Améliorer la prise en charge de l'hypertension arterielle en favorisant la collaboration avec les pharmaciens et les infirmières [Team-based care involving pharmacists and nurses to improve the management of hypertension].

Only half of hypertensive patients has controlled blood pressure. Chronic kidney disease (CKD) is also associated with low blood pressure control, 25-30% of CKD patients achieving adequate blood pressure. The Community Preventive Services Task Force has recently recommended team-based care to improve blood pressure control. Team-based care of hypertension involves facilitating coordination of care among physician, pharmacist and nurse and requires sharing clinical data, laboratory results, and medications, e.g., electronically or by fax. Based on recent studies, development and evaluation of team-based care of hypertensive patients should be done in the Swiss healthcare system.

Iowa Conservation Reserve Enhancement Program, Helping Landowners Protect Iowa’s Natural Resources,January 2009

The Iowa Conservation Reserve Enhancement Program is a state, federal, local, and private partnership that provides incentives to landowners who voluntarily establish wetlands for water quality improvement in the tile-drained regions of Iowa. The goal of the program is to reduce nitrogen loads and movement of other agricultural chemicals from croplands to streams and rivers. In addition to improving water quality, these wetlands will provide wildlife habitat and increase recreational opportunities.

L'Evidence-based nursing, un levier au changement des pratiques infirmières [Evidence-based nursing, a driver for change in nursing practice].

A urology nursing team examined its perioperative practices in the light of scientific data and implemented updated care practices adapted to this context.This experience favours the development of skills essential for interdisciplinary collaboration drawing on the resources of each profession, to work towards a common goal for the benefit of the patient.

Carbon stock and its compartments in a subtropical oxisol under long-term tillage and crop rotation systems

Soil organic matter (SOM) plays a crucial role in soil quality and can act as an atmospheric C-CO2 sink under conservationist management systems. This study aimed to evaluate the long-term effects (19 years) of tillage (CT-conventional tillage and NT-no tillage) and crop rotations (R0-monoculture system, R1-winter crop rotation, and R2- intensive crop rotation) on total, particulate and mineral-associated organic carbon (C) stocks of an originally degraded Red Oxisol in Cruz Alta, RS, Southern Brazil. The climate is humid subtropical Cfa 2a (Köppen classification), the mean annual precipitation 1,774 mm and mean annual temperature 19.2 ºC. The plots were divided into four segments, of which each was sampled in the layers 0-0.05, 0.05-0.10, 0.10-0.20, and 0.20-0.30 m. Sampling was performed manually by opening small trenches. The SOM pools were determined by physical fractionation. Soil C stocks had a linear relationship with annual crop C inputs, regardless of the tillage systems. Thus, soil disturbance had a minor effect on SOM turnover. In the 0-0.30 m layer, soil C sequestration ranged from 0 to 0.51 Mg ha-1 yr-1, using the CT R0 treatment as base-line; crop rotation systems had more influence on soil stock C than tillage systems. The mean C sequestration rate of the cropping systems was 0.13 Mg ha-1 yr-1 higher in NT than CT. This result was associated to the higher C input by crops due to the improvement in soil quality under long-term no-tillage. The particulate C fraction was a sensitive indicator of soil management quality, while mineral-associated organic C was the main pool of atmospheric C fixed in this clayey Oxisol. The C retention in this stable SOM fraction accounts for 81 and 89 % of total C sequestration in the treatments NT R1 and NT R2, respectively, in relation to the same cropping systems under CT. The highest C management index was observed in NT R2, confirming the capacity of this soil management practice to improve the soil C stock qualitatively in relation to CT R0. The results highlighted the diversification of crop rotation with cover crops as a crucial strategy for atmospheric C-CO2 sequestration and SOM quality improvement in highly weathered subtropical Oxisols.

Prescription footwear for severe injuries of foot and ankle: effect on regularity and symmetry of the gait assessed by trunk accelerometry.

After foot and/or ankle fracture, the restoration of optimal gait symmetry is one of the criteria of recovery. Orthotic insoles and orthopaedic shoes improve gait symmetry and regularity by controlling joint motion and improving alignment. The aim of the present study was to assess the effect of prescription footwear on gait quality by using accelerometers attached to the lower back. Sixteen adult patients with persistent disability after ankle and/or foot fractures performed two 30-s walking trials with and without prescription footwear (insoles and stabilizing shoes). Sixteen control subjects were also tested for comparison. The autocorrelation function was computed from the acceleration signal and the first two dominant periods were assessed (d1 and d2). Two parameters were used: (1) Stride Regularity (SR) which expresses the similarity between strides over time (d2), and (2) Stride Symmetry (SS) a ratio (d1/d2) which expresses the left/right similarity of gait independently of repeatability in the successive movements of each limb. In control subjects, SR and SS were 0.86+/-0.05 (correlation coefficient) and 81+/-10%, respectively. In the patient group, the effect of footwear was significant (SR: 0.88+/-0.06 vs. 0.90+/-0.05, SS: 38+/-23% vs. 46+/-27%). Pain was also significantly reduced (-34%). By using a rapid and low-cost method, we objectively quantified gait quality improvement after footwear intervention, concomitant to pain reduction. Substantial inter-patient variability in the footwear outcome was observed. In conclusion, we believe that trunk accelerometry can be a useful tool in the field of gait rehabilitation.

Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial.

BACKGROUND: The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital. METHODS/DESIGN: This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded. DISCUSSION: The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof.The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).

Sharing and Learning= Changing. A real story at the Institute of Public Security of Catalonia

The Institute has professionals with extensive experience in training, specifically with experience in the field of police and emergencies training. Moreover, it also has very talented people. But above all, our institution has public professionals with a desire to serve, who love security and emergency responders and want to provide them with the best knowledge to make them every day better professionals. In the quest for continuous training improvement, its during 2009 when e-learning begins to have a presence at the Institute. Virtual training methodology becomes a facilitator for the training of various professionals, avoiding geographical displacement and easing the class schedule.

Rehabilitación del Parque Recreativo Cariari : propuesta de actividades de educación ambiental

El proyecto de rehabilitación del "Parque Recreativo Cariari" se enmarca en el proyecto más amplio "Proyecto Limón Ciudad Puerto". Se ubica en la zona más desfavorecida de Costa Rica, a nivel social y de infraestructuras. Nuestra labor en el proyecto de rehabilitación, se centra en la preparación de la propuesta de actividades de educación ambiental, aprovechando los recursos biológicos y geológicos del parque, así como las infraestructuras que incluirá una vez rehabilitado. Para la realización del proyecto fue necesaria una gran revisión bibliográfica, una serie de encuestas y reuniones con escuelas, profesores y la responsable del Ministerio de Educación Pública en la región. También se contactó con personal especializado con materias claves para los talleres. Además se acordó con universidades nacionales la realización de prácticas de sus estudiantes de los sectores de turismo ecológico y administración. Así, el resultado, son los 18 talleres, y la preparación de un hormiguero y un mariposario abierto, que se implementarán durante la rehabilitación del parque. De llevarse a cabo correctamente, se espera que transmitan a sus participantes la importancia ambiental de la zona, implicándolos en la conservación de esta. A nivel general, se espera que el parque sea vía de escape y ayude al progreso social y mejora de la calidad de vida de Limón.

09008-005 Hewitt Creek Final Report

The primary goal of the Hewitt Creek watershed council is to have Hewitt-Hickory Creek removed from the Iowa impaired waters (303d) list. Hewitt Creek watershed, a livestock dense 23,005 acre sub-watershed of the Maquoketa River Basin, is 91.2% agricultural and 7.5% woodland. Since 2005, sixty-seven percent of 84 watershed farm operations participated in an organized watershed improvement effort using a performance­ based watershed management approach, reducing annual sediment delivery to the stream by 4,000 tons. Watershed residents realize that water quality improvement efforts require a long-term commitment in order to meet their watershed improvement goals and seek funding for an additional five years to continue their successful watershed improvement project. Cooperators will be provided incentives for improved environmental performance, along with incentives and technical support to address feedlot runoff issues and sub-surface nitrate-nitrogen loss. The Phosphorus Index, Soil Conditioning Index and cornstalk nitrate test will be used by producers as measures of performance to refine nutrient and soil loss management and to determine effective alternatives to reduce nutrient and sediment delivery. Twenty-five livestock operations will improve feedlot runoff control systems and five sub-surface bioreactors will be installed to reduce nitrate delivery from priority tile-drained fields. The Hewitt Creek council will seek additional cost-share funding for high-cost feedlot runoff control structures, sediment control basins and stream bank stabilization projects.

1009-004 Lost Island Lake Watershed Final Report

The Lost Island Lake watershed is located in the prairie pothole region, a region dotted with glacial wetlands and shallow lakes. At 1,180 acres, Lost Island Lake is the state's fifth largest natural lake and its watershed is comprised of nearly 1,000 acres of wetland habitat, including Iowa 's largest natural wetland – Barringer Slough. Unfortunately, Lost Island and its associated wetlands are not functioning to their fullest ecological and water quality potential. In 2002 and 2004, Lost Island Lake was categorized as '·impaired'" on Iowa's Impaired Waters List. Frequent algal blooms and suspended solids drastically increase turbidity levels resulting in its impairment. To investigate these concerns, a two-year study and resulting Water Quality Improvement Plan were completed. The water quality study identified an overabundance of non-native common carp (Cyprinus carpio) in the lake and its surrounding wetlands as a primary cause of impairment. The goal of the Lost Island Lake Watershed Enhancement Project is to restore ecological health to Lost Island Lake and its intricate watershed resulting in improved water quality and a diverse native plant and wildlife community. The purpose of this grant is to obtain funding for the construction of two combination fish barriers and water control structures placed at key locations in the watershed within the Blue Wing Marsh complex. Construction of the fish barriers and water control structures would aid restoration efforts by preventing spawning common carp from entering wetlands in the watershed and establishing the ability to manage water levels in large wetland areas. Water level management is crucial in wetland health and exotic fish control. These two structures are part of a larger construction project that involves a total of four combination fish barriers and water control structures and one additional fish barrier. The entire Lost Island Lake Watershed Enhancement Project is a multi-year project, but the construction phase for the fish barriers and water control structures will be completed before December 31, 2011.

06014-007 Lower Coldwater-Palmer Creek Watershed Final Report

Lower Coldwater and Palmer Creeks in Butler and Floyd counties are subwatersheds of the Cedar River, which provides drinking water to Cedar Rapids, IA. The increasing concentration of nitrate+nitrate in the river is of concern to the Cedar Rapids water utility, and IDNR snapshot monitoring shows Coldwater and Palmer to be significant potential sources (above the 90th percentile for subwatersheds monitored). Both creeks are also on the Iowa Section 303(d) list of impaired waters (aquatic life). Citizens of these predominantly agricultural watersheds organized the Coldwater-Palmer Watershed Improvement Association to deal proactively with nonpoint source pollutants from crop and livestock operations through a performance-based environmental management program. The locally-adapted program implemented by the Coldwater-Palmer watershed council rewards participants for environmental accomplishments - soil quality improvement and nutrient source reduction as measured by accepted, scientifically-based tests and models. Most of the locally­appropriate BMPs used to improve performance are undertaken voluntarily at participants' initiative. WIRB funds will be combined with funding from the Iowa Com Growers Association and significant in-kind support from the Cedar River Watershed Monitoring Coalition, Iowa State University Extension and other partners. The project will result in sustainable reduction in nutrient loading achieved with voluntary participation of a majority of watershed farm operators.

06034-016 Lake Colchester/Middle Creek Watershed Final Report

In-lake management can be a critical need for water quality improvement for impaired recreation lakes. Biomanipulation practices to achieve the proper balance of predatory fish, zooplankton grazing of algae, and native aquatic vegetation can sometimes restore water clarity of turbid, nutrient enriched lakes. Lakewood leaders have a renovation plan for Lake Colchester, involving several common and three innovative practices. Lakewood is prepared to pay for proven practices, but seeks WIRB grant support to test innovations in collaboration with Iowa DNR biologists, and ISU limnologists, serving as advisors and monitors for the entire project.

2 years' review of pediatric emergencies admitted in the resuscitation room of a Swiss university hospital

Introduction: Paediatric resuscitation is an intense, stressful andchallenging process performed in a specific surrounding. In theresuscitation room (RR), a dedicated pediatric team is not alwaysavailable and its composition varies according to local resources. Aregular review of the children admitted in the resuscitation room andthe assessment of various outcome measures are the basis of qualitycontrol (QC). The epidemiology of Potentially Life ThreateningPaediatric (LTP) emergencies admitted in a Swiss university hospitalhas never been reported. The aims of this study were to review theLTP emergency population with regards to origin, patients'demographics, reason for admission and final diagnosis, treatmentmodalities, critical events and outcome.Methods: A retrospective observational cohort study of prospectivelycollected data was conducted, including all LTP emergencies admittedover a period of 2 years in the RR of a Swiss university hospitalfunctioning as a tertiary level referral centre. Multiple variablesincluding indication for transfer, mode of pre-hospital transportation,diagnosis and the time spent in RR were assessed. Data assessmenttook place 2 years after the implementation of a quality control (QC)team assessing the pediatric resuscitations occurring within theinstitution on a monthly basis.Results: Out of 60 939 pediatric emergencies treated in LausanneUniversity Medical center over 2 years, a total of 277 LTP emergencies(0.46%) were admitted to the RR, including 160 boys and 117 girls,aged 6 days to 15.95 years (mean 6.69 years, median 5.06). The tablebelow illustrates in more details the identified problems, average age,time in hospital and outcome of both surgical and medical groups ofpatients.Conclusions: With the need for health care quality improvement andfinancial restrictions, an excellent knowledge of the characteristics ofLTP emergencies is unavoidable. A thorough understanding of theresuscitation process and humans resources involved can be achievedwith a systematic review of the cases. A dedicated quality control teamevaluating LTP emergencies in a hospital will identify areas forimprovement. A LTP registry at the national level would be of greatvalue in Switzerland.

JPEG standard uniform quantization error modeling with applications to sequential and progressive operation modes

In this paper we propose a method for computing JPEG quantization matrices for a given mean square error or PSNR. Then, we employ our method to compute JPEG standard progressive operation mode definition scripts using a quantization approach. Therefore, it is no longer necessary to use a trial and error procedure to obtain a desired PSNR and/or definition script, reducing cost. Firstly, we establish a relationship between a Laplacian source and its uniform quantization error. We apply this model to the coefficients obtained in the discrete cosine transform stage of the JPEG standard. Then, an image may be compressed using the JPEG standard under a global MSE (or PSNR) constraint and a set of local constraints determined by the JPEG standard and visual criteria. Secondly, we study the JPEG standard progressive operation mode from a quantization based approach. A relationship between the measured image quality at a given stage of the coding process and a quantization matrix is found. Thus, the definition script construction problem can be reduced to a quantization problem. Simulations show that our method generates better quantization matrices than the classical method based on scaling the JPEG default quantization matrix. The estimation of PSNR has usually an error smaller than 1 dB. This figure decreases for high PSNR values. Definition scripts may be generated avoiding an excessive number of stages and removing small stages that do not contribute during the decoding process with a noticeable image quality improvement.

Osavalmistusprosessin laadunhallinta, perustuen SFS-EN ISO 9001.1994 laatujärjestelmästandardiin

Työn tavoitteena oli luoda yritykseen soveltuva, toimiva laatujärjestelmän kirjallinen kuvaus sekä parantaa laadun hallintaa. Laatutoimintojen kehittämisessä perustana käytettiin laatujärjestelmästandardia SFS-EN ISO 9001. Työn lähtökohtana oli perusteellinen nykytilan selvitys. Saatujen tulosten perusteella voitiin kohdistaa toimenpiteet oikein, jolloin laadun parannus oli merkittävää ja mitattavissa. Lähtötilanteessa havaittiin suuria laatuongelmia niin asiakkaiden keskuudessa kuin yrityksen sisäisissä toiminnoissa, verrattaessa ISO 9001 standardiin. Prosessit pyrittiin kirjaamaan sekä aloitustilanteessaettä havaittujen puutteiden korjaamisen jälkeen. Tästä dokumentaatiosta muodostettiin pohja yrityksen laatujärjestelmän kuvaukselle - laatukäsikirjalle. Dokumentoitua työ- tai toiminto-ohjetta kehitettiin edelleen vastaamaan parasta havaittua toimintatapaa.Työ osoitti laadun hallinnan parantuneen merkittävästi, kun prosessi on onnistuttu kuvaamaan käytännönläheisesti ja yksinkertaisesti. Ratkaisevan tärkeää on prosessin suorittamiseen osallistuvan henkilöstön panos kuvattaessa ja kehitettäessä toimintoa. Ilman henkilöstön sitouttamista kuvaukset ja ohjeet jäävät vain hyödyttömiksi papereiksi, joita ei noudateta eikä päivitetä. Laadun, kuten minkään muunkaan parametrin, kehitystä on mahdoton seurata ilman selkeitä ja yksiselitteisiä mittareita. Työssä luotiin tärkeimpiinprosesseihin kehitystä ilmaisevat laatumittarit. Parhaimmillaan havaittiin maalaamossa suoritettujen toimenpiteiden seurauksena virheellisten kappaleiden osuuden pudonneen kertaluokkaa pienemmäksi. Laatujärjestelmän kehitystyö osoittautui tämänkin kokoisessa yrityksessä erittäin työlääksi ja aikaa vieväksi. Kuitenkin on selvää, että laadunhallinnan parantuessa ja todistusaineiston karttuessa onnistumisten kautta, lisääntyy koko yrityksen usko laadun parantamisen tärkeyteen ja näin nopeuttaa joskus kipeidenkin uudistusten läpivientiä.