing a low-power NEP power systems testbed that utilizes an existing 2- kWe Brayton power conversion unit (PCU) from previous solar dynamic technology efforts. The PCU includes a turboalternator, a recuperator, and a gas cooler connected by gas ducts. The rotating assembly is supported by gas foil bearings and consists of a turbine, a compressor, a thrust rotor, and an alternator on a single shaft. The alternator produces alternating-current power that is rectified to 120-V direct-current power by the PMAD unit. The NEP power systems testbed will be utilized to conduct future investigations of operational control methods, high-voltage PMAD, electric thruster interactions, and advanced heat rejection techniques. The PCU was tested in Glenn s Vacuum Facility 6. The Brayton PCU was modified from its original solar dynamic configuration by the removal of the heat receiver and retrofitting of the electrical resistance gas heater to simulate the thermal input of a steady-state nuclear source. Then, the Brayton PCU was installed in the 3-m test port of Vacuum Facility 6, as shown. A series of tests were performed between June and August of 2002 that resulted in a total PCU operational time of about 24 hr. An initial test sequence on June 17 determined that the reconfigured unit was fully operational. Ensuing tests provided the operational data needed to characterize PCU

  5. Services provided to other organizational units, Annex 7; Prilog 7 - Usluge drugim organizacionim jedinicama

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1965-12-15

    During 1965, the RA reactor staff provided services to other organizational units in: designing new systems, repair of electronic equipment, installing measuring devices, constructing mechanical elements in the workshop. [Serbo-Croat] U toku 1965. godine reaktor RA je pruzio usluge drugim jedinicama i to: projektovanjem novih sistema, popravkom elektronskih uredjaja, instaliranjem mernih sistema, izradom mehanickih elemenata i sklopova u mehanickoj radionici.

  6. Noise pollution levels in the pediatric intensive care unit.

    Science.gov (United States)

    Kramer, Bree; Joshi, Prashant; Heard, Christopher

    2016-12-01

    Patients and staff may experience adverse effects from exposure to noise. This study assessed noise levels in the pediatric intensive care unit and evaluated family and staff opinion of noise. Noise levels were recorded using a NoisePro DLX. The microphone was 1 m from the patient's head. The noise level was averaged each minute and levels above 70 and 80 dBA were recorded. The maximum, minimum, and average decibel levels were calculated and peak noise level great than 100 dBA was also recorded. A parent questionnaire concerning their evaluation of noisiness of the bedside was completed. The bedside nurse also completed a questionnaire. The average maximum dB for all patients was 82.2. The average minimum dB was 50.9. The average daily bedside noise level was 62.9 dBA. The average % time where the noise level was higher than 70 dBA was 2.2%. The average percent of time that the noise level was higher than 80 dBA was 0.1%. Patients experienced an average of 115 min/d where peak noise was greater than 100 dBA. The parents and staff identified the monitors as the major contribution to noise. Patients experienced levels of noise greater than 80 dBA. Patients experience peak noise levels in excess of 100 dB during their pediatric intensive care unit stay. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  8. The 2011 United Nations High-Level Meeting on Non ...

    African Journals Online (AJOL)

    The 2011 United Nations High-Level Meeting on Non- Communicable Diseases: The Africa agenda calls for a 5-by-5 approach. ... 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).

  9. 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.

  10. 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.

  11. Nuclear Electricity in the United States : Providing Energy For The Nation's Security and Well-Being

    International Nuclear Information System (INIS)

    Finger, Harold B.

    1988-01-01

    Nuclear energy in the United States has made major contributions since the small Shippingport prototype power plant began operating in 1957. Recent legislative and regulatory actions, as well as research an development, are indicating that additional nuclear capacity can be available in the years ahead. These actions reflect the public's recognition of the importance of nuclear energy. In addition, recent regulatory actions are reaffirming the health and safety of our current nuclear plants, as well as of those being completed. The performance of our current plants is being improved through the conscious dedication of the entire industry to excellence. There is increasing discussion in the United States of the importance of advanced reactor concepts development. The next generation of nuclear plants is already being ordered outside of the United States for example, here in Korea, in Japan, in the United Kingdom and those plants all use light water reactors. We are pleased that U. S. companies are working with you on these new plants. That continues to mean that we never let up on our drive for excellence. Excellence in operations must continue to be the conscious target of all operators. Excellence in communications to the public of the need for electrical capacity, of the benefits of nuclear energy, and of the excellence being achieved in operations is also essential. And excellence in communication to decision makers at all levels of government is also required to assure that sound legalisation and regulation is established and implemented

  12. Low-level radioactive waste disposal in the United States

    International Nuclear Information System (INIS)

    Ozaki, Calvin B.; Kerr, Thomas A.; Williams, R. Eric

    1991-01-01

    Two national systems comprise the low-level radioactive waste management system in the United States of America. The U.S. Nuclear Regulatory Commission regulates low-level radioactive waste produced in the public sector (commercial waste), and the U.S. Department of Energy manages low-level radioactive waste produced by government-sponsored programs. The primary distinction between the two national systems is the source of regulatory control. This paper discusses two issues critical to the success of each system: the site selection process used by the commercial low-level waste disposal system, and the evaluation process used to determine configuration of the DOE waste management system. The two national systems take different approaches to reach the same goals, which are increased social responsibility, protection of public health and safety, and protection of the environment

  13. Plant Outage Time Savings Provided by Subcritical Physics Testing at Vogtle Unit 2

    International Nuclear Information System (INIS)

    Cupp, Philip; Heibel, M.D.

    2006-01-01

    The most recent core reload design verification physics testing done at Southern Nuclear Company's (SNC) Vogtle Unit 2, performed prior to initial power operations in operating cycle 12, was successfully completed while the reactor was at least 1% ΔK/K subcritical. The testing program used was the first application of the Subcritical Physics Testing (SPT) program developed by the Westinghouse Electric Company LLC. The SPT program centers on the application of the Westinghouse Subcritical Rod Worth Measurement (SRWM) methodology that was developed in cooperation with the Vogtle Reactor Engineering staff. The SRWM methodology received U. S. Nuclear Regulatory Commission (NRC) approval in August of 2005. The first application of the SPT program occurred at Vogtle Unit 2 in October of 2005. The results of the core design verification measurements obtained during the SPT program demonstrated excellent agreement with prediction, demonstrating that the predicted core characteristics were in excellent agreement with the actual operating characteristics of the core. This paper presents an overview of the SPT Program used at Vogtle Unit 2 during operating cycle 12, and a discussion of the critical path outage time savings the SPT program is capable of providing. (authors)

  14. Scope of physician procedures independently billed by mid-level providers in the office setting.

    Science.gov (United States)

    Coldiron, Brett; Ratnarathorn, Mondhipa

    2014-11-01

    Mid-level providers (nurse practitioners and physician assistants) were originally envisioned to provide primary care services in underserved areas. This study details the current scope of independent procedural billing to Medicare of difficult, invasive, and surgical procedures by medical mid-level providers. To understand the scope of independent billing to Medicare for procedures performed by mid-level providers in an outpatient office setting for a calendar year. Analyses of the 2012 Medicare Physician/Supplier Procedure Summary Master File, which reflects fee-for-service claims that were paid by Medicare, for Current Procedural Terminology procedures independently billed by mid-level providers. Outpatient office setting among health care providers. The scope of independent billing to Medicare for procedures performed by mid-level providers. In 2012, nurse practitioners and physician assistants billed independently for more than 4 million procedures at our cutoff of 5000 paid claims per procedure. Most (54.8%) of these procedures were performed in the specialty area of dermatology. The findings of this study are relevant to safety and quality of care. Recently, the shortage of primary care clinicians has prompted discussion of widening the scope of practice for mid-level providers. It would be prudent to temper widening the scope of practice of mid-level providers by recognizing that mid-level providers are not solely limited to primary care, and may involve procedures for which they may not have formal training.

  15. 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)

  16. Determination of optimum pressurizer level for kori unit 1

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-12-31

    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)

  17. Quality of care provided in two Scottish rural community maternity units: a retrospective case review.

    Science.gov (United States)

    Denham, Sara; Humphrey, Tracy; Taylor, Ruth

    2017-06-21

    Women in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model. The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit. Following appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics. Regarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth. Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs. These findings support the recommendations of professional

  18. Risk classification priorities in an emergency unit and outcomes of the service provided

    Directory of Open Access Journals (Sweden)

    Rafael Silva Marconato

    2017-12-01

    Full Text Available ABSTRACT Objective: to check the association of the proposed priorities of the institutional protocol of risk classification with the outcomes and evaluate the profile of the care provided in an emergency unit. Method: observational epidemiological study based on data from the computerized files of a Reference Emergency Unit. Care provided to adults was evaluated regarding risk classification and outcomes (death, hospitalization and hospital discharge based on the information recorded in the emergency bulletin. Results: the mean age of the 97,099 registered patients was 43.4 years; 81.5% cases were spontaneous demand; 41.2% had been classified as green, 15.3% yellow, 3.7% blue, 3% red and 36.and 9% had not received a classification; 90.2% of the patients had been discharged, 9.4% hospitalized and 0.4% had died. Among patients who were discharged, 14.7% had been classified as yellow or red, 13.6% green or blue, and 1.8% as blue or green. Conclusion: the protocol of risk classification showed good sensitivity to predict serious situations that can progress to death or hospitalization.

  19. Provider Beliefs Regarding Early Mobilization in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Joyce, Christine L; Taipe, Cosme; Sobin, Brittany; Spadaro, Marissa; Gutwirth, Batsheva; Elgin, Larissa; Silver, Gabrielle; Greenwald, Bruce M; Traube, Chani

    Critically ill patients are at risk for short and long term morbidity. Early mobilization (EM) of critically ill adults is safe and feasible, with improvement in outcomes. There are limited studies evaluating EM in pediatric critical care patients. Provider beliefs and concerns must be evaluated prior to EM implementation in the pediatric intensive care unit (PICU). A survey was distributed to PICU providers assessing beliefs and concerns with regards to EM of PICU patients. Seventy-one providers responded. Most staff believed EM would be beneficial. The largest perceived benefits were decreased length of both stay and mechanical ventilation. The largest perceived concerns were risk of both endotracheal tube and central venous catheter dislodgement. Surveyed clinicians felt significantly more comfortable mobilizing the oldest as compared to the youngest patients (p<0.0001). Clinicians also felt significantly more comfortable mobilizing patients receiving invasive mechanical ventilation in the oldest as compared to the youngest patients (p<0.0001). There is clear benefit to the EM of adult ICU patients, with evidence supporting its safety and feasibility. As pediatric patients pose different challenges, it is imperative to understand provider concerns prior to the implementation of EM. Our research demonstrates similar concerns between adult and pediatric programs, with the addition of significant concern surrounding EM in very young children. Understanding pediatric specific concerns with regards to EM will allow for the proper development and implementation of pediatric EM programs, allowing us to assess safety, feasibility, and ultimately outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Resource-level QoS metric for CPU-based guarantees in cloud providers

    OpenAIRE

    Goiri Presa, Íñigo; Julià Massó, Ferran; Fitó, Josep Oriol; Macías Lloret, Mario; Guitart Fernández, Jordi

    2010-01-01

    Success of Cloud computing requires that both customers and providers can be confident that signed Service Level Agreements (SLA) are supporting their respective business activities to their best extent. Currently used SLAs fail in providing such confidence, especially when providers outsource resources to other providers. These resource providers typically support very simple metrics, or metrics that hinder an efficient exploitation of their resources. In this paper, we propose a re...

  1. 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.

  2. Health Care Provider Burnout in a United States Military Medical Center During a Period of War.

    Science.gov (United States)

    Sargent, Paul; Millegan, Jeffrey; Delaney, Eileen; Roesch, Scott; Sanders, Martha; Mak, Heather; Mallahan, Leonard; Raducha, Stephanie; Webb-Murphy, Jennifer

    2016-02-01

    Provider burnout can impact efficiency, empathy, and medical errors. Our study examines burnout in a military medical center during a period of war. A survey including the Maslach Burnout Inventory (MBI), deployment history, and work variables was distributed to health care providers. MBI subscale means were calculated and associations between variables were analyzed. Approximately 60% of 523 respondents were active duty and 34% had deployed. MBI subscale means were 19.99 emotional exhaustion, 4.84 depersonalization, and 40.56 personal accomplishment. Frustration over administrative support was associated with high emotional exhaustion and depersonalization; frustration over life/work balance was associated with high emotional exhaustion. Levels of burnout in our sample were similar to civilian medical centers. Sources of frustration were related to administrative support and life/work balance. Deployment had no effect on burnout levels. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  3. Patients' and Health Care Providers' Perception of Stressors in the Intensive Care Units.

    Science.gov (United States)

    Abuatiq, Alham

    2015-01-01

    The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care

  4. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States.

    Science.gov (United States)

    Desai, Tejas; Ali, Sadeem; Fang, Xiangming; Thompson, Wanda; Jawa, Pankaj; Vachharajani, Tushar

    2016-10-01

    Gender disparities in income continue to exist, and many studies have quantified the gap between male and female workers. These studies paint an incomplete picture of gender income disparity because of their reliance on notoriously inaccurate or incomplete surveys. We quantified gender reimbursement disparity between female and male healthcare providers using objective, non-self-reported data and attempted to adjust the disparity against commonly held beliefs as to why it exists. We analysed over three million publicly available Medicare reimbursement claims for calendar year 2012 and compared the reimbursements received by male and female healthcare providers in 13 medical specialties. We adjusted these reimbursement totals against how hard providers worked, how productive each provider was, and their level of experience. We calculated a reimbursement differential between male and female providers by primary medical specialty. The overall adjusted reimbursement differential against female providers was -US$18 677.23 (95% CI -US$19 301.94 to -US$18 052.53). All 13 specialties displayed a negative reimbursement differential against female providers. Only two specialties had reimbursement differentials that were not statistically significant. After adjustment for how hard a physician works, his/her years of experience and his/her productivity, female healthcare providers are still reimbursed less than male providers. Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Financing the Business. PACE Revised. Level 2. Unit 8. Research & Development Series No. 240BB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on financing a small business, the eighth in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about and try out…

  6. Motor unit recruitment by size does not provide functional advantages for motor performance.

    Science.gov (United States)

    Dideriksen, Jakob L; Farina, Dario

    2013-12-15

    It is commonly assumed that the orderly recruitment of motor units by size provides a functional advantage for the performance of movements compared with a random recruitment order. On the other hand, the excitability of a motor neuron depends on its size and this is intrinsically linked to its innervation number. A range of innervation numbers among motor neurons corresponds to a range of sizes and thus to a range of excitabilities ordered by size. Therefore, if the excitation drive is similar among motor neurons, the recruitment by size is inevitably due to the intrinsic properties of motor neurons and may not have arisen to meet functional demands. In this view, we tested the assumption that orderly recruitment is necessarily beneficial by determining if this type of recruitment produces optimal motor output. Using evolutionary algorithms and without any a priori assumptions, the parameters of neuromuscular models were optimized with respect to several criteria for motor performance. Interestingly, the optimized model parameters matched well known neuromuscular properties, but none of the optimization criteria determined a consistent recruitment order by size unless this was imposed by an association between motor neuron size and excitability. Further, when the association between size and excitability was imposed, the resultant model of recruitment did not improve the motor performance with respect to the absence of orderly recruitment. A consistent observation was that optimal solutions for a variety of criteria of motor performance always required a broad range of innervation numbers in the population of motor neurons, skewed towards the small values. These results indicate that orderly recruitment of motor units in itself does not provide substantial functional advantages for motor control. Rather, the reason for its near-universal presence in human movements is that motor functions are optimized by a broad range of innervation numbers.

  7. PERHITUNGAN DANA PENSIUN DENGAN METODE PROJECTED UNIT CREDIT DAN INDIVIDUAL LEVEL PREMIUM

    Directory of Open Access Journals (Sweden)

    I GUSTI AYU KOMANG KUSUMA WARDHANI

    2014-08-01

    Full Text Available The company which provides the pension program needs the actuarial valuation to estimate the fund amount required by the company to pay for pension funding. Actuarial method that used in this research are projected unit credit and invidual level premium method. Through this research be obtained the result of valuation pension benefits with career average salary assumption is lower than the other salary assumptions. On the other hand, the result of normal cost final value valuation using individual level premium method is smaller than projected unit credit method that suits for the participants of the pension funding program.

  8. PERHITUNGAN DANA PENSIUN DENGAN METODE PROJECTED UNIT CREDIT DAN INDIVIDUAL LEVEL PREMIUM

    Directory of Open Access Journals (Sweden)

    I GUSTI AYU KOMANG KUSUMA WARDHANI

    2014-05-01

    Full Text Available The company which provides the pension program needs the actuarial valuation to estimate the fund amount required by the company to pay for pension funding. Actuarial method that used in this research are projected unit credit and invidual level premium method. Through this research be obtained the result of valuation pension benefits with career average salary assumption is lower than the other salary assumptions. On the other hand, the result of normal cost final value valuation using individual level premium method is smaller than projected unit credit method that suits for the participants of the pension funding program.

  9. 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.

  10. Blood Pressure Directed Booster Trainings Improve Intensive Care Unit Provider Retention of Excellent Cardiopulmonary Resuscitation Skills.

    Science.gov (United States)

    Wolfe, Heather; Maltese, Matthew R; Niles, Dana E; Fischman, Elizabeth; Legkobitova, Veronika; Leffelman, Jessica; Berg, Robert A; Nadkarni, Vinay M; Sutton, Robert M

    2015-11-01

    Brief, intermittent cardiopulmonary resuscitation (CPR) training sessions, "Booster Trainings," improve CPR skill acquisition and short-term retention. The objective of this study was to incorporate arterial blood pressure (ABP) tracings into Booster Trainings to improve CPR skill retention. We hypothesized that ABP-directed CPR "Booster Trainings" would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining. A CPR manikin creating a realistic relationship between chest compression depth and ABP was used for training/testing. Thirty-six ICU providers were randomized to brief, bedside ABP-directed CPR manikin skill retrainings: (1) Booster Plus (ABP visible during training and testing) versus (2) Booster Alone (ABP visible only during training, not testing) versus (3) control (testing, no intervention). Subjects completed skill tests pretraining (baseline), immediately after training (acquisition), and then retention was assessed at 12 hours, 3 and 6 months. The primary outcome was retention of excellent CPR skills at 3 months. Excellent CPR was defined as systolic blood pressure of 100 mm Hg or higher and compression rate 100 to 120 per minute. Overall, 14 of 24 (58%) participants acquired excellent CPR skills after their initial training (Booster Plus 75% vs 50% Booster Alone, P = 0.21). Adjusted for age, ABP-trained providers were 5.2× more likely to perform excellent CPR after the initial training (95% confidence interval [95% CI], 1.3-21.2; P = 0.02), and to retain these skills at 12 hours (adjusted odds ratio, 4.4; 95% CI, 1.3-14.9; P = 0.018) and 3 months (adjusted odds ratio, 4.1; 95% CI, 1.2-13.9; P = 0.023) when compared to baseline performance. The ABP-directed CPR booster trainings improved ICU provider 3-month retention of excellent CPR skills without the need for interval retraining.

  11. Cost Benefit Analysis of Providing Level II Trauma Care at William Beaumont Army Medical Center (WBAMC)

    National Research Council Canada - National Science Library

    Gerepka, Peter

    2002-01-01

    .... During the period from 1 October 2000 to 30 September 2001, WBAMC, a designated Level II trauma center by the American College of Surgeons, provided care for 410 patients of which 181 were civilian emergencies...

  12. Time to standardise levels of care amongst Out-of-Hospital Emergency Care providers in Africa

    OpenAIRE

    Mould-Millman, N.K.; Stein, C.; Wallis, L.A.

    2016-01-01

    The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life suppor...

  13. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates.

    Science.gov (United States)

    Edrees, Hanan H; Ismail, Mohd Nasir Mohd; Kelly, Bernadette; Goeschel, Christine A; Berenholtz, Sean M; Pronovost, Peter J; Al Obaidli, Ali Abdul Kareem; Weaver, Sallie J

    2017-11-01

    Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  14. Interprovider Communication Using a Scheduled Provider Alert-Response Communication System in 3 Inpatient Neurology Units.

    Science.gov (United States)

    Siegler, James E; Finegan, Dan; Kasner, Scott E; Price, Raymond S

    2017-10-01

    Nonemergent communications between nursing staff and residents often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest. The aim of this study was to determine whether a quality improvement communication strategy can reduce interruptive notifications during scheduled resident didactic sessions. We conducted a prospective, mixed-methods trial of a communication strategy between nurses and residents in 3 neurology units of an academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight and categorized these notifications according to levels of urgency. We implemented an intervention requiring multidisciplinary evening work rounds between the on-call resident and charge nurse and batching of nonemergent communications. Survey data were collected. The total census during the 6-month study period was 728 patients. Of the 704 resident-reported nursing notifications, 50% could be safely deferred until change of shift. After the intervention, there was a 52% decrement of notifications (0.52 vs 0.25 notifications per patient, P communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was perceived as safe and effective and resulted in higher satisfaction among participants.

  15. 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

    Identification of ectomycorrhizal (ECM) fungi is often achieved through comparisons of ribosomal DNA internal transcribed spacer (ITS) sequences with accessioned sequences deposited in public databases. A major problem encountered is that annotation of the sequences in these databases is not always....... At present UNITE contains 758 ITS sequences from 455 species and 67 genera of ECM fungi. •  UNITE can be searched by taxon name, via sequence similarity using blastn, and via phylogenetic sequence identification using galaxie. Following implementation, galaxie performs a phylogenetic analysis of the query...... 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...

  16. Process of motion by unit steps over a surface provided with elements regularly arranged

    International Nuclear Information System (INIS)

    Cooper, D.E.; Hendee, L.C. III; Hill, W.G. Jr.; Leshem, Adam; Marugg, M.L.

    1977-01-01

    This invention concerns a process for moving by unit steps an apparatus travelling over a surface provided with an array of orifices aligned and evenly spaced in several lines and several parallel rows regularly spaced, the lines and rows being parallel to axes x and y of Cartesian co-ordinates, each orifice having a separate address in the Cartesian co-ordinate system. The surface travelling apparatus has two previously connected arms aranged in directions transversal to each other thus forming an angle corresponding to the intersection of axes x and y. In the inspection and/or repair of nuclear or similar steam generator tubes, it is desirable that such an apparatus should be able to move in front of a surface comprising an array of orifices by the selective alternate introduction and retraction of two sets of anchoring claws of the two respective arms, in relation to the orifices of the array, it being possible to shift the arms in a movement of translation, transversally to each other, as a set of claws is withdrawn from the orifices. The invention concerns a process and aparatus as indicated above that reduces to a minimum the path length of the apparatus between the orifices it is effectively opposite and a given orifice [fr

  17. Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

    Directory of Open Access Journals (Sweden)

    João Maurício Castaldelli-Maia

    2013-12-01

    Full Text Available Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018. Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%. Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.

  18. Games policy makers and providers play: introducing case-mix-based payment to hospital chronic care units in Japan.

    Science.gov (United States)

    Ikegami, Naoki

    2009-06-01

    Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

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

    Science.gov (United States)

    Kõljalg, Urmas; Larsson, Karl-Henrik; Abarenkov, Kessy; Nilsson, R Henrik; Alexander, Ian J; Eberhardt, Ursula; Erland, Susanne; Høiland, Klaus; Kjøller, Rasmus; Larsson, Ellen; Pennanen, Taina; Sen, Robin; Taylor, Andy F S; Tedersoo, Leho; Vrålstad, Trude; Ursing, Björn M

    2005-06-01

    Identification of ectomycorrhizal (ECM) fungi is often achieved through comparisons of ribosomal DNA internal transcribed spacer (ITS) sequences with accessioned sequences deposited in public databases. A major problem encountered is that annotation of the sequences in these databases is not always complete or trustworthy. In order to overcome this deficiency, we report on UNITE, an open-access database. UNITE comprises well annotated fungal ITS sequences from well defined herbarium specimens that include full herbarium reference identification data, collector/source and ecological data. At present UNITE contains 758 ITS sequences from 455 species and 67 genera of ECM fungi. UNITE can be searched by taxon name, via sequence similarity using blastn, and via phylogenetic sequence identification using galaxie. Following implementation, galaxie performs a phylogenetic analysis of the query 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

  20. Providing Transthoracic Echocardiography Training for Intensive Care Unit Trainees: An Educational Improvement Initiative.

    Science.gov (United States)

    Kuza, Catherine M; Hanifi, M Tariq; Koç, Melissa; Stopfkuchen-Evans, Matthias

    2018-04-09

    Transthoracic echocardiography (TTE) is important in the management of critically ill patients, yet it has not been incorporated into many residency programs' curricula. Our objective is to determine if trainees undergoing a 60-minute training session on TTE have improved knowledge, ultrasound skills, and increases the utilization of TTE during their rotation in the intensive care unit (ICU). We will also compare the results of participants with prior TTE exposure to TTE-naïve trainees. Our hypothesis is that after the training, participants' will have improved knowledge and ultrasound skills compared to before training. Our secondary hypotheses are that TTE-naïve trainees will have greater improvements in knowledge scores compared to those who have had prior TTE experience and trainees will increase their use of TTE in the ICU. Single-center, prospective trial. Brigham and Women's Hospital (academic hospital). Residents and fellows rotating through the ICU, at any level of postgraduate training. Forty-two trainees participated in the study. Statistically significant improvement after training was observed for all multiple choice questions (MCQ) and practical assessments (p < 0.001). When assessing the differences in score improvement between TTE-experienced versus TTE-naïve users, mean score improvements were notably higher for TTE-naïve participants (MCQ: 28.2 ± 11.6; echo clinical: 48.6 ± 23.4) compared to TTE-experienced users (MCQ: 18.6 ± 13.5, p = 0.01; echo clinical: 38.3 ± 30.2, p = 0.04). A short didactic presentation on TTE use may be useful in teaching ICU trainees basic TTE skills and encouraging the use of bedside TTE in the ICU. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis.

    Science.gov (United States)

    Kyeremanteng, Kwadwo; Hendin, Ariel; Bhardwaj, Kalpana; Thavorn, Kednapa; Neilipovitz, Dave; Kubelik, Dalibour; D'Egidio, Gianni; Stotts, Grant; Rosenberg, Erin

    2017-01-01

    With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team. Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping. A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay. An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality

  2. Nintendo WII remotes provide a reconfigurable tool-changing unit with an automatic calibration capability

    Directory of Open Access Journals (Sweden)

    Collins, James

    2014-08-01

    Full Text Available Modular machines within the reconfigurable manufacturing paradigm require auxiliary modules to enhance the system’s capability. A tool-changing unit was developed as one of these auxiliary modules. The unit had to be able to adapt itself efficiently to changes in the configuration of the machine it was servicing. This necessitated the development of a real- time 3D tracking system in order for the unit to sense alterations in the position of the spindle to which it was delivering tools. An economic positioning system was produced using Nintendo Wii remotes. This paper presents the development, implementation, and testing of this positioning system.

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

    NARCIS (Netherlands)

    Steven Vos; Jeroen Scheerder

    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

  5. Incentives and compensation: providing resources for communities hosting low-level waste facilities

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    State responsibility for the management of low-level radioactive waste necessitates the selection of candidate locations for a disposal facility. Concern over potential impacts can be expected from segments of the citizenry neighboring a proposed site. A number of national organizations comprising state and local officials have recommended the use of incentives and compensation to help offset the negative local impacts. This document explores that concept. Discussion provides background information on potential local impacts from a low-level waste facility and considers the nature and types of incentives and compensation benefits that could be provided. The document then examines realistic options for planning and implementing the benefit program. This information is intended, primarily, to assist state officials - executive, legislative, and agency - in planning for and managing low-level waste disposal facilities

  6. Coral reef structural complexity provides important coastal protection from waves under rising sea levels

    Science.gov (United States)

    Harris, Daniel L.; Rovere, Alessio; Casella, Elisa; Power, Hannah; Canavesio, Remy; Collin, Antoine; Pomeroy, Andrew; Webster, Jody M.; Parravicini, Valeriano

    2018-01-01

    Coral reefs are diverse ecosystems that support millions of people worldwide by providing coastal protection from waves. Climate change and human impacts are leading to degraded coral reefs and to rising sea levels, posing concerns for the protection of tropical coastal regions in the near future. We use a wave dissipation model calibrated with empirical wave data to calculate the future increase of back-reef wave height. We show that, in the near future, the structural complexity of coral reefs is more important than sea-level rise in determining the coastal protection provided by coral reefs from average waves. We also show that a significant increase in average wave heights could occur at present sea level if there is sustained degradation of benthic structural complexity. Our results highlight that maintaining the structural complexity of coral reefs is key to ensure coastal protection on tropical coastlines in the future. PMID:29503866

  7. 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.

  8. How unit level nursing responsibilities are structured in US hospitals.

    Science.gov (United States)

    Minnick, Ann F; Mion, Lorraine C; Johnson, Mary E; Catrambone, Cathy

    2007-10-01

    To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources. The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes. Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel. No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources. Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

  9. Status of activities: Low-level radioactive waste management in the United States

    International Nuclear Information System (INIS)

    Ozaki, C.B.; Shilkett, R.C.; Kirkpatrick, T.D.

    1989-01-01

    A primary objective of low-level radioactive waste management in the United States is to protect the health and safety of the public and the quality of the environment. In support of this objective is the development of waste treatment and disposal technologies designed to provide stabilization and long-term institutional control of low-level radioactive wastes. Presented herein is a technical review of specific low-level radioactive waste management activities in the United States. Waste treatment and disposal technologies are discussed along with the performance objectives of the technologies aimed at protecting the health and safety of the public and the quality of the environment. 13 refs., 4 figs

  10. Design of shared unit-dose drug distribution network using multi-level particle swarm optimization.

    Science.gov (United States)

    Chen, Linjie; Monteiro, Thibaud; Wang, Tao; Marcon, Eric

    2018-03-01

    Unit-dose drug distribution systems provide optimal choices in terms of medication security and efficiency for organizing the drug-use process in large hospitals. As small hospitals have to share such automatic systems for economic reasons, the structure of their logistic organization becomes a very sensitive issue. In the research reported here, we develop a generalized multi-level optimization method - multi-level particle swarm optimization (MLPSO) - to design a shared unit-dose drug distribution network. Structurally, the problem studied can be considered as a type of capacitated location-routing problem (CLRP) with new constraints related to specific production planning. This kind of problem implies that a multi-level optimization should be performed in order to minimize logistic operating costs. Our results show that with the proposed algorithm, a more suitable modeling framework, as well as computational time savings and better optimization performance are obtained than that reported in the literature on this subject.

  11. Development of Curriculum Units as Basic Course for Calculus Provided for Freshmen with Low Academic Achievement

    Science.gov (United States)

    Lue, Yuang-Tswong

    2015-01-01

    This study was to design, develop, and investigate instructional units for freshmen with low academic achievement to learn before they study calculus. Because the concepts, skills, and theories of function are fundamental for the calculus course but the below average students were not familiar with the basic knowledge and ability in function when…

  12. A relational leadership perspective on unit-level safety climate.

    Science.gov (United States)

    Thompson, Debra N; Hoffman, Leslie A; Sereika, Susan M; Lorenz, Holly L; Wolf, Gail A; Burns, Helen K; Minnier, Tamra E; Ramanujam, Rangaraj

    2011-11-01

    This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

  13. Impact of CRM on the competitiveness level of ICT services in Croatian service providers

    Directory of Open Access Journals (Sweden)

    Dražen Alerić

    2007-07-01

    Full Text Available This paper proves a higher competitiveness of ICT service providers who utilize CRM versus the providers who do not. The study of observed participating ICT service providers in Croatia proves that the value added of the services incorporating CRM is more competitive than the same services but without CRM. There is also stronger demand from clients for the services enriched with CRM. Increased service competitiveness generated by CRM utilization raises the company’s general competitiveness. A systematic application of CRM creates a long-lasting relationship between clients and providers and thus enables high-quality long-term term solutions to client demands. CRM represents the value added that raises the level of service competitiveness and makes the service provider unique and recognizable among numerous competitors. Consequently, the satisfaction of clients with the provider and their preference for the same provider result in higher client loyalty. A service company that incorporates CRM in its practices has a higher success rate in fulfilling its mission and attaining goals in accordance with the marketing philosophy.

  14. Evaluation of power commissioning of the Mochovce Unit 1 power level up to 100 % Nnom

    International Nuclear Information System (INIS)

    Sarvaic, I.; Mickolci, M.

    1998-01-01

    The document contains an evaluation of the power phase of power commissioning of the Mochovce Unit 1 in the phase up to the power level of 100 % N nom .In the document, the courses and results of tests in this phase of power commissioning are summarized, evaluation of the performance of important systems and equipment of the unit is carried out, and the compliance with Limits and Conditions in the course of the phase is assessed. On this basis, conclusions are drawn and recommendations for the unit to be ready for subsequent phases of the power commissioning. The evaluation was developed by the scientific management of the Mochovce commissioning providing an independent support for the operators for supervising the commissioning tasks from the point of nuclear safety

  15. Providing music therapy to the unconscious child in the paediatric intensive care unit

    OpenAIRE

    Kennelly, Jeanette; Edwards, Jane

    1997-01-01

    peer-reviewed This paper describes techniques used in the provision of music therapy to two children in a Paediatric Intensive Care Unit during the phase of admission when they were unconscious. The presentation of known songs and adaptations of known songs elicited a range of responses in these children. Further study of the role and effects of music with this patient group is required following positive outcomes for these children receiving music therapy while unconscious ...

  16. Organic foods contain higher levels of certain nutrients, lower levels of pesticides, and may provide health benefits for the consumer.

    Science.gov (United States)

    Crinnion, Walter J

    2010-04-01

    The multi-billion dollar organic food industry is fueled by consumer perception that organic food is healthier (greater nutritional value and fewer toxic chemicals). Studies of the nutrient content in organic foods vary in results due to differences in the ground cover and maturity of the organic farming operation. Nutrient content also varies from farmer to farmer and year to year. However, reviews of multiple studies show that organic varieties do provide significantly greater levels of vitamin C, iron, magnesium, and phosphorus than non-organic varieties of the same foods. While being higher in these nutrients, they are also significantly lower in nitrates and pesticide residues. In addition, with the exception of wheat, oats, and wine, organic foods typically provide greater levels of a number of important antioxidant phytochemicals (anthocyanins, flavonoids, and carotenoids). Although in vitro studies of organic fruits and vegetables consistently demonstrate that organic foods have greater antioxidant activity, are more potent suppressors of the mutagenic action of toxic compounds, and inhibit the proliferation of certain cancer cell lines, in vivo studies of antioxidant activity in humans have failed to demonstrate additional benefit. Clear health benefits from consuming organic dairy products have been demonstrated in regard to allergic dermatitis.

  17. 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.

    2014-01-01

    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. PMID:23299226

  18. 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

  19. The relationship of financial and mission factors to the level of uncompensated care provided in California hospitals.

    Science.gov (United States)

    Kim, Tae Hyun; Mccue, Michael J; Thompson, Jon M

    2009-01-01

    Community hospitals in the United States have experienced a substantial rise in the burden of uncompensated care over the past few years. Debate continues, however, about whether hospitals, especially private not-for-profits, are providing sufficient levels of uncompensated care. Increased scrutiny regarding uncompensated care and the community benefit of not-for-profit hospitals may be fueled in part by the growing profitability of community hospitals. This study assesses how and whether a hospital's financial performance, mission characteristics, or other significant factors influence its provision of uncompensated care. The study sample consists of 193 short-term, private, acute care community hospitals in California. Results from multivariate regression suggest that free cash flow is positively associated with the provision of uncompensated care in not-for-profit hospitals, whereas a higher level of debt is related to a lower level of uncompensated care. Ownership type (for-profit versus private not-for-profit) does not make a significant difference in the provision of uncompensated care, and overall levels of uncompensated care in the local market are positively associated with a hospital's level of uncompensated care.

  20. Self-reported healthcare provider utilization across United States Midwestern households

    Directory of Open Access Journals (Sweden)

    S.R. Dominick

    2018-06-01

    Full Text Available Understanding the relationships between health care provider usage and demographics of patients is necessary for the development of educational materials, outreach information, and programs targeting individuals who may benefit from services. This analysis identified relationships between health care provider usage and individual's demographics. A sample of Midwestern U.S. respondents (n = 1265 was obtained through the use of an online survey distributed February 12–26, 2016 and was targeted to be representative of the population of the Midwestern states sampled in terms of sex, age, income, and state of residence. Specific factors identified as significant in contributing to provider usage (in the past five years differed across the eleven provider types studied. In the most commonly used practitioners (the general or primary physician, relationships between provider usage and age, income, health insurance coverage status, and having children in the household were identified. Furthermore, significant (and positive correlations were identified between the usage of various practitioners; reporting the use of one type of practitioner studied was correlated positively with reporting the use of another type of health care provider studied in this analysis. This analysis provides insight into the relationships between health care provider usage and demographics of individuals, which can aid in the development of educational materials, outreach programs, and policy development. Keywords: Healthcare, Provider use, Clinician use, Primary physician

  1. 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...

  2. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus

    Directory of Open Access Journals (Sweden)

    Susan Trang

    2015-11-01

    Full Text Available Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI and Canada’s Food Guide (CFG recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9–1.1 g/kg/day. Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  3. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus.

    Science.gov (United States)

    Trang, Susan; Fraser, Jackie; Wilkinson, Lori; Steckham, Katherine; Oliphant, Heather; Fletcher, Heather; Tzianetas, Roula; Arcand, JoAnne

    2015-11-11

    Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI) and Canada's Food Guide (CFG) recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9-1.1 g/kg/day). Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  4. Economic Evaluation of the Information Security Levels Achieved by Electric Energy Providers in North Arctic Region

    Science.gov (United States)

    Sushko, O. P.; Kaznin, A. A.; Babkin, A. V.; Bogdanov, D. A.

    2017-10-01

    The study we are conducting involves the analysis of information security levels achieved by energy providers operating in the North Arctic Region. We look into whether the energy providers’ current information security levels meet reliability standards and determine what further actions may be needed for upgrading information security in the context of the digital transformation that the world community is undergoing. When developing the information security systems for electric energy providers or selecting the protection means for them, we are governed by the fact that the assets to be protected are process technologies. While information security risk can be assessed using different methods, the evaluation of the economic damage from these risks appears to be a difficult task. The most probable and harmful risks we have identified when evaluating the electric energy providers’ information security will be used by us as variables. To provide the evaluation, it is necessary to calculate the costs relating to elimination of the risks identified. The final stage of the study will involve the development of an operation algorithm for the North Arctic Region’s energy provider’s business information protection security system - a set of information security services, and security software and hardware.

  5. 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

  6. Strategy for reducing ozone levels in the northeast United States

    International Nuclear Information System (INIS)

    Bradley, M.

    1992-01-01

    In the northeast USA, ozone episodes are frequent during the summer; most of these episodes last 3-4 days. The duration and frequency of these episodes is mainly determined by weather conditions. The persistence of ozone episodes in the region is explained by the fact that emissions of ozone precursors (nitrogen oxides (NOx) and volatile organic compounds (VOC)) are like those of other regions of the USA affected by acute ozone problems. The population density, industry, and use of automobiles are other factors contributing to the difficulty of maintaining acceptable ozone levels. The ozone problem is especially severe in the New York metropolitan area and most of New Jersey. Strategies for combating ozone precursors have relied entirely on reducing emissions of VOCs, while little has been done to reduce NOx, except for automobile emissions. The Clean Air Act of 1990 provides for significant reductions of NOx and VOC from mobile sources and insists on VOC emissions reductions from stationary sources. In California, stricter emission standards for VOC and NOx have been implemented for new vehicles, requiring wider use of low- or zero-emission vehicles. The Northeast States for Coordinated Air Use Management (NESCAUM) organization, formed by the state agencies responsible for air quality, is aiding the northeast states to evaluate the advantages of adopting California standards for vehicles. Twelve northeast states propose to adopt the Californian low-emission vehicle program and are examining other options such as reformulated gasolines, improved maintenance and verification programs, and measures to reduce the number of miles travelled. 1 fig., 1 tab

  7. Top level risk study for units 1 to 4 at NPP Kozloduy

    International Nuclear Information System (INIS)

    Shishkova, I.

    1997-01-01

    The first Top Level Study of NPP Kozloduy Units 1/4 was started in 1991 and completed in March 1992 by BEQE. The Primary objective of the project was to provide in a short term a tool for quantified comparison of the relative risk benefits that various design or operational modifications would have if implemented on NPP Kozloduy Units 1/4. This original version of the Study was reviewed by the IAEA who agreed in general with the conclusions indicating that the report provides valuable insights which should be used in the decision making process. The IAEA made suggestion for some changes. These comments were taken into account in the subsequent version. In early 1994 the new version was issued. The objective of this second project, in addition to revising the original study to reflect the IAEA comments, was to address the potential benefits from further improvements at NPP Kozloduy. The work on the second version was going on in parallel with the activities carried out in the mainframe of several NPP Kozloduy Units 1/4 Upgrading Program (WANO Six-Month Program, Program for the NPP Kozloduy Units 1-4 Upgrading, Twinning Program, etc.). And at last, a Top-Level Probabilistic Safety Study was carried out by EQE - Bulgaria and completed early in 1995 at the request of NPP Kozloduy. The objective of the project was the contribution of the different activities performed in the mainframe of the Program for the NPP Kozloduy Units 1-4 Safety Upgrading in the overall safety improvement to be assessed. 3 figs, 1 tab

  8. Noise level in a pediatric intensive care unit.

    Science.gov (United States)

    Carvalho, Werther B; Pedreira, Mavilde L G; de Aguiar, Maria Augusta L

    2005-01-01

    The purpose of this study was to verify the noise level at a PICU. This prospective observational study was performed in a 10 bed PICU at a teaching hospital located in a densely populated district within the city of São Paulo, Brazil. Sound pressure levels (dBA) were measured 24 hours during a 6-day period. Noise recording equipment was placed in the PICU access corridor, nursing station, two open wards with three and five beds, and in isolation rooms. The resulting curves were analyzed. A basal noise level variation between 60 and 70 dBA was identified, with a maximum level of 120 dBA. The most significant noise levels were recorded during the day and were produced by the staff. The basal noise level identified exceeds International Noise Council recommendations. Education regarding the effects of noise on human hearing and its relation to stress is the essential basis for the development of a noise reduction program.

  9. 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

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

    Science.gov (United States)

    Castro, Filipa de; Place, Jean Marie; Allen-Leigh, Betania; Rivera-Rivera, Leonor; Billings, Deborah

    2016-08-01

    To provide evidence on perinatal mental healthcare in Mexico. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. 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%). Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

  11. Comparison of curves of units Hounsfields of planning and provided by the OBI cono beam CT

    International Nuclear Information System (INIS)

    Rodriguez Alarcon, C.; Vicent granado, D.; Gutierrez Ramos, S. M.; Sanchez Carmona, G.; Herrador Cordoba, M.

    2013-01-01

    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)

  12. Providing palliative care in rural Nepal: Perceptions of mid-level health workers

    Directory of Open Access Journals (Sweden)

    Rajesh N Gongal

    2018-01-01

    Full Text Available Introduction: Nepal is beginning to develop palliative care services across the country. Most people live in rural areas, where the Mid-Level Health Workers (MHWs are the major service providers. Their views on providing palliative care are most important in determining how the service is organized and developed.Aim: This study aims to ascertain the perceptions of MHWs about palliative care in their local community, to inform service development.Methods: A> qualitative descriptive design, using focus group discussions, was used to collect data from a rural district of Makwanpur, 1 of the 75 districts of Nepal. Twenty-eight MHWs participated in four focus group discussions. The data were analyzed using content analysis.Result: Four themes emerged from the discussion: (i suffering of patients and families inflicted by life-threatening illness, (ii helplessness and frustration felt when caring for such patients, (iii sociocultural issues at the end of life, and (iv improving care for patients with palliative care needs.Conclusion: MHWs practicing in rural areas reported the suffering of patients inflicted with life-limiting illness and their family due to poverty, poor access, lack of resources, social discrimination, and lack of knowledge and skills of the health workers. While there are clear frustrations with the limited resources, there is a willingness to learn among the health workers and provide care in the community.

  13. HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

    Science.gov (United States)

    Cuffe, Kendra M; Esie, Precious; Leichliter, Jami S; Gift, Thomas L

    2017-04-07

    The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD

  14. 30 CFR 250.417 - What must I provide if I plan to use a mobile offshore drilling unit (MODU)?

    Science.gov (United States)

    2010-07-01

    ... both hurricane and non-hurricane seasons. If sufficient environmental information and data are not... requirements. You must provide information and data to demonstrate the drilling unit's capability to perform at the proposed drilling location. This information must include the maximum environmental and...

  15. Realising participation within an action research project on two Care Innovation Units providing care for older people.

    NARCIS (Netherlands)

    Drs Miranda Snoeren; MSc Donna Frost

    2011-01-01

    Background: On two Care Innovation Units in the Netherlands, staff, students and Lecturer Practitioners work intensively together to provide care, create a rich learning environment, and to foster innovation and research. In striving to advance the quality of care and to develop person centred

  16. A Mixed-Methods Investigation of Early Childhood Professional Development for Providers and Recipients in the United States

    Science.gov (United States)

    Linder, Sandra M.; Rembert, Kellye; Simpson, Amber; Ramey, M. Deanna

    2016-01-01

    This multi-phase mixed-methods study explores provider and recipient perceptions of the current state of early childhood professional development in a southeastern area of the United States. Professional development for the early childhood workforce has been shown to positively influence the quality of early childhood classrooms. This study…

  17. Evaluation of tectonic impact on radon level of lithological units

    International Nuclear Information System (INIS)

    Wolkowicz, S.; Strzelecki, R.

    2000-01-01

    The radon potential maps of the Sudetes Mountains and Upper Silesian Coal Basin have been prepared on a base of arithmetic mean value of radon concentration in soil air in distinguished lithological/stratigraphic units. Both zones of shallow position of ground table and the fault zones influence value of this parameter: the first one affects in specific conditions lowering of background values, the second ones - origin of values several and teen times higher than rock background values. Estimation of power of tectonic influence on general radon potential of the lithological units has been made on a base of examination of histograms of distribution of radon concentration in soil air. In the Sudetes area, 0 % to about 30 % of the measurements is related to fault zones. Higher tectonic engagement (about 30 %) characterizes the Karkonosze Granites, Izera Gneisses and Strzegom Granites. In the cases of Karkonosze Granites and the Strzegom Granites, rock background values concentrations in soil air are a little than 50 kBq/m 3 , what is the value defined for lower threshold of high radon risk areas. In conclusion, presence of numerous fault zones and fissures increases radon risk category with one class. Background modal values of radon emanations, defined for the studied units, in the 5 cases fulfill criteria for medium radon risk areas, and in other cases do not exceed of the threshold 10 kBq/m 3 . It displays, that in the case of low radon potential rocks only a few-percent rich population of measurements related to tectonic zones, is sufficient to substantially deform of the image of the studied unit radon potential. For instance, medium radon potential characterizes the Klodzko - Zloty Stok Granites (the arithmetic mean value of this class is 36.15 kBq/m 3 , n=104) and small tectonic engagement (about 3.8 %). In the result the modal value belongs to the class 20-30 kBq/m 3 . The Poreba Beds in the Upper Silesian Coal Basin are characterised by almost the same radon

  18. Low level radiation: how does the linear without threshold model provide the safety of Canadian

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    The linear without threshold model is a model of risk used worldwide by the most of health organisms of nuclear regulation in order to establish dose limits for workers and public. It is in the heart of the approach adopted by the Canadian commission of nuclear safety (C.C.S.N.) in matter of radiation protection. The linear without threshold model presumes reasonably it exists a direct link between radiation exposure and cancer rate. It does not exist scientific evidence that chronicle exposure to radiation doses under 100 milli sievert (mSv) leads harmful effects on health. Several scientific reports highlighted scientific evidences that seem indicate a low level of radiation is less harmful than the linear without threshold predicts. As the linear without threshold model presumes that any radiation exposure brings risks, the ALARA principle obliges the licensees to get the radiation exposure at the lowest reasonably achievable level, social and economical factors taken into account. ALARA principle constitutes a basic principle in the C.C.S.N. approach in matter of radiation protection; On the radiation protection plan, C.C.S.N. gets a careful approach that allows to provide health and safety of Canadian people and the protection of their environment. (N.C.)

  19. Modification of an existing radwaste facility to provide onsite low level waste storage

    International Nuclear Information System (INIS)

    Ault, G.M.; Reiss, J.F.; Commonwealth Edison Co., Chicago, IL)

    1985-01-01

    The decision of whether or not to install onsite storage capacity for low-level radioactive waste is dictated by individual utility circumstances. Commonwealth Edison has decided to construct facilities to store low-level radwaste onsite at each of their four operating nuclear stations, and they plan to have those facilities in operation by January, 1986. At Dresden, that onsite storage capacity is being provided by modifying an existing radwaste building which already has installed a remotely-operated precision-placement type crane. The purposes of this paper are to describe: (1) how Commonwealth Edison arrived at the decision to construct onsite storage facilities as a hedge against possible disruption of burial site availability in January, 1986; (2) why the desire to minimize the capital investment for this protection led to selection of an uncomplicated design for their ''standard'' facility and to the decision to modify an existing building at Dresden rather than construct a new one; and (3) what is being done to adapt the Dresden 1 Decontamination/Radwaste Building for extended onsite storage

  20. High-level radioactive waste management in the United States. Background and status: 1996

    International Nuclear Information System (INIS)

    Dyer, J.R.

    1996-01-01

    The US high-level radioactive waste disposal program is investigating a site at Yucca Mountain, Nevada, to determine whether or not it is a suitable location for the development of a deep mined geologic repository. At this time, the US program is investigating a single site, although in the past, the program involved successive screening and comparison of alternate locations. The United States civilian reactor programs do not reprocess spent fuel; the high-level waste repository will be designed for the emplacement or spent fuel and a limited amount of vitrified high-level wastes from previous reprocessing in the US. The legislation enabling the US program also contains provisions for a Monitored Retrievable Storage facility, which could provide temporary storage of spent fuel accepted for disposal, and improve the flexibility of the repository development schedule

  1. Integrated Level 3 risk assessment for the LaSalle Unit 2 nuclear power plant

    International Nuclear Information System (INIS)

    Payne, A.C. Jr.; Brown, T.D.; Miller, L.A.

    1991-01-01

    An integrated Level 3 probabilistic risk assessment (PRA) was performed on the LaSalle County Station nuclear power plant using state-of-the-art PRA analysis techniques. The objective of this study was to provide an estimate of the risk to the offsite population during full power operation of the plant and to include a characterization of the uncertainties in the calculated risk values. Uncertainties were included in the accident frequency analysis, accident progression analysis, and the source term analysis. Only weather uncertainties were included in the consequence analysis. In this paper selected results from the accident frequency, accident progression, source term, consequence, and integrated risk analyses are discussed and the methods used to perform a fully integrated Level 3 PRA are examined. LaSalle County Station is a two-unit nuclear power plant located 55 miles southwest of Chicago, Illinois. Each unit utilizes a Mark 2 containment to house a General Electric 3323 MWt BWR-5 reactor. This PRA, which was performed on Unit 2, included internal as well as external events. External events that were propagated through the risk analysis included earthquakes, fires, and floods. The internal event accident scenarios included transients, transient-induced LOCAs (inadvertently stuck open relief valves), anticipated transients without scram, and loss of coolant accidents

  2. Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands.

    Science.gov (United States)

    Ronis, Scott T; Slaunwhite, Amanda K; Malcom, Kathryn E

    2017-11-01

    This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.

  3. AP600 level of automation: United States utility perspective

    International Nuclear Information System (INIS)

    Bekkerman, A.Y.

    1997-01-01

    Design of the AP600 advanced nuclear plant man-machine interface system (M-MIS) is guided by the applicable requirements from the Utility Requirements Document (URD). However, the URD has left certain aspects of the M-MIS to be determined by the designer working together with utilities sponsoring the work. This is particularly true in the case of the level of automation to be designed into the M-MIS. Based on experience from currently operating plants, utilities have specified the identity and roles of personnel in the control room, which has led to establishing a number of level of automation issues for the AP600. The key role of automated computerized procedures in the AP600 automation has been determined and resolved. 5 refs

  4. Effects of Provided Trainings Regarding Non-Invasive Mechanical Ventilation on the Knowledge Level of Nurses

    Directory of Open Access Journals (Sweden)

    Sonay Göktaş

    2017-04-01

    Full Text Available Objective: Having experienced members in the team for obtaining successful outcomes in non-invasive mechanical ventilation (NIMV is important. The aim of our study is to determine the effectiveness of training on nurse’s level of knowledge about NIMV Methods: This study was done with 70 nurses who were working at an university hospital. The data collection tools that were used were form for individual characteristics and knowledge test questions form consisting of multiple-choice for NIMV. Firstly, Pre-tests have been collected in the survey. Secondly, courses regarding NIMV indications, contraindications and patients management topics were given verbally by researchers. Finally, final tests were performed and data were collected. Analyzing for data were used frequency, percentage, wilcoxon and dependent samples Mc Nemar tests. Results: Mean age were 33.2±7.3, 87.1% were female, 68.6% had bachelor degrees. Of 47.1% were working in intensive care. 54.3% often provide care to NIMV applied patients. 94.7% mentioned that they don’t have any knowledge of NIMV applications. The differences between the pre-post training scores were higher statistically (p<0.001. It was determined that knowledge levels of nurses about NIMV indications and contraindications after training increased statistically significantly. (p<0.05. Conclusion: In our research it was understood that nurses’ knowledge has increased significantly after the training for non-invasive applications. By means of these trainings that will develop the affective, cognitive and psychomotor skills of nurses, it is expected to reveal the results of the extensive research and successful outcomes for NIMV applications will increase.

  5. AIRS/Aqua Level 3 Pentad quantization in physical units (AIRS-only) V005

    Data.gov (United States)

    National Aeronautics and Space Administration — AIRS/Aqua Level 3 pentad quantization product in physical units (AIRS Only). The quantization products (QP) are distributional summaries derived from the Level-2...

  6. Aqua AIRS Level 3 Quantization in Physical Units (AIRS+AMSU) V006

    Data.gov (United States)

    National Aeronautics and Space Administration — AIRS/Aqua Level 3 monthly quantization product in physical units (Without HSB). The quantization products (QP) are distributional summaries derived from the Level-2...

  7. AIRS/Aqua Level 3 Pentad quantization in physical units (AIRS+AMSU+HSB) V005

    Data.gov (United States)

    National Aeronautics and Space Administration — AIRS/Aqua Level 3 pentad quantization product in physical units (With HSB). The quantization products (QP) are distributional summaries derived from the Level-2...

  8. Financing the Business. PACE Revised. Level 3. Unit 8. Research & Development Series No. 240CB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on financing businesses, the eighth 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 other materials at…

  9. The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit.

    Science.gov (United States)

    Butler, Ashleigh E; Hall, Helen; Copnell, Beverley

    2018-01-01

    To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.

  10. Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

    Science.gov (United States)

    Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

    2018-06-01

    The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

  11. 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

  12. 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

  13. Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

    Science.gov (United States)

    Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

    2014-01-01

    Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

  14. Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

    Science.gov (United States)

    Trifunovic, Natasa; Jatic, Zaim; Kulenovic, Alma Dzubur

    2017-06-01

    To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

  15. Resource Conservation and Recovery Act closure plan for the Intermediate-Level Transuranic Storage Facility mixed waste container storage units

    International Nuclear Information System (INIS)

    Nolte, E.P.; Spry, M.J.; Stanisich, S.N.

    1992-11-01

    This document describes the proposed plan for clean closure of the Intermediate-Level Transuranic Storage Facility mixed waste container storage units at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act closure requirements. Descriptions of the location, size, capacity, history, and current status of the units are included. The units will be closed by removing waste containers in storage, and decontamination structures and equipment that may have contacted waste. Sufficient sampling and documentation of all activities will be performed to demonstrate clean closure. A tentative schedule is provided in the form of a milestone chart

  16. 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.

  17. 42 CFR 433.67 - Limitations on level of FFP for permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... provider-related donations. 433.67 Section 433.67 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... permissible provider-related donations. (a)(1) Limitations on bona fide donations. There are no limitations on the amount of bona fide provider-related donations that a State may receive without a reduction in FFP...

  18. 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.

  19. Family participation during intensive care unit rounds: attitudes and experiences of parents and healthcare providers in a tertiary pediatric intensive care unit.

    Science.gov (United States)

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

    2014-02-01

    To compare the experiences and attitudes of healthcare providers and parents regarding parental participation in morning rounds, in particular to evaluate for differences in perception of parental comprehension of rounds content and parental comfort with attendance, and to identify subgroups of parents who are more likely to report comfort with attending rounds. Cross-sectional survey of 100 parents and 131 healthcare providers in a tertiary care pediatric medical/surgical intensive care unit. Descriptive statistics were used to analyze survey responses; univariate and multivariate analyses were performed to compare parent and healthcare provider responses. Of parents, 92% reported a desire to attend rounds, and 54% of healthcare providers reported a preference for parental presence. There were significant discrepancies in perception of understanding between the 2 groups, with healthcare providers much less likely to perceive that parents understood both the format (30% vs 73%, P parents. Analysis of parent surveys did not reveal characteristics correlated with increased comfort or desire to attend rounds. A majority of parents wish to participate in morning rounds, whereas healthcare provider opinions are mixed. Important discrepancies exist between parent and healthcare provider perceptions of parental comfort and comprehension on rounds, which may be important in facilitating parental presence. Copyright © 2014 Mosby, Inc. All rights reserved.

  20. Determining Your Potential as an Entrepreneur. PACE Revised. Level 2. Unit 2. Research & Development Series No. 240BB2.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on determining one's potential as an entrepreneur, the second in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about…

  1. Planning the Marketing Strategy. PACE Revised. Level 2. Unit 6. Research & Development Series No. 240BB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This unit on planning marketing strategy for a small business, the sixth in a series of 18 modules, is on the second level of the revised PACE (Program for Acquiring Competence in Entrepreneurship) comprehensive curriculum. Geared to advanced secondary and beginning postsecondary or adult students, the modules provide an opportunity to learn about…

  2. 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.

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

    OpenAIRE

    Călin Cherecheş Marius; Paula Timofe Mara; Ovidiu Oniga

    2015-01-01

    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 o...

  4. Thermal characteristics of a medium-level concentration photovoltaic unit with evaporation cooling

    Science.gov (United States)

    Kokotov, Yuri V.; Reyz, Michael A.; Fisher, Yossi

    2009-08-01

    The results of thermal analysis and experiments are presented for a 1-kW brand new medium-level (8X) concentration photovoltaic (CPV) unit that is cooled by evaporation and built as an elongated floating solar unit. The unit keeps the silicon PV elements at low and stable temperature around the clock, significantly outperforms competitors' systems in terms of the power output and the life span of identical PV elements. It is demonstrated theoretically and experimentally that the PV element temperature level exceeds the temperature level of water in the water basin (used as a heat sink) by just a few degrees.

  5. 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.

  6. 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...

  7. 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.

  8. 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

    -test, correlations, and logistic regression modelling in four separate models. SETTING AND SUBJECTS: The population (151 731) and all healthcare in Blekinge in 2007. MAIN OUTCOME MEASURE: Actively or passively listed in primary care, registered on 31 December 2007. RESULTS: Number of consultations (OR 1.31, 95% CI 1...... 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...

  9. New York vs. United States: Federalism and the disposal of low-level radioactive waste

    International Nuclear Information System (INIS)

    Weiner, R.D.

    1994-01-01

    Although 97 percent of LLRW is so slightly radioactive that it requires little or no shielding to protect the public, the remaining 3 percent consists of materials that must be shielded for periods ranging from 300 to several thousand years. Some of the material classified as LLRW contains open-quotes open-quote hot spots close-quote, where concentrations of radioactivity may be quite high.close quotes Even aside from such hot spots, LLRW poses a threat to human health. While nuclear power plants generate the bulk of LLRW, a significant quantity of LLRW is generated by industry, and academic and medical institutions. States are allowed to regulate LLRW that is generated by the private sector, as long as the regulations are compatible with, and at least as restrictive as, those of the NRC. However, states may not regulate LLRW generated by NRC-licensed nuclear power plants. The Low-Level Radioactive Waste Policy Amendments Act of 1985 (LLR-WPAA, or the Act) attempted to solve the problem of insufficient LLRW disposal capacity in the United States by further shifting responsibility for LLRW disposal to the states. The Act required each state to provide an approved disposal site that could be located either within that state or within a region formed by a compact including that state. In June, 1992, the United States Supreme Court struck down a key provision of the Act that would have forced a state to take title to all LLRW generated within its borders if that state failed to meet a 1996 deadline for providing such a disposal site. This note will examine the constitutional basis for, and the consequences of, that decision. In addition, this note will suggest that the Court's new criterion for determining when a federal statute violates principles of federalism be replaced by a more coherent and workable test resting on a theory of political accountability and on the Guarantee Clause of the United States Constitution

  10. 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. .... by their friends or the hospital porter, for example, had passed the. Fig. 1. Quality of .... must be completed and stuck onto the patient's file would force.

  11. 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.

  12. [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.

  13. 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

  14. AIRS/Aqua Level 3 Pentad quantization in physical units (AIRS+AMSU) V005

    Data.gov (United States)

    National Aeronautics and Space Administration — AIRS/Aqua Level 3 pentad quantization product in physical units (Without HSB). The geophysical parameters have been averaged and binned into 1 x 1 deg grid cells,...

  15. Local Flexibility Market Design for Aggregators Providing Multiple Flexibility Services at Distribution Network Level

    Directory of Open Access Journals (Sweden)

    Pol Olivella-Rosell

    2018-04-01

    Full Text Available This paper presents a general description of local flexibility markets as a market-based management mechanism for aggregators. The high penetration of distributed energy resources introduces new flexibility services like prosumer or community self-balancing, congestion management and time-of-use optimization. This work is focused on the flexibility framework to enable multiple participants to compete for selling or buying flexibility. In this framework, the aggregator acts as a local market operator and supervises flexibility transactions of the local energy community. Local market participation is voluntary. Potential flexibility stakeholders are the distribution system operator, the balance responsible party and end-users themselves. Flexibility is sold by means of loads, generators, storage units and electric vehicles. Finally, this paper presents needed interactions between all local market stakeholders, the corresponding inputs and outputs of local market operation algorithms from participants and a case study to highlight the application of the local flexibility market in three scenarios. The local market framework could postpone grid upgrades, reduce energy costs and increase distribution grids’ hosting capacity.

  16. 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.

  17. Deadbeat control of power leveling unit with bidirectional buck/boost DC/DC converter

    OpenAIRE

    Hamasaki, Shin-ichi; Mukai, Ryosuke; Yano, Yoshihiro; Tsuji, Mineo

    2014-01-01

    As a distributed generation system increases, a stable power supply becomes difficult. Thus control of power leveling (PL) unit is required to maintain the balance of power flow for irregular power generation. The unit is required to respond to change of voltage and bidirectional power flow. So the bidirectional buck/boost DC/DC converter is applied for the control of PL unit in this research. The PL unit with Electric double-layer capacitor (EDLC) is able to absorb change of power, and it is...

  18. The impact of a noise reduction quality improvement project upon sound levels in the open-unit-design neonatal intensive care unit.

    Science.gov (United States)

    Liu, W F

    2010-07-01

    To decrease measured sound levels in the neonatal intensive care unit through implementation of human factor and minor design modification strategies. Prospective time series. Two open-unit-design neonatal centers. Implementation of a coordinated program of noise reduction strategies did not result in any measurable improvement in levels of loudness or quiet. Two centers, using primarily human behavior noise reduction strategies, were unable to demonstrate measurable improvements in sound levels within the occupied open-unit-design neonatal intensive care unit.

  19. United States regulations for institutional controls at high-level waste repositories

    International Nuclear Information System (INIS)

    Piccone, Josephine

    2015-01-01

    The United States regulations for disposal of spent nuclear fuel and high-level radioactive waste are found at Title 10 of the Code of Federal Regulations (10 CFR) Parts 60 and 63, which cover deep geologic disposal at a generic site and at Yucca Mountain, Nevada, respectively. As an independent regulator, the US Nuclear Regulatory Commission (NRC) is responsible for licensing and oversight of a high-level waste repository in the United States. The licensing approach for disposal has discreet decisions, made by the NRC, that include approval of construction authorisation, approval to receive and possess high-level radioactive waste, and approval for permanent closure. For construction authorisation approval, the applicant must provide a description of the programme to be used to maintain the records. The NRC will have an active oversight role during the construction and operation period, which can be on the order of 100 years for the facility before permanent closure. The oversight activities are part of the active institutional controls, and serve as a means of conveying knowledge for that initial period, given that this will likely involve multiple generations of workers for both the implementer and the regulator. Additionally, the NRC provides requirements for the physical protection of stored spent nuclear fuel and high-level radioactive waste at 10 CFR Chap. 73.51. For permanent closure approval, the applicant must provide a detailed description of the measures to be employed-such as land use controls, construction of monuments, and preservation of records. The NRC's regulatory role in any licensing action is to apply the applicable regulations and guidance, and to review applications for proposed actions to determine if compliance with regulations has been achieved. The burden of proof is on the applicant or licensee to show that the proposed action is safe, to demonstrate that regulations are met, and to ensure continued compliance with the regulations

  20. 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)...

  1. Middle Level Preservice Teachers Experience a Natural History Arts-Integrated Interdisciplinary Thematic Unit

    Science.gov (United States)

    Weber, Carolyn A.; Rule, Audrey C.

    2017-01-01

    Curricular demands and best practices for middle school require interdisciplinary units. Arts integration can provide motivation and a new pathway to learning. This unit focused on inquiry into the natural history of artifacts and rocks recovered from the exposed subsoil of an area near Cedar Falls, Iowa that had been bulldozed as part of…

  2. Recruitment of rat diaphragm motor units across motor behaviors with different levels of diaphragm activation.

    Science.gov (United States)

    Seven, Yasin B; Mantilla, Carlos B; Sieck, Gary C

    2014-12-01

    Phrenic motor neurons are recruited across a range of motor behaviors to generate varying levels of diaphragm muscle (DIAm) force. We hypothesized that DIAm motor units are recruited in a fixed order across a range of motor behaviors of varying force levels, consistent with the Henneman Size Principle. Single motor unit action potentials and compound DIAm EMG activities were recorded in anesthetized, neurally intact rats across different motor behaviors, i.e., eupnea, hypoxia-hypercapnia (10% O2 and 5% CO2), deep breaths, sustained airway occlusion, and sneezing. Central drive [estimated by root-mean-squared (RMS) EMG value 75 ms after the onset of EMG activity (RMS75)], recruitment delay, and onset discharge frequencies were similar during eupnea and hypoxia-hypercapnia. Compared with eupnea, central drive increased (∼25%) during deep breaths, and motor units were recruited ∼12 ms earlier (P motor units were recruited ∼30 ms earlier (P motor unit onset discharge frequencies were significantly higher (P Recruitment order of motor unit pairs observed during eupnea was maintained for 98%, 87%, and 84% of the same pairs recorded during hypoxia-hypercapnia, deep breaths, and airway occlusion, respectively. Reversals in motor unit recruitment order were observed primarily if motor unit pairs were recruited motor unit recruitment order being determined primarily by the intrinsic size-dependent electrophysiological properties of phrenic motor neurons. Copyright © 2014 the American Physiological Society.

  3. Manchester Coding Option for SpaceWire: Providing Choices for System Level Design

    Science.gov (United States)

    Rakow, Glenn; Kisin, Alex

    2014-01-01

    This paper proposes an optional coding scheme for SpaceWire in lieu of the current Data Strobe scheme for three reasons. First reason is to provide a straightforward method for electrical isolation of the interface; secondly to provide ability to reduce the mass and bend radius of the SpaceWire cable; and thirdly to provide a means for a common physical layer over which multiple spacecraft onboard data link protocols could operate for a wide range of data rates. The intent is to accomplish these goals without significant change to existing SpaceWire design investments. The ability to optionally use Manchester coding in place of the current Data Strobe coding provides the ability to DC balanced the signal transitions unlike the SpaceWire Data Strobe coding; and therefore the ability to isolate the electrical interface without concern. Additionally, because the Manchester code has the clock and data encoded on the same signal, the number of wires of the existing SpaceWire cable could be optionally reduced by 50. This reduction could be an important consideration for many users of SpaceWire as indicated by the already existing effort underway by the SpaceWire working group to reduce the cable mass and bend radius by elimination of shields. However, reducing the signal count by half would provide even greater gains. It is proposed to restrict the data rate for the optional Manchester coding to a fixed data rate of 10 Megabits per second (Mbps) in order to make the necessary changes simple and still able to run in current radiation tolerant Field Programmable Gate Arrays (FPGAs). Even with this constraint, 10 Mbps will meet many applications where SpaceWire is used. These include command and control applications and many instruments applications with have moderate data rate. For most NASA flight implementations, SpaceWire designs are in rad-tolerant FPGAs, and the desire to preserve the heritage design investment is important for cost and risk considerations. The

  4. Association of provider recommendation and offer and influenza vaccination among adults aged ≥18 years - United States.

    Science.gov (United States)

    Lu, Peng-Jun; Srivastav, Anup; Amaya, Ashley; Dever, Jill A; Roycroft, Jessica; Kurtz, Marshica Stanley; O'Halloran, Alissa; Williams, Walter W

    2018-02-01

    Influenza vaccination has been recommended for all persons aged ≥6 months since 2010. Data from the 2016 National Internet Flu Survey were analyzed to assess provider vaccination recommendations and early influenza vaccination during the 2016-17 season among adults aged ≥18 years. Predictive marginals from a multivariable logistic regression model were used to identify factors independently associated with early vaccine uptake by provider vaccination recommendation status. Overall, 24.0% visited a provider who both recommended and offered influenza vaccination, 9.0% visited a provider who only recommended but did not offer, 25.1% visited a provider who neither recommended nor offered, and 41.9% did not visit a doctor from July 1 through date of interview. Adults who reported that a provider both recommended and offered vaccine had significantly higher vaccination coverage (66.6%) compared with those who reported that a provider only recommended but did not offer (48.4%), those who neither received recommendation nor offer (32.0%), and those who did not visit a doctor during the vaccination period (28.8%). Results of multivariable logistic regression indicated that having received a provider recommendation, with or without an offer for vaccination, was significantly associated with higher vaccination coverage after controlling for demographic and access-to-care factors. Provider recommendation was significantly associated with influenza vaccination. However, overall, 67.0% of adults did not visit a doctor during the vaccination period or did visit a doctor but did not receive a provider recommendation. Evidence-based strategies such as client reminder/recall, standing orders, provider reminders, or health systems interventions in combination should be undertaken to improve provider recommendation and influenza vaccination coverage. Other factors significantly associated with a higher level of influenza vaccination included age ≥50 years, being Hispanic

  5. Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM).

    Science.gov (United States)

    Asan, Onur; Holden, Richard J; Flynn, Kathryn E; Yang, Yushi; Azam, Laila; Scanlon, Matthew C

    2016-07-20

    The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.

  6. A cytosolic copper storage protein provides a second level of copper tolerance in Streptomyces lividans.

    Science.gov (United States)

    Straw, Megan L; Chaplin, Amanda K; Hough, Michael A; Paps, Jordi; Bavro, Vassiliy N; Wilson, Michael T; Vijgenboom, Erik; Worrall, Jonathan A R

    2018-01-24

    Streptomyces lividans has a distinct dependence on the bioavailability of copper for its morphological development. A cytosolic copper resistance system is operative in S. lividans that serves to preclude deleterious copper levels. This system comprises of several CopZ-like copper chaperones and P 1 -type ATPases, predominantly under the transcriptional control of a metalloregulator from the copper sensitive operon repressor (CsoR) family. In the present study, we discover a new layer of cytosolic copper resistance in S. lividans that involves a protein belonging to the newly discovered family of copper storage proteins, which we have named Ccsp (cytosolic copper storage protein). From an evolutionary perspective, we find Ccsp homologues to be widespread in Bacteria and extend through into Archaea and Eukaryota. Under copper stress Ccsp is upregulated and consists of a homotetramer assembly capable of binding up to 80 cuprous ions (20 per protomer). X-ray crystallography reveals 18 cysteines, 3 histidines and 1 aspartate are involved in cuprous ion coordination. Loading of cuprous ions to Ccsp is a cooperative process with a Hill coefficient of 1.9 and a CopZ-like copper chaperone can transfer copper to Ccsp. A Δccsp mutant strain indicates that Ccsp is not required under initial copper stress in S. lividans, but as the CsoR/CopZ/ATPase efflux system becomes saturated, Ccsp facilitates a second level of copper tolerance.

  7. Pifithrin-α provides neuroprotective effects at the level of mitochondria independently of p53 inhibition.

    Science.gov (United States)

    Neitemeier, Sandra; Ganjam, Goutham K; Diemert, Sebastian; Culmsee, Carsten

    2014-12-01

    Impaired mitochondrial integrity and function are key features of intrinsic death pathways in neuronal cells. Therefore, key regulators of intrinsic death pathways acting upstream of mitochondria are potential targets for therapeutic approaches of neuroprotection. The tumor suppressor p53 is a well-established regulator of cellular responses towards different kinds of lethal stress, including oxidative stress. Recent reports suggested that p53 may affect mitochondrial integrity and function through both, transcriptional activation of mitochondria-targeted pro-death proteins and direct effects at the mitochondrial membrane. In the present study, we compared the effects of pharmacological inhibition of p53 by pifithrin-α with those of selective p53 gene silencing by RNA interference. Using MTT assay and real-time cell impedance measurements we confirmed the protective effect of both strategies against glutamate-induced oxidative stress in immortalized mouse hippocampal HT-22 neurons. Further, we observed full restoration of mitochondrial membrane potential and inhibition of glutamate-induced mitochondrial fragmentation by pifithrin-α which was, in contrast, not achieved by p53 gene silencing. Downregulation of p53 by siRNA decreased p53 transcriptional activity and reduced expression levels of p21 mRNA, while pifithrin-α did not affect these endpoints. These results suggest a neuroprotective effect of pifithrin-α which occurred at the level of mitochondria and independently of p53 inhibition.

  8. 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

  9. 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.

  10. Noosphere: Does the Internet Provide an Evolutionary Leap to a Higher Level of Collective Intelligence?

    Directory of Open Access Journals (Sweden)

    Tatjana Milivojević

    2015-09-01

    Full Text Available The neologism noosphere signifies global human consciousness. According to T. de Chardin, it is the third stage in the development of the earth, after the geosphere and the biosphere. As well as the emergence of life has fundamentally changed the geosphere, the emergence of human consciousness has fundamentally changed the biosphere. De Chardin envisioned the “planetarization” of mankind, which is equivalent to the current globalization by information technology. From an anthropological point of view, internet is not a technology or media as others: it has the potential to revolutionize the current civilizational paradigm. With the advent of the internet the idea of the noosphere has been reactualized and related to the concept of collective intelligence. The article questions the hypothesis of an evolutionary leap in a greater collective intelligence or higher level of collective consciousness presenting pros and cons.

  11. Future-oriented tweets predict lower county-level HIV prevalence in the United States.

    Science.gov (United States)

    Ireland, Molly E; Schwartz, H Andrew; Chen, Qijia; Ungar, Lyle H; Albarracín, Dolores

    2015-12-01

    Future orientation promotes health and well-being at the individual level. Computerized text analysis of a dataset encompassing billions of words used across the United States on Twitter tested whether community-level rates of future-oriented messages correlated with lower human immunodeficiency virus (HIV) rates and moderated the association between behavioral risk indicators and HIV. Over 150 million tweets mapped to U.S. counties were analyzed using 2 methods of text analysis. First, county-level HIV rates (cases per 100,000) were regressed on aggregate usage of future-oriented language (e.g., will, gonna). A second data-driven method regressed HIV rates on individual words and phrases. Results showed that counties with higher rates of future tense on Twitter had fewer HIV cases, independent of strong structural predictors of HIV such as population density. Future-oriented messages also appeared to buffer health risk: Sexually transmitted infection rates and references to risky behavior on Twitter were associated with higher HIV prevalence in all counties except those with high rates of future orientation. Data-driven analyses likewise showed that words and phrases referencing the future (e.g., tomorrow, would be) correlated with lower HIV prevalence. Integrating big data approaches to text analysis and epidemiology with psychological theory may provide an inexpensive, real-time method of anticipating outbreaks of HIV and etiologically similar diseases. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

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

    International Nuclear Information System (INIS)

    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

  13. Main factors determining the KNP units 5 and 6 safety level according to the PSA level 1 result

    International Nuclear Information System (INIS)

    Manchev, B.; Marinova, B.; Nenkova, B.

    2004-01-01

    The Probabilistic Safety Analysis (PSA) is a powerful tool for ascertainment of the safety level reached at nuclear power plants operation. The results of PSA determine very clearly the functions, systems, equipment or operator actions that have to be improved in order to increase the plant safety level as a whole. The present report presents the main results of the last upgraded revision of PSA level 1 of units 5 and 6 of KNPP. The objective of the report is to lay emphasis on the factors determining the result obtained, i.e. to demonstrate the scopes whose improvement leads to an increase of the safety level reached at the units power operation. In the frame of the study presented the following categories of initiating events are included: Internal initiating events; Initiating events result of internal fires; Initiating events result of seismic action; Floods. Only the reactor core is considered as a source of radioactive contamination. Only initiating events related to the reactor work on power are analyzed. Unit 5 of KNPP is accepted as a basic unit for the study. All modifications and design changes implemented up to year 2000 are taken into account. The results of PSA level 1 for units 5 and 6 of KNPP covering the risk of internal initiators are presented. The assessment of the core damage due to internal initiators is based on the analysis of 18 groups of initiating events. 932 consequences and two groups of initial events are identified, leading to core damage. As a result of the quantitative calculation, over 15000 minimal cuts for the core damage are obtained. The first 80 cuts bear over 75% of the frequency obtained, and the first 700 cuts bear over 90%. Distribution of the core damage frequency by different groups of initiators is presented in tables and diagrams. A comparison of the result obtained for the reactor core damage of KNPP units 5 and 6 with assessment obtained for similar power plants is presented. The data for different NPPs are taken

  14. Views of parents and health-care providers regarding parental presence at bedside rounds in a neonatal intensive care unit.

    Science.gov (United States)

    Grzyb, M J; Coo, H; Rühland, L; Dow, K

    2014-02-01

    To examine the views of parents and health-care providers regarding parental presence during neonatal intensive care rounds. Cross-sectional survey of parents whose children were admitted to a tertiary-care neonatal intensive care unit (n=81). Medical trainees (n=67) and nurses (n=28) were also surveyed. The majority of parents reported that attending rounds reduced their anxiety and increased their confidence in the health-care team. Nurses were more likely than medical trainees to support parental presence at rounds (P=0.02). About three-quarters of medical trainees and nurses thought discussion is inhibited and 69% of trainees felt teaching is decreased when parents attend rounds. Most parents who attended rounds found the experience beneficial, but medical trainees' views were mixed. The positive impact on parents, and the learning opportunities created in family-centered care and communication when parents are present on rounds, should be highlighted for trainees and other neonatal intensive care personnel.

  15. 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.

  16. A study of concrete for the tumulus disposal units in low-level radioactive waste management

    International Nuclear Information System (INIS)

    Lee, J.H.; Roy, D.M.; Licastro, P.H.; Scheetz, B.E.

    1991-01-01

    The tumulus disposal concept can provide a major means for the disposal of low-level radioactive waste (LLRW) provided the concrete structures of the tumulus disposal units are designed and fabricated for long term durability. As an initial phase of the study, a detailed characterization and testing of the component materials for the tumulus concrete have been evaluated. Key properties of hardened concrete that are important in assuring and predicting the long term durability, which have been evaluated, or are being evaluated, include: water permeability; chloride permeability; sulfate resistance; porosity and pore structure; freeze-thaw resistance; leaching and dissolution; alkali-aggregate reaction; and strength. Those properties were evaluated on samples from field concrete cylinders provided by Martin Marietta Energy Systems (MMES), or samples prepared in the laboratory, or both. The proposed concrete mix design showed an excellent resistance to repeated freeze-thaw cycles, and a very low permeability to chloride. An accelerated test method was used to evaluate alkali-aggregate reactivity in concrete for samples containing representative coarse and fine aggregates proposed for the tumulus concrete, and also conducted for samples cored from the field concrete cylinders

  17. Health Care Provider Counseling for Weight Loss Among Adults with Arthritis and Overweight or Obesity - United States, 2002-2014.

    Science.gov (United States)

    Guglielmo, Dana; Hootman, Jennifer M; Murphy, Louise B; Boring, Michael A; Theis, Kristina A; Belay, Brook; Barbour, Kamil E; Cisternas, Miriam G; Helmick, Charles G

    2018-05-04

    In the United States, 54.4 million adults report having doctor-diagnosed arthritis (1). Among adults with arthritis, 32.7% and 38.1% also have overweight and obesity, respectively (1), with obesity being more prevalent among persons with arthritis than among those who do not have arthritis (2). Furthermore, severe joint pain among adults with arthritis in 2014 was reported by 23.5% of adults with overweight and 31.7% of adults with obesity (3). The American College of Rheumatology recommends weight loss for adults with hip or knee osteoarthritis and overweight or obesity,* which can improve function and mobility while reducing pain and disability (4,5). The Healthy People 2020 target for health care provider (hereafter provider) counseling for weight loss among persons with arthritis and overweight or obesity is 45.3%. † Adults with overweight or obesity who receive weight-loss counseling from a provider are approximately four times more likely to attempt to lose weight than are those who do not receive counseling (6). To estimate changes in the prevalence of provider counseling for weight loss reported by adults with arthritis and overweight or obesity, CDC analyzed National Health Interview Survey (NHIS) data. § Overall, age-standardized estimates of provider counseling for weight loss increased by 10.4 percentage points from 2002 (35.1%; 95% confidence interval [CI] = 33.0-37.3) to 2014 (45.5%; 95% CI = 42.9-48.1) (phealth benefits for this population.

  18. Comparison of nurse staffing based on changes in unit-level workload associated with patient churn.

    Science.gov (United States)

    Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie

    2015-04-01

    This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.

  19. The centrosomal linker and microtubules provide dual levels of spatial coordination of centrosomes.

    Directory of Open Access Journals (Sweden)

    Marko Panic

    2015-05-01

    Full Text Available The centrosome is the principal microtubule organizing center in most animal cells. It consists of a pair of centrioles surrounded by pericentriolar material. The centrosome, like DNA, duplicates exactly once per cell cycle. During interphase duplicated centrosomes remain closely linked by a proteinaceous linker. This centrosomal linker is composed of rootletin filaments that are anchored to the centrioles via the protein C-Nap1. At the onset of mitosis the linker is dissolved by Nek2A kinase to support the formation of the bipolar mitotic spindle. The importance of the centrosomal linker for cell function during interphase awaits characterization. Here we assessed the phenotype of human RPE1 C-Nap1 knockout (KO cells. The absence of the linker led to a modest increase in the average centrosome separation from 1 to 2.5 μm. This small impact on the degree of separation is indicative of a second level of spatial organization of centrosomes. Microtubule depolymerisation or stabilization in C-Nap1 KO cells dramatically increased the inter-centrosomal separation (> 8 μm. Thus, microtubules position centrosomes relatively close to one another in the absence of linker function. C-Nap1 KO cells had a Golgi organization defect with a two-fold expansion of the area occupied by the Golgi. When the centrosomes of C-Nap1 KO cells showed considerable separation, two spatially distinct Golgi stacks could be observed. Furthermore, migration of C-Nap1 KO cells was slower than their wild type RPE1 counterparts. These data show that the spatial organization of centrosomes is modulated by a combination of centrosomal cohesion and microtubule forces. Furthermore a modest increase in centrosome separation has major impact on Golgi organization and cell migration.

  20. 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…

  1. Financing the Business. PACE Revised. Level 1. Unit 8. Research & Development Series No. 240AB8.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This lesson on financing a business, the eighth in a series of 18 units, is part of the first level of a comprehensive entrepreneurship curriculum entitled: A Program for Acquiring Competence in Entrepreneurship (PACE). (Designed for use with secondary students, the first level of PACE introduces students to the concepts involved in…

  2. 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.

  3. Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover.

    Science.gov (United States)

    Nelson-Brantley, Heather V; Park, Shin Hye; Bergquist-Beringer, Sandra

    2018-01-01

    The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.

  4. Low-level radioactive waste disposal technologies used outside the United States

    International Nuclear Information System (INIS)

    Templeton, K.J.; Mitchell, S.J.; Molton, P.M.; Leigh, I.W.

    1994-01-01

    Low-level radioactive waste (LLW) disposal technologies are an integral part of the waste management process. In the United States, commercial LLW disposal is the responsibility of the State or groups of States (compact regions). The United States defines LLW as all radioactive waste that is not classified as spent nuclear fuel, high- level radioactive waste, transuranic waste, or by-product material as defined in Section II(e)(2) of the Atomic Energy Act. LLW may contain some long-lived components in very low concentrations. Countries outside the United States, however, may define LLW differently and may use different disposal technologies. This paper outlines the LLW disposal technologies that are planned or being used in Canada, China, Finland, France, Germany, Japan, Sweden, Taiwan, and the United Kingdom (UK)

  5. 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

    2017-11-01

    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.

  6. An interdisciplinary visual team in an acute and sub-acute stroke unit: Providing assessment and early rehabilitation.

    Science.gov (United States)

    Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer; Deurell, Eva Maria; Forchhammer, Hysse Birgitte

    2016-07-15

    To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke. For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. Of 349 acute stroke admissions, 84 (24.1%) had visual or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. In this consecutive sample, a quarter of all stroke patients had visual or visuo-attentional deficits initially. This emphasizes how professionals should have increased awareness of the existence of such deficits after stroke in order to provide the necessary interdisciplinary assessment and rehabilitation.

  7. Patients' experiences and satisfaction about care provided by male nurses in medical surgical units in Islamabad, Pakistan: A pilot study.

    Science.gov (United States)

    Younas, Ahtisham; Sundus, Amara

    2018-01-01

    Nursing is predominantly a female profession and caring has been considered an attribute of female nurses, which could imply a noncaring image of male nurses. To determine patients' experiences and satisfaction from care provided by male nurses in a private hospital in Islamabad, Pakistan. This cross-sectional study included a purposive sample of 50 patients admitted to medical surgical units for at least 2 days and who had at least three professional interactions with a male nurse. The Newcastle Satisfaction with Nursing Scale was used for data collection. Descriptive statistics were used for data analysis. The total score for experience and satisfaction was 81 and 51, respectively. A statistically significant difference existed between experience and satisfaction scores of male and female participants, indicating that males were more pleased and satisfied with their experience of receiving care from male nurses compared to the female participants. The male nurses were concerned for their patients, they were knowledgeable about the patients' condition and care, and provided them with clear explanations of the medical and nursing procedures. However, they seem to lack interpersonal relationship with patients and did not take initiative in understanding their patients. © 2017 Wiley Periodicals, Inc.

  8. [Environmental noise levels in 2 intensive care units in a tertiary care centre].

    Science.gov (United States)

    Ornelas-Aguirre, José Manuel; Zárate-Coronado, Olivia; Gaxiola-González, Fabiola; Neyoy-Sombra, Venigna

    2017-04-03

    The World Health Organisation (WHO) has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise levels in 2 different intensive care units at a tertiary care centre. Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level. The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points. Noise levels measured in intensive care wards exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of environmental noise. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  9. 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.

  10. An Analysis of United States Marine Corps Enlisted Entry-Level Training Using Supply Chain and Operations Management

    Science.gov (United States)

    2010-12-01

    An Analysis of United States Marine Corps Enlisted Entry-Level Training Using Supply Chain and Operations Management ______________________________________ By...Report 4. TITLE AND SUBTITLE: An Analysis of United States Marine Corps Enlisted Entry-Level Training Using Supply Chain and Operations Management 6...Level Training; United States Marine Corps; Operations Management ; Supply Chain Management; Process Analysis 16. PRICE CODE 17. SECURITY

  11. The Association Between Immigration Status and Office-based Medical Provider Visits for Cancer Patients in the United States.

    Science.gov (United States)

    Wang, Yang; Wilson, Fernando A; Chen, Li-Wu

    2017-06-01

    We examined differences in cancer-related office-based provider visits associated with immigration status in the United States. Data from the 2007-2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups. We measured the relationships of immigrant status to number of visits and associated expenditure within the past 12 months, adjusting for age, sex, educational attainment, race/ethnicity, self-reported health status, time since cancer diagnosis, cancer remission status, marital status, poverty status, insurance status, and usual source of care. We finally performed sensitivity analyses for regression results by using the propensity score matching method to adjust for potential selection bias. Noncitizens had about 2 fewer visits in a 12-month period in comparison to US-born citizens (4.0 vs. 5.9). Total expenditure per patient was higher for US-born citizens than immigrants (not statistically significant). Noncitizens (88.3%) were more likely than US-born citizens (76.6%) to be seen by a medical doctor during a visit. Multivariate regression results showed that noncitizens had 42% lower number of visiting medical providers at office-based settings for cancer care than US-born citizens, after adjusting for all the other covariates. There were no significant differences in expenditures across immigration groups. The propensity score matching results were largely consistent with those in multivariate-adjusted regressions. Results suggest targeted interventions are needed to reduce disparities in utilization between immigrants and US-born citizen cancer patients.

  12. 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

    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. 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. 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). 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.

  13. The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.

    Science.gov (United States)

    Khojah, Imad; Li, Suhui; Luo, Qian; Davis, Griffin; Galarraga, Jessica E; Granovsky, Michael; Litvak, Ori; Davis, Samuel; Shesser, Robert; Pines, Jesse M

    2017-09-01

    We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. "Hospital admission" was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study.

    Science.gov (United States)

    Coghill, Cara-Lee; Valaitis, Ruta K; Eyles, John D

    2015-05-03

    Few studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs. This descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis. Themes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited. Public health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.

  15. 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.

  16. Dento-oral care in patients with head and neck radiation therapy. Questionnaire to institutions provided with radiotherapy units

    International Nuclear Information System (INIS)

    Ashikagaya, Misa; Fuzisawa, Yuko; Kato, Tokunori; Hayashi, Takafumi; Nakayama, Hitoshi; Nakamura, Motoyasu

    1995-01-01

    We sent a questionnaire to 465 institutions provided with radiotherapy units in order to search for the radiotherapists' understanding of and concern about dento-oral care in patients with head and neck radiation therapy and subsequent occurrence of radiation side effects in the oral-maxillofacial region. An analysis of 292 responses showed that in 183 (62.7%) institutions radiotherapist had experience of dental consultation of these patients for dento-oral care to the dental facility and in 109 (37.3%) they hadn't. In dental consultation, the symptomatic care for toothache etc. were more often requested than the preventive care for radiation side effects. Of 6 items of the preventive care, periodical oral examination, oral hygiene instruction and treatment for radiation caries were less frequently requested. It is concluded that radiotherapists are not fully aware of the importance of dento-oral care including the preventive care in patients with radiation therapy in the head and neck region. (author)

  17. Cernavoda NPP Unit 1: Ensuring heat sink at very low Danube river levels

    International Nuclear Information System (INIS)

    Urjan, D.

    2005-01-01

    Full text: On August 24, 2003 the summer heat wave has caused the Danube River to drop to its lowest level in more than a century, forcing a government commission of experts and a team of technical specialists from Cernavoda NPP to close Romania's unique nuclear reactor in operation at Cernavoda. The paper presents some of the required actions needed for plant shutdown and ensuring adequate fuel cooling at very low suction bay levels, due to the Danube River level drop (Danube waters cools the reactor). The water level in the Danube River at Cernavoda village, where the reactor is located, fell to a depth of less than three meters (10 feet) on Saturday, down from its usual level of almost seven meters (23 feet). Consequently, the Unit 1 nuclear power plant was shut down Sunday due to this record drought, which left insufficient water to cool down the reactor. Operating Instruction procedures were elaborated in order to provide a logical sequence of actions when the bay level decreases under 2.25 m, or the estimated level after 3 days will be lower than 1.8 m. When Raw Service Water (RSW) is lost, Recirculated Cooling Water (RCW) will remain in service only for Moderator, ESC, HT Pumps, HT Purification, D/C Cooler, LAC's, and D 2 O Feed Pump. Alternate water sources, like potable water and water from the fire protection system were taken in consideration in order to ensure heat sink to the RCW loads. At the same time, in case of total loss of Class III and Class IV Power, and Stand-By Diesel Generators unavailable because of the loss of heat sink provided by the RSW, Emergency Power System (EPS) was configured to supply directly the Class III Power 6 kV bus (BUG bus). Economical Impact According to a report, closing the nuclear plant costs Romania $500,000 a day. The total cost includes also losses due to a 40 percent reduction in hydroelectric power generation due to reduced river flow. The country had to cease power exports until the reactor comes back on line

  18. Pediatric providers and radiology examinations. Knowledge and comfort levels regarding ionizing radiation and potential complications of imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wildman-Tobriner, Benjamin; Maxfield, Charles M. [Duke University Hospital, Department of Radiology, Durham, NC (United States); Parente, Victoria M. [Duke University Hospital, Department of Pediatrics, Durham, NC (United States)

    2017-12-15

    Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost. (orig.)

  19. Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging.

    Science.gov (United States)

    Wildman-Tobriner, Benjamin; Parente, Victoria M; Maxfield, Charles M

    2017-12-01

    Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, Pionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.

  20. I'm trying to heal...noise levels in a pediatric intensive care unit.

    Science.gov (United States)

    Milette, Isabelle H; Carnevale, Franco A

    2003-01-01

    The literature demonstrates clearly that most intensive care units exceed the standard recommendations for noise levels in hospitals, and that high noise levels have negative impacts on patients and staff. The purpose of this study was to evaluate the level of noise in a PICU and compare it to the recommendations of international bodies. We outline recommendations to promote the awareness of this problem and suggest strategies to decrease the level of noise in a PICU. The orientations of these strategies are threefold: 1) architectural-acoustic design, 2) equipment design and, most importantly, 3) staff education.

  1. A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States.

    Science.gov (United States)

    Klassen, Aaron B; Core, S Brent; Lohse, Christine M; Sztajnkrycer, Matthew D

    2018-04-01

    required in order to identify potential barriers to care and to develop appropriate training and policy recommendations. Klassen AB , Core SB , Lohse CM , Sztajnkrycer MD . A descriptive analysis of care provided by law enforcement prior to EMS arrival in the United States. Prehosp Disaster Med. 2018;33(2):165-170.

  2. Level 1 PSA study of Mochovce unit 1 NPP (SM AA 10 and 08)

    International Nuclear Information System (INIS)

    Cillik, I.

    1997-01-01

    This paper presents genesis of Level 1 PSA project preparation for all operational modes of Mochovce NPP unit 1 including the description of its' main objectives, scope and working method. The PSA study which includes full power (FPSA) as well as shutdown and low power conditions (SPSA) Level 1 PSA has to support the nuclear safety improvements of the unit. They evaluate the basic design and the benefits of all improvements, which were found necessary to be incorporated before the start-up of the unit. The study includes internal events (transients and under-loss of coolant accident, LOCAs), internal hazards as fires and floods and selected external hazards as earthquake, influence of external industry, extreme meteorological conditions and aircraft crash.The PSA (both FPSA and SPSA) models is developed using the RISK SPECTRUM PSA code. (author)

  3. 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

  4. Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States.

    Science.gov (United States)

    Philbin, Morgan M; Tanner, Amanda E; Ma, Alice; Chambers, Brittany D; Ware, Samuella; Kinnard, Elizabeth N; Hussen, Sophia A; Lee, Sonia; Fortenberry, J Dennis

    2017-10-01

    It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.

  5. Prospective cohort study on noise levels in a pediatric cardiac intensive care unit.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Sheppard, Cathy; Pugh, Jodie; Moez, Elham Khodayari; Dinu, Irina A; Jou, Hsing; Hartling, Lisa; Vohra, Sunita

    2018-04-01

    To describe noise levels in a pediatric cardiac intensive care unit, and to determine the relationship between sound levels and patient sedation requirements. Prospective observational study at a pediatric cardiac intensive care unit (PCICU). Sound levels were measured continuously in slow A weighted decibels dB(A) with a sound level meter SoundEarPro® during a 4-week period. Sedation requirement was assessed using the number of intermittent (PRNs) doses given per hour. Analysis was conducted with autoregressive moving average models and the Granger test for causality. 39 children were included in the study. The average (SD) sound level in the open area was 59.4 (2.5) dB(A) with a statistically significant but clinically unimportant difference between day/night hours (60.1 vs. 58.6; p-value noise levels were > 90 dB. There was a significant association between average (p-value = 0.030) and peak sound levels (p-value = 0.006), and number of sedation PRNs. Sound levels were above the recommended values with no differences between day/night or open area/single room. High sound levels were significantly associated with sedation requirements. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Increasing children's physical activity levels during recess periods in elementary schools: the effects of providing game equipment.

    Science.gov (United States)

    Verstraete, Stefanie J M; Cardon, Greet M; De Clercq, Dirk L R; De Bourdeaudhuij, Ilse M M

    2006-08-01

    During recess, children can be active on a daily basis, making it an important school environmental factor for the promotion of health-related physical activity. The aim of the present study was to investigate the effects of providing game equipment on children's physical activity levels during morning recess and lunch break in elementary schools. Seven elementary schools were randomly assigned to the intervention group (four schools), including 122 children (75 boys, 47 girls, mean age: 10.8 +/- 0.6 years), and to the control group (three schools), including 113 children (46 boys, 67 girls, mean age: 10.9 +/- 0.7 years). Children's activity levels were measured before and three months after providing game equipment, using MTI accelerometers. During lunch break, children's moderate and vigorous physical activity significantly increased in the intervention group (moderate: from 38 to 50%, vigorous: from 10 to 11%), while it decreased in the control group (moderate: from 44 to 39%, vigorous: from 11 to 5%). At morning recess, providing game equipment was effective in increasing children's moderate physical activity (from 41 to 45%), while it decreased in the control group (from 41 to 34%). Providing game equipment during recess periods was found to be effective in increasing children's physical activity levels. This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health.

  7. 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).

  8. Analysis of area level and unit level models for small area estimation in forest inventories assisted with LiDAR auxiliary information.

    Science.gov (United States)

    Mauro, Francisco; Monleon, Vicente J; Temesgen, Hailemariam; Ford, Kevin R

    2017-01-01

    Forest inventories require estimates and measures of uncertainty for subpopulations such as management units. These units often times hold a small sample size, so they should be regarded as small areas. When auxiliary information is available, different small area estimation methods have been proposed to obtain reliable estimates for small areas. Unit level empirical best linear unbiased predictors (EBLUP) based on plot or grid unit level models have been studied more thoroughly than area level EBLUPs, where the modelling occurs at the management unit scale. Area level EBLUPs do not require a precise plot positioning and allow the use of variable radius plots, thus reducing fieldwork costs. However, their performance has not been examined thoroughly. We compared unit level and area level EBLUPs, using LiDAR auxiliary information collected for inventorying 98,104 ha coastal coniferous forest. Unit level models were consistently more accurate than area level EBLUPs, and area level EBLUPs were consistently more accurate than field estimates except for large management units that held a large sample. For stand density, volume, basal area, quadratic mean diameter, mean height and Lorey's height, root mean squared errors (rmses) of estimates obtained using area level EBLUPs were, on average, 1.43, 2.83, 2.09, 1.40, 1.32 and 1.64 times larger than those based on unit level estimates, respectively. Similarly, direct field estimates had rmses that were, on average, 1.37, 1.45, 1.17, 1.17, 1.26, and 1.38 times larger than rmses of area level EBLUPs. Therefore, area level models can lead to substantial gains in accuracy compared to direct estimates, and unit level models lead to very important gains in accuracy compared to area level models, potentially justifying the additional costs of obtaining accurate field plot coordinates.

  9. 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.

  10. Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States.

    Science.gov (United States)

    Agrawal, Pooja; Venkatesh, Arjun Krishna

    2016-04-01

    We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States.

  11. Factors predicting organochlorine pesticide levels in pregnant Latina women living in a United States agricultural area

    Science.gov (United States)

    Bradman, Asa; Schwartz, Jackie M.; Fenster, Laura; Barr, Dana B.; Holland, Nina T.; Eskenazi, Brenda

    2015-01-01

    Organochlorine (OC) pesticide use was restricted starting in the 1970s in developed countries and the 1980s and 1990s in developing countries. Current exposure to OC pesticides – DDT, lindane (99% pure gamma-hexachlorocyclohexane (γ-HCH)), hexachlorobenzene (HCB) – occurs on a limited basis. We measured p,p′-DDE, p,p′-DDT, o,p′-DDT, HCB, beta (β)-HCH (the most persistent isomer of technical-grade HCH) and γ-HCH in serum from 426 low-income pregnant Latina women living in an agricultural community in California. Detection frequencies were 94-100%. Median levels (ng/g-lipid) of p,p′-DDE (1,052), p,p′-DDT (13), β-HCH (37) and HCB (65) were significantly higher than U.S. population levels. Multivariate analyses of p,p′-DDE, p,p′-DDT, o,p′-DDT, β-HCH and HCB indicate that time spent living outside the United States and birthplace in an area of Mexico with recent use of OC pesticides were significant predictors of exposure. Time spent living in the United States was associated with increased serum levels of p,p′-DDE and β-HCH, but the increase for each year lived in the United States was lower than for each year lived outside the United States. There was no difference between the increase of HCB levels over time spent in or outside the United States, suggesting current and thus preventable exposure routes. However, we observed no associations between serum levels of any OC compound and current intake of saturated fat or agricultural take-home exposure risk factors. Lactation history and recent weight gain were negatively associated with serum levels of some, but not all OC compounds studied. Smoking history was borderline associated with elevated HCB levels. We observed no significant associations with body mass index. Although the weight of evidence from this study indicates that most exposure occurred prior to moving to the United States, the results for HCB indicate the possibility of ongoing exposure in this country. PMID:17033681

  12. Directions in low-level radioactive-waste management. Incentives and compensation: providing resources for communities hosting low-level waste facilities

    International Nuclear Information System (INIS)

    1982-10-01

    State responsibility for the management of low-level radioactive waste necessitates the selection of candidate locations for a disposal facility. Concern over potential impacts can be expected from segments of the citizenry neighboring a proposed site. A number of national organizations comprising state and local officials have recommended the use of incentives and compensation to help offset the negative local impacts. This document explores that concept. Discussion provides background information on potential local impacts from a low-level waste facility and considers the nature and types of incentives and compensation benefits that could be provided. The document then examines realistic options for planning and implementing the benefit program. This information is intended, primarily, to assist state officials - executive, legislative, and agency - in planning for and managing low-level waste disposal facilities

  13. 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.

  14. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis.

    Science.gov (United States)

    Harter, James K; Schmidt, Frank L; Hayes, Theodore L

    2002-04-01

    Based on 7,939 business units in 36 companies, this study used meta-analysis to examine the relationship at the business-unit level between employee satisfaction-engagement and the business-unit outcomes of customer satisfaction, productivity, profit, employee turnover, and accidents. Generalizable relationships large enough to have substantial practical value were found between unit-level employee satisfaction-engagement and these business-unit outcomes. One implication is that changes in management practices that increase employee satisfaction may increase business-unit outcomes, including profit.

  15. Units 3 and 4 steam generators new water level control system

    International Nuclear Information System (INIS)

    Dragoev, D.; Genov, St.

    2001-01-01

    The Steam Generator Water Level Control System is one of the most important for the normal operation systems, related to the safety and reliability of the units. The main upgrading objective for the SG level and SGWLC System modernization is to assure an automatic maintaining of the SG level within acceptable limits (below protections and interlocks) from 0% to 100% of the power in normal operation conditions and in case of transients followed by disturbances in the SG controlled parameters - level, steam flow, feedwater flow and/or pressure/temperature. To achieve this objective, the computerized controllers of new SG water level control system follows current computer control technology and is implemented together with replacement of the feedwater control valves and the needed I and C equipment. (author)

  16. Community-level Language Planning for Chinese Heritage Language Maintenance in the United States

    Directory of Open Access Journals (Sweden)

    An Chung Cheng

    2012-08-01

    Full Text Available This paper investigates the development of Chinese heritage language in the United States from the perspective of language policy and planning. The case study examines the Chinese heritage language maintenance through community-based Chinese schools (CHS, and CHS’s relationships with Chinese American community, as well as governments and non-government organizations in China, Taiwan, and the United States. The paper starts with a theoretical discussion on the definition of language policy and planning, and then describes the history and heritage language education of Chinese Americans in the United States. The paper also presents micro-level planning activities initiated by CHSs in the Chinese American community and non-government organizations. Special focus is placed on the interaction between non-government organizations in the US and governmental bodies in Taiwan and mainland China and in the United States. This paper suggests that micro planning of heritage language maintenance is beneficial when initiated in the community, but it can only be developed and sustained within the wider scope of macro-level planning from governments

  17. 75 FR 73972 - Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To...

    Science.gov (United States)

    2010-11-30

    ... District Court for the District of Columbia on May 23, 2008 in Alameda County Medical Center, et al. v... limit on reimbursement. On May 23, 2008, the United States District Court for the District of Columbia...), DHHS is removing the word ``nursing facilities'' replacing it with ``NFs.'' In Sec. 447.272(a)(1), DHHS...

  18. Ambient Noise Levels in Acute Neonatal Intensive Care Unit of a Tertiary Referral Hospital

    OpenAIRE

    Sonia R. B D'Souza; Leslie Edward Lewis; Vijay Kumar; Ramesh Bhat Y; Jayashree Purkayastha; Hari Prakash

    2017-01-01

    Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods...

  19. Comparison of the N Reactor and Ignalina Unit No. 2 Level 1 Probabilistic Safety Assessments

    International Nuclear Information System (INIS)

    Coles, G.A.; McKay, S.L.

    1995-06-01

    A multilateral team recently completed a full-scope Level 1 Probabilistic Safety Assessment (PSA) on the Ignalina Unit No. 2 reactor plant in Lithuania. This allows comparison of results to those of the PSA for the U.S. Department of Energy's (DOE) N Reactor. The N Reactor, although unique as a Western design, has similarities to Eastern European and Soviet graphite block reactors

  20. Diagnostic reference levels for X-ray investigations in pain management units in Belgium

    International Nuclear Information System (INIS)

    Lichtherte, S.; Le Polain de Waroux, B.

    2008-01-01

    X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidural (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and trans-foraminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP corr ), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidural, facet joint nerve blocks and trans-foraminal are 0.5, 2.5 and 3 Gy cm 2 for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system. (authors)

  1. Noise level in a neonatal intensive care unit in Santa Marta - Colombia.

    Science.gov (United States)

    Garrido Galindo, Angélica Patricia; Camargo Caicedo, Yiniva; Velez-Pereira, Andres M

    2017-09-30

    The environment of neonatal intensive care units is influenced by numerous sources of noise emission, which contribute to raise the noise levels, and may cause hearing impairment and other physiological and psychological changes on the newborn, as well as problems with care staff. To evaluate the level and sources of noise in the neonatal intensive care unit. Sampled for 20 consecutive days every 60 seconds in A-weighting curves and fast mode with a Type I sound level meter. Recorded the average, maximum and minimum, and the 10th, 50th and 90th percentiles. The values are integrated into hours and work shift, and studied by analysis of variance. The sources were characterized in thirds of octaves. The average level was 64.00 ±3.62 dB(A), with maximum of 76.04 ±5.73 dB(A), minimum of 54.84 ±2.61dB(A), and background noise of 57.95 ±2.83 dB(A). We found four sources with levels between 16.8-63.3 dB(A). Statistical analysis showed significant differences between the hours and work shift, with higher values in the early hours of the day. The values presented exceed the standards suggested by several organizations. The sources identified and measured recorded high values in low frequencies.

  2. Commercial processing and disposal alternatives for very low levels of radioactive waste in the United States

    International Nuclear Information System (INIS)

    Benda, G.A.

    2005-01-01

    The United States has several options available in the commercial processing and disposal of very low levels of radioactive waste. These range from NRC licensed low level radioactive sites for Class A, B and C waste to conditional disposal or free release of very low concentrations of material. Throughout the development of disposal alternatives, the US promoted a graded disposal approach based on risk of the material hazards. The US still promotes this approach and is renewing the emphasis on risk based disposal for very low levels of radioactive waste. One state in the US, Tennessee, has had a long and successful history of disposal of very low levels of radioactive material. This paper describes that approach and the continuing commercial options for safe, long term processing and disposal. (author)

  3. 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.

  4. Sound levels in a neonatal intensive care unit significantly exceeded recommendations, especially inside incubators.

    Science.gov (United States)

    Parra, Johanna; de Suremain, Aurelie; Berne Audeoud, Frederique; Ego, Anne; Debillon, Thierry

    2017-12-01

    This study measured sound levels in a 2008 built French neonatal intensive care unit (NICU) and compared them to the 2007 American Academy of Pediatrics (AAP) recommendations. The ultimate aim was to identify factors that could influence noise levels. The study measured sound in 17 single or double rooms in the NICU. Two dosimeters were installed in each room, one inside and one outside the incubators, and these conducted measurements over a 24-hour period. The noise metrics measured were the equivalent continuous sound level (L eq ), the maximum noise level (L max ) and the noise level exceeded for 10% of the measurement period (L 10 ). The mean L eq , L 10 and L max were 60.4, 62.1 and 89.1 decibels (dBA), which exceeded the recommended levels of 45, 50 and 65 dBA (p care was correlated to an increased noise level, except for a postconceptional age below 32 weeks. The sound levels significantly exceeded the AAP recommendations, particularly inside incubators. A multipronged strategy is required to improve the sound environment and protect the neonates' sensory development. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  5. 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…

  6. Development of a unit cell model for interim performance assessment of vitrified low level waste disposal

    International Nuclear Information System (INIS)

    Kline, N.W.

    1995-09-01

    The unit cell modeling approach has been developed and used in analysis of some design options for a vitrified low level waste disposal facility. The unit cell modeling approach is likely to be useful in interim performance assessment for the facility. The present unit cell model will probably need to be refitted in terms of some model parameters for the latter purpose. Two present disposal facility concepts differ in the length of a capillary barrier proposed to limit effective recharge through the top of the facility. Results of the study summarized herein suggest design of a capillary barrier which can reduce a recharge rate of 0.1 cm/yr by one or two orders of magnitude seems feasible for both concepts. A benchmark comparison of the unit cell model against a full facility model shows comparable predictive accuracy in less than one percent of the computer time. Results suggest that model parameters include capillary barrier performance, inter-canister spacing, rate of moisture withdrawal due to glass corrosion, contaminant inventory, and the well interceptor factor. It is also important that variations of waste form hydraulic parameters suggest that transport through the waste form is dominated by diffusion

  7. A Hybrid Heuristic Approach to Provider Selection and Task Allocation Problem in Telecommunications with Varying QoS Levels

    Directory of Open Access Journals (Sweden)

    Nihat Kasap

    2017-01-01

    Full Text Available In this research, we study a cost minimization problem for a firm that acquires capacity from providers to accomplish daily operations on telecommunication networks. We model the related optimization problem considering quality of service and capacity requirements and offer a solution approach based on genetic algorithm (GA. Our model reckons the tradeoff between the network capacity acquisition cost and opportunity cost arise when data transmission quality for real-time tasks manifested at undesired levels. To better represent the related features and complexities, we model both capacity and loss probability requirements explicitly, and then, formulate delay and jitter requirements as level matching constraints. Using an experimental framework, we analyze how optimal behavior of the firm is affected by different price schemes, transmission quality and task distributions. We also compare three GA based heuristic solution approaches and comment on the suitability of them on resource selection and task allocation problems.

  8. Level 1 shutdown and low power operation of Mochovce NPP, Unit 1, Slovakia

    International Nuclear Information System (INIS)

    Halada, P.; Cillik, I.; Stojka, T.; Kuzma, M.; Prochaska, J.; Vrtik, L.

    2004-01-01

    The paper presents general approach, used methods and form of documentation of the results that have been applied within the shutdown and low power PSA (SPSA) study for Mochovce NPP, Unit 1, Slovakia. The SPSA project was realized by VUJE Trnava Inc., Slovakia in 2001-2002 years. The Level 1 SPSA study for Mochovce NPP Unit 1 covers internal events as well as internal (fires, floods and heavy load drop) and external (aircraft crash, extreme meteorological conditions, seismic event and influence of surrounding industry) hazards. Mochovce NPP consists of two operating units equipped with VVER 440/V213 reactors safety upgraded before construction finishing and operation start. 87 safety measures based on VVER 440 operational experience and international mission insights were implemented to enhance its operational and nuclear safety. The SPSA relates to full power PSA (FPSA) as a continuation of the effort to create a harmonized level 1 PSA model for all operational modes of the plant with the goal to use it for further purposes as follows: Real Time Risk Monitor, Maintenance Optimization, Technical Specifications Optimization, Living PSA. (author)

  9. Investigation of background radiation levels and geologic unit profiles in Durango, Colorado

    International Nuclear Information System (INIS)

    Triplett, G.H.; Foutz, W.L.; Lesperance, L.R.

    1989-11-01

    As part of the Uranium Mill Tailings Remedial Action (UMTRA) Project, Oak Ridge National Laboratory (ORNL) has performed radiological surveys on 435 vicinity properties (VPs) in the Durango area. This study was undertaken to establish the background radiation levels and geologic unit profiles in the Durango VP area. During the months of May through June, 1986, extensive radiometric measurements and surface soil samples were collected in the Durango VP area by personnel from ORNL's Grand Junction Office. A majority of the Durango VP surveys were conducted at sites underlain by Quaternary alluvium, older Quaternary gravels, and Cretaceous Lewis and Mancos shales. These four geologic units were selected to be evaluated. The data indicated no formation anomalies and established regional background radiation levels. Durango background radionuclide concentrations in surface soil were determined to be 20.3 ± 3.4 pCi/g for 40 K, 1.6 ± 0.5 pCi/g for 226 Ra, and 1.2 ± 0.3 pCi/g for 232 Th. The Durango background gamma exposure rate was found to be 16.5 ± 1.3 μR/h. Average gamma spectral count rate measurements for 40 K, 226 Ra and 232 Th were determined to be 553, 150, and 98 counts per minute (cpm), respectively. Geologic unit profiles and Durango background radiation measurements are presented and compared with other areas. 19 refs., 15 figs., 5 tabs

  10. Task-dependent output of human parasternal intercostal motor units across spinal levels.

    Science.gov (United States)

    Hudson, Anna L; Gandevia, Simon C; Butler, Jane E

    2017-12-01

    During breathing, there is differential activity in the human parasternal intercostal muscles and the activity is tightly coupled to the known mechanical advantages for inspiration of the same regions of muscles. It is not known whether differential activity is preserved for the non-respiratory task of ipsilateral trunk rotation. In the present study, we compared single motor units during resting breathing and axial rotation of the trunk during apnoea. We not only confirmed non-uniform recruitment of motor units across parasternal intercostal muscles in breathing, but also demonstrated that the same motor units show an altered pattern of recruitment in the non-respiratory task of trunk rotation. The output of parasternal intercostal motoneurones is modulated differently across spinal levels depending on the task and these results help us understand the mechanisms that may govern task-dependent differences in motoneurone output. During inspiration, there is differential activity in the human parasternal intercostal muscles across interspaces. We investigated whether the earlier recruitment of motor units in the rostral interspaces compared to more caudal spaces during inspiration is preserved for the non-respiratory task of ipsilateral trunk rotation. Single motor unit activity (SMU) was recorded from the first, second and fourth parasternal interspaces on the right side in five participants in two tasks: resting breathing and 'isometric' axial rotation of the trunk during apnoea. Recruitment of the same SMUs was compared between tasks (n = 123). During resting breathing, differential activity was indicated by earlier recruitment of SMUs in the first and second interspaces compared to the fourth space in inspiration (P motor units showed an altered pattern of recruitment because SMUs in the first interspace were recruited later and at a higher rotation torque than those in the second and fourth interspaces (P recruitment measures, was good-excellent [intraclass

  11. United States family planning providers' knowledge of and attitudes towards preexposure prophylaxis for HIV prevention: a national survey.

    Science.gov (United States)

    Seidman, Dominika; Carlson, Kimberly; Weber, Shannon; Witt, Jacki; Kelly, Patricia J

    2016-05-01

    The Centers for Disease Control and Prevention defines HIV prevention as a core family planning service. The HIV community identified family planning visits as key encounters for women to access preexposure prophylaxis (PrEP) for HIV prevention. No studies explore US family planning providers' knowledge of and attitudes towards PrEP. We conducted a national survey of clinicians to understand barriers and facilitators to PrEP implementation in family planning. Family planning providers recruited via website postings, national meetings, and email completed an anonymous survey in 2015. Descriptive statistics were performed. Among 604 respondents, 495 were eligible for analysis and 342 were potential PrEP prescribers (physicians, nurse practitioners, midwives or physicians assistants). Among potential prescribers, 38% correctly defined PrEP [95% confidence interval (CI): 32.5-42.8], 37% correctly stated the efficacy of PrEP (95% CI: 32.0-42.4), and 36% chose the correct HIV test after a recent exposure (95% CI: 30.6-40.8). Characteristics of those who answered knowledge questions correctly included age less than 35 years, practicing in the Northeast or West, routinely offering HIV testing, providing rectal sexually transmitted infection screening or having seen any PrEP guidelines. Even among providers in the Northeast and West, the proportion of respondents answering questions correctly was less than 50%. Thirty-six percent of respondents had seen any PrEP guidelines. Providers identified lack of training as the main barrier to PrEP implementation; 87% wanted PrEP education. To offer comprehensive HIV prevention services, family planning providers urgently need training on PrEP and HIV testing. US family planning providers have limited knowledge about HIV PrEP and HIV testing, and report lack of provider training as the main barrier to PrEP provision. Provider education is needed to ensure that family planning clients access comprehensive HIV prevention methods

  12. Determining Your Potential as an Entrepreneur. PACE Revised. Level 3. Unit 2. Research & Development Series No. 240CB2.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on determining one's potential as an entrepreneur, the second 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…

  13. Planning the Marketing Strategy. PACE Revised. Level 3. Unit 6. Research & Development Series No. 240CB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This individualized, competency-based unit on planning marketing strategy, the sixth 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 other…

  14. 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.

  15. Determination of Noise Level and Its Sources in the Neonatal Intensive Care Unit and Neonatal Ward

    Directory of Open Access Journals (Sweden)

    Mahdi Jahangir Blourchian

    2015-12-01

    Full Text Available Background: In Neonatal intensive care units (NICU different sound intensities and frequencies are produced from different sources, which may exert undesirable physiological effects on the infants. The aim of this study was to determine the noise level and its sources in the NICU and neonatal ward of Al-Zahra Hospital of Rasht, Iran. Methods: In this descriptive cross-sectional study, the intensity of the sounds generated by the internal and external sources in the NICU and neonatal ward was measured using a sound level meter device. The sound produced by each of the sources was individually calculated. Data were analyzed performing descriptive and analytical statistics, using SPSS version 19. Results: The mean noise levels in six rooms and a hallway during morning, afternoon and night shifts with the electromechanical devices turned on were 61.67±4.5, 61.32±4.32 and 60.71±4.56 dB, respectively. Moreover, with the devices tuned off the mean noise levels during morning, afternoon and evening shifts were 64.97±2.6, 60.6±1.29 and 57.91±4.73 dB, respectively. The differences between the mean noise levels in the neonatal wards (standard noise level=45 dB during each shift with the electromechanical devices turned on and off were statistically significant (P=0.002 and P

  16. Multipurpose radiometric equipment provided with a microcontroller for use in industrial applications (e.g., measurements of level, density, thickness, etc.)

    International Nuclear Information System (INIS)

    Kluger, A.; Popescu, C.; Patrascu, S.

    1998-01-01

    The goal of this research was to modernize the radiometric equipment used for the control and automation of technological processes. A microcontroller-equipped electronic block was designed and realized, capable of performing all the tasks of a radiometric system, regardless of the application range (i.e. measurement of density, thickness, level, composition, etc.) or the detector type employed. In this work, the experimental model for the multipurpose radiometric equipment was devised. The electronic unit was designed using a high performance controller 80C552 and was provided with low-power transceivers for RS-232 and RS-485 communication with a PC. The results of the measured parameters are displayed using a graphic liquid crystal display, LCD G 242 C, that allows both graphics and character display. (authors)

  17. A survey on the knowledge and attitudes of anaesthesia providers in the United States of America, United Kingdom and Singapore on visual experiences during cataract surgery.

    Science.gov (United States)

    Tan, C S H; Kumar, C M; Fanning, G L; Lai, Y C; Au Eong, K G

    2006-04-01

    To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

  18. Ambient Noise Levels in Acute Neonatal Intensive Care Unit of a Tertiary Referral Hospital

    Directory of Open Access Journals (Sweden)

    Sonia R. B D'Souza

    2017-10-01

    Full Text Available Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU. However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods: The ambient noise, in this study was the background sound existing in the environment of the acute NICU of a tertiary referral hospital in South India. The ambient noise levels were analyzed by an audiologist and acoustical engineer using a standardized and calibrated Sound Level Meter (SLM i.e., the Hand Held Analyzer type 2250, Brüel and Kjær, Denmark on a weighted frequency A and reported as dB (A. Results: The ambient noise levels were timed measurements yielded by the SLM in terms of L eq, L as well as L exceeded the standard A 10 Aeqmax levels (Leq< 45 dB, L ≤ 50 dB, and Lmax ≤ 65 10 dB.The L eq ranged from 59.4 to 62.12 dB A. A Ventilators with alarms caused the maximum amount of ambient noise yielding a L Sound Pressure Level AF (SPL of 82.14 dB A. Conclusion: The study has found high levels of ambient noise in the acute NICU. Though there are several measures to reduce the ambient noise levels in the NICU, it is essential to raise awareness among health care personnel regarding the observed ambient noise levels and its effects on neonates admitted to the NICU.

  19. 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. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

    Kline, N.W.

    1996-01-01

    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

  1. Characteristics of unit-level patient safety culture in hospitals in Japan: a cross-sectional study.

    Science.gov (United States)

    Fujita, Shigeru; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika; Hasegawa, Tomonori

    2014-10-22

    Patient safety culture (PSC) has an important role in determining safety and quality in healthcare. Currently, little is known about the status of unit-level PSC in hospitals in Japan. To develop appropriate strategies, characteristics of unit-level PSC should be investigated. Work units may be classified according to the characteristics of PSC, and common problems and appropriate strategies may be identified for each work unit category. This study aimed to clarify the characteristics of unit-level PSC in hospitals in Japan. In 2012, a cross-sectional study was conducted at 18 hospitals in Japan. The Hospital Survey on Patient Safety Culture questionnaire, developed by the United States Agency for Healthcare Research and Quality, was distributed to all healthcare workers (n =12,076). Percent positive scores for 12 PSC sub-dimensions were calculated for each unit, and cluster analysis was used to categorise the units according to the percent positive scores. A generalised linear mixed model (GLMM) was used to analyse the results of the cluster analysis, and odds ratios (ORs) for categorisation as high-PSC units were calculated for each unit type. A total of 9,124 respondents (75.6%) completed the questionnaire, and valid data from 8,700 respondents (72.0%) were analysed. There were 440 units in the 18 hospitals. According to the percent positive scores for the 12 sub-dimensions, the 440 units were classified into 2 clusters: high-PSC units (n =184) and low-PSC units (n =256). Percent positive scores for all PSC sub-dimensions for high-PSC units were significantly higher than those for low-PSC units. The GLMM revealed that the combined unit type of 'Obstetrics and gynaecology ward, perinatal ward or neonatal intensive care unit' was significantly more likely to be categorised as high-PSC units (OR =9.7), and 'Long-term care ward' (OR =0.2), 'Rehabilitation unit' (OR =0.2) and 'Administration unit' (OR =0.3) were significantly less likely to be categorised as high

  2. Problems in shallow land disposal of solid low-level radioactive waste in the united states

    Science.gov (United States)

    Stevens, P.R.; DeBuchananne, G.D.

    1976-01-01

    Disposal of solid low-level wastes containing radionuclides by burial in shallow trenches was initiated during World War II at several sites as a method of protecting personnel from radiation and isolating the radionuclides from the hydrosphere and biosphere. Today, there are 11 principal shallow-land burial sites in the United States that contain a total of more than 1.4 million cubic meters of solid wastes contaminated with a wide variety of radionuclides. Criteria for burial sites have been few and generalized and have contained only minimal hydrogeologic considerations. Waste-management practices have included the burial of small quantities of long-lived radionuclides with large volumes of wastes contaminated with shorter-lived nuclides at the same site, thereby requiring an assurance of extremely long-time containment for the entire disposal site. Studies at 4 of the 11 sites have documented the migration of radionuclides. Other sites are being studied for evidence of containment failure. Conditions at the 4 sites are summarized. In each documented instance of containment failure, ground water has probably been the medium of transport. Migrating radionuclides that have been identified include90Sr,137Cs,106Ru,239Pu,125Sb,60Co, and3H. Shallow land burial of solid wastes containing radionuclides can be a viable practice only if a specific site satisfies adequate hydrogeologic criteria. Suggested hydrogeologic criteria and the types of hydrogeologic data necessary for an adequate evaluation of proposed burial sites are given. It is mandatory that a concomitant inventory and classification be made of the longevity, and the physical and chemical form of the waste nuclides to be buried, in order that the anticipated waste types can be matched to the containment capability of the proposed sites. Ongoing field investigations at existing sites will provide data needed to improve containment at these sites and help develop hydrogeologic criteria for new sites. These

  3. Use mobile pumps and liquid chilling water units to provide chilled water for nuclear reactor during nuclear power plant accident

    International Nuclear Information System (INIS)

    Zhang Guobin; Feng Jiaxuan

    2012-01-01

    From the nuclear accident in Japan Fuksuhima in March this year, despite a shut down of the reactor, the residue heat inside the reactor was not able to remove due to the failure of the cooling system and it finally caused the catastrophe. It was observed that when the failure of the cooling system after an earthquake of magnitude 9 and a tsunami of 28 meters height, the containment vessel for the reactor core was still able to maintain its integrity in the first 24 hours before the first explosion was happened. A backup emergency heat removal system for nuclear power plants using mo- bile pumps and liquid chilling units has been proposed 20 years ago by Cheung [Ref. 1]. Due to the fact that there are more than 400 nuclear power plants around the world and 10% of them are located in earthquake active zone, together with the aging of some of the power plants which were built more than 30 years ago, the risk of another nuclear accident becomes high. An emergency safety measure has to be designed in order to deal with the unforeseen scenario. This re- port re-visits the proposal again; to re-design to the suit the need and to integrate with the current situation of the nuclear industry. (authors)

  4. The Significance of Privacy and Trust in Providing Health-Related Services to Behaviorally Bisexual Men in the United States

    Science.gov (United States)

    Dodge, Brian; Schnarrs, Phillip W.; Goncalves, Gabriel; Malebranche, David; Martinez, Omar; Reece, Michael; Rhodes, Scott D.; Van Der Pol, Barbara; Nix, Ryan; Fortenberry, J. Dennis

    2012-01-01

    Previous research suggests that bisexual men face unique health concerns in comparison to their exclusively homosexual and heterosexual counterparts. However, little is known about behaviorally bisexual men's experiences with health services, including ways of providing services that would be most appropriate to meet the health needs of this…

  5. Quantifying the role of National Forest system lands in providing surface drinking water supply for the Southern United States

    Science.gov (United States)

    Peter Caldwell; Corinne Muldoon; Chelcy Ford-Miniat; Erika Cohen; Suzanne Krieger; Ge Sun; Steven McNulty; Paul V. Bolstad

    2014-01-01

    Forests and water are inextricably linked, and people are dependent on forested lands to provide clean, reliable water supplies for drinking and to support local economies. These water supplies are at risk of degradation from a growing population, continued conversion of forests to other land uses, and climate change. Given the variety of threats to surface water, it...

  6. The influence of neonatal intensive care unit design on sound level.

    Science.gov (United States)

    Chen, Hsin-Li; Chen, Chao-Huei; Wu, Chih-Chao; Huang, Hsiu-Jung; Wang, Teh-Ming; Hsu, Chia-Chi

    2009-12-01

    Excessive noise in nurseries has been found to cause adverse effects in infants, especially preterm infants in neonatal intensive care units (NICUs). The NICU design may influence the background sound level. We compared the sound level in two differently designed spaces in one NICU. We hypothesized that the sound level in an enclosed space would be quieter than in an open space. Sound levels were measured continuously 24 hours a day in two separate spaces at the same time, one enclosed and one open. Sound-level meters were placed near beds in each room. Sound levels were expressed as decibels, A-weighted (dBA) and presented as hourly L(eq), L(max), L(10), and L(90). The hourly L(eq) in the open space (50.8-57.2dB) was greater than that of the enclosed space (45.9-51.7dB), with a difference of 0.4-10.4dB, and a mean difference of 4.5dB (p<0.0001). The hourly L(10), L(90), and L(max) in the open space also exceeded that in the enclosed space (p<0.0001). The sound level measured in the enclosed space was quieter than in the open space. The design of bed space should be taken into consideration when building a new NICU. Besides the design of NICU architecture, continuous monitoring of sound level in the NICU is important to maintain a quiet environment.

  7. Maintaining reduced noise levels in a resource-constrained neonatal intensive care unit by operant conditioning.

    Science.gov (United States)

    Ramesh, A; Denzil, S B; Linda, R; Josephine, P K; Nagapoornima, M; Suman Rao, P N; Swarna Rekha, A

    2013-03-01

    To evaluate the efficacy of operant conditioning in sustaining reduced noise levels in the neonatal intensive care unit (NICU). Quasi-experimental study on quality of care. Level III NICU of a teaching hospital in south India. 26 staff employed in the NICU. (7 Doctors, 13 Nursing staff and 6 Nursing assistants). Operant conditioning of staff activity for 6 months. This method involves positive and negative reinforcement to condition the staff to modify noise generating activities. Comparing noise levels in decibel: A weighted [dB (A)] before conditioning with levels at 18 and 24 months after conditioning. Decibel: A weighted accounts for noise that is audible to human ears. Operant conditioning for 6 months sustains the reduced noise levels to within 62 dB in ventilator room 95% CI: 60.4 - 62.2 and isolation room (95% CI: 55.8 - 61.5). In the preterm room, noise can be maintained within 52 dB (95% CI: 50.8 - 52.6). This effect is statistically significant in all the rooms at 18 months (P = 0.001). At 24 months post conditioning there is a significant rebound of noise levels by 8.6, 6.7 and 9.9 dB in the ventilator, isolation and preterm room, respectively (P =0.001). Operant conditioning for 6 months was effective in sustaining reduced noise levels. At 18 months post conditioning, the noise levels were maintained within 62 dB (A), 60 dB (A) and 52 dB (A) in the ventilator, isolation and pre-term room, respectively. Conditioning needs to be repeated at 12 months in the ventilator room and at 18 months in the other rooms.

  8. 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.

  9. Development of low-level radioactive waste disposal capacity in the United States - progress or stalemate?

    International Nuclear Information System (INIS)

    Devgun, J.S.; Larson, G.S.

    1995-01-01

    It has been fifteen years since responsibility for the disposal of commercially generated low-level radioactive waste (LLW) was shifted to the states by the United States Congress through the Low-Level Radioactive Waste Policy Act of 1980 (LLRWPA). In December 1985, Congress revisited the issue and enacted the Low-Level Radioactive Waste Policy Amendments Act of 1985 (LLRWPAA). No new disposal sites have opened yet, however, and it is now evident that disposal facility development is more complex, time-consuming, and controversial than originally anticipated. For a nation with a large nuclear power industry, the lack of availability of LLW disposal capacity coupled with a similar lack of high-level radioactive waste disposal capacity could adversely affect the future viability of the nuclear energy option. The U.S. nuclear power industry, with 109 operating reactors, generates about half of the LLW shipped to commercial disposal sites and faces dwindling access to waste disposal sites and escalating waste management costs. The other producers of LLW - industries, government (except the defense related research and production waste), academic institutions, and medical institutions that account for the remaining half of the commercial LLW - face the same storage and cost uncertainties. This paper will summarize the current status of U.S. low-level radioactive waste generation and the status of new disposal facility development efforts by the states. The paper will also examine the factors that have contributed to delays, the most frequently suggested alternatives, and the likelihood of change

  10. Development of low-level radioactive waste disposal capacity in the United States -- Progress or stalemate?

    International Nuclear Information System (INIS)

    Devgun, J.S.

    1995-01-01

    It has been fifteen years since responsibility for the disposal of commercially generated low-level radioactive waste (LLW) was shifted to the states by the United States Congress through the Low-Level Radioactive Waste Policy Act of 1980 (LLRWPA). In December 1985, Congress revisited the issue and enacted the Low-Level Radioactive Waste Policy Amendments Act of 1985 (LLRWPAA). No new disposal sites have opened yet, however, and it is now evident that disposal facility development is more complex, time-consuming, and controversial than originally anticipated. For a nation with a large nuclear power industry, the lack of availability of LLW disposal capacity coupled with a similar lack of high-level radioactive waste disposal capacity could adversely affect the future viability of the nuclear energy option. The US nuclear power industry, with 109 operating reactors, generates about half of the LLW shipped to commercial disposal sites and faces dwindling access to waste disposal sites and escalating waste management costs. The other producers of LLW -- industries, government (except the defense related research and production waste), academic institutions, and medical institutions that account for the remaining half of the commercial LLW -- face the same storage and cost uncertainties. This paper will summarize the current status of US low-level radioactive waste generation and the status of new disposal facility development efforts by the states. The paper will also examine the factors that have contributed to delays, the most frequently suggested alternatives, and the likelihood of change

  11. 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

  12. [Providing information to patient's families on the end of life process in the intensive care unit. Nursing evaluation].

    Science.gov (United States)

    Pascual-Fernández, M Cristina

    2014-01-01

    Informing is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment. To describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals' attitude on this subject. An observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU. The majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P<.01), with pediatric ICU professionals being more empathetic. ICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. 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.

  14. Hierarchical Bayes Small Area Estimation under a Unit Level Model with Applications in Agriculture

    Directory of Open Access Journals (Sweden)

    Nageena Nazir

    2016-09-01

    Full Text Available To studied Bayesian aspect of small area estimation using Unit level model. In this paper we proposed and evaluated new prior distribution for the ratio of variance components in unit level model rather than uniform prior. To approximate the posterior moments of small area means, Laplace approximation method is applied. This choice of prior avoids the extreme skewness, usually present in the posterior distribution of variance components. This property leads to more accurate Laplace approximation. We apply the proposed model to the analysis of horticultural data and results from the model are compared with frequestist approach and with Bayesian model of uniform prior in terms of average relative bias, average squared relative bias and average absolute bias. The numerical results obtained highlighted the superiority of using the proposed prior over the uniform prior. Thus Bayes estimators (with new prior of small area means have good frequentist properties such as MSE and ARB as compared to other traditional methods viz., Direct, Synthetic and Composite estimators.

  15. 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.

  16. 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.

  17. Genome-level comparisons provide insight into the phylogeny and metabolic diversity of species within the genus Lactococcus.

    Science.gov (United States)

    Yu, Jie; Song, Yuqin; Ren, Yan; Qing, Yanting; Liu, Wenjun; Sun, Zhihong

    2017-11-03

    The genomic diversity of different species within the genus Lactococcus and the relationships between genomic differentiation and environmental factors remain unclear. In this study, type isolates of ten Lactococcus species/subspecies were sequenced to assess their genomic characteristics, metabolic diversity, and phylogenetic relationships. The total genome sizes varied between 1.99 (Lactococcus plantarum) and 2.46 megabases (Mb; L. lactis subsp. lactis), and the G + C content ranged from 34.81 (L. lactis subsp. hordniae) to 39.67% (L. raffinolactis) with an average value of 37.02%. Analysis of genome dynamics indicated that the genus Lactococcus has an open pan-genome, while the core genome size decreased with sequential addition at the genus and species group levels. A phylogenetic dendrogram based on the concatenated amino acid sequences of 643 core genes was largely consistent with the phylogenetic tree obtained by 16S ribosomal RNA (rRNA) genes, but it provided a more robust phylogenetic resolution than the 16S rRNA gene-based analysis. Comparative genomics indicated that species in the genus Lactococcus had high degrees of diversity in genome size, gene content, and carbohydrate metabolism. This may be important for the specific adaptations that allow different Lactococcus species to survive in different environments. These results provide a quantitative basis for understanding the genomic and metabolic diversity within the genus Lactococcus, laying the foundation for future studies on taxonomy and functional genomics.

  18. Noise levels in neonatal intensive care unit and use of sound absorbing panel in the isolette.

    Science.gov (United States)

    Altuncu, E; Akman, I; Kulekci, S; Akdas, F; Bilgen, H; Ozek, E

    2009-07-01

    The purposes of this study were to measure the noise level of a busy neonatal intensive care unit (NICU) and to determine the effect of sound absorbing panel (SAP) on the level of noise inside the isolette. The sound pressure levels (SPL) of background noise, baby crying, alarms and closing of isolette's door/portholes were measured by a 2235-Brüel&Kjaer Sound Level Meter. Readings were repeated after applying SAP (3D pyramidal shaped open cell polyurethane foam) to the three lateral walls and ceiling of the isolette. The median SPL of background noise inside the NICU was 56dBA and it decreased to 47dBA inside the isolette. The median SPL of monitor alarms and baby crying inside the isolette were not different than SPL measured under radiant warmer (p>0.05). With SAP, the median SPL of temperature alarm inside the isolette decreased significantly from 82 to 72dBA, monitor alarm from 64 to 56dBA, porthole closing from 81 to 74dBA, and isolette door closing from 80 to 68dBA (pnoise produced by baby crying when SAP was used in the isolette (79dBA vs 69dBA, respectively) (pnoise. The noise level in our NICU is significantly above the universally recommended levels. Being inside the isolette protects infants from noise sources produced outside the isolette. However, very high noises are produced inside the isolette as well. Sound absorbing panel can be a simple solution and it attenuated the noise levels inside the isolette.

  19. A dynamic state-level analysis of carbon dioxide emissions in the United States

    International Nuclear Information System (INIS)

    Roach, Travis

    2013-01-01

    As climate change and the regulation of carbon dioxide emissions play an increasingly important role in the global policy debate, careful consideration of the state-level determinants driving emissions must be considered. The importance of state-level determinants in the transmission of carbon dioxide matters especially for a country that differs from coast to coast in energy use and industry makeup like the United States. To add to the policy debate this paper estimates two models that account for the dynamic nature of emissions of carbon dioxide emissions at the state-level from 1980–2010 while taking account of scale, technique, and composition effects. When stochastic trends are taken account of, an environmental Kuznets curve relationship with a feasible turning point is found for carbon dioxide emissions. - Highlights: • State-level analysis of carbon dioxide emissions. • Dynamic panel estimation to account for time series properties. • Feasible environmental Kuznets curve for carbon dioxide emissions. • Implications for state environmental policy discussed

  20. Wide variations in blood product transfusion practices among providers who care for patients with acute leukemia in the United States.

    Science.gov (United States)

    Pine, Alexander B; Lee, Eun-Ju; Sekeres, Mikkael; Steensma, David P; Zelterman, Daniel; Prebet, Thomas; DeZern, Amy; Komrokji, Rami; Litzow, Mark; Luger, Selina; Stone, Richard; Erba, Harry P; Garcia-Manero, Guillermo; Lee, Alfred I; Podoltsev, Nikolai A; Barbarotta, Lisa; Kasberg, Stephanie; Hendrickson, Jeanne E; Gore, Steven D; Zeidan, Amer M

    2017-02-01

    Transfusion of blood products is a key component of the supportive management in patients with acute leukemia (AL). However high-quality trial evidence and clinical outcome data to support specific transfusion goals for blood products for patients with AL remain limited leading to diverse transfusion practices. The primary objective of this study was to determine the spectrum of transfusion patterns in a variety of care settings among providers who treat AL patients. A 31-question survey queried providers caring for AL patients about the existence of institutional guidelines for transfusion of blood products, transfusion triggers for hemoglobin (Hb), platelets (PLTs), and fibrinogen in various settings including inpatient and outpatient and before procedures. We analyzed 130 responses and identified divergent transfusion Hb goals in hospitalized and ambulatory patients, fibrinogen goals for cryoprecipitate transfusions, and variation in practice for use of certain PLTs and red blood cell products. The least variable transfusion patterns were reported for PLT goals in thrombocytopenia and in the setting of invasive procedures such as bone marrow biopsy and lumbar punctures. This survey confirmed wide variations in blood product transfusion practices across several clinical scenarios in patients with AL. The findings emphasized the need for large prospective randomized trials to develop standardized evidence-based guidelines for blood product transfusions in patients with AL with the goal of limiting unnecessary transfusions without compromising outcomes. © 2016 AABB.

  1. 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.

  2. Modelling high level system design and unit commitment for a microgrid

    Energy Technology Data Exchange (ETDEWEB)

    Hawkes, A.D. [Centre for Energy Policy and Technology, Imperial College London, London SW7 2AZ (United Kingdom); Leach, M.A. [Centre for Environmental Strategy, Faculty of Engineering, University of Surrey, Guildford GU2 7XH (United Kingdom)

    2009-07-15

    This article develops a linear programming cost minimisation model for the high level system design and corresponding unit commitment of generators and storage within a microgrid; a set of energy resources working co-operatively to create a cost effective, reliable and environmentally friendly energy provision system. Previous work in this area is used as a basis for formulation of a new approach to this problem, with particular emphasis on why a microgrid is different to centralised generation or other grid-connected decentralised energy resources. Specifically, the model explicitly defines the amount of time that the microgrid would be expected to operate autonomously, and restricts flow of heat between microgrid participants to defined cases. The model developed is applied to a set of United Kingdom commercial load profiles, under best current estimates of energy prices and technology capital costs, to determine investment attractiveness of the microgrid. Sensitivity analysis of results to variations in energy prices is performed. The results broadly indicate that a microgrid can offer an economic proposition, although it is necessarily slightly more expensive than regular grid-connected decentralised generation. The analysis results have raised important questions regarding a fair method for settlement between microgrid participants, and game theory has been identified as a suitable tool to analyse aspects of this situation. (author)

  3. Modelling high level system design and unit commitment for a microgrid

    International Nuclear Information System (INIS)

    Hawkes, A.D.; Leach, M.A.

    2009-01-01

    This article develops a linear programming cost minimisation model for the high level system design and corresponding unit commitment of generators and storage within a microgrid; a set of energy resources working co-operatively to create a cost effective, reliable and environmentally friendly energy provision system. Previous work in this area is used as a basis for formulation of a new approach to this problem, with particular emphasis on why a microgrid is different to centralised generation or other grid-connected decentralised energy resources. Specifically, the model explicitly defines the amount of time that the microgrid would be expected to operate autonomously, and restricts flow of heat between microgrid participants to defined cases. The model developed is applied to a set of United Kingdom commercial load profiles, under best current estimates of energy prices and technology capital costs, to determine investment attractiveness of the microgrid. Sensitivity analysis of results to variations in energy prices is performed. The results broadly indicate that a microgrid can offer an economic proposition, although it is necessarily slightly more expensive than regular grid-connected decentralised generation. The analysis results have raised important questions regarding a fair method for settlement between microgrid participants, and game theory has been identified as a suitable tool to analyse aspects of this situation. (author)

  4. High level waste transport and disposal cost calculations for the United Kingdom

    International Nuclear Information System (INIS)

    Nattress, P.C.; Ward, R.D.

    1992-01-01

    Commercial nuclear power has been generated in the United Kingdom since 1962, and throughout that time fuel has been reprocessed giving rise to high level waste. This has been managed by storing fission products and related wastes as highly active liquor, and more recently by a program of vitrification and storage of the glass blocks produced. Government policy is that vitrified high level waste should be stored for at least 50 years, which has the technical advantage of allowing the heat output rate of the waste to fall, making disposal easier and cheaper. Thus, there is no immediate requirement to develop a deep geological repository in the UK, but the nuclear companies do have a requirement to make financial provision out of current revenues for high level waste disposal at a future repository. In 1991 the interested organizations undertook a new calculation of costs for such provisions, which is described here. The preliminary work for the calculation included the assumption of host geology characteristics, a compatible repository concept including overpacking, and a range of possible nuclear programs. These have differing numbers of power plants, and differing mixes of high level waste from reprocessing and spent fuel for direct disposal. An algorithm was then developed so that the cost of high level waste disposal could be calculated for any required case within a stated envelope of parameters. An Example Case was then considered in detail leading to the conclusion that a repository to meet the needs of a constant UK nuclear economy up to the middle of the next century would have a cash cost of UK Pounds 1194M (US$2011M). By simple division the cost to a kWh of electricity is UK Pounds 0.00027 (0.45 US mil). (author)

  5. State-level differences in breast and cervical cancer screening by disability status: United States, 2008.

    Science.gov (United States)

    Armour, Brian S; Thierry, JoAnn M; Wolf, Lesley A

    2009-01-01

    Despite reported disparities in the use of preventive services by disability status, there has been no national surveillance of breast and cervical cancer screening among women with disabilities in the United States. To address this, we used state-level surveillance data to identify disparities in breast and cervical cancer screening among women by disability status. Data from the 2008 Behavioral Risk Factor Surveillance System were used to estimate disability prevalence and state-level differences in breast and cervical cancer screening among women by disability status. Overall, modest differences in breast cancer screening were found; women with a disability were less likely than those without to report receiving a mammogram during the past 2 years (72.2% vs. 77.8%; p < .001). However, disparities in breast cancer screening were more pronounced at the state level. Furthermore, women with a disability were less likely than those without a disability to report receiving a Pap test during the past 3 years (78.9% vs. 83.4%; p < .001). This epidemiologic evidence identifies an opportunity for federal and state programs, as well as other stakeholders, to form partnerships to align disability and women's health policies. Furthermore, it identifies the need for increased public awareness and resource allocation to reduce barriers to breast and cervical cancer screening experienced by women with disabilities.

  6. Safety assessment and licensing issues of low level radioactive waste disposal facilities in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Fearnley, I. G. [British Nuclear Fuels Ltd., Sellafield (United Kingdom)

    1997-12-31

    More than 90% of radioactive waste generated in the United Kingdom is classified as low level and is disposed of in near surface repositories. BNFL owns and operates the principal facility for the disposal of this material at Drigg in West Cumbria. In order to fully optimise the use of the site and effectively manage this `national` resource a full understanding and assessment of the risks associated with the performance of the repository to safely contain the disposed waste must be achieved to support the application for the site authorization for disposal. This paper describes the approaches adopted by BNFL to reviewing these risks by the use of systematic Safety and Engineering Assessments supported in turn by experimental programmes and computations models. (author). 6 refs., 1 tab., 4 figs.

  7. United States Program on Spent Nuclear Fuel and High-Level Radioactive Waste Management

    International Nuclear Information System (INIS)

    Stewart, L.

    2004-01-01

    The President signed the Congressional Joint Resolution on July 23, 2002, that designated the Yucca Mountain site for a proposed geologic repository to dispose of the nation's spent nuclear fuel (SNF) and high-level radioactive waste (HLW). The United States (U.S.) Department of Energy's (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is currently focusing its efforts on submitting a license application to the U.S. Nuclear Regulatory Commission (NRC) in December 2004 for construction of the proposed repository. The legislative framework underpinning the U.S. repository program is the basis for its continuity and success. The repository development program has significantly benefited from international collaborations with other nations in the Americas

  8. Effects of shutdown chemistry on steam generator radiation levels at Point Beach Unit 2. Interim report

    International Nuclear Information System (INIS)

    Kormuth, J.W.

    1982-05-01

    A refueling shutdown chemistry test was conducted at a PWR, Point Beach Unit 2. The objective was to yield reactor coolant chemistry data during the cooldown/shutdown process which might establish a relationship between shutdown chemistry and its effects on steam generator radiation fields. Of particular concern were the effects of the presence of hydrogen in the coolant as contrasted to an oxygenated coolant. Analysis of reactor coolant samples showed a rapid soluble release (spike) in Co-58, Co-60, and nickel caused by oxygenation of the coolant. The measurement of radioisotope specific activities indicates that the material undergoing dissolution during the shutdown originated from different sources which had varying histories of activation. The test program developed no data which would support theories that oxygenation of the coolant while the steam generators are full of water contributes to increased steam generator radiation levels

  9. Safety assessment and licensing issues of low level radioactive waste disposal facilities in the United Kingdom

    International Nuclear Information System (INIS)

    Fearnley, I. G.

    1997-01-01

    More than 90% of radioactive waste generated in the United Kingdom is classified as low level and is disposed of in near surface repositories. BNFL owns and operates the principal facility for the disposal of this material at Drigg in West Cumbria. In order to fully optimise the use of the site and effectively manage this 'national' resource a full understanding and assessment of the risks associated with the performance of the repository to safely contain the disposed waste must be achieved to support the application for the site authorization for disposal. This paper describes the approaches adopted by BNFL to reviewing these risks by the use of systematic Safety and Engineering Assessments supported in turn by experimental programmes and computations models. (author). 6 refs., 1 tab., 4 figs

  10. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

    OpenAIRE

    Lai, Veronica Ka Wai; Lee, Anna; Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John; Joynt, Gavin Matthew

    2016-01-01

    Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Meth...

  11. 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

  12. 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

  13. A mathematical model of metabolism an regulation provides a systems-level view of how Escherichia coli responds to oxigen

    NARCIS (Netherlands)

    Ederer, M.; Steinsiek, S.; Stagge, S.; Rolfe, M.D.; ter Beek, A.; Knies, D.; Teixeira De Mattos, M.J.; Sauter, T.; Green, J.; Poole, R.K.; Bettenbrock, K.; Sawodny, O.

    2014-01-01

    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

  14. Collective Training and Fielding Opportunities for the Objective Force Maneuver Systems at the Unit of Action Level in a Unit Manning/Unit Replacement Personnel System

    National Research Council Canada - National Science Library

    Courts, Michael

    2003-01-01

    The introduction of Objective Force formations, beginning with the first Unit of Action, will fundamentally change existing organizational structures, training requirements and operational constructs for the U.S. Army...

  15. 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...

  16. GSHR, a Web-Based Platform Provides Gene Set-Level Analyses of Hormone Responses in Arabidopsis

    Directory of Open Access Journals (Sweden)

    Xiaojuan Ran

    2018-01-01

    Full Text Available Phytohormones regulate diverse aspects of plant growth and environmental responses. Recent high-throughput technologies have promoted a more comprehensive profiling of genes regulated by different hormones. However, these omics data generally result in large gene lists that make it challenging to interpret the data and extract insights into biological significance. With the rapid accumulation of theses large-scale experiments, especially the transcriptomic data available in public databases, a means of using this information to explore the transcriptional networks is needed. Different platforms have different architectures and designs, and even similar studies using the same platform may obtain data with large variances because of the highly dynamic and flexible effects of plant hormones; this makes it difficult to make comparisons across different studies and platforms. Here, we present a web server providing gene set-level analyses of Arabidopsis thaliana hormone responses. GSHR collected 333 RNA-seq and 1,205 microarray datasets from the Gene Expression Omnibus, characterizing transcriptomic changes in Arabidopsis in response to phytohormones including abscisic acid, auxin, brassinosteroids, cytokinins, ethylene, gibberellins, jasmonic acid, salicylic acid, and strigolactones. These data were further processed and organized into 1,368 gene sets regulated by different hormones or hormone-related factors. By comparing input gene lists to these gene sets, GSHR helped to identify gene sets from the input gene list regulated by different phytohormones or related factors. Together, GSHR links prior information regarding transcriptomic changes induced by hormones and related factors to newly generated data and facilities cross-study and cross-platform comparisons; this helps facilitate the mining of biologically significant information from large-scale datasets. The GSHR is freely available at http://bioinfo.sibs.ac.cn/GSHR/.

  17. Comparison study on models for calculation of NPP’s levelized unit electricity cost

    International Nuclear Information System (INIS)

    Nuryanti; Mochamad Nasrullah; Suparman

    2014-01-01

    Economic analysis that is generally done through the calculation of Levelized Unit Electricity Cost (LUEC) is crucial to be done prior to any investment decision on the nuclear power plant (NPP) project. There are several models that can be used to calculate LUEC, which are: R&D PT. PLN (Persero) Model, Mini G4ECONS model and Levelized Cost model. This study aimed to perform a comparison between the three models. Comparison technique was done by tracking the similarity used for each model and then given a case of LUEC calculation for SMR NPP 2 x 100 MW using these models. The result showed that the R&D PT. PLN (Persero) Model have a common principle with Mini G4ECONS model, which use Capital Recovery Factor (CRF) to discount the investment cost which eventually become annuity value along the life of plant. LUEC on both models is calculated by dividing the sum of the annual investment cost and the cost for operating NPP with an annual electricity production.While Levelized Cost model based on the annual cash flow. Total of annual costs and annual electricity production were discounted to the first year of construction in order to obtain the total discounted annual cost and the total discounted energy generation. LUEC was obtained by dividing both of the discounted values. LUEC calculations on the three models produce LUEC value, which are: 14.5942 cents US$/kWh for R&D PT. PLN (Persero) Model, 15.056 cents US$/kWh for Mini G4ECONs model and 14.240 cents US$/kWh for Levelized Cost model. (author)

  18. A survey of nurse staffing levels in interventional radiology units throughout the UK

    International Nuclear Information System (INIS)

    Christie, A.; Robertson, I.

    2016-01-01

    Aim: To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. Materials and methods: A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Results: Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. Conclusion: A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. - Highlights: • A significant disparity exists between the level of nursing support provided in-hours and OOH. • This applies to both the availability of a nurse to scrub and to monitor the patient. • Having a dedicated 24/7 nursing rota is mandatory to providing a deliverable OOH service.

  19. Welcoming expertise: Bereaved parents' perceptions of the parent-healthcare provider relationship when a critically ill child is admitted to the paediatric intensive care unit.

    Science.gov (United States)

    Butler, Ashleigh E; Copnell, Beverley; Hall, Helen

    2017-11-15

    Entering the paediatric intensive care unit with a critically ill child is a stressful experience for parents. In addition to fearing for their child's well-being, parents must navigate both a challenging environment and numerous new relationships with healthcare staff. How parents form relationships with staff and how they perceive both their own and the healthcare providers' roles in this early stage of their paediatric intensive care journey is currently unknown. This paper explores bereaved parents' perceptions of their role and their relationships with healthcare providers when their child is admitted to the intensive care unit, as part of a larger study exploring their experiences when their child dies in intensive care. A constructivist grounded theory approach was utilised to recruit 26 bereaved parents from 4 Australian intensive care units. Parents participated in audio-recorded, semi-structured interviews lasting 90-150min. All data were analysed using the constant comparative analysis processes, supported by theoretical memos. Upon admission, parents viewed healthcare providers as experts, both of their child's medical care and of the hospital system. This expertise was welcomed, with the parent-healthcare provider relationship developing around the child's need for medical care. Parents engaged in 2 key behaviours in their relationships with staff: prioritising survival, and learning 'the system'. Within each of these behaviours are several subcategories, including 'Stepping back', 'Accepting restrictions' and 'Deferring to medical advice'. The relationships between parents and staff shift and change across the child's admission and subsequent death in the paediatric intensive care unit. However, upon admission, this relationship centres around the child's potential survival and their need for medical care, and the parent's recognition of the healthcare staff as experts of both the child's care and the hospital system. Copyright © 2017 Australian

  20. Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega?3 to unhealthy levels?

    OpenAIRE

    Lin, C.; Andersen, J. R.; V?ge, V.; Rajalahti, T.; Mj?s, S. A.; Kvalheim, O. M.

    2016-01-01

    Summary Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11?12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega?3 being similar to ...

  1. Seasonal forecasting of groundwater levels in natural aquifers in the United Kingdom

    Science.gov (United States)

    Mackay, Jonathan; Jackson, Christopher; Pachocka, Magdalena; Brookshaw, Anca; Scaife, Adam

    2014-05-01

    Groundwater aquifers comprise the world's largest freshwater resource and provide resilience to climate extremes which could become more frequent under future climate changes. Prolonged dry conditions can induce groundwater drought, often characterised by significantly low groundwater levels which may persist for months to years. In contrast, lasting wet conditions can result in anomalously high groundwater levels which result in flooding, potentially at large economic cost. Using computational models to produce groundwater level forecasts allows appropriate management strategies to be considered in advance of extreme events. The majority of groundwater level forecasting studies to date use data-based models, which exploit the long response time of groundwater levels to meteorological drivers and make forecasts based only on the current state of the system. Instead, seasonal meteorological forecasts can be used to drive hydrological models and simulate groundwater levels months into the future. Such approaches have not been used in the past due to a lack of skill in these long-range forecast products. However systems such as the latest version of the Met Office Global Seasonal Forecast System (GloSea5) are now showing increased skill up to a 3-month lead time. We demonstrate the first groundwater level ensemble forecasting system using a multi-member ensemble of hindcasts from GloSea5 between 1996 and 2009 to force 21 simple lumped conceptual groundwater models covering most of the UK's major aquifers. We present the results from this hindcasting study and demonstrate that the system can be used to forecast groundwater levels with some skill up to three months into the future.

  2. Effect of therapeutic Swedish massage on anxiety level and vital signs of Intensive Care Unit patients.

    Science.gov (United States)

    Alves da Silva, Tatiana; Stripari Schujmann, Debora; Yamada da Silveira, Leda Tomiko; Caromano, Fátima Aparecida; Fu, Carolina

    2017-07-01

    To evaluate how Swedish massage affects the level of anxiety and vital signs of Intensive Care Unit (ICU) patients. Quasi-experimental study. ICU patients, 18-50 years old, cooperative, respiratory and hemodynamic stable, not under invasive mechanical ventilation. allergic to massage oil, vascular or orthopedic post-operative, skin lesions, thrombosis, fractures. A 30-min Swedish massage was applied once. arterial pressure, heart rate, respiratory rate, S-STAI questionnaire. Timing of evaluation: pre-massage, immediately post-massage, 30 min post-massage. Comparison: T-test, corrected by Bonferroni method, level of significance of 5%, confidence interval of 95%. 48 patients included, 30 (62.5%) female, mean age 55.46 (15.70) years old. Mean S-STAI pre-massage: 42.51 (9.48); immediately post-massage: 29.34 (6.37); 30 min post-massage: 32.62 (8.56), p < 0.001 for all comparison. Mean vital signs achieved statistical significance between pre-massage and immediately post-massage. Swedish massage reduced anxiety of ICU patients immediately and 30 min post-massage. Vital signs were reduced immediately post-massage. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Males collectively defend their one-male units against bachelor males in a multi-level primate society.

    Science.gov (United States)

    Xiang, Zuo-Fu; Yang, Bang-He; Yu, Yang; Yao, Hui; Grueter, Cyril C; Garber, Paul A; Li, Ming

    2014-07-01

    Group-level male-male co-operation, which has been documented in several primate and non-primate societies, may be mutualistically advantageous to the participants when confronted with threats such as takeovers and cuckoldry by external males. Co-operation among members of distinct social units-while universal among humans-is extremely rare in non-human primates. We present the first observations of collective action or co-operation among males of different one-male units (OMU) in a multi-level society of Rhinopithecus roxellana. A total of 59 instances of male co-operation were recorded. Male co-operation included coordinated chasing, joint vigilance, and patrolling behavior directed at lone adult males trying to enter an OMU. Male co-operation was significantly more frequent during the mating season when the risk of incursions and extra-group paternity was higher. Paternity of infants born in the subsequent birth season and kin relationships among resident males were identified using microsatellite genotype. All infants were sired by OMU males, which we interpret as possible evidence for their success at thwarting mating attempts by satellite males. OMU males were principally unrelated suggesting that male co-operation is best understood in terms of the mutual direct benefits individuals obtain through collective action. Our findings lend support to the bachelor threat hypothesis in which the cooperative behavior of several individuals is more effective than the lone action of a single individual in providing mate defense. Our research has implications for understanding male bonding, higher-level collective action, and the evolution of social co-operation in human societies. © 2013 Wiley Periodicals, Inc.

  4. Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

    Directory of Open Access Journals (Sweden)

    Colleen Diane Fant

    2017-12-01

    Full Text Available IntroductionEmergency medicine is a relatively new field in sub-Saharan Africa and dedicated training in pediatric emergency care is limited. While guidelines from the African Federation of Emergency Medicine (AFEM regarding emergency training exist, a core curriculum in pediatric emergency care has not yet been established for providers at the district hospital level.MethodsThe objective of the project was to develop a curriculum for providers with limited training in pediatric emergencies, and contain didactic and simulation components with emphasis on treatment and resuscitation using available resources. A core curriculum for pediatric emergency care was developed using a validated model of medical education curriculum development and through review of existing guidelines and literature. Based on literature review, as well as a review of existent guidelines in pediatric and emergency care, 10 core topics were chosen and agreed upon by experts in the field, including pediatric and emergency care providers in Kenya and the United States. These topics were confirmed to be consistent with the principles of emergency care endorsed by AFEM as well as complimentary to existing Kenyan medical school syllabi. A curriculum based on these 10 core topics was created and subsequently piloted with a group of medical residents and clinical officers at a community hospital in western Kenya.ResultsThe 10 core pediatric topics prioritized were airway management, respiratory distress, thoracic and abdominal trauma, head trauma and cervical spine management, sepsis and shock, endocrine emergencies, altered mental status/toxicology, orthopedic emergencies, burn and wound management, and pediatric advanced life support. The topics were incorporated into a curriculum comprised of ten 1.5-h combined didactic plus low-fidelity simulation modules. Feedback from trainers and participating providers gave high ratings to the ease of information delivery, relevance, and

  5. 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

  6. High Incidence and Levels of Ochratoxin A in Wines Sourced from the United States.

    Science.gov (United States)

    De Jesus, Christopher Lawrence; Bartley, Amanda; Welch, Aaron Z; Berry, John P

    2017-12-21

    Ochratoxin A (OTA) is one of the most prevalent mycotoxin contaminants of food crops. Among the agricultural products consequently contaminated by OTA is wine. In the present study, a sample of wines sourced from the United States was assessed for OTA. Wines were primarily analyzed by high-performance liquid chromatography with fluorescence detection (HPLC-FD) coupled to a liquid-liquid extraction (LLE) technique which was developed and validated as a simplified sample preparation approach. More than 85% of the wines evaluated were found to contain OTA, at levels above the limit-of-detection (LOD = 0.1 µg L -1 ), and 76% were above the limit-of-quantitation (LOQ = 0.3 µg L -1 ) for the LLE/HPLC-FD method. More than two-thirds of the wines above the LOQ were found to exceed 1 µg L -1 . Complementary analysis by HPLC coupled to tandem mass spectrometry (HPLC-MS/MS) confirmed OTA in 74% of the OTA-positive wines (i.e., >LOQ by HPLC-FD). Overall, both the occurrence and measured levels of OTA were generally high, specifically relative to previous assessments of OTA in wine, and two of the wines were above the only current (European Union) regulatory limit of two parts-per-billion (ppb, ~2 µg L -1 ). Possible trends with respect to geographical region and/or growing climate are noted. As the first assessment of U.S. wines in more than a decade, the overall high occurrence and levels of OTA in wine, and possible geographic and climatic trends, point to a need for regular surveillance of wines, as well as investigation of the relevant contributors to OTA occurrence toward mitigating contamination and exposure risks.

  7. Peer review of the Barselina Level 1 probabilistic safety assessment of the Ignalina Nuclear Power Plant, Unit 2

    International Nuclear Information System (INIS)

    McKay, S.L.; Coles, G.A.

    1995-01-01

    The Barselina Project is a Swedish-funded, cooperative effort among Lithuania, Russia and Sweden to transfer Western probabilistic safety assessment (PSA) methodology to the designers/operators of Ignalina Nuclear Power Plant (INPP). The overall goal is to use the PSA as a tool for assessing plant operational safety. The INPP is a two-unit, Former Soviet Union-designed nuclear facility located in Lithuania. The results of this PSA will ultimately be used to identify plant-specific improvements in system design and the conduct of facility operations, allowing improved operational safety. Pacific Northwest Laboratory (PNL) was asked to perform an independent expert peer review of the Barselina PSA. This report documents the findings of this review. This review, financed with nuclear safety assistance funds through the US Agency for International Development (USAID) and the US Department of Energy (DOE), satisfies Task II of the PNL peer review of the Barselina project. The objective is to provide an independent, in-proce ss examination of the Barselina Level 1 PSA of Ignalina Nuclear Power Plant, Unit 2. The review consisted of an investigation of the project documentation, interviews, and extensive discussions with the PSA staff during critical stages of the project. PNL assessed the readability, completeness, consistency, validity, and applicability of the PSA. The major aspects explored were its purpose, major assumptions, analysis/modeling, results, and interpretation. It was not within the scope of this review to perform plant walkdowns or to review material other than the PSA documentation

  8. 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

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

    International Nuclear Information System (INIS)

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

    1995-01-01

    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 ampersand 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

  10. Improving the repeatability of Motor Unit Number Index (MUNIX) by introducing additional epochs at low contraction levels.

    Science.gov (United States)

    Peng, Yun; Zhang, Yingchun

    2017-07-01

    To evaluate the repeatability of (Motor Unit Number Index) MUNIX under repeatability conditions, specify the origin of variations and provide strategies for quality control. MUNIX calculations were performed on the bicep brachii muscles of eight healthy subjects. Negative effect of suboptimal electrode positions on MUNIX accuracy was eliminated by employing the high-density surface electromyography technique. MUNIX procedures that utilized a variety of surface interferential pattern (SIP) epoch recruitment strategies (including the original MUNIX procedure, two proposed improvement strategies and their combinations) were described. For each MUNIX procedure, ten thousands of different SIP pools were constructed by randomly recruiting necessary SIP epochs from a large SIP epoch pool (3 datasets, 9 independent electromyography recordings at different contraction levels per dataset and 10 SIP epochs per recording) and implemented for MUNIX calculation. The repeatability of each MUNIX procedure was assessed by summarizing the resulting MUNIX distribution and compared to investigate the effect of SIP epoch selection strategy on repeatability performance. SIP epochs selected at lower contraction levels have a stronger influence on the repeatability of MUNIX than those selected at higher contraction levels. MUNIX under repeatability conditions follows a normal distribution and the standard deviation can be significantly reduced by introducing more epochs near the MUNIX definition line. The MUNIX technique shows an inherent variation attributable to SIP epochs at low contraction levels. It is recommended that more epochs should be sampled at these low contraction levels to improve the repeatability. The present study thoroughly documented the inherent variation of MUNIX and the causes, and offered practical solutions to improve the repeatability of MUNIX. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  11. Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega-3 to unhealthy levels.

    Science.gov (United States)

    Lin, C; Andersen, J R; Våge, V; Rajalahti, T; Mjøs, S A; Kvalheim, O M

    2016-08-01

    Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11-12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega-3 being similar to the healthy controls. This is contrary to observations for patients subjected to bariatric surgery where omega-3 levels dropped to levels significantly lower than in the lifestyle patients and healthy controls. During the next 3 weeks of treatment, the FA levels in lifestyle patients were unchanged, while the weight loss continued at almost the same rate as in the first 3 weeks. Multivariate analysis revealed that weight loss and change of serum FA patterns were unrelated outcomes of the intervention for lifestyle patients. For bariatric patients, these processes were associated probably due to reduced dietary input and increased input from the patients' own fat deposits, causing a higher rate of weight loss and simultaneous reduction of the ratio of serum eicosapentaenoic to arachidonic acid. © 2016 World Obesity.

  12. Economics of defense high-level waste management in the United States

    International Nuclear Information System (INIS)

    Slate, S.C.; McDonell, W.R.

    1987-01-01

    The Department of Energy (DOE) is responsible for managing defense high-level wastes (DHLW) from U.S. defense activities using environmentally safe and cost-effective methods. In parallel with its technical programs, the DOE is performing economic studies to ensure that costs are minimized. To illustrate the cost estimating techniques and to provide a sense of cost magnitude, the DHLW costs for the Savannah River Plant (SRP) are calculated. Since operations at SRP must be optimized within relatively fixed management practices, the estimation of incremental costs is emphasized. Treatment and disposal costs are shown to equally contribute to the incremental cost of almost $400,000/canister

  13. Planning the Marketing Strategy. PACE Revised. Level 1. Unit 6. Research & Development Series No. 240AB6.

    Science.gov (United States)

    Ashmore, M. Catherine; Pritz, Sandra G.

    This lesson on planning a marketing strategy, the sixth in a series of 18 units, is part of the first level of a comprehensive entrepreneurship curriculum entitled: A Program for Acquiring Competence in Entrepreneurship (PACE). (Designed for use with secondary students, the first level of PACE introduces students to the concepts involved in…

  14. Flowsheet development studies for the decontamination of high-activity-level water at Three Mile Island Unit 2

    International Nuclear Information System (INIS)

    Collins, E.D.; Bigelow, J.E.; Campbell, D.O.; King, L.J.; Knauer, J.B.

    1980-01-01

    Several chemical processing flowsheets were considered for the decontamination of high-activity-level water at the Three Mile Island (TMI) Unit 2. A zeolite ion exchange process was evaluated and recommended for absorption of the bulk of the highly radioactive cesium and strontium. Standard organic ion-exchange resins were selected to remove the remaining traces of radioactive nuclides (except tritium which cannot be removed by any practical process). Process conditions were evaluated using both synthetic, tracer-level solutions and samples of actual, high-activity level water from TMI Unit 2

  15. Siting the high level radioactive waste repository in the United States

    International Nuclear Information System (INIS)

    Tourtellotte, J.

    1992-01-01

    For more than twenty-five years after the National Academy of Science issued its 1957 report recommending a Mined Geologic Disposal System (''MGDS'') for high level radioactive waste, no substantial progress was made in selecting and siting a repository. The United States Congress attempted to give substantive and procedural direction to the program in the Nuclear Waste Policy Act of 1982. Seeing that very little had been accomplished some five years later, Congress gave further direction and tentatively selected a single site, Yucca Mountain in Nevada, in the Nuclear Waste Policy Act Amendments of 1987. Selection of the Yucca Mountain site created a political conflict between federal and state authorities. Until recently, that conflict stalled the site characterization and evaluation program. Standards development under a polycentric regulatory regime has also been slow and has created a number of technical, legal and policy controversies. The Environmental Protection Agency (EPA), charged with setting radiation protection rules, may be developing regulatory standards which are technically unachievable and, therefore, legally unprovable in a licensing proceeding. The Nuclear Regulatory Commission (NRC), having the responsibility for licensing and setting performance objectives, may be taking an overly conservative approach. This approach could seriously impact the cost and may preclude the ability to reach an affirmative finding on license issuance. The Department of Energy (DOE) has responsibility for siting, construction and operation of the repository. In so doing, DOE must apply both EPA and NRC standards. To the extent that EPA and NRC standards are untimely, poorly defined, unrealistic, inconsistent, and technically or legally unsound, DOE may be forestalled from fulfilling its responsibilities. The US must rethink its approach to siting the high level radioactive waste repository and take realistic, timely action to preserve the nuclear option. (Author)

  16. Haematological parameters in different african populations: an experience from united nations level 3 hospital

    International Nuclear Information System (INIS)

    Iftikhar, R.; Khan, N.U.; Iqbal, Z.; Anwar, M.I.

    2017-01-01

    To evaluate hematological parameters in African population to estimate normal reference intervals for these tests. Study Design: Cross sectional observational study. Place and Duration of Study: Department of Pathology, United Nations level 3 hospital, Nyala, Darfur from 1st Mar to 30th Dec 2014. Material and Methods: There were 396 healthy African male and female volunteers selected between 18-65 years of age, belonging to different countries. Fresh whole blood was used to measure haemoglobin (Hb) concentration, haematocrit (Hct), total red blood cell (TRBC) count, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), platelet count, total leucocyte count (TLC) and differential white blood cells count. Data were analysed using SPSS version 19. Results: Mean Hb of study group was 13.81 +- 1.99 g/dl. Mean TLC was 5.50 +- 1.96 x 103/ul. Mean lymphocyte count was 2.58 +- 0.95. Mean platelet count was 234 +- 92 x103 /ul. Mean values for Hb Concentration, TRBC, Hct Ratio, MCV, MCH and MCHC were all higher for African Males than Females; this difference was statistically significant (p<0.05). Conclusion: This multi-national African population based study confirms the variations in haematological parameters previously described in single nation African studies. The commonly observed variations in normal adults are low RBC indices, relative neutropenia and lymphocytosis. (author)

  17. Impact of County-Level Socioeconomic Status on Oropharyngeal Cancer Survival in the United States.

    Science.gov (United States)

    Megwalu, Uchechukwu C

    2017-04-01

    Objective To evaluate the impact of county-level socioeconomic status on survival in patients with oropharyngeal cancer in the United States. Study Design Retrospective cohort study via a large population-based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 18,791 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. Results Patients residing in counties with a low socioeconomic status index had worse overall survival (56.5% vs 63.0%, P socioeconomic status index. On multivariable analysis, residing in a county with a low socioeconomic status index was associated with worse overall survival (hazard ratio, 1.21; 95% CI, 1.14-1.29; P status, year of diagnosis, site, American Joint Committee on Cancer stage group, presence of distant metastasis, presence of unresectable tumor, histologic grade, surgical resection of primary site, treatment with neck dissection, and radiation therapy. Conclusion Residing in a county with a low socioeconomic status index is associated with worse survival. Further research is needed to elucidate the mechanism by which socioeconomic status affects survival in oropharyngeal cancer.

  18. Function of "nontrauma" surgeons in level I trauma centers in the United States.

    Science.gov (United States)

    Pate, J W

    1997-06-01

    Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

  19. 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.

  20. Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009

    Science.gov (United States)

    Wang, Liya

    2016-01-01

    This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and…

  1. 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.

  2. Overview of commercial low-level radioactive waste disposal in the United States

    International Nuclear Information System (INIS)

    Smith, P.

    1994-01-01

    Disposal of commercial low-level radioactive waste (LLW) is a critical part of the national infrastructure needed to maintain the health of American businesses, universities, and hospitals. Currently only 19 States (located in the Northwest and Southeast) have access to operating disposal facilities; all other States are storing their LLW until they open new disposal facilities on their own or in concert with other States through regional compact agreements. In response to recommendations from the National Governors Association, Congress assigned the burden for LLW disposal to all States, first in 1980 through Public Law 96-573, the open-quotes Low-level Radioactive Waste Policy Actclose quotes, and again in 1986 through Public Law 99-240, the open-quotes Low-Level Radioactive Waste Policy Amendments Act of 1985close quotes. As directed by Congress, the Department of Energy provides technical assistance to States and compact regions with this task. After almost 14 years, nine compact regions have been ratified by Congress; California, Texas, North Carolina, and Nebraska have submitted license applications; California has issued an operating license; and the number of operating disposal facilities has decreased from three to two

  3. The siting dilemma: Low-level radioactive waste disposal in the United States

    International Nuclear Information System (INIS)

    English, M.R.

    1991-01-01

    The 1980 Low-Level Radioactive Waste Policy Act ushered in a new era in low-level waste disposal; one with vastly increased state responsibilities. By a 1985 amendment, states were given until January 1993 to fulfill their mandate. In this dissertation, their progress is reviewed. The focus then turns to one particularly intractable problem: that of finding technically and socially acceptable sites for new disposal facilities. Many lament the difficulty of siting facilities that are intended to benefit the public at large but are often locally unwanted. Many label local opposition as purely self-interested; as simply a function of the NIMBY (Not In My Backyard) syndrome. Here, it is argued that epithets such as NIMBY are unhelpful. Instead, to lay the groundwork for widely acceptable solutions to siting conflicts, deeper understanding is needed of differing values on issues concerning authority, trust, risk, and justice. This dissertation provides a theoretical and practical analysis of those issues as they pertain to siting low-level waste disposal facilities and, by extension, other locally unwanted facilities

  4. Cernavoda NPP Unit 1: Operating experience program and plant specific performance indicators (level 2)

    International Nuclear Information System (INIS)

    Teodor, Vasile; Popa, Viorel

    1998-01-01

    The basis for the Operating Experience Program was set in place since early stages of the commissioning phase (1993), when a system based on the Canadian approach was implemented for reporting, reviewing, assessing and establishing of the necessary corrective action for unplanned events. This system provided excellent opportunity to train staff in unplanned event assessment methodology, and prepare the station for the formal reporting process following criticality in accordance with the licensing requirements. The formal process, set in place after criticality is described in Station Instruction Procedure SI-01365-P13 'Unplanned Event Report' and was developed under the supervision of Safety and Compliance Department. In parallel, a program for information exchange and trending of performance indicators was developed by Technical Services Department. The WANO recommendations following August 1997 Peer Review provided the opportunity for a better understanding and reconsideration of the Operating Experience Program. As a result, all the activities related to this topic were assigned to a new structure, within Safety and Compliance Department. As such an Operating Experience Group was created and a new program is now being developed in an integrated and centralized manner. The content of the paper is the following: - Overview; - Operating Experience Program; - Event Analysis (Unplanned Events Assessment System - UEIR Process- and Systematic Analysis of Operational Events - ACR Process); - Information Exchange Program; - Monitoring of Operating Experience - Plant Specific Performance Indicators; - Purpose; - Level 2 Performance Indicators. Four appendices are added containing: - A. Station performance indicators/targets (Level 2); - B. SPI (Station Performance Indicators - Level 2) - Graphics; - C. UEIR, LRS (Safety and Licensing Review Sheet), UEFR (Unplanned Event Follow-up Report), ACR and OPEX forms. (authors)

  5. 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…

  6. 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. © 2015 International Union of Biochemistry and Molecular Biology.

  7. 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.

  8. United States high-level radioactive waste management program: Current status and plans

    International Nuclear Information System (INIS)

    Williams, J.

    1992-01-01

    The inventory of spent fuel in storage at reactor sites in the United States is approximately 20,000 metric tons heavy metal (MTHM). It is increasing at a rate of 1700 to 2100 MTHM per year. According to current projections, by the time the last license for the current generation of nuclear reactors expires, there will be an estimated total of 84,000 MTHm. No commercial reprocessing capacity exists or is planned in the US. Therefore, the continued storage of spent fuel is required. The majority of spent fuel remains in the spent fuel pools of the utilities that generated it. Three utilities are presently supplementing pool capacity with on-site dry storage technologies, and four others are planning dry storage. Commercial utilities are responsible for managing their spent fuel until the Federal waste management system, now under development, accepts spent fuel for storage and disposal. Federal legislation charges the Office of Civilian Radioactive Waste Management (OCRWM) within the US Department of Energy (DOE) with responsibility for developing a system to permanently dispose of spent fuel and high level radioactive waste in a manner that protects the health and safety of the public and the quality of the environment. We are developing a waste management system consisting for three components: a mined geologic repository, with a projected start date of 2010; a monitored retrievable storage facility (MRS), scheduled to begin waste acceptance in 1998; and a transportation system to support MRS and repository operations. This paper discusses the background and framework for the program, as well as the current status and plans for management of spent nuclear fuel at commercial utilities; the OCRWM's development of a permanent geologic repository, an MRS, and a transportation system; the OCRWM's safety approach; the OCRWM's program management initiatives; and the OCRWM's external relations activities

  9. GEOCHEMISTRY OF ROCK UNITS AT THE POTENTIAL REPOSITORY LEVEL, YUCCA MOUNTAIN, NEVADA

    International Nuclear Information System (INIS)

    Peterman, Z.E.; Cloke, P.L.

    2000-01-01

    The compositional variability of the phenocryst-poor member of the 12.8-million-year Topopah Spring Tuff at the potential repository level was assessed by duplicate analysis of 20 core samples from the cross drift at Yucca Mountain, Nevada. Previous analyses of outcrop and core samples of the Topopah Spring Tuff showed that the phenocryst-poor rhyolite, which includes both lithophysal and nonlithophysal zones, is relatively uniform in composition. Analyses of rock samples from the cross drift, the first from the actual potential repository block, also indicate the chemical homogeneity of this unit excluding localized deposits of vapor-phase minerals and low-temperature calcite and opal in fractures, cavities, and faults, The possible influence of vapor-phase minerals and calcite and opal coatings on rock composition at a scale sufficiently large to incorporate these heterogeneously distributed deposits was evaluated and is considered to be relatively minor. Therefore, the composition of the phenocryst-poor member of the Topopah Spring Tuff is considered to be adequately represented by the analyses of samples from the cross drift. The mean composition as represented by the 10 most abundant oxides in weight percent or grams per hundred grams is: SiO 2 , 76.29; Al 2 O 3 , 12.55; FeO, 0.14; Fe 2 O 3 , 0.97; MgO, 0.13; CaO, 0.50; Na 2 O, 3.52; K 2 O, 4.83; TiO 2 , 0.11; and MnO, 0.07

  10. [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. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Conversion between network-level and project-level units of measure for use in a bridge-management system.

    Science.gov (United States)

    1998-01-01

    VDOT is implementing Pontis 3.0 to provide the analytical component of its Bridge Management System (BMS). This system prioritizes bridge maintenance, repair, rehabilitation, and replacement (MRR & R) needs using cost/benefit analysis. The accuracy o...

  13. Clinical evaluation of monitor unit software and the application of action levels

    International Nuclear Information System (INIS)

    Georg, Dietmar; Nyholm, Tufve; Olofsson, Joergen; Kjaer-Kristoffersen, Flemming; Schnekenburger, Bruno; Winkler, Peter; Nystroem, Hakan; Ahnesjoe, Anders; Karlsson, Mikael

    2007-01-01

    Purpose: The aim of this study was the clinical evaluation of an independent dose and monitor unit verification (MUV) software which is based on sophisticated semi-analytical modelling. The software was developed within the framework of an ESTRO project. Finally, consistent handling of dose calculation deviations applying individual action levels is discussed. Materials and methods: A Matlab-based software ('MUV') was distributed to five well-established treatment centres in Europe (Vienna, Graz, Basel, Copenhagen, and Umea) and evaluated as a quality assurance (QA) tool in clinical routine. Results were acquired for 226 individual treatment plans including a total of 815 radiation fields. About 150 beam verification measurements were performed for a portion of the individual treatment plans, mainly with time variable fluence patterns. The deviations between dose calculations performed with a treatment planning system (TPS) and the MUV software were scored with respect to treatment area, treatment technique, geometrical depth, radiological depth, etc. Results: In general good agreement was found between calculations performed with the different TPSs and MUV, with a mean deviation per field of 0.2 ± 3.5% (1 SD) and mean deviations of 0.2 ± 2.2% for composite treatment plans. For pelvic treatments less than 10% of all fields showed deviations larger than 3%. In general, when using the radiological depth for verification calculations the results and the spread in the results improved significantly, especially for head-and-neck and for thorax treatments. For IMRT head-and-neck beams, mean deviations between MUV and the local TPS were -1.0 ± 7.3% for dynamic, and -1.3 ± 3.2% for step-and-shoot IMRT delivery. For dynamic IMRT beams in the pelvis good agreement was obtained between MUV and the local TPS (mean: -1.6 ± 1.5%). Treatment site and treatment technique dependent action levels between ±3% and ±5% seem to be clinically realistic if a radiological depth

  14. A unique collaboration of female medical providers within the United States Armed Forces: rehabilitation of a marine with post-concussive vestibulopathy.

    Science.gov (United States)

    Gottshall, Kim; Gray, Nicola; Drake, Angela I

    2005-01-01

    Uncle Sam's loyal nieces have come a long way from the days of World War I. The development of occupational and physical therapy was heavily influenced by an early relationship with medical specialists during the First World War. This relationship can be considered largely responsible for the eventual acceptance (by the Armed Forces) of women working in this area. Over the past decade active duty women have seen many changes in opportunities to serve and are now stationed aboard aircraft carriers, performing roles previously considered for male personnel. We report a case study of the medical care provided by both military and civilian women working for the United States Armed Forces. Initial assessment was conducted in a battalion aid station of a United States Marine Corp base and the subject was then referred to a military medical center with highly technical vestibular assessment and rehabilitation services. The subject's case represents a unique collaboration of women therapists, enabling a Marines' access to timely and accurate assessment, treatment and ultimately, successful return to active duty. This case study is one of many examples of the acceptance and successful integration of women as providers of medical care within the Military's medical framework.

  15. DNA barcoding discriminates freshwater fishes from southeastern Nigeria and provides river system-level phylogeographic resolution within some species.

    Science.gov (United States)

    Nwani, Christopher D; Becker, Sven; Braid, Heather E; Ude, Emmanuel F; Okogwu, Okechukwu I; Hanner, Robert

    2011-10-01

    Fishes are the main animal protein source for human beings and play a vital role in aquatic ecosystems and food webs. Fish identification can be challenging, especially in the tropics (due to high diversity), and this is particularly true for larval forms or fragmentary remains. DNA barcoding, which uses the 5' region of the mitochondrial cytochrome c oxidase subunit I (COI) as a target gene, is an efficient method for standardized species-level identification for biodiversity assessment and conservation, pending the establishment of reference sequence libraries. In this study, fishes were collected from three rivers in southeastern Nigeria, identified morphologically, and imaged digitally. DNA was extracted, PCR-amplified, and the standard barcode region was bidirectionally sequenced for 363 individuals belonging to 70 species in 38 genera. All specimen provenance data and associated sequence information were recorded in the barcode of life data systems (BOLD; www.barcodinglife.org ). Analytical tools on BOLD were used to assess the performance of barcoding to identify species. Using neighbor-joining distance comparison, the average genetic distance was 60-fold higher between species than within species, as pairwise genetic distance estimates averaged 10.29% among congeners and only 0.17% among conspecifics. Despite low levels of divergence within species, we observed river system-specific haplotype partitioning within eight species (11.4% of all species). Our preliminary results suggest that DNA barcoding is very effective for species identification of Nigerian freshwater fishes.

  16. 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.

  17. Vaccination of Sheep with a Methanogen Protein Provides Insight into Levels of Antibody in Saliva Needed to Target Ruminal Methanogens.

    Directory of Open Access Journals (Sweden)

    Supatsak Subharat

    Full Text Available Methane is produced in the rumen of ruminant livestock by methanogens and is a major contributor to agricultural greenhouse gases. Vaccination against ruminal methanogens could reduce methane emissions by inducing antibodies in saliva which enter the rumen and impair ability of methanogens to produce methane. Presently, it is not known if vaccination can induce sufficient amounts of antibody in the saliva to target methanogen populations in the rumen and little is known about how long antibody in the rumen remains active. In the current study, sheep were vaccinated twice at a 3-week interval with a model methanogen antigen, recombinant glycosyl transferase protein (rGT2 formulated with one of four adjuvants: saponin, Montanide ISA61, a chitosan thermogel, or a lipid nanoparticle/cationic liposome adjuvant (n = 6/formulation. A control group of sheep (n = 6 was not vaccinated. The highest antigen-specific IgA and IgG responses in both saliva and serum were observed with Montanide ISA61, which promoted levels of salivary antibodies that were five-fold higher than the second most potent adjuvant, saponin. A rGT2-specific IgG standard was used to determine the level of rGT2-specific IgG in serum and saliva. Vaccination with GT2/Montanide ISA61 produced a peak antibody concentration of 7 × 1016 molecules of antigen-specific IgG per litre of saliva, and it was estimated that in the rumen there would be more than 104 molecules of antigen-specific IgG for each methanogen cell. Both IgG and IgA in saliva were shown to be relatively stable in the rumen. Salivary antibody exposed for 1-2 hours to an in vitro simulated rumen environment retained approximately 50% of antigen-binding activity. Collectively, the results from measuring antibody levels and stablility suggest a vaccination-based mitigation strategy for livestock generated methane is in theory feasible.

  18. 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

    2015-01-01

    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. PMID:26046933

  19. 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.

  20. Relationship Between State-Level Google Online Search Volume and Cancer Incidence in the United States: Retrospective Study.

    Science.gov (United States)

    Phillips, Charles A; Barz Leahy, Allison; Li, Yimei; Schapira, Marilyn M; Bailey, L Charles; Merchant, Raina M

    2018-01-08

    In the United States, cancer is common, with high morbidity and mortality; cancer incidence varies between states. Online searches reflect public awareness, which could be driven by the underlying regional cancer epidemiology. The objective of our study was to characterize the relationship between cancer incidence and online Google search volumes in the United States for 6 common cancers. A secondary objective was to evaluate the association of search activity with cancer-related public events and celebrity news coverage. We performed a population-based, retrospective study of state-level cancer incidence from 2004 through 2013 reported by the Centers for Disease Control and Prevention for breast, prostate, colon, lung, and uterine cancers and leukemia compared to Google Trends (GT) relative search volume (RSV), a metric designed by Google to allow interest in search topics to be compared between regions. Participants included persons in the United States who searched for cancer terms on Google. The primary measures were the correlation between annual state-level cancer incidence and RSV as determined by Spearman correlation and linear regression with RSV and year as independent variables and cancer incidence as the dependent variable. Temporal associations between search activity and events raising public awareness such as cancer awareness months and cancer-related celebrity news were described. At the state level, RSV was significantly correlated to incidence for breast (r=.18, P=.001), prostate (r=-.27, P<.001), lung (r=.33, P<.001), and uterine cancers (r=.39, P<.001) and leukemia (r=.13, P=.003) but not colon cancer (r=-.02, P=.66). After adjusting for time, state-level RSV was positively correlated to cancer incidence for all cancers: breast (P<.001, 95% CI 0.06 to 0.19), prostate (P=.38, 95% CI -0.08 to 0.22), lung (P<.001, 95% CI 0.33 to 0.46), colon (P<.001, 95% CI 0.11 to 0.17), and uterine cancers (P<.001, 95% CI 0.07 to 0.12) and leukemia (P<.001, 95

  1. Polybrominated diphenyl ether levels in foodstuffs collected from three locations from the United States

    International Nuclear Information System (INIS)

    Schecter, Arnold; Colacino, Justin; Patel, Keyur; Kannan, Kurunthachalam; Yun, Se Hun; Haffner, Darrah; Harris, T. Robert; Birnbaum, Linda

    2010-01-01

    Objectives: The objectives of this study were to provide updated measurements of PBDEs in US food, to estimate possible difference in levels from differing geographical regions, and to provide an improved estimate of current dietary intake. Methods: Thirty matched food samples for a total of 90 samples were collected from each of three cities (Los Angeles, California; Dallas, Texas; and Albany, New York) and were analyzed for 13 polybrominated diphenyl ether congeners (BDE 28, 47, 49, 66, 85, 99, 100, 138, 153, 154, 183, 203, and 209). Dietary intake of PBDEs was estimated by food type, age, and sex. Results: In this pilot study, we did not note a statistically significant difference in total PBDE levels in food collected from the three locations. The median total PBDE levels (estimating non-detected values as half of the detection limit) in meat, dairy, eggs, and fish were 267 pg/g wet weight (ww) (range 102-3156 pg/g ww), 176 pg/g ww (range 41-954 pg/g ww), 637 pg/g ww (range 193-932 pg/g ww), and 243 pg/g ww (range 36-2161 pg/g ww). PBDE intake from food was estimated to range from 2.7 ng/kg/day for children 2 through 5 years of age to 0.8 ng/kg/day for women aged 60 years and older. This compares closely with our previous study where the intake estimate was 2.7 ng/kg/day for children 2 through 5 years of age and 0.9 ng/kg/day for women aged 60 years and older. Conclusion: We did not find a decrease of PBDEs in food since our previous studies which we expected to find due to the declining use of PBDEs in the USA. These findings could be consistent with food contamination from depot sources of PBDEs. A larger, more representative sampling of the US food supply is indicated based on our findings.

  2. Management of commercial high-level nuclear waste in the United States

    International Nuclear Information System (INIS)

    Mann, S.A.

    1981-01-01

    The Nuclear Waste Policy Act of 1982 (Act), enacted by the 97th Congress in December and signed into law on Jan 7, 1983, by President Reagan, brings a whole new perspective to the nation's nuclear waste management effort. An elaborate set of near-term requirements and actions have to be accomplished within the first 180 days of this Act. As an initial step, Secretary of Energy Donald P. Hodel has established a Nuclear Waste Policy Act (NWPA) project office. The director of the NWPA project office, Robert L. Morgan, is responsible for the department's initial activities to implement the Act until the Office of Civilian Radioactive Waste Management, established by Section 304 of the Act, is activated. The Act requires major efforts in two primary areas: disposal and storage of spent fuel and high-level waste. Efforts in the former area are to be financed by fees collected from utilities and placed into a Nuclear Waste Fund for disposal services. The Act provides for federal storage of up to 1900 tons of spent fuel for those utilities that the Nuclear Regulatory Commission (NRC) determines cannot reasonably provide sufficient additional on-site storage. This federal storage is to be financed through utility-user fees that are placed into an Interim Storage Fund. The Act also provides for cooperative research, development, and demonstration activities at utility sites and federal sites. These activities are to be jointly funded by the utilities and the federal government. Lastly, there are generic research and development (RandD) activities in the spent fuel area that are funded from general appropriations. Mandated milestones have been established by the Act in the areas of gologic repository, fund management, monitored retrievable storage, and spent fuel storage

  3. Firm-level perspectives on public sector engagement with private healthcare providers: survey evidence from Ghana and Kenya.

    Directory of Open Access Journals (Sweden)

    Neeraj Sood

    Full Text Available BACKGROUND: Health systems in Sub-Saharan Africa (SSA are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. METHODOLOGY/PRINCIPAL FINDINGS: In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is "command-and-control" type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. CONCLUSIONS/SIGNIFICANCE: Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities--particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals.

  4. Firm-Level Perspectives on Public Sector Engagement with Private Healthcare Providers: Survey Evidence from Ghana and Kenya

    Science.gov (United States)

    Sood, Neeraj; Burger, Nicholas; Yoong, Joanne; Kopf, Dan; Spreng, Connor

    2011-01-01

    Background Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. Methodology/Principal Findings In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is “command-and-control” type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. Conclusions/Significance Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities—particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals. PMID:22132092

  5. Vision-Related Functional Burden of Diabetic Retinopathy Across Severity Levels in the United States.

    Science.gov (United States)

    Willis, Jeffrey R; Doan, Quan V; Gleeson, Michelle; Haskova, Zdenka; Ramulu, Pradeep; Morse, Lawrence; Cantrell, Ronald A

    2017-09-01

    Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. To assess the functional burden of DR across severity levels in the United States. This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95

  6. Use of provider-based complementary and alternative medicine by adult smokers in the United States: Comparison from the 2002 and 2007 NHIS survey.

    Science.gov (United States)

    Hamm, Eric; Muramoto, Myra L; Howerter, Amy; Floden, Lysbeth; Govindarajan, Lubna

    2014-01-01

    To provide a snapshot of provider-based complementary and alternative medicine (pbCAM) use among adult smokers and assess the opportunity for these providers to deliver tobacco cessation interventions. Cross-sectional analysis of data from the 2002 and 2007 National Health Interview Surveys. Nationally representative sample. A total of 54,437 (31,044 from 2002; 23,393 from 2007) adults 18 years and older. The analysis focuses on 10 types of pbCAM, including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy therapy, folk medicine, hypnosis, massage, and naturopathy. The proportions of current smokers using any pbCAM as well as specific types of pbCAM in 2002 and 2007 are compared using SAS SURVEYLOGISTIC. Between 2002 and 2007, the percentage of recent users of any pbCAM therapy increased from 12.5% to 15.4% (p = .001). The largest increases occurred in massage, chiropractic, and acupuncture. Despite a decrease in the national average of current smokers (22.0% to 19.4%; p = .001), proportions of smokers within specific pbCAM disciplines remained consistent. Complementary and alternative medicine (CAM) practitioners, particularly those in chiropractic, acupuncture, and massage, represent new cohorts in the health care community to promote tobacco cessation. There is an opportunity to provide brief tobacco intervention training to CAM practitioners and engage them in public health efforts to reduce the burden of tobacco use in the United States.

  7. 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 A.; Kim, Sunghwan

    2016-01-01

    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 12 year 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.

  8. 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 A.; Kim, Sunghwan

    2016-01-01

    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 12 year 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 molecular-level signatures presented here can be a fundamental basis for in-depth analysis of oil contamination.

  9. 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.

  10. 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.

  11. Fructose intake at current levels in the United States may cause gastrointestinal distress in normal adults.

    Science.gov (United States)

    Beyer, Peter L; Caviar, Elena M; McCallum, Richard W

    2005-10-01

    Fructose intake has increased considerably in the United States, primarily as a result of increased consumption of high-fructose corn syrup, fruits and juices, and crystalline fructose. The purpose was to determine how often fructose, in amounts commonly consumed, would result in malabsorption and/or symptoms in healthy persons. Fructose absorption was measured using 3-hour breath hydrogen tests and symptom scores were used to rate subjective responses for gas, borborygmus, abdominal pain, and loose stools. The study included 15 normal, free-living volunteers from a medical center community and was performed in a gastrointestinal specialty clinic. Subjects consumed 25- and 50-g doses of crystalline fructose with water after an overnight fast on separate test days. Mean peak breath hydrogen, time of peak, area under the curve (AUC) for breath hydrogen and gastrointestinal symptoms were measured during a 3-hour period after subjects consumed both 25- and 50-g doses of fructose. Differences in mean breath hydrogen, AUC, and symptom scores between doses were analyzed using paired t tests. Correlations among peak breath hydrogen, AUC, and symptoms were also evaluated. More than half of the 15 adults tested showed evidence of fructose malabsorption after 25 g fructose and greater than two thirds showed malabsorption after 50 g fructose. AUC, representing overall breath hydrogen response, was significantly greater after the 50-g dose. Overall symptom scores were significantly greater than baseline after each dose, but scores were only marginally greater after 50 g than 25 g. Peak hydrogen levels and AUC were highly correlated, but neither was significantly related to symptoms. Fructose, in amounts commonly consumed, may result in mild gastrointestinal distress in normal people. Additional study is warranted to evaluate the response to fructose-glucose mixtures (as in high-fructose corn syrup) and fructose taken with food in both normal people and those with

  12. 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. © 2016 John Wiley & Sons Australia, Ltd.

  13. 38 CFR 8.16 - Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U.S.C.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U.S.C. 8.16 Section 8.16 Pensions... Plan § 8.16 Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U...

  14. Relation between location of a motor unit in the human biceps brachii and its critical firing levels for different tasks

    NARCIS (Netherlands)

    Gielen, C.C.A.M.; Haar Romeny, B.M. ter; Gon, J.J.D. van der

    1984-01-01

    Critical firing levels (CFLs) of single motor units (MUs) in the long head of the human biceps brachii muscle were determined in combinations of two isometric tasks: flexion of the elbow, supination of the lower arm, and exorotation of the humerus, as well as the corresponding antagonistic tasks.

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

    Science.gov (United States)

    2015-03-24

    Melnyk and Eileen Fineout-Overholt, who graciously and consistently support military nursing science. Building a Unit-Level Mentored Program...Rosenberg W, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71-72.doi: http

  16. Literacy at All Levels. Proceedings of the Annual Study Conference of the United Kingdom Reading Assn. (8th, Manchester, 1971).

    Science.gov (United States)

    Southgate, Vera, Ed.

    Edited versions of selected major papers presented at the July 1971 study conference of the United Kingdom Reading Association, which had the theme "Literacy at All Levels," are included in this book. This group defines literacy as "the mastery of our native language in all its aspects, as a means of communication," and…

  17. 40 CFR 75.81 - Monitoring of Hg mass emissions and heat input at the unit level.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Monitoring of Hg mass emissions and... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Hg Mass Emission Provisions § 75.81 Monitoring of Hg mass emissions and heat input at the unit level. The owner or operator of the...

  18. Investigation of Pupils' Levels of MVPA and VPA during Physical Education Units Focused on Direct Instruction and Tactical Games Models

    Science.gov (United States)

    Harvey, Stephen; Smith, Lindsey; Fairclough, Stuart; Savory, Louise; Kerr, Catherine

    2015-01-01

    We investigated the moderate to vigorous physical activity (MVPA) and vigorous physical activity (VPA) levels of pupils during coeducational physical education units focused on direct instruction and tactical games models (TGM). Thirty-two children (11-12 years, 17 girls) were randomly assigned to either a direct instruction (control) or TGM…

  19. 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); I. Prokopenko (Inga); W. Rathmann (Wolfgang); A.V. Smith; J.H. Zhao; K.K.H. Aben (Katja); D. Absher (Devin); A.L. Dixon (Anna); B.M. Shields (Beverley); N.L. Glazer (Nicole); N.L. Heard-Costa (Nancy); V. Hoesel (Volker); J.J. Hottenga (Jouke Jan); B. Thorand (Barbara); C. Lamina (Claudia); S. Li (Shengxu); R.M. van Dam (Rob); R.H. Myers (Richard); M.J. Peters (Marjolein); M. Preuss (Michael); S. Ripatti (Samuli); F. Rivadeneira Ramirez (Fernando); C. Sandholt (Camilla); N. Timpson (Nicholas); J.P. Tyrer (Jonathan); S. van Wingerden (Sophie); C.C. White (Charles); F. Wiklund (Fredrik); D.I. Chasman (Daniel); R.W. Lawrence (Robert); N. Pellikka (Niina); J. Shi (Jianxin); E. Thiering (Elisabeth); H. Alavere (Helene); M.T.S. Alibrandi (Maria); A.M. Arnold (Alice); T. Aspelund (Thor); I. Rudan (Igor); E.J.G. Sijbrands (Eric); S.M. Bergmann (Sven); H. Biebermann (Heike); A.I.F. Blakemore (Alexandra); T. Boes (Tanja); S.R. Bornstein (Stefan R.); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); F. Busonero; C. Cavalcanti-Proença (Christine); F.B. Hu (Frank); C.-M. Chen (Chih-Mei); R. Clarke (Robert); J. Connell (John); I.N.M. Day (Ian N.M.); J. Duan (Jubao); R. Elosua (Roberto); G. Eiriksdottir (Gudny); T. Illig (Thomas); S.B. Felix (Stephan); P. Fischer-Posovszky (Pamela); A.R. Folsom (Aaron); N. Friedrich (Nele); M. Fu (Mao); S. Gaget (Stefan); P.V. Gejman (Pablo); E.J. Geus (Eeco); A.P. Gjesing (Anette); P. Goyette (Philippe); J. Gräsler (Jürgen); A.S. Havulinna (Aki); C. Hayward (Caroline); A.C. Heath (Andrew C.); C. Hengstenberg (Christian); A.A. Hicks (Andrew); A. Hinney (Anke); G. Homuth (Georg); J. Hui (Jennie); W. Igl (Wilmar); K.B. Jacobs (Kevin); I. Jarick (Ivonne); E. Jewell (Eelizabeth); U. John (Ulrich); P. Jousilahti (Pekka); A. Jula (Antti); M. Kaakinen (Marika); L. Kaplan (Lee); S. Kathiresan (Sekar); J. Kettunen (Johannes); J. Yang (Joanna); J.W. Knowles (Joshua); T. Esko (Tõnu); I.R. König (Inke); S. Koskinen (Seppo); P. Kovacs (Peter); S. Raychaudhuri (Soumya); J. Laitinen (Jaana); O. Lantieri (Olivier); C. Lanzani (Chiara); L.J. Launer (Lenore); C. Lecoeur (Cécile); T. Lehtimäki (Terho); G. Lettre (Guillaume); J. Liu (Jianjun); M.L. Lokki; M. Lorentzon (Mattias); M.E. Goddard (Michael); B. Ludwig (Barbara); P. Manunta (Paolo); D. Marek (Diana); N.G. Martin (Nicholas); T. Johnson (Toby); B. McKnight (Barbara); O. Melander (Olle); D. Meyre (David); G.W. Montgomery (Grant); R. Mulic (Rosanda); J.S. Ngwa; M. Nelis (Mari); M.J. Neville (Matthew); D.R. Nyholt (Dale); C.J. O'Donnell (Christopher); L.J. Scott (Laura); B.A. Oostra (Ben); G. Pare (Guillame); A.N. Parker (Alex); I. Pichler (Irene); K.H. Pietilainen (Kirsi Hannele); C.P. Platou (Carl); O. Polasek (Ozren); M.N. Cooper (Matthew); S. Rafelt (Suzanne); O.T. Raitakari (Olli T.); N.W. Rayner (Nigel William); M. Ridderstråle (Martin); J. Shi (Jianxin); E. Thiering (Eelisabeth); V. Salomaa (Veikko); M.S. Sandhu (Manjinder); S. Sanna (Serena); J. Saramies (Jouko); M.J. Savolainen (Markku); A. Scherag (Andre); S. Schipf (Sabine); Y. Ben-Shlomo; H. Schunkert (Heribert); K. Silander (Kaisa); J. Sinisalo (Juha); D.S. Siscovick (David); J.H. Smit (Jan); N. Soranzo (Nicole); S.R. Bornstein (Stefan); J. Stephens (Jonathan); T.A. Buchanan (Thomas); M.L. Tammesoo; J.-C. Tardif (Jean-Claude); F.P. Cappuccio (Francesco); T.M. Teslovich (Tanya M.); J.R. Thompson (John); B. Thomson (Brian); A. Tönjes (Anke); R. Clarke; L. Coin (Lachlan); V. Vatin (Vincent); I.N.M. Day (Ian); M. den Heijer (Martin); S. Ebrahim (Shanil); L. Waite (Lindsay); H. Wallaschofski (Henri); E. Widen (Elisabeth); S. Wiegand (Susanna); S.H. Wild (Sarah); G.A.H.M. Willemsen (Gonneke); J.C.M. Witteman (Jacqueline); J. Xu (Jianfeng); L. Zgaga (Lina); J.P. Beilby (John); I.S. Farooqi (I. Sadaf); J. Hebebrand (Johannes); H.V. Huikuri (Heikki); A. James (Alan); M. Kähönen (Mika); F. Macciardi (Fabio); M.S. Nieminen (Markku); C. Ohlsson (Claes); V. Gudnason (Vilmundur); P.M. Ridker (Paul); M. Stumvoll (Michael); J.S. Beckmann (Jacques); D.I. Boomsma (Dorret); M. Caulfield (Mark); S.J. Chanock (Stephen); L.A. Cupples (Adrienne); G.D. Smith; J. Erdmann (Jeanette); H. Grönberg (Henrik); P. Hall (Per); T.B. Harris (Tamara); R.B. Hayes (Richard); J. Heinrich (Joachim); M.-R. Jarvelin (Marjo-Riitta); J. Kaprio (Jaakko); K.T. Khaw; L.A.L.M. Kiemeney (Bart); H. Krude; D.A. Lawlor (Debbie); A. Metspalu (Andres); W.H. Ouwehand (Willem); B.W.J.H. Penninx; A. Peters (Annette); T. Quertermous (Thomas); T. Reinehr (Thomas); A. Rissanen (Aila); N.J. Samani (Nilesh); P.E.H. Schwarz (Peter); A.R. Shuldiner (Alan); T.D. Spector (Timothy); M. Uda (Manuela); Wabitsch, M. (Martin); G. Waeber (Gérard); A.F. Wright (Alan); M.C. Zillikens (Carola); N. Chatterjee (Nilanjan); T. Lehtimäki (Terho); J. Liu (Jianjun); T.L. Assimes (Themistocles); I.B. Borecki (Ingrid); P. Deloukas (Panagiotis); L. Groop (Leif); T. Haritunians (Talin); R.C. Kaplan (Robert); L. Peltonen (Leena Johanna); D.P. Strachan (David); H.E. Wichmann (Heinz Erich); K.E. North (Kari); J.N. Hirschhorn (Joel); E. Ingelsson (Erik); G.W. Montgomery (Grant); L. Parts (Leopold); D. Glass (Daniel); J. Nisbet (James); A. Barrett (Angela); M. Sekowska (Magdalena); M.E. Travers (Mary); S.C. Potter (Simon); E. Grundberg (Elin); S. O'Rahilly (Stephen); A.K. Hedman (Asa); V. Bataille (Veronique); J.T. Bell (Jordana); G. Surdulescu (Gabriela); M. Perola (Markus); F.O. Nestle (Frank); J. Min (Josine); A. Wilk (Alicja); C.J. Hammond (Christopher J.); T.-P. Yang (Tsun-Po); O. Raitakari (Olli); R. Durbin (Richard); K.R. Ahmadi (Kourosh); H. Holm (Hilma); A.F. Stewart (Alexandre F.); M. Barbalic (maja); Z. Aherrahrou (Zouhair); H. Allayee (Hooman); S.S. Anand (Sonia); K. Andersen (Karl); S. Schreiber (Stefan); D. Ardissino (Diego); T.A. Barnes (Timothy); D.M. Becker (Diane); L.C. Becker (Lewis); K. Berger (Klaus); J.C. Bis (Joshua); S.M. Boekholdt (Matthijs); P.S. Braund (Peter); 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); P. Diemert (Patrick); R. Do (Ron); A. Doering (Angela); S. Eifert (Sandra); N.E. El Mokhtari (Nour Eddine); S.G. Ellis (Stephen); S.E. Epstein (Stephen); U. de Faire (Ulf); M. Fischer (Marcus); J. Freyer (Jennifer); B. 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

  20. 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

    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

  1. 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.; et al.,

    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

  2. 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, 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; Boekholdt, S. Matthijs; Kastelein, John J. P.; Rosendaal, Frits R.

    2011-01-01

    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

  3. 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.

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

    International Nuclear Information System (INIS)

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

    1998-01-01

    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

  5. Assessment of the Impact of Radioactive Disposals and Discharges from the United Kingdom Low Level Waste Repository on the Ecosystem

    International Nuclear Information System (INIS)

    Barber, N.

    2009-01-01

    This paper describes an assessment of the impacts to ecosystems and wildlife species from radioactive discharges and disposals at the United Kingdom's low level waste disposal facility in West Cumbria. The assessment was undertaken in response to a requirement in the site's current authorisation and comprised a detailed desk based review along with an exercise to screen relevant monitoring data from the site against generic assessment criteria and undertake a numerical risk assessment. Much of the site is vegetated, comprising a variety of habitats including grassland, relict dune heath and surface water bodies. Furthermore, the site is located adjacent to a coastal/estuarine area which is protected as it provides a habitat of high ecological value and species of animals and plants are present that are rare, endangered or vulnerable. However, the current impact of aerial and liquid radioactive discharges from the low level waste repository on ecosystems and wildlife species is considered to be low. Site monitoring data also indicate that there has been a reduction of radionuclide activities in ground and surface water and leachates over time, a result of measures initiated to minimise rainwater infiltration and improve leachate management associated with the disposal area. A quantitative assessment was undertaken to assess future impacts to relevant terrestrial, fresh water and marine ecosystems. This showed that modelled peak radionuclide concentrations in the first 4,000 years after site closure were not sufficiently high to cause potential impact to any of these ecosystems or associated wildlife. This cut-off date was chosen as it is considered probable that, due to the effects of future climate and landscape change and, unless actions are taken to defend the coastline, the site is likely to be disrupted by coastal erosion in the next 4,000 years. (authors)

  6. 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.

  7. 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...

  8. Noise levels in a neonatal intensive care unit in the Cape metropole ...

    African Journals Online (AJOL)

    Introduction. Continuous noise exposure is potentially harmful to infants\\' auditory systems and wellbeing. Although the effects of noise on infants in a neonatal intensive care unit (NICU) have been well researched overseas, limited studies have been conducted in South Africa. Aim. To conduct a detailed noise assessment ...

  9. Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.

    Science.gov (United States)

    de Souza, Carlos Henrique Amaral; Morbeck, Renata Albaladejo; Steinman, Milton; Hors, Cora Pereira; Bracco, Mario Maia; Kozasa, Elisa H; Leão, Eliseth Ribeiro

    2017-06-01

    In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.

  10. Unit Level Variations And Peer Influences In Mental Health Diagnoses In The U.S. Army

    Science.gov (United States)

    2017-12-01

    Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302, and to the Office of Management and Budget...variations across units without unobserved time-invariant differences such as culture or leadership style , as well as effects of time-variant variables...Nanyang Technological University, 2008 Submitted in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN MANAGEMENT from the

  11. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

    Ardani, K. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Davidson, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Margolis, R. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Nobler, E. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    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).

  13. EMG analysis tuned for determining the timing and level of activation in different motor units.

    Science.gov (United States)

    Lee, Sabrina S M; Miara, Maria de Boef; Arnold, Allison S; Biewener, Andrew A; Wakeling, James M

    2011-08-01

    Recruitment patterns and activation dynamics of different motor units greatly influence the temporal pattern and magnitude of muscle force development, yet these features are not often considered in muscle models. The purpose of this study was to characterize the recruitment and activation dynamics of slow and fast motor units from electromyographic (EMG) recordings and twitch force profiles recorded directly from animal muscles. EMG and force data from the gastrocnemius muscles of seven goats were recorded during in vivo tendon-tap reflex and in situ nerve stimulation experiments. These experiments elicited EMG signals with significant differences in frequency content (p<0.001). The frequency content was characterized using wavelet and principal components analysis, and optimized wavelets with centre frequencies, 149.94 Hz and 323.13 Hz, were obtained. The optimized wavelets were used to calculate the EMG intensities and, with the reconstructed twitch force profiles, to derive transfer functions for slow and fast motor units that estimate the activation state of the muscle from the EMG signal. The resulting activation-deactivation time constants gave r values of 0.98-0.99 between the activation state and the force profiles. This work establishes a framework for developing improved muscle models that consider the intrinsic properties of slow and fast fibres within a mixed muscle, and that can more accurately predict muscle force output from EMG. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Unit Roots in Economic and Financial Time Series: A Re-Evaluation at the Decision-Based Significance Levels

    Directory of Open Access Journals (Sweden)

    Jae H. Kim

    2017-09-01

    Full Text Available This paper re-evaluates key past results of unit root tests, emphasizing that the use of a conventional level of significance is not in general optimal due to the test having low power. The decision-based significance levels for popular unit root tests, chosen using the line of enlightened judgement under a symmetric loss function, are found to be much higher than conventional ones. We also propose simple calibration rules for the decision-based significance levels for a range of unit root tests. At the decision-based significance levels, many time series in Nelson and Plosser’s (1982 (extended data set are judged to be trend-stationary, including real income variables, employment variables and money stock. We also find that nearly all real exchange rates covered in Elliott and Pesavento’s (2006 study are stationary; and that most of the real interest rates covered in Rapach and Weber’s (2004 study are stationary. In addition, using a specific loss function, the U.S. nominal interest rate is found to be stationary under economically sensible values of relative loss and prior belief for the null hypothesis.

  15. A Study on Determination of Proper Pressurizer Level for Kori Unit 1

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Sup; Song, Dong Soo [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1996-12-31

    1. Determination of Proper Pressurizer Level. To determine operation level of pressurizer, LOFTRAN code is used with conservative model and assumption. 2. Performance Analysis. To simulate the plant, RETRAN computer code is used with realistic model and assumptions. The control and protection systems are fully credited. The turbine trip event is simulated at the condition of 47.62% of pressurizer level at full power. After that the same event as that with 55% of pressurizer level is simulated. And the FSAR requirements of pressurizer are verified with the new level setpoints. 3. Safety Analysis. As safety analyses, Loss of Normal Feedwater/Station Blackout which is significantly affected by the initial pressurizer water level is performed. Turbine Trip accident is also analyzed to verify if the peak primary side pressure is within the limit. LOFTRAN code is used with conservative mode and assumption. 3. Steam Generator Replacement. Relating to the steam generator replacement planed in 1998, safety analysis in terms of pressurizer level setpoint change. 4. Limit Condition for Operation. The LCO of pressurizer level is changed from 60% to 67.4% which is included pressurizer level uncertainty. (author). 13 refs., figs., tabs.

  16. 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

    2009-09-01

    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 medekodeerder geanaliseer

  17. S. 2844: A Bill to provide for radon testing. Introduced in the Senate of the United States, One Hundredth Congress, Second Session, September 29, 1988

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This bill, entitled as the Department of Housing and Urban Development Radon Policy Act, has been introduced to provide for radon testing. The purposes of this Act are to: provide the Department of Housing and Urban Development with a mandate to establish a departmental radon policy and program; require the Department of Housing and Urban Development to use its programs to assist the EPA in addressing radon contamination; and require the Department of Housing and Urban Development, in coordination with the EPA, to develop a radon assessment and mitigation program which utilized EPA recommended guidelines and standards to ensure that occupants of housing covered under this Act are not exposed to elevated levels of radon

  18. S. 2844: A Bill to provide for radon testing. Introduced in the Senate of the United States, One Hundredth Congress, Second Session, September 29, 1988

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    Bill S. 2844 provides for radon testing and is cited as the Department of Housing and Urban Development Policy Act. The bill provides the Department of Housing and Urban Development (HUD) with a mandate to establish a departmental radon policy and program. The department will be required to use its programs to assist the Environmental Protection Agency (EPA) address radon contamination. The bill also requires HUD, in coordination with the EPA, to develop a radon assessment and mitigation program which utilizes EPA recommended guidelines and standards to ensure that occupants of housing covered under this act are not exposed to elevated levels of radon. The entire contents of the bill are presented in eight sections entitled: Short Title, findings, Purpose, Definitions, Program, Information, Cooperation with Environmental Protection Agency, and Authorization. The bill was referred to the Committee on Banking, Housing and Urban Affairs

  19. The Influence of Neonatal Intensive Care Unit Design on Sound Level

    Directory of Open Access Journals (Sweden)

    Hsin-Li Chen

    2009-12-01

    Conclusion: The sound level measured in the enclosed space was quieter than in the open space. The design of bed space should be taken into consideration when building a new NICU. Besides the design of NICU architecture, continuous monitoring of sound level in the NICU is important to maintain a quiet environment.

  20. 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.

  1. Trends Analysis of rhBMP2 Utilization in Single-Level Anterior Lumbar Interbody Fusion in the United States.

    Science.gov (United States)

    Lao, Lifeng; Cohen, Jeremiah R; Buser, Zorica; Brodke, Darrel S; Yoon, S Tim; Youssef, Jim A; Park, Jong-Beom; Meisel, Hans-Joerg; Wang, Jeffrey C

    2018-04-01

    Retrospective case study. To evaluate the trends and demographics of recombinant human bone morphogenetic protein 2 (rhBMP2) utilization in single-level anterior lumbar interbody fusion (ALIF) in the United States. Patients who underwent single-level ALIF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database (PearlDiver Technologies, Fort Wayne, IN), a national database of orthopedic insurance records. The year of procedure, age, gender, and region of the United States were analyzed for each patient. A total of 921 patients were identified who underwent a single-level ALIF in this study. The average rate of single-level ALIF with rhBMP2 utilization increased (35%-48%) from 2005 to 2009, but sharply decreased to 16.7% in 2010 and 15.0% in 2011. The overall incidence of single-level ALIF without rhBMP2 (0.20 cases per 100 000 patients) was more than twice of the incidence of single-level ALIF with rhBMP2 (0.09 cases per 100 000 patients). The average rate of single-level ALIF with rhBMP2 utilization is highest in West (41.4%), followed by Midwest (33.3%), South (26.5%) and Northeast (22.2%). The highest incidence of single-level ALIF with rhBMP2 was observed in the group aged less than 65 years (compared with any other age groups, P level ALIF increased from 2006 to 2009, but decreased in 2010 and 2011. The Northeast region had the lowest incidence of rhBMP2 utilization. The group aged less than 65 years trended to have the higher incidence of single-level ALIF with rhBMP2 utilization.

  2. [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.

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

    OpenAIRE

    Strawbridge, Rona; Dupuis, Josée; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John; Bouatia-Naji, Nabila; Dimas, Antigone; Wheeler, Eleanor; Chen, Han; Voight, Benjamin; Taneera, Jalal; Kanoni, Stavroula; Peden, John

    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 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...

  4. Results from probabilistic safety analysis level 2 for Kozloduy NPP units 3 and 4

    International Nuclear Information System (INIS)

    Velev, V.; Mancheva, K.

    2006-01-01

    The study considers full power operation analysis results and impact of strategies and modernisation implementations of Kozloduy NPP units 3 and 4. In this paper the following issues are discussed: the development of Severe Accident Management Guidelines and Symptom Based Emergency Operating Procedures, installation of brand new system as Emergency Filter Ventilation System, Passive Autocatalytic Hydrogen recombiners, etc. In order to respond to the objectives of the study, the analyses assets the impact of different initiating events on risk based on the frequencies of various plant damage states, the confinement failure and the radiological release frequencies and finally estimates the total risk as frequency of radiological releases

  5. Tract- and county-level income inequality and individual risk of obesity in the United States.

    Science.gov (United States)

    Fan, Jessie X; Wen, Ming; Kowaleski-Jones, Lori

    2016-01-01

    We tested three alternative hypotheses regarding the relationship between income inequality and individual risk of obesity at two geographical scales: U.S. Census tract and county. Income inequality was measured by Gini coefficients, created from the 2000 U.S. Census. Obesity was clinically measured in the 2003-2008 National Health and Nutrition Examination Survey (NHANES). The individual measures and area measures were geo-linked to estimate three sets of multi-level models: tract only, county only, and tract and county simultaneously. Gender was tested as a moderator. At both the tract and county levels, higher income inequality was associated with lower individual risk of obesity. The size of the coefficient was larger for county-level Gini than for tract-level Gini; and controlling income inequality at one level did not reduce the impact of income inequality at the other level. Gender was not a significant moderator for the obesity-income inequality association. Higher tract and county income inequality was associated with lower individual risk of obesity, indicating that at least at the tract and county levels and in the context of cross-sectional data, the public health goal of reducing the rate of obesity is in line with anti-poverty policies of addressing poverty through mixed-income development where neighborhood income inequality is likely higher than homogeneous neighborhoods. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. 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)

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

    2005-01-01

    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

  7. 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.

  8. 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.

  9. Theoretical parameter histories of dynamic tests during power commissioning of Mochovce units power level up to 100 % Nnom

    International Nuclear Information System (INIS)

    Jagrik, J.; Mraz, M.; Rapant, M.; Stefanovic, P.; Kotasek, J.; Gieci, A.; Macko, J.; Mosny, J.

    1998-01-01

    Theoretical histories of selected parameters for dynamic tests carried out in the course of power commissioning of the Mochovce Unit 1 at the power level 100% N nom are shown in the report. The expected histories given were developed based on calculations performed by means of simulator in Nuclear Power Plants Research Institute Trnava, Inc., simulator in EGU Praha and simulator at the Mochovce plant, as well as based on similar tests at both Bohunice and Dukovany plants

  10. The Effect of One Session Low Level Laser Therapy of Extracted Follicular Units on the Outcome of Hair Transplantation

    OpenAIRE

    Tabaie, Seyed Mehdi; Berenji Ardestani, Hoda; Azizjalali, Mir Hadi

    2016-01-01

    Introduction: Photobiostimulation with low level laser (LLL) has been used in medicine for a long time and its effects have been shown in many diseases. Some studies have evaluated the effect of LLL on androgenic alopecia. One of the most important limitations of the use of LLL in the treatment of alopecia is the requirement for multiple sessions, which is hardly accepted by patients. This study was conducted to evaluate the effect of the irradiation of extracted follicular hair units by LLL ...

  11. 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.

  12. Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil

    Directory of Open Access Journals (Sweden)

    Luciana C. Silva

    2017-12-01

    Full Text Available Objective: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência – CAPSi in São Paulo, Brazil. Methods: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1 pre-intervention observation; 2 meeting with staff to assess the main needs of the training program; 3 developing materials for training and evaluation; 4 meetings to discuss program implementation; 5 a final meeting for case discussion and evaluation; and 6 distance supervision. Three measures were used to evaluate the training program: i the Knowledge, Attitudes, and Practices (KAP questionnaire; ii videos containing questions designed to assess program comprehension; and iii a satisfaction survey. Results: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. Conclusion: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

  13. Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil.

    Science.gov (United States)

    Silva, Luciana C; Teixeira, Maria C T V; Ribeiro, Edith L; Paula, Cristiane S

    2017-12-18

    To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

  14. Investigating the relationship between costs and outcomes for English mental health providers: a bi-variate multi-level regression analysis.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2018-06-01

    Provider payment systems for mental health care that incentivize cost control and quality improvement have been a policy focus in a number of countries. In England, a new prospective provider payment system is being introduced to mental health that should encourage providers to control costs and improve outcomes. The aim of this research is to investigate the relationship between costs and outcomes to ascertain whether there is a trade-off between controlling costs and improving outcomes. The main data source is the Mental Health Minimum Data Set (MHMDS) for the years 2011/12 and 2012/13. Costs are calculated using NHS reference cost data while outcomes are measured using the Health of the Nation Outcome Scales (HoNOS). We estimate a bivariate multi-level model with costs and outcomes simultaneously. We calculate the correlation and plot the pairwise relationship between residual costs and outcomes at the provider level. After controlling for a range of demographic, need, social, and treatment variables, residual variation in costs and outcomes remains at the provider level. The correlation between residual costs and outcomes is negative, but very small, suggesting that cost-containment efforts by providers should not undermine outcome-improving efforts under the new payment system.

  15. 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

  16. Design and operational considerations of United States commercial nea-surface low-level radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Birk, Sandra M.

    1997-01-01

    Low-level radioactive waste disposal standards and techniques in the United States have evolved significantly since the early 1960's. Six commercial LLW disposal facilities(Barnwell, Richland, Ward Valley, Sierra Blanca, Wake County and Boyd County) operated and proposed between 1962 and 1997. This report summarizes each site's design and operational considerations for near-surface disposal of low-level radioactive waste. These new standards and mitigating efforts at closed facilities (Sheffield, Maxey Flats, Beatty and West Valley) have helped to ensure that the public has been safely protected from LLW. 15 refs

  17. 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.

  18. Large Item Disposal At The Drigg Low Level Waste Repository, United Kingdom

    International Nuclear Information System (INIS)

    Griffiths, Steve

    2012-01-01

    Currently the UK operates only one repository for low level radioactive waste, the LLWR near Drigg in Cumbria. It is located on the West Cumbrian coast near the village of Drigg. LLWR is designed for the management of solid LLW and has operated as the principal national disposal facility for LLW since 1959. LLWR is managed and operated on behalf of the Nuclear Decommissioning Authority (NDA) by UK Nuclear Waste Management Ltd. (UKNWM), parent body of LLW Repository Ltd. UKNWM is a consortium led by URS, Studsvik and AREVA. Waste is accepted at LLWR based on conditions for acceptance (1). Although there is some history of disposal of non-containerised 'large items' at the Drigg site these are anecdotally described as 'not quite fitting into an ISO container (2)' and enquiries indicate that their disposal was restricted to the legacy times when items were tumble-tipped into open trenches at the site, a practise now long ceased. The feasibility of true single large item disposal at the LLWR presents complex problems arising from the poor suitability of both rail and road infrastructure in UK. LLWR is serviced both by road and rail links. The static weight of large items being taken nominally as up to ∼300 metric tons would not necessarily preclude transportation by rail but the practicalities of this route are limited. The ageing rail infrastructure includes numerous tunnels, bridges and sections of line with overhead electrification. All these would require either careful justification or significant work to ensure the safe transit of large loads. Nuclear facilities in UK are by design in remote locations, not all of which are serviced by rail connections and the rail network itself has evolved to service inter-city transportation rather than heavy freight and as such tends to route through town centres, exacerbating the tunnel, bridge and pantograph concerns already identified. Within only a few miles of the LLWR itself there are requirements to pass both over and

  19. Job satisfaction levels of physician assistant faculty in the United States.

    Science.gov (United States)

    Graeff, Evelyn C; Leafman, Joan S; Wallace, Lisa; Stewart, Gloria

    2014-01-01

    Understanding job satisfaction in academia is important in order to recruit and retain faculty. Faculty members with greater job dissatisfaction are more likely to leave than faculty members who are satisfied. Physician assistant (PA) faculty job satisfaction needs to be assessed to determine which job facets are satisfying or dissatisfying. A quantitative descriptive study was done using a Web-based survey sent to PA faculty. The Job Descriptive Index (JDI), a validated survey, was used to measure levels of job satisfaction. The means for each facet were calculated to indicate levels of satisfaction with the job overall, work, supervision, co-workers, pay, promotion, levels of stress, and trustworthiness in management. Correlations were run among demographic factors, salary, and overall job satisfaction. Of the 1,241 PA faculty that received the survey, 239 responses (19.3% response rate) met the criteria for study inclusion. The highest level of satisfaction was with one's co-workers (mean 46.83, range 0 to 54). The promotion facet received the lowest mean level of satisfaction with a 22.2 (range 0 to 54). A small correlation was found between job satisfaction and academic rank (r = -.153, P = .020). Job satisfaction is linked to increased productivity and performance. It is important to understand job satisfaction to make improvements in the appropriate areas. Overall, the results indicate that PA faculty are satisfied with their jobs. Further research is needed to understand the factors that contribute to satisfaction among PA faculty.

  20. 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.

  1. 24 CFR 81.17 - Affordability-Income level definitions-family size and income known (owner-occupied units, actual...

    Science.gov (United States)

    2010-04-01

    ... definitions-family size and income known (owner-occupied units, actual tenants, and prospective tenants). 81...—Income level definitions—family size and income known (owner-occupied units, actual tenants, and...-income families, where the unit is owner-occupied or, for rental housing, family size and income...

  2. The frequency and level of sweep in mixed hardwood saw logs in the eastern United States

    Science.gov (United States)

    Peter Hamner; Marshall S. White; Philip A. Araman

    2007-01-01

    Hardwood sawmills traditionally saw logs in a manner that either orients sawlines parallel to the log central axis (straight sawing) or the log surface (allowing for taper). Sweep is characterized as uniform curvature along the entire length of a log. For logs with sweep, lumber yield losses from straight and taper sawing increase with increasing levels of sweep. Curve...

  3. 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…

  4. County-level job automation risk and health: Evidence from the United States.

    Science.gov (United States)

    Patel, Pankaj C; Devaraj, Srikant; Hicks, Michael J; Wornell, Emily J

    2018-04-01

    Previous studies have observed a positive association between automation risk and employment loss. Based on the job insecurity-health risk hypothesis, greater exposure to automation risk could also be negatively associated with health outcomes. The main objective of this paper is to investigate the county-level association between prevalence of workers in jobs exposed to automation risk and general, physical, and mental health outcomes. As a preliminary assessment of the job insecurity-health risk hypothesis (automation risk → job insecurity → poorer health), a structural equation model was used based on individual-level data in the two cross-sectional waves (2012 and 2014) of General Social Survey (GSS). Next, using county-level data from County Health Rankings 2017, American Community Survey (ACS) 2015, and Statistics of US Businesses 2014, Two Stage Least Squares (2SLS) regression models were fitted to predict county-level health outcomes. Using the 2012 and 2014 waves of the GSS, employees in occupational classes at higher risk of automation reported more job insecurity, that, in turn, was associated with poorer health. The 2SLS estimates show that a 10% increase in automation risk at county-level is associated with 2.38, 0.8, and 0.6 percentage point lower general, physical, and mental health, respectively. Evidence suggests that exposure to automation risk may be negatively associated with health outcomes, plausibly through perceptions of poorer job security. More research is needed on interventions aimed at mitigating negative influence of automation risk on health. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Prevalence, level and distribution of Salmonella in shipments of imported capsicum and sesame seed spice offered for entry to the United States: observations and modeling results.

    Science.gov (United States)

    Van Doren, Jane M; Blodgett, Robert J; Pouillot, Régis; Westerman, Ann; Kleinmeier, Daria; Ziobro, George C; Ma, Yinqing; Hammack, Thomas S; Gill, Vikas; Muckenfuss, Martin F; Fabbri, Linda

    2013-12-01

    In response to increased concerns about spice safety, the United States Food and Drug Administration (FDA) initiated research to characterize the prevalence and levels of Salmonella in imported spices. 299 imported dried capsicum shipments and 233 imported sesame seed shipments offered for entry to the United States were sampled. Observed Salmonella shipment prevalence was 3.3% (1500 g examined; 95% CI 1.6-6.1%) for capsicum and 9.9% (1500 g; 95% Confidence Interval (CI) 6.3-14%) for sesame seed. Within shipment contamination was not inconsistent with a Poisson distribution. Shipment mean Salmonella level estimates among contaminated shipments ranged from 6 × 10(-4) to 0.09 (capsicum) or 6 × 10(-4) to 0.04 (sesame seed) MPN/g. A gamma-Poisson model provided the best fit to observed data for both imported shipments of capsicum and imported shipments of sesame seed sampled in this study among the six parametric models considered. Shipment mean levels of Salmonella vary widely between shipments; many contaminated shipments contain low levels of contamination. Examination of sampling plan efficacy for identifying contaminated spice shipments from these distributions indicates that sample size of spice examined is critical. Sampling protocols examining 25 g samples are predicted to be able to identify a small fraction of contaminated shipments of imported capsicum or sesame seeds. Published by Elsevier Ltd.

  6. Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation.

    Science.gov (United States)

    Baldwin, Aleta M; Dodge, Brian; Schick, Vanessa; Sanders, Stephanie A; Fortenberry, J Dennis

    Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women. Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider-a widely used measure of health care quality-through regression analysis. Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers. Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Breckenridge-Sproat, Sara T; Throop, Meryia D; Raju, Dheeraj; Murphy, Deborah A; Loan, Lori A; Patrician, Patricia A

    2015-01-01

    This study tested the effectiveness of a dynamic educational and mentoring program, facilitated by unit-level mentors, to introduce, promote, and sustain an evidence-based practice (EBP) culture among nurses in a military healthcare setting. The need to identify gaps in practice, apply principles of EBP, and advance scientific applications in the pursuit of quality nursing care is as important to military healthcare as it is in the civilian sector. The Advancing Research through Close Collaboration Model guided the intervention and study. Three instruments were used: the Organizational Readiness for System-wide Integration of Evidence-Based Practice, EBP Beliefs, and EBP Implementation scales. The study took place in 3 military hospitals simultaneously undergoing facility and staff integration. Data were collected from staff nurses in the inpatient nursing units before and after a facilitated education and mentoring intervention. Three hundred sixty nurses (38%) completed baseline, and 325 (31%) completed follow-up surveys. Scores improved on all 3 measures following implementation of the program; however, the differences were statistically significant only for the Organizational Readiness for System-wide Integration of Evidence-Based Practice scale (70.96 vs 77.63, t = -3.95, P culture may diffuse among individuals in an organization, even while experiencing significant change. It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure and workforce composition.

  8. 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.

  9. 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

    2016-01-01

    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. PMID:27222741

  10. [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.

  11. Trends Analysis of rhBMP Utilization in Single-Level Posterior Lumbar Interbody Fusion in the United States.

    Science.gov (United States)

    Lao, Lifeng; Cohen, Jeremiah R; Buser, Zorica; Brodke, Darrel S; Youssef, Jim A; Park, Jong-Beom; Yoon, S Tim; Wang, Jeffrey C; Meisel, Hans-Joerg

    2017-10-01

    Retrospective study. Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been widely used in spinal fusion surgery, but there is little information on rhBMP-2 utilization in single-level posterior lumbar interbody fusion (PLIF). The purpose of our study was to evaluate the trends and demographics of rhBMP-2 utilization in single-level PLIF. Patients who underwent single-level PLIF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database, a national database of orthopedic insurance records. The year of procedure, age, gender, and region of the United States were recorded for each patient. Results were reported for each variable as the incidence of procedures identified per 100 000 patients searched in the database. A total of 2735 patients had single-level PLIF. The average rate of single-level PLIF with rhBMP-2 maintained at a relatively stable level (28% to 31%) from 2005 to 2009, but decreased in 2010 (9.9%) and 2011 (11.8%). The overall incidence of single-level PLIF without rhBMP-2 (0.68 cases per 100 000 patients) was statistically higher ( P level PLIF with rhBMP-2 (0.21 cases per 100 000 patients). The average rate of single-level PLIF with rhBMP-2 utilization was the highest in West (30.1%), followed by Midwest (26.9%), South (20.5%), and Northeast (17.8%). The highest incidence of single-level PLIF with rhBMP-2 was observed in the age group level PLIF. There was a 3-fold increase in the rate of PLIF without rhBMP-2 compared to PLIF with rhBMP-2, with both procedures being mainly done in patients less than 65 years of age.

  12. Control of water infiltration into near surface LLW [low-level radioactive waste] disposal units

    International Nuclear Information System (INIS)

    Schulz, R.K.; Ridky, R.W.; O'Donnell, E.O.

    1990-12-01

    Three kinds of waste disposal unit covers a barriers to water infiltration are being investigated. They are: (1) resistive layer barrier, (2) conductive layer barrier, and (3) bioengineering management. The resistive layer barrier consists of compacted earthen material (e.g. clay). The conductive layer barrier consists of a conductive layer in conjunction with a capillary break. As long as unsaturated flow conditions are maintained the conductive layer will wick water around the capillary break. Below grade layered covers such as (1) and (2) will fail if there is appreciable subsidence of the cover. Remedial action for this kind of failure will be difficult. A surface cover, called bioengineering management, is meant to overcome this problem. The bioengineering management surface barrier is easily repairable if damaged by subsidence; therefore, it could be the system of choice under active subsidence conditions. The bioengineering management procedure also has been shown to be effective in dewatering saturated trenches and could be used for remedial action efforts. After cessation of subsidence, that procedure could be replaced by a resistive layer barrier, or perhaps even better, a resistive layer barrier/conductive layer barrier system. This latter system would then give long-term effective protection against water entry to waste and without institutional care. These various concepts are being assessed in six large (70ft x 45ft x 10ft each) lysimeters at Beltsville, Maryland. 6 refs., 20 figs.,

  13. 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.

  14. State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004.

    Science.gov (United States)

    Armour, Brian S; Campbell, Vincent A; Crews, John E; Malarcher, Ann; Maurice, Emmanuel; Richard, Roland A

    2007-10-01

    To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers. We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers. We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available. Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service's clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.

  15. Mapping critical levels of ozone, sulfur dioxide and nitrogen oxide for crops, forests and natural vegetation in the United States

    International Nuclear Information System (INIS)

    Rosenbaum, B.J.; Strickland, T.C.; McDowell, M.K.

    1994-01-01

    Air pollution abatement strategies for controlling nitrogen dioxide, sulfur dioxide, and ozone emissions in the United States focus on a 'standards-based' approach. This approach places limits on air pollution by maintaining a baseline value for air quality, no matter what the ecosystem can or cannot withstand. This paper, presents example critical levels maps for the conterminous U.S. developed using the 'effects-based' mapping approach as defined by the United Nations Economic Commission for Europe's Convention on Long-Range Transboundary Air Pollution, Task Force on Mapping. This approach emphasizes the pollution level or load capacity an ecosystem can accommodate before degradation occurs, and allows for analysis of cumulative effects. Presents the first stage of an analysis that reports the distribution of exceedances of critical levels for NO 2 , SO 2 , and O 3 in sensitive forest, crop, and natural vegetation ecosystems in the contiguous United States. It is concluded that extrapolation to surrounding geographic areas requires the analysis of diverse and compounding factors that preclude simple extrapolation methods. Pollutant data depicted in this analysis are limited to locationally specific data, and would be enhanced by utilizing spatial statistics, along with converging associated anthropogenic and climatological factors. Values used for critical levels were derived from current scientific knowledge. While not intended to be a definitive value, adjustments will occur as the scientific community gains new insight to pollutant/receptor relationships. We recommend future analysis to include a refinement of sensitive receptor data coverages and to report relative proportions of exceedances at varying grid scales. 27 refs., 4 figs., 1 tab

  16. An Analysis of Purchasing Systems at the Ship Level in the United States and Hellenic Navies

    Science.gov (United States)

    2014-12-01

    HNGS Hellenic Navy General Staff i-ENCON Incentivize Energy Conservation ISM Institute of Supply Management JIT just in time NAVICP Naval...level managers can effectively measure the results. Result controls can be an effective and inexpensive tool in increasing motivation and performance...if not well planned, however, they can lead to undesired behaviors. Moreover, result measures may not work successful with all types of employees

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

    Directory of Open Access Journals (Sweden)

    J. Austin

    1999-09-01

    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

  18. 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

  19. A descriptive study of noise in the neonatal intensive care unit: ambient levels and perceptions of contributing factors.

    Science.gov (United States)

    Darcy, Ashley E; Hancock, Lauren E; Ware, Emily J

    2008-10-01

    To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. Noise levels were found to be above the American Academy of Pediatrics-recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated

  20. A descriptive study of noise in the neonatal intensive care unit. Ambient levels and perceptions of contributing factors.

    Science.gov (United States)

    Darcy, Ashley E; Hancock, Lauren E; Ware, Emily J

    2008-06-01

    To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. Noise levels were found to be above the American Academy of Pediatrics--recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated

  1. 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 ...

  2. TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

    Directory of Open Access Journals (Sweden)

    Babucea Ana-Gabriela

    2017-02-01

    Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

  3. 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...

  4. 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.

  5. 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...

  6. Geohydrologic problems at low-level radioactive waste disposal sites in the United States of America

    International Nuclear Information System (INIS)

    Fischer, J.N.; Robertson, J.B.

    1984-01-01

    Several commercial and US Department of Energy low-level radioactive waste disposal sites in the USA have not adequately contained the waste products. Studies of these sites indicate a number of causes for the problems, including water accumulation in filled trenches, breaches of trench cap integrity, erosion, high water table, hydrogeological complexity, flooding, complex leachate chemistry, and rapid radionuclide migration in groundwater. These problems can be avoided through the application of practical, comprehensive, and common sense earth-science guidelines discussed in this paper. (author)

  7. Elevated levels of interleukin 17A and kynurenine in candidemic patients, compared with levels in noncandidemic patients in the intensive care unit and those in healthy controls.

    Science.gov (United States)

    Krause, Robert; Zollner-Schwetz, Ines; Salzer, Helmut J F; Valentin, Thomas; Rabensteiner, Jasmin; Prüller, Florian; Raggam, Reinhard; Meinitzer, Andreas; Prattes, Jürgen; Rinner, Beate; Strohmaier, Heimo; Quehenberger, Franz; Strunk, Dirk; Heidrich, Katharina; Buzina, Walter; Hoenigl, Martin

    2015-02-01

    The interplay between Candida species and pattern recognition receptors, interleukins, kynurenine, and T cells has been studied in murine and ex vivo human studies, but data are lacking from patients with invasive fungal infections. Interleukin 17A (IL-17A) is considered an important component in host defense against Candida infections and is modulated by Candida-induced impairment of tryptophan-kynurenine metabolism. Dectin-1, Toll-like receptor 2, and Toll-like receptor 4 expression; regulatory T cell (Treg) percentages; and interleukin 6, interleukin 10, IL-17A, interleukin 22, interleukin 23, interferon γ, kynurenine, and tryptophan levels were determined in candidemic patients and compared to levels in noncandidemic patients who are in the intensive care unit (ICU) and receiving antibiotic therapy and those in healthy controls, both with and without Candida colonization. Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients, including Candida-colonized ICU patients and healthy controls. Within candidemic patients, time-dependent elevation of IL-17A and kynurenine levels was detected. IL-17A areas under the curve for differentiation between patients with early candidemia and those without candidemia (ICU patients, including Candida-colonized patients, and healthy controls) were between 0.94 (95% confidence interval [CI], .89-.99) and 0.99 (95% CI, .99-1). Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients. The statistically significant association between IL-17A and kynurenine levels and candidemia suggests their potential as biomarkers for anticipation of invasive candidiasis. NCT00786903. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  8. Viability study for the implantation of an incineration unit for low level radioactive wastes

    International Nuclear Information System (INIS)

    Andrade, Andre Wagner Oliani

    1995-01-01

    Incineration have been a world-wide accepted volume reduction technique for combustible materials due to its high efficiency and excellent results. This technique is used since the last century as an alternative to reduce cities garbage and during the last four decades for the hazardous wastes. The nuclear industry is also involved in this technique development related to the low level radioactive waste management. There are different types of incineration installations and the definition of the right system is based on a criterious survey of its main characteristics, related to the rad wastes as well technical, economical and burocratic parameters. After the autonomous Brazilian nuclear programme development and the onlook of the future intensive nuclear energy uses, a radwaste generation increase is expected. One of the installations where these radwastes volumes are awaited to be high is the Experimental Center of ARAMAR (CEA). Nuclear reactors for propulsion and power generation have been developed in CEA beyond other nuclear combustible cycle activities. In this panorama it is important to evaluate the incineration role in CEA installations, as a volume reduction technique for an appropriate radioactive wastes management implementation. In this work main aspects related to the low level radwaste incineration systems were up rised. This information are important to a coherent viability study and also to give a clear and impartial about a topic that is still non discussed in the national scenery. (author)

  9. A supply chain analysis framework for assessing state-level forest biomass utilization policies in the United States

    International Nuclear Information System (INIS)

    Becker, Dennis R.; Moseley, Cassandra; Lee, Christine

    2011-01-01

    The number of state policies aimed at fostering biomass utilization has proliferated in recent years in the United States. Several states aim to increase the use of forest and agriculture biomass through renewable energy production. Several more indirectly encourage utilization by targeting aspects of the supply chain from trees standing in the forest to goods sold. This research classifies 370 state policies from across the United States that provides incentives for forest biomass utilization. We compare those policies by types of incentives relative to the supply chain and geographic clustering. We then develop a framework for policy evaluation building on the supply chain steps, which can be used to assess intended and unintended consequences of policy interactions. These findings may inform policy development and identify synergies at different steps in the supply chain to enhance forest biomass utilization.

  10. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Effect of Magnesium Level to the Development of Delirium in Patients Under Sedation in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Zümrüt Ela Aslan

    2015-04-01

    Full Text Available Objective: Delirium is a state not to be neglected which can cause severe consequences that is related to critical illness in intensive care unit with acute cerebral dysfunction. Magnesium (Mg plays an important role in many physiological events affecting the brain. In this study, we retrospectively investigated the incidence of delirium development and its relationship with the serum Mg levels. Material and Method: Patients who admitted to intensive care unit (ICU were divided in to two groups according to their serum Mg levels (0.7 normomagnesemia. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for ICU. We identified the duration of mechanical ventilation, applied sedation, age, gender, sepsis, shock, malignancy, ICU requirement after operation, admission SOFA score, admission APACHE II score, admission of Mg and mean Mg levels as secondary outcome measures whether they affected delirium incidence. Results: A total of 178 patients were assessed, 72 of them were found delirium positive. The incidence of delirium was found 45% in patients with hypomagnesaemia; this was found 25% in patients with normomagnesaemia. Duration of mechanical ventilation, ICU stay, and mortality rate were found higher in patients with delirium than those in individuals without delirium. Conclusion: We retrospectively investigated delirium incidence in critically ill patients and the percentage was found remarkably high. Our findings were parallel with the other studies that, delirium has a negative impact on morbidity and mortality rates.

  12. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment.

    Science.gov (United States)

    Damian, April Joy; Gallo, Joseph; Leaf, Philip; Mendelson, Tamar

    2017-11-21

    While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers' professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Analysis of survey data indicated significant improvements in participants' organizational culture and professional satisfaction at training completion. Participants' perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including "Implementation of more flexible, less-punitive policies towards clients," "Adoption of trauma-informed workplace design," "Heightened awareness of own traumatic stress and need for self-care," and "Greater sense of camaraderie and empathy for colleagues." Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers' compassion satisfaction, burnout, and secondary

  13. Status of the United States' high-level nuclear waste disposal program

    International Nuclear Information System (INIS)

    Rusche, B.

    1985-01-01

    The Nuclear Waste Policy Act of 1982 is a remarkable piece of legislation in that there is general agreement on its key provisions. Nevertheless, this is a program intended to span more than a century, with some choices by Congress, states, Indian tribes and the nuclear power industry yet to be made. The crafters of the Act clearly recognized this. And further, the crafters recognized ''. . .that. . .state, Indian tribe and public participation in the planning and development of repositories is essential in order to promote public confidence in the safety of disposal of such waste and spent fuel . . . High-level radioactive waste and spent nuclear fuel have become major subjects of public concern, and appropriate precautions must be taken to ensure that such waste and spent fuel do not adversely affect the public health and safety and the environment for this or future generations

  14. The third level trigger and output event unit of the UA1 data-acquisition system

    International Nuclear Information System (INIS)

    Cittolin, S.; Demoulin, M.; Fucci, A.; Haynes, W.; Martin, B.; Porte, J.P.; Sphicas, P.

    1989-01-01

    The upgraded UA1 experiment utilizes twelve 3081/E emulators for its third-level trigger system. The system is interfaced to VME, and is controlled by 68000 microprocessor VME boards on the input and output. The output controller communicates with an IBM 9375 mainframe via the CERN-IBM developed VICI interface. The events selected by the emulators are output on IBM-3480 cassettes. The usder interface to this system is based on a series of Macintosh personal computers connected to the VME bus. These Macs are also used for developing software for the emulators and for monitoring the entire system. The same configuration has also been used for offline event reconstruction. A description of the system, together with details of both the online and offline modes of operation and an evaluation of its performance are presented. (orig.)

  15. The third level trigger and output event unit of the UA1 data-acquisition system

    Science.gov (United States)

    Cittolin, S.; Demoulin, M.; Fucci, A.; Haynes, W.; Martin, B.; Porte, J. P.; Sphicas, P.

    1989-12-01

    The upgraded UA1 experiment utilizes twelve 3081/E emulators for its third-level trigger system. The system is interfaced to VME, and is controlled by 68000 microprocessor VME boards on the input and output. The output controller communicates with an IBM 9375 mainframe via the CERN-IBM developed VICI interface. The events selected by the emulators are output on IBM-3480 cassettes. The user interface to this system is based on a series of Macintosh personal computer connected to the VME bus. These Macs are also used for developing software for the emulators and for monitoring the entire system. The same configuration has also been used for offline event reconstruction. A description of the system, together with details of both the online and offline modes of operation and an eveluation of its performance are presented.

  16. Design and operational experience of low level radioactive waste disposal in the United Kingdom

    International Nuclear Information System (INIS)

    Grimwood, P. D.

    1997-01-01

    Low level radioactive wastes have been disposed of at the Drigg near-surface disposal site for over 30 years. These are carried out under a disposal authorization granted by the UK Environment Agency. This is augmented by a three tier comprehensive system of waste controls developed by BNFL involving wasteform specification, consignor and waste stream qualification and waste consignment verification. Until 1988 wastes were disposed of into trench facilities. However, based on a series of integrated optioneering studies, new arrangements have since been brought into operation. Central to these is a wasteform specification based principally on high force compaction of wastes, grouting within 20 m 3 steel overpack containers to essentially eliminate associated voidage and subsequent disposal in concrete lined vaults. These arrangements ensure efficient utilisation of the Drigg site capacity and a cost-effective disposal concept which meets both national and international standards. (author). 7 figs

  17. 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.

  18. A Bi-Level Particle Swarm Optimization Algorithm for Solving Unit Commitment Problems with Wind-EVs Coordinated Dispatch

    Science.gov (United States)

    Song, Lei; Zhang, Bo

    2017-07-01

    Nowadays, the grid faces much more challenges caused by wind power and the accessing of electric vehicles (EVs). Based on the potentiality of coordinated dispatch, a model of wind-EVs coordinated dispatch was developed. Then, A bi-level particle swarm optimization algorithm for solving the model was proposed in this paper. The application of this algorithm to 10-unit test system carried out that coordinated dispatch can benefit the power system from the following aspects: (1) Reducing operating costs; (2) Improving the utilization of wind power; (3) Stabilizing the peak-valley difference.

  19. Economics of defense high level waste management in the United States

    International Nuclear Information System (INIS)

    McDonell, W.R.

    1987-01-01

    Life-cycle costs of defense waste disposal, as presented in the foregoing sections, are summarized. Expressed as incremental costs per canister of waste deposited in a Federal geologic repository and per gallon of decontaminated salt solution immobilized in onsite concrete vaults, the tabulated values provide a measure of waste management costs relatively independent of the inventories of waste processed. Total values are about $350,000 per glass waste canister processed and $4.68 per gallon of decontaminated salt immobilized. These costs do not generally include contributions of fixed charges, such as capital costs, except in the case of transport and repository charges for which the quantities of waste handled determine allocation of fixed costs included in the fee assessments. 14 refs., 2 figs., 3 tabs

  20. Vertical land motion controls regional sea level rise patterns on the United States east coast since 1900

    Science.gov (United States)

    Piecuch, C. G.; Huybers, P. J.; Hay, C.; Mitrovica, J. X.; Little, C. M.; Ponte, R. M.; Tingley, M.

    2017-12-01

    Understanding observed spatial variations in centennial relative sea level trends on the United States east coast has important scientific and societal applications. Past studies based on models and proxies variously suggest roles for crustal displacement, ocean dynamics, and melting of the Greenland ice sheet. Here we perform joint Bayesian inference on regional relative sea level, vertical land motion, and absolute sea level fields based on tide gauge records and GPS data. Posterior solutions show that regional vertical land motion explains most (80% median estimate) of the spatial variance in the large-scale relative sea level trend field on the east coast over 1900-2016. The posterior estimate for coastal absolute sea level rise is remarkably spatially uniform compared to previous studies, with a spatial average of 1.4-2.3 mm/yr (95% credible interval). Results corroborate glacial isostatic adjustment models and reveal that meaningful long-period, large-scale vertical velocity signals can be extracted from short GPS records.

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

    Directory of Open Access Journals (Sweden)

    Helen Prytherch

    2012-10-01

    Full Text Available 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

  2. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies

    Directory of Open Access Journals (Sweden)

    Jason Liwen Huang

    2017-06-01

    Full Text Available Background: Despite the proven effectiveness of colorectal cancer (CRC screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. Methods: A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. Discussion: The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. Conclusion: Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to

  3. 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

  4. 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.

  5. State-level medical and absenteeism cost of asthma in the United States.

    Science.gov (United States)

    Nurmagambetov, Tursynbek; Khavjou, Olga; Murphy, Louise; Orenstein, Diane

    2017-05-01

    For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.

  6. Perceptions of methicillin-resistant Staphylococcus aureus and hand hygiene provider training and patient education: results of a mixed method study of health care providers in Department of Veterans Affairs spinal cord injury and disorder units.

    Science.gov (United States)

    Hill, Jennifer N; Hogan, Timothy P; Cameron, Kenzie A; Guihan, Marylou; Goldstein, Barry; Evans, Martin E; Evans, Charlesnika T

    2014-08-01

    The goal of this study was to assess current practices for training of spinal cord injury and disorder (SCI/D) health care workers and education of veterans with SCI/D in Department of Veterans Affairs (VA) spinal cord injury (SCI) centers on methicillin-resistant Staphylococcus aureus (MRSA) prevention. Mixed methods. A Web-based survey was distributed to 673 VA SCI/D providers across 24 SCI centers; 21 acute care and 1 long-term care facility participated. There were 295 that responded, 228 had complete data and were included in this analysis. Semistructured interviews were conducted with 30 SCI/D providers across 9 SCI centers. Nurses, physicians, and therapists represent most respondents (92.1%, n = 210); over half (56.6%, n = 129) were nurses. Of providers, 75.9% (n = 173) reported receiving excellent or good training on how to educate patients about MRSA. However, nurses were more likely to report having excellent or good training for how to educate patients about MRSA (P = .005). Despite this, only 63.6% (n = 82) of nurses perceived the education they provide patients on how MRSA is transmitted as excellent or good. Despite health care workers reporting receiving excellent or good training on MRSA-related topics, this did not translate to excellent or good education for patients, suggesting that health care workers need additional training for educating patients. Population-specific MRSA prevention educational materials may also assist providers in educating patients about MRSA prevention for individuals with SCI/D. Published by Mosby, Inc.

  7. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management.

    Science.gov (United States)

    Savel, Richard H; Cohen, Wess; Borgia, Dena; Simon, Ronald J

    2018-01-01

    The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care.

  8. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

    Directory of Open Access Journals (Sweden)

    Richard H Savel

    2018-01-01

    Full Text Available The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1 leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2 preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3 intensivist staffing changes; (4 roles for and training of advanced practice practitioners; (5 graduate medical education issues; (6 optimizing interactions with closely related services; (7 nursing, staffing, and training issues; (8 bed allocation issues; and (9 reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care.

  9. The Effect of One Session Low Level Laser Therapy of Extracted Follicular Units on the Outcome of Hair Transplantation.

    Science.gov (United States)

    Tabaie, Seyed Mehdi; Berenji Ardestani, Hoda; Azizjalali, Mir Hadi

    2016-01-01

    Photobiostimulation with low level laser (LLL) has been used in medicine for a long time and its effects have been shown in many diseases. Some studies have evaluated the effect of LLL on androgenic alopecia. One of the most important limitations of the use of LLL in the treatment of alopecia is the requirement for multiple sessions, which is hardly accepted by patients. This study was conducted to evaluate the effect of the irradiation of extracted follicular hair units by LLL on the outcome of hair transplantation. We enrolled 10 patients with androgenic alopecia and after screening tests for infections and other diseases, we extracted hair follicular units. The hair units were divided in two groups. One group was irradiated by LLL 20 minutes before transplantation (660 nm, 80 Hz, 100 mW) and the other one was used as control. The containing plates were labeled as A and B and sent to the operation room. The surgeon was unaware of the therapy assigned to the plates and transplanted them randomly on the right or left side of the head. One hundred follicular units on each sides of the scalp were transplanted symmetrically. The follicles on both sides were evaluated at 3 and 6 months of transplantation for hair growth rate by another physician, blinded to the treatment assigned to each side. Ten patient with androgenic alopecia and mean (SD) age of 31.5 (6.6) years (range 25-45 years) completed the study. All patients had 100% hair growth at 3 and 6 months follow-up except one who had hair growth of 20% at three months of transplantation, which changed to 100% at sixth months. There was no significant difference between the groups regarding hair growth (P > 0.8). One session of LLL irradiation has no significant effect on the outcome of transplanted hair follicles. Studies with larger sample size are needed to draw a definite conclusion.

  10. The Impact of Resources on Education: A Position Paper on How Theories of Social Capital Provide Insight on the Achievement Gap in the United States Education System

    Science.gov (United States)

    Zeisler, Kayla

    2012-01-01

    Research has shown that there is a gap in educational achievement between socioeconomic and racial groups in the public education system in the United States. This paper identifies the link between resources and academic achievement. Through examining educational resources, from in-school factors, such as facilities and teacher quality, to…

  11. Directory of Regional Centers and Educational Programs Providing Services to Deaf/Blind Children and Youth in the United States (Including Puerto Rico and the Virgin Islands).

    Science.gov (United States)

    Alonso, Lou, Comp.

    Listed in the directory are over 200 educational programs and services for deaf blind children in the United States and U. S. territories. It is noted that the 10 coordinators of regional centers for services to deaf blind children have aided in compilation of the directory. Listings are arranged by state within the New England, Mid-Atlantic…

  12. 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...

  13. Frequency and pattern of skin diseases among uniformed personnel at united nations level iii hospital-darfur, sudan

    International Nuclear Information System (INIS)

    Raza, N.; Suhail, M.

    2014-01-01

    Objective: The objective of the study was to determine the frequency and pattern of skin diseases among uniformed personnel at a United Nations peace-keeping mission Level III hospital at Darfur, Sudan. Design: A descriptive study Place and Duration of Study: This study was conducted at dermatology outpatient department of United Nations peace keeping mission (UNAMID) level III Hospital from Jan 2010-2011. Patients and Methods: All soldiers/ policemen of either gender reporting to dermatology department of the hospital for the first time during the study period were registered after informed consent. A specially designed proforma was filled for each patient separately. In addition to date of reporting, demographic profile and disease information were noted. The data was managed and analyzed using SPSS-14. Results: There were a total of 438 uniformed personnel of the age ranging from 20-52 years (mean of 34.30+6.43). Eczema in various forms was the most common disease (21.9%), followed by fungal infections (10%) and melasma (08.9%). One hundred and seventy five (40.0%) patients had the disease 02 months to >30 years before their deployment, whereas 263 (60%) developed the disease 03 days to 01 year after deployment. Conclusion: Eczema, fungal infections and melasma were the commonest skin problems among uniformed personnel. Forty percent of these had dermatological problems before deployment. (author)

  14. Impact of provider level, training and gender on the utilization of palliative care and hospice in neuro-oncology: a North-American survey.

    Science.gov (United States)

    Walbert, Tobias; Glantz, Michael; Schultz, Lonni; Puduvalli, Vinay K

    2016-01-01

    Specialized palliative care (PC) services have emerged to address symptoms and provide end-of-life management for patients with brain tumors. The utilization patterns of PC in neuro-oncology are unknown. A 22-question survey was distributed to participants of the society for neuro-oncology annual meeting 2012 (n = 4487). Nonparametric methods including Wilcoxon two-sample and Kruskal-Wallis tests were used to assess differences in responses. 239 (5.3 %) evaluable responses were received; 79 % of respondents were physicians, and 17 % were nurses or midlevel providers. Forty-seven percent were medical or neuro-oncologists, 31 % neurosurgeons and 11 % radiation oncologists. Forty percent had no formal training in PC, 57 % had some formal training and 3 % completed a PC fellowship. Seventy-nine percent practiced in an academic setting. Of the respondents, 57 % referred patients to PC when symptoms required treatment and 18 % at end of life. Only 51 % of all providers felt comfortable dealing with end-of-life issues and symptoms, while 33 % did not. Fifty-one percent preferred a service named "Supportive Care" rather than "Palliative Care" (MDs > midlevel providers, p training in neuro-oncology and PC, and medical versus surgical neuro-oncology training were significantly associated with hospice referral, comfort in dealing with end-of-life issues, and ease of access to PC services. Provider level, specialty, gender, training in PC and neuro-oncology have significant impact on the utilization of PC and hospice in neuro-oncology.

  15. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment

    Directory of Open Access Journals (Sweden)

    April Joy Damian

    2017-11-01

    Full Text Available Abstract Background While there is increasing support for training youth-serving providers in trauma-informed care (TIC as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers’ professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Methods Government workers and nonprofit professionals (N = 90 who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16 was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Results Analysis of survey data indicated significant improvements in participants’ organizational culture and professional satisfaction at training completion. Participants’ perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including “Implementation of more flexible, less-punitive policies towards clients,” “Adoption of trauma-informed workplace design,” “Heightened awareness of own traumatic stress and need for self-care,” and “Greater sense of camaraderie and empathy for colleagues.” Conclusion Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and

  16. 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.

  17. Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit.

    Science.gov (United States)

    Wang, Wenru; Kong, Amelia Wai Man; Chair, Sek Ying

    2011-11-01

    The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit. This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale. Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05). Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Short-arm human centrifugation with 0.4g at eye and 0.75g at heart level provides similar cerebrovascular and cardiovascular responses to standing.

    Science.gov (United States)

    Goswami, Nandu; Bruner, Michelle; Xu, Da; Bareille, Marie-Pierre; Beck, Arnaud; Hinghofer-Szalkay, Helmut; Blaber, Andrew P

    2015-07-01

    Orthostatic intolerance continues to be a problem with astronauts upon return to Earth as a result of cerebral and cardiovascular adaptations to weightlessness. We tested the hypothesis that artificial gravity from a short-arm human centrifuge (SAHC) could provide cerebral and cardiovascular stimuli similar to upright posture and thereby serve as a suitable countermeasure. We compared cardiovascular and cerebrovascular responses before, during, and after exposure to hyper-G with that of standing in healthy young participants. The head was positioned such that the middle cerebral artery (MCA) was 0.46 m from the center of rotation. Two levels of hyper-G that provided 1g and 2g at foot level were investigated. Continuous blood pressure, heart rate, calf blood volume, MCA mean blood flow velocity (MFV) and end-tidal CO2 were measured. Blood pressure at the level of the MCA (BP-MCA) and MFV was reduced during stand and at 2g. The relationship between MFV and BP-MCA at 2g was different from supine and similar to standing, while 1g centrifugation was not different from supine. The cardiovascular system was also not different from supine at 1g but was similarly challenged in 2g compared to stand. Our data suggest that short-arm centrifugation 2g at the feet, with the head offset 0.5 m from the center, provides similar cardiovascular and cerebral responses to standing. This supports the hypothesis that passive 2g SAHC exposure at the feet could be used as a countermeasure for in-flight cardiovascular and cerebrovascular deconditioning.

  19. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

    Science.gov (United States)

    Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John

    2016-01-01

    Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Methods and analysis 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. Trial registration number ChiCTR-IOR-15006971. PMID:27334883

  20. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention.

    Science.gov (United States)

    Lai, Veronica Ka Wai; Lee, Anna; Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John; Joynt, Gavin Matthew

    2016-06-22

    Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethical approval has been obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. ChiCTR-IOR-15006971. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Case Study: A Bio-Inspired Control Algorithm for a Robotic Foot-Ankle Prosthesis Provides Adaptive Control of Level Walking and Stair Ascent

    Directory of Open Access Journals (Sweden)

    Uzma Tahir

    2018-04-01

    Full Text Available Powered ankle-foot prostheses assist users through plantarflexion during stance and dorsiflexion during swing. Provision of motor power permits faster preferred walking speeds than passive devices, but use of active motor power raises the issue of control. While several commercially available algorithms provide torque control for many intended activities and variations of terrain, control approaches typically exhibit no inherent adaptation. In contrast, muscles adapt instantaneously to changes in load without sensory feedback due to the intrinsic property that their stiffness changes with length and velocity. We previously developed a “winding filament” hypothesis (WFH for muscle contraction that accounts for intrinsic muscle properties by incorporating the giant titin protein. The goals of this study were to develop a WFH-based control algorithm for a powered prosthesis and to test its robustness during level walking and stair ascent in a case study of two subjects with 4–5 years of experience using a powered prosthesis. In the WFH algorithm, ankle moments produced by virtual muscles are calculated based on muscle length and activation. Net ankle moment determines the current applied to the motor. Using this algorithm implemented in a BiOM T2 prosthesis, we tested subjects during level walking and stair ascent. During level walking at variable speeds, the WFH algorithm produced plantarflexion angles (range = −8 to −19° and ankle moments (range = 1 to 1.5 Nm/kg similar to those produced by the BiOM T2 stock controller and to people with no amputation. During stair ascent, the WFH algorithm produced plantarflexion angles (range −15 to −19° that were similar to persons with no amputation and were ~5 times larger on average at 80 steps/min than those produced by the stock controller. This case study provides proof-of-concept that, by emulating muscle properties, the WFH algorithm provides robust, adaptive control of level walking at

  2. Assessment of changes in plasma hemoglobin and potassium levels in red cell units during processing and storage.

    Science.gov (United States)

    Saini, Nishant; Basu, Sabita; Kaur, Ravneet; Kaur, Jasbinder

    2015-06-01

    Red cell units undergo changes during storage and processing. The study was planned to assess plasma potassium, plasma hemoglobin, percentage hemolysis during storage and to determine the effects of outdoor blood collection and processing on those parameters. Blood collection in three types of blood storage bags was done - single CPDA bag (40 outdoor and 40 in-house collection), triple CPD + SAGM bag (40 in-house collection) and quadruple CPD + SAGM bag with integral leukoreduction filter (40 in-house collection). All bags were sampled on day 0 (day of collection), day 1 (after processing), day 7, day 14 and day 28 for measurement of percentage hemolysis and potassium levels in the plasma of bag contents. There was significant increase in percentage hemolysis, plasma hemoglobin and plasma potassium level in all the groups during storage (p levels during the storage of red blood cells. Blood collection can be safely undertaken in outdoor blood donation camps even in hot summer months in monitored blood transport boxes. SAGM additive solution decreases the red cell hemolysis and allows extended storage of red cells. Prestorage leukoreduction decreases the red cell hemolysis and improves the quality of blood. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Geologic and hydrologic considerations for various concepts of high-level radioactive waste disposal in conterminous United States

    International Nuclear Information System (INIS)

    Ekren, E.B.; Dinwiddie, G.A.; Mytton, J.W.; Thordarson, W.; Weir, J.E. Jr.; 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 to 50,000 ft or 9,140 to 15,240 m), (2) a matrix of (an array of multiple) drill holes (1,000 to 20,000 ft or 305 to 6,100 m), (3) a mined chamber (1,000 to 10,000 ft or 305 to 3,050 m), (4) a cavity with separate manmade structures (1,000 to 10,000 ft or 305 to 3,050 m), and (5) an exploded cavity (2,000 to 20,000 ft or 610 to 6,100 m). Areas considered to be unsuitable for waste disposal are those where seismic risk is high, where possible sea-level rise would inundate potential sites, where high topographic relief coincides with high frequency of faults, where there are unfavorable ground-water conditions, and where no suitable rocks are known to be present to depths of 20,000 feet (6,100 m) or more, and where these strata either contain large volumes of ground water or have high oil and gas potential

  4. 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.

  5. 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.

  6. Inventory and characteristics of current and projected low-level radioactive materials and waste in the United States

    International Nuclear Information System (INIS)

    Bisaria, A.; Bugos, R.G.; Pope, R.B.; Salmon, R.; Storch, S.N.; Lester, P.B.

    1994-01-01

    The Integrated Data Base (IDB), under US Department of Energy (DOE) funding and guidance, provides an annual update of compiled data on current and projected inventories and characteristics of DOE and commercially owned radioactive wastes. The data base addresses also the inventories of DOE and commercial spent fuel. These data are derived from reliable information from government sources, open literature, technical reports, and direct contacts. The radioactive materials considered are spent nuclear fuel, high-level waste (HLW), transuranic (TRU) waste, low-level waste (LLW), commercial uranium mill tailings, environmental restoration wastes, and mixed-LLW. This paper primarily focuses on LLW inventory and characterization

  7. 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

  8. 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.

  9. 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 attitudes, which are strongly dependent on religious precepts and dogma.

  10. 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

  11. Handling and treatment of low-level radioactive wastes from gaseous diffusion plants in the United States of America

    International Nuclear Information System (INIS)

    Wing, J.F.; Behrend, J.E.

    1984-01-01

    Gaseous diffusion plants in the United States of America currently generate very small quantities of low-level radioactive wastes. These wastes consist primarily of airborne effluent solid trapping media and liquid scrubber solutions, liquid effluent treatment sludges, waste oils and solvents, scrap metals and conventional combustible wastes such as floor sweepings, cleaning rags and shoe covers. In addition to waste emanating from current operations, large quantities of scrap metal generated during the Cascade Improvement Program are stored above ground at each of the diffusion plants. The radionuclides of primary concern are uranium and 99 Tc. Current radioactive waste treatment consists of uranium dissolution in weak acids followed by chemical precipitation and/or solvent extraction for uranium recovery. Current disposal operations consist of above ground storage of scrap metals, shallow land burial of inorganic solids and incineration of combustible wastes. With increased emphasis on reducing the potential for off-site radiological dose, several new treatment and disposal options are being studied and new projects are being planned. One project of particular interest involves the installation of a high temperature incinerator to thermally degrade hazardous organic wastes contaminated with low-level radioactive wastes. Other technologies being studied include fixation of uranium-bearing sludges in concrete before burial, decontamination of scrap metals by smelting and use of specially engineered centralized burial grounds. (author)

  12. The WRF model forecast-derived low-level wind shear climatology over the United States great plains

    Energy Technology Data Exchange (ETDEWEB)

    Storm, B. [Wind Science and Engineering Research Center, Texas Tech University, Lubbock, TX (United States); Basu, S. [Atmospheric Science Group, Department of Geosciences, Texas Tech University, Lubbock, TX (United States)

    2010-07-01

    For wind resource assessment projects, it is common practice to use a power-law relationship (U(z) {proportional_to} z{sup {alpha}}) and a fixed shear exponent ({alpha} = 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. (author)

  13. 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

  14. Quality of travel health advice in higher-education establishments in the United Kingdom and its relationship to the demographic background of the provider.

    Science.gov (United States)

    Porter, J F Hugh; Knill-Jones, Robin P

    2004-01-01

    The number of international trips undertaken by residents of the United Kingdom has risen dramatically over the past 50 years. Likewise, the numbers studying in higher education have also shown a huge increase. This study aimed to assess the appropriateness of advice given to traveling students by higher education-based health services and to relate this to the demography and experience of the professionals involved. A postal questionnaire describing three hypothetical groups of students traveling to different parts of the world was sent to 335 doctors and nurses. These clinicians belonged to the British Association of Health Services in Higher Education. They worked in 105 practices that serve higher-educational establishments in the United Kingdom. Main outcome measures included whether appropriate immunizations were advised and given correctly through the National Health Service (NHS) or privately, and whether appropriate advice was given regarding malaria, human immunodeficiency virus (HIV), and miscellaneous risks. The sources of information used to advise travelers were also asked, and the effect of demographic characteristics of the respondents on the quality of advice was investigated. Two hundred fifteen (64%) questionnaires were returned. The mean score for whether the correct immunizations were advised was 77%, and for whether these were given correctly through the NHS or privately was 79.6%. For malaria, HIV, and miscellaneous risks, the scores were lower at 65%, 38%, and 32%, respectively. The score for correct immunizations was significantly affected by sex, with females respondents scoring higher (p = .036). Previous training in travel medicine improved scores for immunizations (p = .034) and for the correct choice being given through the NHS or privately (p = .006). Age, hours worked, role, and size of practice had no influence on scores. Charts in the general practice free newspapers were the most popular source of information. Practices serving

  15. Conservation Below The Species Level: Suitable Evolutionarily Significant Units Among Mountain Vipers (The Montivipera Raddei Complex) in Iran.

    Science.gov (United States)

    Behrooz, Roozbeh; Kaboli, Mohammad; Arnal, Véronique; Nazarizadeh, Masoud; Asadi, Atefeh; Salmanian, Amin; Ahmadi, Mohsen; Montgelard, Claudine

    2018-02-01

    Northern and western mountains of Iran are among the most important biodiversity and endemism hot spots for reptiles in the Middle East. Among herpetofauna, the montivipers represent an emblematic and fragmented endemic group for which estimating their level of genetic differentiation and defining conservation priorities is urgently needed. Here, we present the most comprehensive phylogenetic study on the Montivipera raddei species group comprising all five known taxa, among which three are endemic to Iran. Based on two mitochondrial genes, phylogenetic and phylogeographic analyses revealed three major lineages each presenting very contrasting distribution area. The Iranian montivipers are highly structured in clades showing low genetic diversity and corresponding to high altitude summits. Molecular dating revealed the role of Quaternary paleo-climatic oscillations and altitudinal movements of montivipers in shaping genetic diversity and differentiation of these sky-island taxa. In addition, the best scenario of historical biogeography allowed identifying three possible refugial areas in Iran most likely arising by vicariance. Based on our mitochondrial results and pending additional data, we recognize three candidate species among the Montivipera raddei complex: M. raddei, M.latifii and M. kuhrangica that are coherent with their geographical distribution. We propose that the most appropriate Evolutionary Significant Units for conservation of the montivipers are represented by thirteen units among which six are recognized as high priority. Finally, we suggest some recommendations to the IUCN as well as to the Iranian conservation policies with respect to conservation prioritization. © The American Genetic Association 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Control of water infiltration into near-surface, low-level waste-disposal units in humid regions

    International Nuclear Information System (INIS)

    O'Donnell, E.; Ridky, R.W.; Schulz, R.K.

    1994-01-01

    This study's objective is to assess means for controlling water infiltration through waste-disposal unit covers in humid regions. Experimental work is being performed in large-scale lysimeters (75 ft x 45 ft x 10 ft) at Beltsville, Maryland. Results of the assessment are applicable to disposal of low-level radioactive waste (LLW), uranium mill tailings, hazardous waste, and sanitary landfills. Three kinds of waste-disposal unit covers or barriers to water infiltration are being investigated: (1) resistive layer barrier, (2) conductive layer barrier, and (3) bioengineering management. The resistive layer barrier consists of compacted earthen material (e.g., clay). The conductive layer barrier consists of a conductive layer in conjunction with a capillary break. As long as unsaturated flow conditions are maintained, the conductive layer will wick water around the capillary break. Below-grade layered covers such as (1) and (2) will fail if there is appreciable subsidence of the cover, and remedial action for this kind of failure will be difficult. A surface cover, called bioengineering management, is meant to overcome this problem. The bioengineering management surface barrier is easily repairable if damaged by subsidence; therefore, it could be the system of choice under active subsidence conditions. The bioengineering management procedure also has been shown to be effective in dewatering saturated trenches and could be used for remedial action efforts. After cessation of subsidence, that procedure could be replaced by a resistive layer barrier or, perhaps even better, by a resistive layer barrier/conductive layer barrier system. The latter system would then give long-term effective protection against water entry into waste without institutional care

  17. 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.

  18. 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...

  19. STATE LEVEL MECHANISMS FOR LEARNING FROM WHISTLEBLOWING CASES AT INSTITUTIONS OF HIGHER EDUCATION IN THE UNITED STATES

    Directory of Open Access Journals (Sweden)

    Christopher R. Schmidt

    2016-06-01

    Full Text Available State level mechanisms for soliciting, validating, and learning from whistleblower claims of fraud, theft, or misconduct against public colleges and universities are explored in four US states: California, Massachusetts, Michigan, and Ohio. Sequential public information requests were used to understand the methods that were used in each state, the types of claims that each state experienced, and to understand their processes for learning from such claims. The types of claims, breadth of scope that the claims span, and disposition of the claims is used to characterize each state’s approach and compare and contrast results with other states in the sample. There was a wide variation in responses and approaches used in each state. Varying from no information solicited or maintained (Michigan to full histories that include case level detail (Ohio, excellent multi-year case tracking and reporting (California to the voluminous tracking of every property loss or damage in every institution (Massachusetts. An organic rubric is developed and used to compare and contrast the responses and service level provided by each of the states. Although anonymous whistleblower claims are essential to the governance and administration of higher education, state level mechanisms vary widely in their approaches to administering this process and ensuring better future outcomes. Establishing a standard based upon best practices would ensure that institutions are making the best use of all information available to them to improve their immunity from employee fraud and theft and misconduct.

  20. UNDERSTANDING IDEA OF CURRICULUM 2013 AND ITS CONSISTENCY ON DEVELOPING CURRICULUM DOCUMENT AT LEVEL OF EDUCATION UNIT (KTSP AT PRIMARY SCHOOL LEVEL

    Directory of Open Access Journals (Sweden)

    - Prihantini

    2018-01-01

    Full Text Available Abstract:. This study is based on various issues of Curriculum 2013, both in terms of teacher readiness to accept the Curriculum 2013, an understanding of the idea of Curriculum 2013, as well as in the implementation of teaching and learning. In the curriculum development theory, curriculum ideas are an important component that the curriculum development team needs to understand, so that the development of curriculum documents composed reflects continuity with curriculum ideas. The purpose of this study is to describe and explore the understanding of principals and teachers about the idea of Curriculum 2013 and its consistency on developing Education Unit Level Curriculum (KTSP at elementary school in Sukalarang sub-district, Sukabumi regency. The research method applied is qualitative research with descriptive exploratory approach. The conclusions of the study are: (1 the understanding of principals and teachers about the idea of the  Curriculum 2013 at the know stage, the understanding that curriculum ideas have consistency in the development of the Education Unit Level Curriculum (KTSP document is not yet owned; (2 the development of KTSP document shows no consistency between the idea of Curriculum 2013 with the documents of Book I KTSP, Book II KTSP, and Book III KTSP; (3 the problems faced by school principals and teachers in relation to the Curriculum 2013 is assessment of learning, both with regard to the techniques and types of assessment and techniques of administering the results of the assessment.Recommendations are proposed to policy makers that training strategies need to be changed from "theory oriented" to "practice oriented" and need to be varied in implementation at the Kecamatan or Cluster levels and enhanced effectiveness of curriculum counseling 2013. For principals and teachers expected to disseminate the 2013 Curriculum should be supported by presenting expert resources during the workshop, Principal Working Group (K3S and

  1. The United States Department of Energy process for performance assessment for disposal of low-level radioactive waste

    International Nuclear Information System (INIS)

    Wood, D.E.; Owens, K.W.; Wilhite, E.L.; Duggan, G.J.

    1993-02-01

    The US Department of Energy (DOE) manages disposal of low-level radioactive waste through the requirements of DOE Order 5820.2A on Radioactive Waste Management. The order specifies long-term performance objectives for permanent disposal, requires a performance assessment to determine compliance with those objectives, and establishes a Peer Review Panel to review those assessments for technical quality and completeness. A Performance Assessment Task Team has been established to provide guidance and recommend policy for implementation and interpretation of the requirements to those preparing the assessments. This paper describes the requirements, the Peer Review Panel, the Performance Assessment Task Team, and their activities to date

  2. Herd-level risk factors for lameness in freestall farms in the northeastern United States and California.

    Science.gov (United States)

    Chapinal, N; Barrientos, A K; von Keyserlingk, M A G; Galo, E; Weary, D M

    2013-01-01

    The objective was to investigate the association between herd-level management and facility design factors and the prevalence of lameness in high-producing dairy cows in freestall herds in the northeastern United States (NE; Vermont, New York, Pennsylvania) and California (CA). Housing and management measures such as pen space, stall design, bedding type, and milking routine were collected for the high-producing pen in 40 farms in NE and 39 farms in CA. All cows in the pen were gait scored using a 1-to-5 scale and classified as clinically lame (score ≥3) or severely lame (score ≥4). Measures associated with the (logit-transformed) proportion of clinically or severely lame cows at the univariable level were submitted to multivariable general linear models. In NE, lameness increased on farms that used sawdust bedding [odds ratio (OR)=1.71; 95% confidence interval (CI)=1.06-2.76] and decreased with herd size (OR=0.94; CI=0.90-0.97, for a 100-cow increase), use of deep bedding (OR=0.48; CI=0.29-0.79), and access to pasture (OR=0.52; CI=0.32-0.85). The multivariable model included herd size, access to pasture, and provision of deep bedding, and explained 50% of the variation in clinical lameness. Severe lameness increased with the percentage of stalls with fecal contamination (OR=1.15; CI=1.06-1.25, for a 10% increase) and with use of sawdust bedding (OR=2.13; CI=1.31-3.47), and decreased with use of deep bedding (OR=0.31; CI=0.19-0.50), sand bedding (OR=0.32; CI=0.19-0.53), herd size (OR=0.93; CI=-0.89-0.97, for a 100-cow increase), and rearing replacement heifers on site (OR=0.57; CI=0.32-0.99). The multivariable model included deep bedding and herd size, and explained 59% of the variation of severe lameness. In CA, clinical lameness increased with the percentage of stalls containing fecal contamination (OR=1.15; CI=1.05-1.26, for a 10% increase), and decreased with herd size (OR=0.96; CI=0.94-0.99, for a 100-cow increase), presence of rubber in the alley to the

  3. Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015.

    Science.gov (United States)

    Ivey-Stephenson, Asha Z; Crosby, Alex E; Jack, Shane P D; Haileyesus, Tadesse; Kresnow-Sedacca, Marcie-Jo

    2017-10-06

    Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts. 2001-2015. Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates

  4. 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.

  5. Improved HIV and TB Knowledge and Competence Among Mid-level Providers in a Cluster-Randomized Trial of One-on-One Mentorship for Task Shifting.

    Science.gov (United States)

    Naikoba, Sarah; Senjovu, Kaggwa D; Mugabe, Pallen; McCarthy, Carey F; Riley, Patricia L; Kadengye, Damazo T; Dalal, Shona

    2017-08-15

    Health worker shortages pose a challenge to the scale up of HIV care and treatment in Uganda. Training mid-level providers (MLPs) in the provision of HIV and tuberculosis (TB) treatment can expand existing health workforce capacity and access to HIV services. We conducted a cluster-randomized trial of on-site clinical mentorship for HIV and TB care at 10 health facilities in rural Uganda. Twenty MLPs at 5 randomly assigned to an intervention facilities received 8 hours a week of one-on-one mentorship, every 6 weeks over a 9-month period; and another 20 at 5 control facilities received no clinical mentorship. Enrolled MLPs' clinical knowledge and competence in management of HIV and TB was assessed using case scenarios and clinical observation at baseline and immediately after the 9-month intervention. The performance of the study health facilities on 8 TB and HIV care indicators was tracked over the 9-month period using facility patient records. Thirty-nine out 40 enrolled MLPs had case scenario and clinical observation scores for both the baseline and end of intervention assessments. Mentorship was associated with a mean score increase of 16.7% (95% confidence interval: 9.8 to 23.6, P shifting.

  6. 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.

  7. 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.

  8. Perianal Dermatitis, Its Incidence, and Patterns of Topical Therapies in a Level IV Neonatal Intensive Care Unit.

    Science.gov (United States)

    Malik, Anuj; Witsberger, Emily; Cottrell, Lesley; Kiefer, Autumn; Yossuck, Panitan

    2018-04-01

     To define the incidence of perianal dermatitis (PD) and determine the usage pattern and cost efficacy of diaper products among neonates admitted to a level IV neonatal intensive care unit (NICU) including those with a diagnosis of neonatal abstinence syndrome (NAS).  A retrospective cohort study to evaluate neonates with PD based on number of orders for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical parameters were recorded. Usage patterns of these five products were analyzed, and their costs estimated. Subgroup analysis was performed among infants with NAS.  Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU stay, while 52.6% had multiple products ordered. Only 23.0% of all neonates had appropriate documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient.  Over half of NICU neonates were exposed to one or more diaper products, usually without documented PD diagnosis. Term NAS infants had three times higher incidence of PD than term non-NAS infants. The cost of diaper product use was significant, and possibly underestimated due to lack of documentation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. 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. Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  10. Assessing the value and pest management window provided by neonicotinoid seed treatments for management of soybean aphid (Aphis glycines Matsumura) in the Upper Midwestern United States.

    Science.gov (United States)

    Krupke, Christian H; Alford, Adam M; Cullen, Eileen M; Hodgson, Erin W; Knodel, Janet J; McCornack, Brian; Potter, Bruce D; Spigler, Madeline I; Tilmon, Kelley; Welch, Kelton

    2017-10-01

    A 2-year, multi-state study was conducted to assess the benefits of using soybean seed treated with the neonicotinoid thiamethoxam to manage soybean aphid in the upper Midwestern USA and compare this approach with an integrated pest management (IPM) approach that included monitoring soybean aphids and treating with foliar-applied insecticide only when the economic threshold was reached. Concentrations of thiamethoxam in soybean foliage were also quantified throughout the growing season to estimate the pest management window afforded by insecticidal seed treatments. Both the IPM treatment and thiamethoxam-treated seed resulted in significant reductions in cumulative aphid days when soybean aphid populations reached threshold levels. However, only the IPM treatment resulted in significant yield increases. Analysis of soybean foliage from thiamethoxam-treated seeds indicated that tissue concentrations of thiamethoxam were statistically similar to plants grown from untreated seeds beginning at the V2 growth stage, indicating that the period of pest suppression for soybean aphid is likely to be relatively short. These data demonstrate that an IPM approach, combining scouting and foliar-applied insecticide where necessary, remains the best option for treatment of soybean aphids, both in terms of protecting the yield potential of the crop and of break-even probability for producers. Furthermore, we found that thiamethoxam concentrations in foliage are unlikely to effectively manage soybean aphids for most of the pests' activity period across the region. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  11. Human reliability analysis approach to level 1 PSA - shutdown and low power operation of Mochovce NPP, Unit 1, Slovakia

    International Nuclear Information System (INIS)

    Stojka, Tibor; Holy, Jaroslav

    2003-01-01

    The paper presents general approach, used methods and form of documentation of the results as have been applied within the Human Reliability Analysis (HRA) task of the shutdown and low power PSA (SPSA) study for Mochovce nuclear power plant, Unit 1, Slovakia. The paper describes main goals of the HRA task within the SPSA project, applied methods and data sources. Basic steps of the HRA task and human errors (HE) classification are also specified in its first part. The main part of the paper deals with pre-initiator human errors, human-induced initiators and response to initiator human errors. Since the expert judgment method (SLIM) was used for the last type of human errors probability assessment, also related activities are described including preparation works (performance shaping factors (PSFs) selection, development of PSF classification tables, preparation of aid tools for interview with plant experts), qualitative analysis (sources of information and basic steps) and quantitative analysis itself (human errors classification for final quantification including criteria used for the classification, description of structure of the spreadsheet used for quantification and treatment with dependencies). The last part of the paper describes form of documentation of the final results and provides some findings. (author)

  12. An Ecological Study on the Spatially Varying Relationship between County-Level Suicide Rates and Altitude in the United States

    Directory of Open Access Journals (Sweden)

    Hoehun Ha

    2018-04-01

    Full Text Available Suicide is a serious but preventable public health issue. Several previous studies have revealed a positive association between altitude and suicide rates at the county level in the contiguous United States. We assessed the association between suicide rates and altitude using a cross-county ecological study design. Data on suicide rates were obtained from a Web-based Injury Statistics Query and Reporting System (WISQARS, maintained by the U.S. National Center for Injury Prevention and Control (NCIPC. Altitude data were collected from the United States Geological Survey (USGS. We employed an ordinary least square (OLS regression to model the association between altitude and suicide rates in 3064 counties in the contiguous U.S. We conducted a geographically weighted regression (GWR to examine the spatially varying relationship between suicide rates and altitude after controlling for several well-established covariates. A significant positive association between altitude and suicide rates (average county rates between 2008 and 2014 was found in the dataset in the OLS model (R2 = 0.483, p < 0.001. Our GWR model fitted the data better, as indicated by an improved R2 (average: 0.62; range: 0.21–0.64 and a lower Akaike Information Criteria (AIC value (13,593.68 vs. 14,432.14 in the OLS model. The GWR model also significantly reduced the spatial autocorrelation, as indicated by Moran’s I test statistic (Moran’s I = 0.171; z = 33.656; p < 0.001 vs. Moran’s I = 0.323; z = 63.526; p < 0.001 in the OLS model. In addition, a stronger positive relationship was detected in areas of the northern regions, northern plain regions, and southeastern regions in the U.S. Our study confirmed a varying overall positive relationship between altitude and suicide. Future research may consider controlling more predictor variables in regression models, such as firearm ownership, religion, and access to mental health services.

  13. 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

  14. Post-reconstruction full power and shut down level 2 PSA study for Unit 1 of Bohunice V1 NPP

    International Nuclear Information System (INIS)

    Kovacs, Z.

    2003-01-01

    The level 2 PSA model of the J. Bohunice V1 NPP was developed in the RISK SPECTRUM Professional code with the following objectives: to identify the ways in which radioactive releases from the plant can occur following the core damage; to calculate the magnitudes and frequency of the release; to provide insights into the plant behaviour during a severe accident; to provide a framework for understanding containment failure modes; the impact of the phenomena that could occur during and following core damage and have the potential to challenge the integrity of the confinement; to support the severe accident management and development of SAMGs. The magnitudes of release categories are calculated using: the MAAP4/VVER for reactor operation and shutdown mode with closed reactor vessel and the MELCOR code for shutdown mode with open reactor vessel. In this paper an overview of the Level 2 PSA methodology; description of the confinement; the interface between the level 1 and 2 PSA and accident progression analyses are presented. An evaluation of the confinement failure modes and construction of the confinement event trees as well as definition of release categories, source term analysis and sensitivity analyses are also discussed. The presented results indicate that: 1)for the full power operation - there is an 25% probability that the confinement will successfully maintain its integrity and prevent an uncontrolled fission product release; the most likely mode of release from the confinement is a confinement bypass after SGTM with conditional probability of 30%; the conditional probability for the confinement isolation failure probability without spray is 5%, for early confinement failure at the vessel failure is 4%, for other categories 1% or less; 2) for the shutdown operating modes - the shutdown risk is high for the open reactor vessel and open confinement; important severe accident sequences exists for release categories: RC5.1, RC5.2 and RC6.2

  15. Design and operational considerations of United States commercial near-surface low-level radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Birk, S.M.

    1997-10-01

    In accordance with the Low-Level Radioactive Waste Policy Amendments Act of 1985, states are responsible for providing for disposal of commercially generated low-level radioactive waste (LLW) within their borders. LLW in the US is defined as all radioactive waste that is not classified as spent nuclear fuel, high-level radioactive waste, transuranic waste, or by-product material resulting from the extraction of uranium from ore. Commercial waste includes LLW generated by hospitals, universities, industry, pharmaceutical companies, and power utilities. LLW generated by the country''s defense operations is the responsibility of the Federal government and its agency, the Department of Energy. The commercial LLRW disposal sites discussed in this report are located near: Sheffield, Illinois (closed); Maxey Flats, Kentucky (closed); Beatty, Nevada (closed); West Valley, New York (closed); Barnwell, South Carolina (operating); Richland, Washington (operating); Ward Valley, California, (proposed); Sierra Blanca, Texas (proposed); Wake County, North Carolina (proposed); and Boyd County, Nebraska (proposed). While some comparisons between the sites described in this report are appropriate, this must be done with caution. In addition to differences in climate and geology between sites, LLW facilities in the past were not designed and operated to today''s standards. This report summarizes each site''s design and operational considerations for near-surface disposal of low-level radioactive waste. The report includes: a description of waste characteristics; design and operational features; post closure measures and plans; cost and duration of site characterization, construction, and operation; recent related R and D activities for LLW treatment and disposal; and the status of the LLW system in the US

  16. Water level measurements for modeling hydraulic properties in the 300-FF-5 and 100 Aggregate Area Operable units

    International Nuclear Information System (INIS)

    Campbell, M.D.; McMahon, W.J.; Simpson, K.R.

    1993-04-01

    Pressure transducers connected to dataloggers were used to measure ground water and Columbia River water elevations simultaneously and hourly at 35 locations in the 300-FF-5 Operable Unit and 16 locations in the 100 Aggregate Area Operable Unit on the Hanford Site. Water temperatures were also measured at 12 of these locations. This report details the findings of these studies

  17. Motor units in vastus lateralis and in different vastus medialis regions show different firing properties during low-level, isometric knee extension contraction.

    Science.gov (United States)

    de Souza, Leonardo Mendes Leal; Cabral, Hélio Veiga; de Oliveira, Liliam Fernandes; Vieira, Taian Martins

    2018-04-01

    Architectural differences along vastus medialis (VM) and between VM and vastus lateralis (VL) are considered functionally important for the patellar tracking, knee joint stability and knee joint extension. Whether these functional differences are associated with a differential activity of motor units between VM and VL is however unknown. In the present study, we, therefore, investigate neuroanatomical differences in the activity of motor units detected proximo-distally from VM and from the VL muscle. Nine healthy volunteers performed low-level isometric knee extension contractions (20% of their maximum voluntary contraction) following a trapezoidal trajectory. Surface electromyograms (EMGs) were recorded from VM proximal and distal regions and from VL using three linear adhesive arrays of eight electrodes. The firing rate and recruitment threshold of motor units decomposed from EMGs were then compared among muscle regions. Results show that VL motor units reached lower mean firing rates in comparison with VM motor units, regardless of their position within VM (P motor units (P = .997). Furthermore, no significant differences in the recruitment threshold were observed for all motor units analysed (P = .108). Our findings possibly suggest the greater potential of VL to generate force, due to its fibres arrangement, may account for the lower discharge rate observed for VL then either proximally or distally detected motor units in VM. Additionally, the present study opens new perspectives on the importance of considering muscle architecture in investigations of the neural aspects of motor behaviour. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. 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.

  19. Development of batch electrolytic enrichment cells with 100-fold volume reduction, control electronic units and neutralization/distillation unit, to enable better sensitivity to be achieved in low-level tritium measurements when liquid scintillation counting follows the enrichment process

    International Nuclear Information System (INIS)

    Taylor, C.B.

    1980-06-01

    Full details of the batch-cell tritium enrichment system design are provided including electronic control circuits specially developed for these cells. The system incorporates a new type of concentric electrode cell (outer cathode of mild steel, anode of stainless steel, inner cathode of mild steel) with volume reduction capability 1 l to ca 9 ml. Electrolysis of 20 cells is performed in 2 steps. Down to sample volume ca 20 ml, the cells are series connected at constant currents up to 14.5 A, in the 2nd step, each cell is connected to its own individual current supply (2A) and control circuit. Automatic shut-off at the desired final volume is achieved by sensing the drop in current through the inner cathode as the electrolyte level falls below a PTFE insulator. The large electrode surface area and careful dimensioning at the foot of the cell allow operation with low starting electrolyte concentration 1.5 g Na 2 O 2 .l -1 . After electrolysis, quantitative recovery as distilled water of all hydrogen from the enriched residue is achieved by CO 2 -neutralisation and vacuum distillation at 100 0 C in a distillation unit which handles 20 cells simultaneously

  20. 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.

  1. Modeling state-level soil carbon emission factors under various scenarios for direct land use change associated with United States biofuel feedstock production

    International Nuclear Information System (INIS)

    Kwon, Ho-Young; Mueller, Steffen; Dunn, Jennifer B.; Wander, Michelle M.

    2013-01-01

    Current estimates of life cycle greenhouse gas emissions of biofuels produced in the US can be improved by refining soil C emission factors (EF; C emissions per land area per year) for direct land use change associated with different biofuel feedstock scenarios. We developed a modeling framework to estimate these EFs at the state-level by utilizing remote sensing data, national statistics databases, and a surrogate model for CENTURY's soil organic C dynamics submodel (SCSOC). We estimated the forward change in soil C concentration within the 0–30 cm depth and computed the associated EFs for the 2011 to 2040 period for croplands, grasslands or pasture/hay, croplands/conservation reserve, and forests that were suited to produce any of four possible biofuel feedstock systems [corn (Zea Mays L)-corn, corn–corn with stover harvest, switchgrass (Panicum virgatum L), and miscanthus (Miscanthus × giganteus Greef et Deuter)]. Our results predict smaller losses or even modest gains in sequestration for corn based systems, particularly on existing croplands, than previous efforts and support assertions that production of perennial grasses will lead to negative emissions in most situations and that conversion of forest or established grasslands to biofuel production would likely produce net emissions. The proposed framework and use of the SCSOC provide transparency and relative simplicity that permit users to easily modify model inputs to inform biofuel feedstock production targets set forth by policy. -- Highlights: ► We model regionalized feedstock-specific United States soil C emission factors. ► We simulate soil C changes from direct land use change associated with biofuel feedstock production. ► Corn, corn-stover, and perennial grass biofuel feedstocks grown in croplands maintain soil C levels. ► Converting grasslands to bioenergy crops risks soil C loss. ► This modeling framework yields more refined soil C emissions than national-level emissions

  2. Evict on write, a management strategy for a prefetch unit and/or first level cache in a multiprocessor system with speculative execution

    Science.gov (United States)

    Gara, Alan; Ohmacht, Martin

    2014-09-16

    In a multiprocessor system with at least two levels of cache, a speculative thread may run on a core processor in parallel with other threads. When the thread seeks to do a write to main memory, this access is to be written through the first level cache to the second level cache. After the write though, the corresponding line is deleted from the first level cache and/or prefetch unit, so that any further accesses to the same location in main memory have to be retrieved from the second level cache. The second level cache keeps track of multiple versions of data, where more than one speculative thread is running in parallel, while the first level cache does not have any of the versions during speculation. A switch allows choosing between modes of operation of a speculation blind first level cache.

  3. A detection-level hazardous waste ground-water monitoring compliance plan for the 200 areas low-level burial grounds and retrievable storage units

    International Nuclear Information System (INIS)

    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

  4. Single-cycle immunodeficiency viruses provide strategies for uncoupling in vivo expression levels from viral replicative capacity and for mimicking live-attenuated SIV vaccines

    International Nuclear Information System (INIS)

    Kuate, Seraphin; Stahl-Hennig, Christiane; Haaft, Peter ten; Heeney, Jonathan; Ueberla, Klaus

    2003-01-01

    To reduce the risks associated with live-attenuated immunodeficiency virus vaccines, single-cycle immunodeficiency viruses (SCIVs) were developed by primer complementation and production of the vaccine in the absence of vif in a vif-independent cell line. After a single intravenous injection of SCIVs into rhesus monkeys, peak viral RNA levels of 10 3 to 10 4 copies/ml plasma were observed, indicating efficient expression of SCIV in the vaccinee. After booster immunizations with SCIVs, SIV-specific humoral and cellular immune responses were observed. Although the vaccine doses used in this pilot study could not protect vaccinees from subsequent intravenous challenge with pathogenic SIVmac239, our results demonstrate that the novel SCIV approach allows us to uncouple in vivo expression levels from the viral replicative capacity facilitating the analysis of the relationship between viral expression levels or viral genes and immune responses induced by SIV

  5. Help for the Entrepreneur. Unit 6. Level 2. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 302-06.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on help for entrepreneurs 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…

  6. Help for the Entrepreneur. Unit 6. Level 3. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 303-06.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on help for the entrepreneur in the PACE (Program for Acquiring Competence in Entrepreneurship) Program 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…

  7. Help for the Entrepreneur. Unit 6. Level 1. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 301-06.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on help for entrepreneurs 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…

  8. Your Potential as an Entrepreneur. Unit 1. Level 1. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 301-01.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on entrepreneurship potential 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…

  9. 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…

  10. 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…

  11. 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…

  12. 12 CFR 1282.17 - Affordability-Income level definitions-family size and income known (owner-occupied units, actual...

    Science.gov (United States)

    2010-01-01

    ... GOALS AND MISSION Housing Goals § 1282.17 Affordability—Income level definitions—family size and income..., for rental housing, family size and income information for the dwelling unit is known to the... sizes: Number of persons in family Percentageof area median income 1 70 2 80 3 90 4 100 5 or more...

  13. Financing the Business. Unit 11. Level 1. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 301-11.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on business financing 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…

  14. Financing the Business. Unit 11. Level 3. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 303-11.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on business finance 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…

  15. Location. Unit 9. Level 2. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 302-09.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on locating a business 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…

  16. Location. Unit 9. Level 3. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 303-09.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on location 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 managing…

  17. Location. Unit 9. Level 1. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 301-09.

    Science.gov (United States)

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on locating a business 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…

  18. Credential Service Provider (CSP)

    Data.gov (United States)

    Department of Veterans Affairs — Provides a VA operated Level 1 and Level 2 credential for individuals who require access to VA applications, yet cannot obtain a credential from another VA accepted...

  19. 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.

  20. An Analysis of Customer’s Satisfaction Level to the Quality of Services Provided by Regional Water Supply Company (PDAM) of Kolaka Regency

    OpenAIRE

    Niar Astaginy

    2017-01-01

    The study is devoted to identifying the customer’s expectation for the service quality of the regional water supply company (PDAM) of Kolaka Regency, describing the customer’s perception of its service quality, and projecting the managerial implication to improve the quality of its services. The analysis methods used are conformity level analysis and important performance analysis. The analysis indicates that the highest expectation of the customer rests on the continuous supply of water with...

  1. Providing Retraining and Advancement Training for Primary/Elementary School Teachers at the State Level in Great Britain and the USA

    OpenAIRE

    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 foundations of pedagogy that ensures the functionality of the mentioned system. The research results on conceptual foundations for forming an education sy...

  2. Managing across levels of government: evaluation of federal-state roles and responsibilities involving nonfederal forests in the United States

    Science.gov (United States)

    Paul V. Ellefson; Calder M. Hibbard; Michael A. Kilgore

    2006-01-01

    With the assistance of state foresters and federal agency executives, an evaluation was made of federal and state government roles and responsibilities focused nonfederal forests in the United States. The evaluation involved an inventory of legally (and administratively) defined federal roles, identification bf federal programs supporting accomplishment of such roles,...

  3. Control of water infiltration into near surface low-level waste disposal units. Final report on field experiments at a humid region site, Beltsville, Maryland

    International Nuclear Information System (INIS)

    Schulz, R.K.; Ridky, R.W.; O'Donnell, E.

    1997-09-01

    This study''s objective was to assess means for controlling water infiltration through waste disposal unit covers in humid regions. Experimental work was carried out in large-scale lysimeters 21.34 m x 13.72 m x 3.05 m (70 ft x 45 ft x 10 ft) at Beltsville, Maryland. Results of the assessment are applicable to disposal of low-level radioactive waste (LLW), uranium mill tailings, hazardous waste, and sanitary landfills. Three kinds of waste disposal unit covers or barriers to water infiltration were investigated: (1) resistive layer barrier, (2) conductive layer barrier, and (3) bioengineering management

  4. 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.

  5. 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 curr