883 resultados para Day care centers for the aged


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Subduction zone magmatism is an important and extensively studied topic in igneous geochemistry. Recent studies focus on from where arc magmas are generated, how subduction components (fluids or melts) are fluxed into the source of the magmas, and whether or how the subduction components affect partial melting processes beneath volcanic arcs at convergent boundaries. ^ At 39.5°S in the Central Southern Volcanic Zone of the Andes, Volcano Villarrica is surrounded by a suite of Small Eruptive Centers (SEC). The SECs are located mostly to the east and northeast of the stratovolcano and aligned along the Liquine-Ofqui Fault Zone, the major fracture system in this area. Former studies observed the geochemical patterns of the SECs differ distinctively from those of V. Villarrica and suggested there may be a relationship between the compositions of the volcanic units and their edifice sizes. This work is a comprehensive geochemical study on the SECs near V. Villarrica, using a variety of geochemical tracers and tools including major, trace and REE elements, Li-Be-B elements, Sr-Nd-Pb isotopes and short-lived isotopes such as U-series and 10Be. In this work, systematic differences between the elemental and isotopic compositions of the SECs and those of V. Villarrica are revealed and more importantly, modeled in terms of magmatic processes occurring at continental arc margins. Detailed modeling calculations in this work reconstruct chemical compositions of the primary magmas, source compositions, compositions and percentages of different subduction endmembers mixed into the source, degrees of partial melting and different time scales of the SECs and V. Villarrica, respectively. Geochemical characteristics and possible origins of the two special SECs—andesitic Llizan, with crustal signatures, and Rucapillan, to the northwest toward the trench, are also discussed in this work. ^

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Introduction: The United States today has become "meeting-conscious." The complexity of conducting business has led to the need for sophisticated coordination of decision-making processes on all levels of the organization. Company meetings have played an increasingly important role in the success and future of many companies. Strategies and decisions are developed at meetings that can determine future policies of crucial importance. Executive training can mean the difference in whether the company will even survive. Large and growing companies have increased their off-premise meeting budgets annually in spite of the state of the economy. however, the rising costs of travel and lodging have made management monitor these budgets more closely than ever. Thus, the need to use every dollar efficiently has compelled companies to examine newer methods of running meetings and alternatives to the usage of typical off-premise meeting facilities. The importance of off-premise meetings in the United States economy has greatly increased due to the billions of dollars spent annually. These factors make it vital to explore the effectiveness of time and monetary expenditures. Up until the mid-1960's, company meetings were held in facilities of various design and purpose, none of which were specifically designed for the small to medium corporate meeting. Upon gathering information concerning the meetings market and the corporate meeting planner, certain individuals endeavored to change the situation. This study is designed to investigate this new concept, which will hereafter be referred to as "conference center." For the purpose of this study, the following two definitions will be used. 1. Conference center - that meeting facility primarily marketing its facilities for the small to medium-sized corporate meeting. The center is operated by specialists aware of market needs in as much detail as are those people working for the company involved. On-premise sleeping rooms are not mandatory provided such facilities are within easy access. 2. Meeting planner - that person within an organization who has primary responsibility for arranging off-premise meetings and all other related items necessary for meeting effectiveness. This person may spend anywhere from 10 to 100l of his time in this capacity. The conference center has effectively satisfied the need for specialized corporate meeting facilities. This study will show the depth of the corporate meetings market and trace the growth and development of this relatively new conference center concept. Information will also be compiled on the top centers in the country. It is hoped that by presenting this research meeting planners will become more aware of the nature and location of these centers, especially for use by the small to medium-sized company. Such exposure of the centers will hopefully increase existing demand and enable the construction of new, innovative centers.

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El Niño and the Southern Oscillation (ENSO) is a cycle that is initiated in the equatorial Pacific Ocean and is recognized on interannual timescales by oscillating patterns in tropical Pacific sea surface temperatures (SST) and atmospheric circulations. Using correlation and regression analysis of datasets that include SST’s and other interdependent variables including precipitation, surface winds, sea level pressure, this research seeks to quantify recent changes in ENSO behavior. Specifically, the amplitude, frequency of occurrence, and spatial characteristics (i.e. events with maximum amplitude in the Central Pacific versus the Eastern Pacific) are investigated. The research is based on the question; “Are the statistics of ENSO changing due to increasing greenhouse gas concentrations?” Our hypothesis is that the present-day changes in amplitude, frequency, and spatial characteristics of ENSO are determined by the natural variability of the ocean-atmosphere climate system, not the observed changes in the radiative forcing due to change in the concentrations of greenhouse gases. Statistical analysis, including correlation and regression analysis, is performed on observational ocean and atmospheric datasets available from the National Oceanographic and Atmospheric Administration (NOAA), National Center for Atmospheric Research (NCAR) and coupled model simulations from the Coupled Model Inter-comparison Project (phase 5, CMIP5). Datasets are analyzed with a particular focus on ENSO over the last thirty years. Understanding the observed changes in the ENSO phenomenon over recent decades has a worldwide significance. ENSO is the largest climate signal on timescales of 2 - 7 years and affects billions of people via atmospheric teleconnections that originate in the tropical Pacific. These teleconnections explain why changes in ENSO can lead to climate variations in areas including North and South America, Asia, and Australia. For the United States, El Niño events are linked to decreased number of hurricanes in the Atlantic basin, reduction in precipitation in the Pacific Northwest, and increased precipitation throughout the southern United Stated during winter months. Understanding variability in the amplitude, frequency, and spatial characteristics of ENSO is crucial for decision makers who must adapt where regional ecology and agriculture are affected by ENSO.

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El Niño and the Southern Oscillation (ENSO) is a cycle that is initiated in the equatorial Pacific Ocean and is recognized on interannual timescales by oscillating patterns in tropical Pacific sea surface temperatures (SST) and atmospheric circulations. Using correlation and regression analysis of datasets that include SST’s and other interdependent variables including precipitation, surface winds, sea level pressure, this research seeks to quantify recent changes in ENSO behavior. Specifically, the amplitude, frequency of occurrence, and spatial characteristics (i.e. events with maximum amplitude in the Central Pacific versus the Eastern Pacific) are investigated. The research is based on the question; “Are the statistics of ENSO changing due to increasing greenhouse gas concentrations?” Our hypothesis is that the present-day changes in amplitude, frequency, and spatial characteristics of ENSO are determined by the natural variability of the ocean-atmosphere climate system, not the observed changes in the radiative forcing due to change in the concentrations of greenhouse gases. Statistical analysis, including correlation and regression analysis, is performed on observational ocean and atmospheric datasets available from the National Oceanographic and Atmospheric Administration (NOAA), National Center for Atmospheric Research (NCAR) and coupled model simulations from the Coupled Model Inter-comparison Project (phase 5, CMIP5). Datasets are analyzed with a particular focus on ENSO over the last thirty years. Understanding the observed changes in the ENSO phenomenon over recent decades has a worldwide significance. ENSO is the largest climate signal on timescales of 2 - 7 years and affects billions of people via atmospheric teleconnections that originate in the tropical Pacific. These teleconnections explain why changes in ENSO can lead to climate variations in areas including North and South America, Asia, and Australia. For the United States, El Niño events are linked to decreased number of hurricanes in the Atlantic basin, reduction in precipitation in the Pacific Northwest, and increased precipitation throughout the southern United Stated during winter months. Understanding variability in the amplitude, frequency, and spatial characteristics of ENSO is crucial for decision makers who must adapt where regional ecology and agriculture are affected by ENSO.

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General note: Title and date provided by Bettye Lane.

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General note: Title and date provided by Bettye Lane.

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General note: Title and date provided by Bettye Lane.

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BACKGROUND: Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate the practice patterns of fluid utilization for resuscitation of adult patients in intensive care units (ICUs) within the USA. METHODS: We conducted a cross-sectional online survey of 502 physicians practicing in medical and surgical ICUs. Survey questions were designed to assess clinical decision-making processes for 3 types of patients who need volume expansion: (1) not bleeding and not septic, (2) bleeding but not septic, (3) requiring resuscitation for sepsis. First-choice fluid used in fluid boluses for these 3 patient types was requested from the respondents. Descriptive statistics were performed using a Kruskal-Wallis test to evaluate differences among the physician groups. Follow-up tests, including t tests, were conducted to evaluate differences between ICU types, hospital settings, and bolus volume. RESULTS: Fluid resuscitation varied with respect to preferences for the factors to determine volume status and preferences for fluid types. The 3 most frequently preferred volume indicators were blood pressure, urine output, and central venous pressure. Regardless of the patient type, the most preferred fluid type was crystalloid, followed by 5 % albumin and then 6 % hydroxyethyl starches (HES) 450/0.70 and 6 % HES 600/0.75. Surprisingly, up to 10 % of physicians still chose HES as the first choice of fluid for resuscitation in sepsis. The clinical specialty and the practice setting of the treating physicians also influenced fluid choices. CONCLUSIONS: Practice patterns of fluid resuscitation varied in the USA, depending on patient characteristics, clinical specialties, and practice settings of the treating physicians.

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The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

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An early example of a printing privilege granted to protect the printing of an individual work, in this case William Conningham's The Cosmographical Glass. The commentary describes the early attitudes of the monarchy towards the regulation of the printing trade within England, and the exercise of the royal prerogative in granting printing privileges not just to the royal printer, but to other favoured subjects both in relation to individual works as well as to entire classes of work (with the latter more often referred to as printing patents).

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Compared to children in other placements, there is much less known about the characteristics and needs of children in the UK who are returned to their birth parents with a care order still in place. That is in spite of evidence to suggest they face more difficulties than young people in other placements. Based on a 2009 census of looked after children in Northern Ireland, just under 10% (n = 193) were found to be living at home under a care order. Case file reviews were conducted for a quarter of these young people (n = 47) to generate descriptive statistics showing a very diverse population. That was followed by semi-structured interviews with members of eight families (ten children and eight birth parent/s), providing transcripts for thematic analysis. Nearly half of the young people whose case files were reviewed had experienced at least one home placement breakdown, but nearly two thirds had a stable last home placement. Care orders appeared to serve two functions: to give legal authority to social services for the monitoring of placements, and to facilitate family access to family support services. Replacing some care orders with supervision orders might better align legal status and actual function.

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Audit report on Northwest Iowa Care Connections for the year ended June 30, 2015

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This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions about adult intensive care that are important to people who have been critically ill, their families, and the health professionals who care for them. Consensus techniques (modified Delphi and Nominal Group) were used to generate suggestions using online and postal surveys. Following verification and iterative editorial review, research topics were constructed from these suggestions. These topics were presented in a second online and postal survey for rating. A Nominal Group of 21 clinicians, patients and family representatives subsequently met to rank the most important research topics and produce a prioritised list. The project was coordinated by a representative Steering Group and independently overseen by the JLA. The initial survey and review of the literature generated over 1,300 suggestions. Preliminary editing and verification permitted us to encapsulate these suggestions within 151 research topics. Iterative review by members of the Steering Group produced 37 topic statements, subsequently rated by participants. Using the mode to determine importance, 19 topics were presented to the group from which a ‘top three’ intensive care research priorities were identified and a further nine topics were prioritised. By applying and adapting the JLA methodology to focus on an area of care rather than to a single disease, we have provided a means to ensure that patients, their families and professionals materially contribute to the prioritisation of intensive care research in the UK.