Risk factors for Clostridium difficile nosocomial diarrhea in patients at the Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas

Background. Clostridium difficile is the leading cause of hospital associated infectious diarrhea and colitis. About 3 million cases of Clostridium difficile diarrhea occur each year with an annual cost of $1 billion. ^ About 20% of patients acquire C. difficile during hospitalization. Infection with Clostridium difficile can result in serious complications, posing a threat to the patient's life. ^ Purpose. The aim of this research was to demonstrate the uniqueness in the characteristics of C. difficile positive nosocomial diarrhea cases compared with C. difficile negative nosocomial diarrhea controls admitted to a local hospital. ^ Methods. One hundred and ninety patients with a positive test and one hundred and ninety with a negative test for Clostridium difficile nosocomial diarrhea, selected from patients tested between January 1, 2002 and December 31, 2003, comprised the study population. Demographic and clinical data were collected from medical records. Logistic regression analyses were conducted to determine the associated odds between selected variables and the outcome of Clostridium difficile nosocomial diarrhea. ^ Results. For the antibiotic classes, cephalosporins (OR, 1.87; CI 95, 1.23 to 2.85), penicillins (OR, 1.57; CI 95, 1.04 to 2.37), fluoroquinolones (OR, 1.65; CI 95, 1.09 to 2.48) and antifungals (OR, 2.17; CI 95, 1.20 to 3.94), were significantly associated with Clostridium difficile nosocomial diarrhea Ceftazidime (OR, 1.95; CI 95, 1.25 to 3.03, p=0.003), gatifloxacin (OR, 1.97; CI 95, 1.31 to 2.97, p=0.001), clindamycin (OR, 3.13; CI 95, 1.99 to 4.93, p<0.001) and vancomycin (OR, 1.77; CI 95, 1.18 to 2.66, p=0.006, were also significantly associated with the disease. Vancomycin was not statistically significant when analyzed in a multivariable model. Other significantly associated drugs were, antacids, laxatives, narcotics and ranitidine. Prolong use of antibiotics and an increased number of comorbid conditions were also associated with C. difficile nosocomial diarrhea. ^ Conclusion. The etiology for C. difficile diarrhea is multifactorial. Exposure to antibiotics and other drugs, prolonged antibiotic usage, the presence and severity of comorbid conditions and prolonged hospital stay were shown to contribute to the development of the disease. It is imperative that any attempt to prevent the disease, or contain its spread, be done on several fronts. ^

A comparison of techniques for forecasting utilization of Veterans Affairs hospitals

This study demonstrated that accurate, short-term forecasts of Veterans Affairs (VA) hospital utilization can be made using the Patient Treatment File (PTF), the inpatient discharge database of the VA. Accurate, short-term forecasts of two years or less can reduce required inventory levels, improve allocation of resources, and are essential for better financial management. These are all necessary achievements in an era of cost-containment.^ Six years of non-psychiatric discharge records were extracted from the PTF and used to calculate four indicators of VA hospital utilization: average length of stay, discharge rate, multi-stay rate (a measure of readmissions) and days of care provided. National and regional levels of these indicators were described and compared for fiscal year 1984 (FY84) to FY89 inclusive.^ Using the observed levels of utilization for the 48 months between FY84 and FY87, five techniques were used to forecast monthly levels of utilization for FY88 and FY89. Forecasts were compared to the observed levels of utilization for these years. Monthly forecasts were also produced for FY90 and FY91.^ Forecasts for days of care provided were not produced. Current inpatients with very long lengths of stay contribute a substantial amount of this indicator and it cannot be accurately calculated.^ During the six year period between FY84 and FY89, average length of stay declined substantially, nationally and regionally. The discharge rate was relatively stable, while the multi-stay rate increased slightly during this period. FY90 and FY91 forecasts show a continued decline in the average length of stay, while the discharge rate is forecast to decline slightly and the multi-stay rate is forecast to increase very slightly.^ Over a 24 month ahead period, all three indicators were forecast within a 10 percent average monthly error. The 12-month ahead forecast errors were slightly lower. Average length of stay was less easily forecast, while the multi-stay rate was the easiest indicator to forecast.^ No single technique performed significantly better as determined by the Mean Absolute Percent Error, a standard measure of error. However, Autoregressive Integrated Moving Average (ARIMA) models performed well overall and are recommended for short-term forecasting of VA hospital utilization. ^

Lecturas sobre The Foundation. A Great American Secret (2007), Joel L. Fleishman, New York, Public Affairs

Fil: Quesada, Fernando. Universidad Nacional de Cuyo. Facultad de Filosofía y Letras. Instituto Multidisciplinario de Estudios Sociales Contemporáneos

Por uma Governança Democrática : Triangulo Mineiro - Brasil - Uberlândia

The City Educator Program is articulated with PROEX-Pro - Deanship Culture and Student Affairs through the Directorate of Extension, along with the Institute of Geography, Faculty of Architecture, Urban Planning and Design Institute and the City Futura Pro. Program is conducted since 2008 by the Federal University of Uberlândia and Motion City Futura. The outreach program aims to promote democratic governance and smart planning municipal and regional level, enabling public and social (government technicians, law enforcement officers, and civil society leaders) seeking implementation of legal instruments, urban and tributaries in the counties of Araguari and Uberlândia, established in the City Statute and Master Plans, and the Fiscal Responsibility, Social Rights established by the Constitution, and all the instruments of social control in the municipalities involved. The methodology includes content developed through dynamic, research participant, group work and exposure dialogue. The results were relevant to holding the Course on Urban Management and Sustainable Democratic, Uberlândia A Forum for Sustainable Leadership Training Course Ethical and Sustainable, Community Workshops Seminars in Neighborhoods assessment; Map Workshop Speaker, Research Participants, Seminars and Interactive Campaigns Mobilization office in the territory. Were produced articles, reports and reflections that are public in book form. At the end of the implementation of program activities, the municipal governments, entities and non-governmental organizations as well as citizens who, directly or indirectly, involved with the program, attended the final seminar where, besides the presentation of results, was made, collectively, evaluation and assessment of all activities

Por uma Governança Democrática : Triangulo Mineiro - Brasil - Uberlândia

The City Educator Program is articulated with PROEX-Pro - Deanship Culture and Student Affairs through the Directorate of Extension, along with the Institute of Geography, Faculty of Architecture, Urban Planning and Design Institute and the City Futura Pro. Program is conducted since 2008 by the Federal University of Uberlândia and Motion City Futura. The outreach program aims to promote democratic governance and smart planning municipal and regional level, enabling public and social (government technicians, law enforcement officers, and civil society leaders) seeking implementation of legal instruments, urban and tributaries in the counties of Araguari and Uberlândia, established in the City Statute and Master Plans, and the Fiscal Responsibility, Social Rights established by the Constitution, and all the instruments of social control in the municipalities involved. The methodology includes content developed through dynamic, research participant, group work and exposure dialogue. The results were relevant to holding the Course on Urban Management and Sustainable Democratic, Uberlândia A Forum for Sustainable Leadership Training Course Ethical and Sustainable, Community Workshops Seminars in Neighborhoods assessment; Map Workshop Speaker, Research Participants, Seminars and Interactive Campaigns Mobilization office in the territory. Were produced articles, reports and reflections that are public in book form. At the end of the implementation of program activities, the municipal governments, entities and non-governmental organizations as well as citizens who, directly or indirectly, involved with the program, attended the final seminar where, besides the presentation of results, was made, collectively, evaluation and assessment of all activities

Por uma Governança Democrática : Triangulo Mineiro - Brasil - Uberlândia

The City Educator Program is articulated with PROEX-Pro - Deanship Culture and Student Affairs through the Directorate of Extension, along with the Institute of Geography, Faculty of Architecture, Urban Planning and Design Institute and the City Futura Pro. Program is conducted since 2008 by the Federal University of Uberlândia and Motion City Futura. The outreach program aims to promote democratic governance and smart planning municipal and regional level, enabling public and social (government technicians, law enforcement officers, and civil society leaders) seeking implementation of legal instruments, urban and tributaries in the counties of Araguari and Uberlândia, established in the City Statute and Master Plans, and the Fiscal Responsibility, Social Rights established by the Constitution, and all the instruments of social control in the municipalities involved. The methodology includes content developed through dynamic, research participant, group work and exposure dialogue. The results were relevant to holding the Course on Urban Management and Sustainable Democratic, Uberlândia A Forum for Sustainable Leadership Training Course Ethical and Sustainable, Community Workshops Seminars in Neighborhoods assessment; Map Workshop Speaker, Research Participants, Seminars and Interactive Campaigns Mobilization office in the territory. Were produced articles, reports and reflections that are public in book form. At the end of the implementation of program activities, the municipal governments, entities and non-governmental organizations as well as citizens who, directly or indirectly, involved with the program, attended the final seminar where, besides the presentation of results, was made, collectively, evaluation and assessment of all activities

The theory of electrostatic probes in strong magnetic fields : Thesis submitted to the Faculty of The Graduate School of the University of Colorado for the Degree Doctor of Philosophy Department of Aerospace Engineering Science

A theory is developed of an electrostatic probe in a fully-ionized plasma in the presence of a strong magnetic field. The ratio of electron Larmor radius to probe transverse dimension is assumed to be small. Poisson's equation, together with kinetic equations for ions and electrons are considered. An asymptotic perturbation method of multiple scales is used by considering the characteristic lengths appearing in the problem. The leading behavior of the solution is found. The results obtained appear to apply to weaker fields also, agreeing with the solutions known in the limit of no magnetic field. The range of potentials for wich results are presented is limited. The basic effects produced by the field are a depletion of the plasma near the probe and a non-monotonic potential surrounding the probe. The ion saturation current is not changed but changes appear in both the floating potential Vf and the slope of the current-voltage diagram at Vf. The transition region extends beyond the space potential Vs,at wich point the current is largely reduced. The diagram does not have an exponential form in this region as commonly assumed. There exists saturation in electron collection. The extent to which the plasma is disturbed is determined. A cylindrical probe has no solution because of a logarithmic singularity at infinity. Extensions of the theory are considered.

Inman E. Page Library Resources for Students and Faculty

Brief introduction of the resources and services provided by Inman E. Page Library to students and faculty at Lincoln University.

A Meta-Analysis of the Effectiveness of Military and Veterans Affairs (VA) Combat-Related PTSD Programs

A meta-analysis was conducted to examine the effectiveness of 55 treatment outcomes reported by military and Veterans Affairs (VA) treatment centers for combat-related posttraumatic stress disorder (PTSD). The analysis includes 46 tested treatment outcomes derived from 21 psychotherapy studies, and nine tested treatment outcomes derived from seven pharmacotherapy studies, which were obtained through PsychINFO and PsychARTICLES database searches, as well as a reference search. Analysis of all treatment outcomes suggested a statistically significant, and meaningful, decrease in PTSD symptoms between baseline and post-treatment time points, t(54) = 9.27, p < .001, d = 0.35. Additionally, analysis of outcomes between psychotherapy and pharmacotherapy treatments resulted in statistically significant differences in PTSD assessment scores at post-test, indicating a greater degree of change for psychotherapy than for pharmacotherapy.

The Future Direction of Delaware Law (Including a Brief Exegesis on Fee Shifting Bylaws)

Delaware sets the governance standards for most public companies. The ability to attract corporations could not be explained solely by the existence of a favorable statutory regime. Delaware was not invariably the first or the only state to implement management friendly provisions. Given the interpretive gaps in the statute and the critical importance of the common law in the governance process, courts played an outsized role in setting legal standards. The management friendly nature of the Delaware courts contributed significantly to the state’s attraction to public corporations. A current example of a management friendly trend in the case law had seen the recent decisions setting out the board’s authority to adopt bylaws under Section 109 of the Delaware General Corporation Law (DGCL), particularly those involving the shifting of fees in litigation against the corporation or its directors. The DGCL allows bylaws that address “the business of the corporation, the conduct of its affairs, and its rights or powers or the rights or powers of its stockholders, directors, officers or employees.” The broad parameters are, however, subject to limits. Bylaws cannot be inconsistent with the certificate of incorporation or “the law.” Law includes the common law. The Delaware courts have used the limitations imposed by “the law” to severely restrict the reach of shareholder inspired bylaws. The courts have not used the same principles to impose similar restraints on bylaws adopted by the board of directors. This can be seen with respect to bylaws that restrict or even eliminate the right of shareholders to bring actions against management and the corporation. In ATP Tour, Inc. v. Deutscher Tennis Bund the court approved a fee shifting bylaw that had littl relationship to the internal affairs of the corporation. The decision upheld the bylaw as facially valid.The decision ignored a number of obvious legal infirmities. Among other things, the decision did not adequately address the requirement in Section 109(b) that bylaws be consistent with “the law.” The decision obliquely acknowledged that the provisions would “by their nature, deter litigation” but otherwise made no effort to assess the impact of this deterrence on shareholders causes of action. The provision in fact had the practical effect of restricting, if not eliminating, litigation rights granted by the DGCL and the common law. Perhaps most significantly, however, the bylaws significantly limited common law rights of shareholders to bring actions against the corporation and the board. Given the high dismissal rates for these actions, fee shifting bylaws imposed a meaningful risk of liability on plaintiffs. Moreover, because judgments in derivative suits were paid to the corporation, shareholders serving as plaintiffs confronted the risk of liability without any offsetting direct benefit. By preventing suits in this area, the bylaw effectively insulated the behavior of boards from legal challenge. The ATP decision was poorly reasoned and overstepped acceptable boundaries. The management friendly decision threatened the preeminent role of Delaware in the development of corporate law. The decision raised the specter of federal intervention and the potential for meaningful competition from the states. Because the opinion examined the bylaw in the context of non-stock companies, the reasoning may remain applicable only to those entities and never make the leap to for-profit stock corporations. Nonetheless, the analysis reflects a management friendly approach that does not adequately take into account the impact of the provision on the rights of shareholders.