Patient Safety Alert : A new way to share patient safety information among departments and units

Communication : If there is one topic that comes up over and over again as we discuss ways to make John Dempsey Hospital the safest hospital, it is “communication.” In fact, several of the 2006 and 2007 National Patient Safety Goals are centered around improving the effectiveness of communication among caregivers. There are many ways of doing this, and we have implemented several already. These include handoffs, medication reconciliation, “SBAR,” etc. On page two, we will talk in more detail about hand-offs and the use of “SBAR.”

Ein schön new Lied, von nützbarlichen dingen : wie sich ein Christ trösten sol, in trübsal, angst un[d] not. Im thon, Hilff Got das mir gelinge

In Fraktur

Ein schön new lied : gena[nn]t Des himmels strassen heyß ich, wiltu wo wandel mich, ... In der weiß, Wolauff gut gesell von hinnen, ...

[Wolff Gernolt ... hat er das lied gedicht]

New Judea : Jewish life in modern Palestine and Egypt

by Benjamin L. Gordon

Prevalence and risk factors of methicillin-resistant Staphylococcus aureus in critically-ill hospitalized patients in a tertiary care center in Houston, Texas: An active surveillance pilot project

Objective. The objective of this study is to determine the prevalence of MRSA colonization in adult patients admitted to intensive care units at an urban tertiary care hospital in Houston, Texas and to evaluate the risk factors associated with colonization during a three month active-screening pilot project. Design. This study used secondary data from a small cross-sectional pilot project. Methods. All patients admitted to the seven specialty ICUs were screened for MRSA by nasal culture. Results were obtained utilizing the BD GeneOhm™ IDI-MRSA assay in vitro diagnostic test, for rapid MRSA detection. Statistical analysis was performed using the STATA 10, Epi Info, and JavaStat. Results . 1283/1531 (83.4%) adult ICU admissions were screened for nasal MRSA colonization. Of those screened, demographic and risk factor data was available for 1260/1283 (98.2%). Unresolved results were obtained for 73 patients. Therefore, a total of 1187/1531 (77.5%) of all ICU admissions during the three month study period are described in this analysis. Risk factors associated with colonization included the following: hospitalization within the last six months (odds ratio 2.48 [95% CI, 1.70-3.63], p=0.000), hospitalization within the last 12 months, (odds ratio 2.27 [95% CI, 1.57-3.80], p=0.000), and having diabetes mellitus (odds ratio 1.63 [95% CI, 1.14-2.32], p=0.007). Conclusion. Based on the literature, the prevalence of MRSA for this population is typical of other prevalence studies conducted in the United States and coincides with the continual increasing trend of MRSA colonization. Significant risk factors were similar to those found in previous studies. Overall, the active surveillance screening pilot project has provided valuable information on a population not widely addressed. These findings can aid in future interventions for the education, control, prevention, and treatment of MRSA. ^

A study of nurses' perceptions of and participation in the resolution of treatment dilemmas for critically ill newborns

This study was an exploratory investigation of variables which are associated with neonatal intensive care nurses' perceptions of and participation in life-sustaining treatment decisions for critically ill newborns. The primary purpose of the research was to examine the extent to which assessment of infants' physical and mental prognoses, parents' preferences regarding treatment, and legal consequences of non-treatment influence nurses' recommendations about life-saving treatment decisions for handicapped newborns. Secondly, the research explored the extent and nature of nurses' reported participation in the resolution of treatment dilemmas for these critically ill newborns. The framework of the study draws upon the work of Crane (1977), Blum (1980), and Pearlman (1982) who have explored the sociological context of decision-making with critical care patients.^ Participants in the study were a volunteer sample of eighty-three registered nurses who were currently working in neonatal intensive care units in five large urban hospitals in Texas. Data were collected through the use of intensive interviews and case study questionnaires. Results from the study indicate that physical and mental prognoses as well as parent preferences and concerns about legal liability are related to nurses' treatment recommendations, but their levels of significance vary according to the type of handicapping condition and whether the treatment questions are posed in terms of initiating aggressive therapy or withdrawing aggressive therapy.^ The majority of nurses reported that the extent of their participation in formal decision-making regarding handicapped newborns was fairly minimal although they provide much of the definitive data used to make decisions by physicians and parents. There was substantial evidence that nurse respondents perceive their primary role as advocates for critically ill newborns, and believe that their involvement in the resolution of treatment dilemmas should be increased. ^

Molecular fingerprinting and amplicon sequencing of the bacterial biofilm on settlement tiles deployed along natural pH gradients in Papua New Guinea

Bacterial biofilms provide cues for the settlement of marine invertebrates such as coral larvae, and are therefore important for the resilience and recovery of coral reefs. This study aimed to better understand how ocean acidification may affect the community composition and diversity of bacterial biofilms on surfaces under naturally reduced pH conditions. Settlement tiles were deployed at coral reefs in Papua New Guinea along pH gradients created by two CO2 seeps, and upper and lower tiles surfaces were sampled 5 and 13 months after deployment. Automated Ribosomal Intergenic Spacer Analysis were used to characterize more than 200 separate bacterial communities, complemented by amplicon sequencing of the bacterial 16S rRNA gene of 16 samples. The bacterial biofilm consisted predominantly of Alpha-, Gamma- and Deltaproteobacteria, as well as Cyanobacteria, Flavobacteriia and Cytophaga, whereas putative settlement-inducing taxa only accounted for a small fraction of the community. Bacterial biofilm composition was heterogeneous with approximately 25% shared operational taxonomic units between samples. Among the observed environmental parameters, pH only had a weak effect on community composition (R² ~ 1%) and did not affect community richness and evenness. In contrast, there were strong differences between upper and lower surfaces (contrasting in light exposure and grazing intensity). There also appeared to be a strong interaction between bacterial biofilm composition and the macroscopic components of the tile community. Our results suggest that on mature settlement surfaces in situ, pH does not have a strong impact on the composition of bacterial biofilms. Other abiotic and biotic factors such as light exposure and interactions with other organisms may be more important in shaping bacterial biofilms than changes in seawater pH.

Changing local elite selection in Thailand : emergence of new local government presidents after direct elections and their capabilities

Before rural local government units were established in Thailand, reform debates within the country faced a crucial issue: Candidates at the rural sub-district levels might adopt electioneering methods such as vote buying and the patronage system of the local political and economic elite, the methods that had been used in the national elections. In fact, the results of the 2006 survey in this paper, which followed the introduction of direct elections in rural local government units in 2003, contrast with the result anticipated during the debates on political reform. The preliminary data of the survey shows that the decentralization process and the introduction of the direct election system in the rural areas had some effect in changing the selection process of the local elite in Thailand.

Method to analyze the influence of hysteresis in optical arithmetic units

A new method to analyze the influence of possible hysteresis cycles in devices employed for optical computing architectures is reported. A simple full adder structure is taken as the basis for this method. Single units, called optical programmable logic cells, previously reported by the authors, compose this structure. These cells employ, as basic devices, on-off and SEED-like components. Their hysteresis cycles have been modeled by numerical analysis. The influence of the different characteristic cycles is studied with respect to the obtained possible errors at the output. Two different approaches have been adopted. The first one shows the change in the arithmetic result output with respect to the different values and positions of the hysteresis cycle. The second one offers a similar result, but in a polar diagram where the total behavior of the system is better analyzed.

Design of a new neutron delivery system for high flux source

La construcción en la actualidad de nuevas fuentes para el uso de haces de neutrones así como los programas de renovación en curso en algunas de las instalaciones experimentales existentes han evidenciado la necesidad urgente de desarrollar la tecnología empleada para la construcción de guías de neutrones con objeto de hacerlas mas eficientes y duraderas. Esto viene motivado por el hecho de que varias instalaciones de experimentación con haces de neutrones han reportado un número de incidentes mecánicos con tales guías, lo que hace urgente el progresar en nuestro conocimiento de los susbtratos vítreos sobre los cuales se depositan los espejos que permiten la reflexión total de los neutrones y como aquellos se degradan con la radiación. La presente tesis se inscribe en un acuerdo de colaboración establecido entre el Institut Max von Laue - Paul Langevin (ILL) de Grenoble y el Consorcio ESS-Bilbao con objeto de mejorar el rendimiento y sostenibilidad de los sistemas futuros de guiado de neutrones. El caso de la Fuente Europea de Espalación en construcción en Lund sirve como ejemplo ya que se contempla la instalación de guías de neutrones de más de 100 metros en algunos de los instrumentos. Por otro lado, instalaciones como el ILL prevén también dentro del programa Endurance de rejuvenecimiento la reconstrucción de varias líneas de transporte de haz. Para el presente estudio se seleccionaron cuatro tipos de vidrios borosilicatados que fueron el Borofloat, N-ZK7, N-BK7 y SBSL7. Los tres primeros son bien conocidos por los especialistas en instrumentación neutrónica ya que se han empleado en la construcción de varias instalaciones mientras que el último es un candidato potencial en la fabricación de substratos para espejos neutrónicos en un futuro. Los cuatro vidrios tiene un contenido en óxido de Boro muy similar, approximadamente un 10 mol.%. Tal hecho que obedece a las regulaciones para la fabricación de estos dispositivos hace que tales substratos operen como protección radiológica absorbiendo los neutrones transmitidos a través del espejo de neutrones. Como contrapartida a tal beneficio, la reacción de captura 10B(n,_)7Li puede degradar el substrato vítreo debido a los 2.5 MeV de energía cinética depositados por la partícula _ y los núcleos en retroceso y de hecho la fragilidad de tales vidrios bajo radiación ha sido atribuida desde hace ya tiempo a los efectos de esta reacción. La metodología empleada en esta tesis se ha centrado en el estudio de la estructura de estos vidrios borosilicatados y como esta se comporta bajo condiciones de radiación. Los materiales en cuestión presentan estructuras que dependen de su composición química y en particular del ratio entre formadores y modificadores de la red iono-covalente. Para ello se han empleado un conjunto de técnicas de caracterización tanto macro- como microscópicas tales como estudios de dureza, TEM, Raman, SANS etc. que se han empleado también para determinar el comportamiento de estos materiales bajo radiación. En particular, algunas propiedades macroscópicas relacionadas con la resistencia de estos vidrios como elementos estructurales de las guías de neutrones han sido estudiadas así como también los cambios en la estructura vítrea consecuencia de la radiación. Para este propósito se ha diseñado y fabricado por el ILL un aparato para irradiación de muestras con neutrones térmicos en el reactor del ILL que permite controlar la temperatura alcanzada por la muestra a menos de 100 °C. Tal equipo en comparación con otros ya existences permite en cuestión de dias acumular las dosis recibidas por una guía en operación a lo largo de varios años. El uso conjunto de varias técnicas de caracterización ha llevado a revelar que los vidrios aqui estudiados son significativamente diferentes en cuanto a su estructura y que tales diferencias afectan a sus propiedades macroscópicas asi como a su comportamiento bajo radiación. Tal resultado ha sido sorprendente ya que, como se ha mencionado antes, algunos de estos vidrios eran bien conocidos por los fabricantes de guías de neutrones y hasta el momento eran considerados prácticamente similares debido a su contenido comparable en óxido de Boro. Sin embargo, los materiales N-BK7 and S-BSL7 muetran gran homogeneidad a todas las escalas de longitud, y más específicamente, a escalas nanométricas las subredes de Sílice y óxido de Boro se mezclan dando logar a estructuras locales que recuerdan a la del cristal de Reedmergnerita. Por el contrario, N-ZK7 y Borofloat muestran dominios separados ricos en Sílice o Boro. Como era de esperar, las importantes diferencias arriba mencionadas se traducen en comportamientos dispares de estos materiales bajo un haz de neutrones térmicos. Los resultados muestran que el N-BK7 y el S-BSL7 son los más estables bajo radiación, lo que macroscópicamente hace que estos materiales muestren un comportamiento similar expandiéndose lentamente en función de la dosis recibida. Por el contario, los otros dos materiales muestran un comportamiento mucho más reactivo, que hace que inicialmente se compacten con la dosis recibida lo que hace que las redes de Silicio y Boro se mezclen resultando en un incremento en densidad hasta alcanzar un valor límite, seguido por un proceso de expansión lenta que resulta comparable al observado para N-BK7 y SBSL7. Estos resultados nos han permitido explicar el origen de las notorias diferencias observadas en cuanto a las dosis límite a partir de las cuales estos materiales desarrollan procesos de fragmentación en superficie. ABSTRACT The building of new experimental neutron beam facilities as well as the renewal programmes under development at some of the already existing installations have pinpointed the urgent need to develop the neutron guide technology in order to make such neutron transport devices more efficient and durable. In fact, a number of mechanical failures of neutron guides have been reported by several research centres. It is therefore important to understand the behaviour of the glass substrates on top of which the neutron optics mirrors are deposited and how these materials degrade under radiation conditions. The case of the European Spallation Source (ESS) at present under construction at Lund is a good example. It previews the deployment of neutron guides having more than 100 metres of length for most of the instruments. Also, the future renovation programme of the ILL, called Endurance, foresees the refurbishment of several beam lines. This Ph.D. thesis was the result of a collaboration agreement between the ILL and ESS-Bilbao aiming to improve the performance and sustainability of future neutron delivery systems. Four different industrially produced alkali-borosilicate glasses were selected for this study: Borofloat, N-ZK7, N-BK7 and SBSL7. The first three are well known within the neutron instrumentation community as they have already been used in several installations whereas the last one is at present considered as a candidate for making future mirror substrates. All four glasses have a comparable content of boron oxide of about 10 mol.%. The presence of such a strong neutron absorption element is in fact a mandatory component for the manufacturing of neutron guides because it provides a radiological shielding for the environment. This benefit is however somewhat counterbalanced since the resulting 10B(n,_)7Li reactions degrade the glass due to the deposited energy of 2.5 MeV by the _ particle and the recoil nuclei. In fact, the brittleness of some of these materials has been ascribed to this reaction. The methodology employed by this study consisted in understanding the general structure of borosilicates and how they behave under irradiation. Such materials have a microscopic structure strongly dependent upon their chemical content and particularly on the ratios between network formers and modifiers. The materials have been characterized by a suite of macroscopic and structural techniques such as hardness, TEM, Raman, SANS, etc. and their behaviour under irradiation was analysed. Some macroscopic properties related to their resistance when used as guide structural elements were monitored. Also, changes in the vitreous structure due to radiation were observed by means of several experimental tools. For such a purpose, an irradiation apparatus has been designed and manufactured to enable irradiation with thermal neutrons within the ILL reactor while keeping the samples below 100 °C. The main advantage of this equipment if compared to others previously available was that it allowed to reach in just some days an equivalent neutron dose to that accumulated by guides after several years of use. The concurrent use of complementary characterization techniques lead to the discovery that the studied glasses were deeply different in terms of their glass network. This had a strong impact on their macroscopic properties and their behaviour under irradiation. This result was a surprise since, as stated above, some of these materials were well known by the neutron guide manufacturers, and were considered to be almost equivalent because of their similar boron oxide content. The N-BK7 and S-BSL7 materials appear to be fairly homogeneous glasses at different length scales. More specifically, at nanometre scales, silicon and boron oxide units seem to mix and generate larger structures somewhat resembling crystalline Reedmergnerite. In contrast, N-ZK7 and Borofloat are characterized by either silicon or boron rich domains. As one could expect, these drastic differences lead to their behaviour under thermal neutron flux. The results show that N-BK7 and S-BSL7 are structurally the most stable under radiation. Macroscopically, such stability results in the fact that these two materials show very slow swelling as a function or radiation dose. In contrast, the two other glasses are much more reactive. The whole glass structure compacts upon radiation. Specifically, the silica network, and the boron units tend to blend leading to an increase in density up to some saturation, followed by a very slow expansion which comes to be of the same order than that shown by N-BK7 and S-BSL7. Such findings allowed us to explain the drastic differences in the radiation limits for macroscopic surface splintering for these materials when they are used in neutron guides.

Parallel Computer Vision Algorithms for Graphics Processing Units

La evolución de los teléfonos móviles inteligentes, dotados de cámaras digitales, está provocando una creciente demanda de aplicaciones cada vez más complejas que necesitan algoritmos de visión artificial en tiempo real; puesto que el tamaño de las señales de vídeo no hace sino aumentar y en cambio el rendimiento de los procesadores de un solo núcleo se ha estancado, los nuevos algoritmos que se diseñen para visión artificial han de ser paralelos para poder ejecutarse en múltiples procesadores y ser computacionalmente escalables. Una de las clases de procesadores más interesantes en la actualidad se encuentra en las tarjetas gráficas (GPU), que son dispositivos que ofrecen un alto grado de paralelismo, un excelente rendimiento numérico y una creciente versatilidad, lo que los hace interesantes para llevar a cabo computación científica. En esta tesis se exploran dos aplicaciones de visión artificial que revisten una gran complejidad computacional y no pueden ser ejecutadas en tiempo real empleando procesadores tradicionales. En cambio, como se demuestra en esta tesis, la paralelización de las distintas subtareas y su implementación sobre una GPU arrojan los resultados deseados de ejecución con tasas de refresco interactivas. Asimismo, se propone una técnica para la evaluación rápida de funciones de complejidad arbitraria especialmente indicada para su uso en una GPU. En primer lugar se estudia la aplicación de técnicas de síntesis de imágenes virtuales a partir de únicamente dos cámaras lejanas y no paralelas—en contraste con la configuración habitual en TV 3D de cámaras cercanas y paralelas—con información de color y profundidad. Empleando filtros de mediana modificados para la elaboración de un mapa de profundidad virtual y proyecciones inversas, se comprueba que estas técnicas son adecuadas para una libre elección del punto de vista. Además, se demuestra que la codificación de la información de profundidad con respecto a un sistema de referencia global es sumamente perjudicial y debería ser evitada. Por otro lado se propone un sistema de detección de objetos móviles basado en técnicas de estimación de densidad con funciones locales. Este tipo de técnicas es muy adecuada para el modelado de escenas complejas con fondos multimodales, pero ha recibido poco uso debido a su gran complejidad computacional. El sistema propuesto, implementado en tiempo real sobre una GPU, incluye propuestas para la estimación dinámica de los anchos de banda de las funciones locales, actualización selectiva del modelo de fondo, actualización de la posición de las muestras de referencia del modelo de primer plano empleando un filtro de partículas multirregión y selección automática de regiones de interés para reducir el coste computacional. Los resultados, evaluados sobre diversas bases de datos y comparados con otros algoritmos del estado del arte, demuestran la gran versatilidad y calidad de la propuesta. Finalmente se propone un método para la aproximación de funciones arbitrarias empleando funciones continuas lineales a tramos, especialmente indicada para su implementación en una GPU mediante el uso de las unidades de filtraje de texturas, normalmente no utilizadas para cómputo numérico. La propuesta incluye un riguroso análisis matemático del error cometido en la aproximación en función del número de muestras empleadas, así como un método para la obtención de una partición cuasióptima del dominio de la función para minimizar el error. ABSTRACT The evolution of smartphones, all equipped with digital cameras, is driving a growing demand for ever more complex applications that need to rely on real-time computer vision algorithms. However, video signals are only increasing in size, whereas the performance of single-core processors has somewhat stagnated in the past few years. Consequently, new computer vision algorithms will need to be parallel to run on multiple processors and be computationally scalable. One of the most promising classes of processors nowadays can be found in graphics processing units (GPU). These are devices offering a high parallelism degree, excellent numerical performance and increasing versatility, which makes them interesting to run scientific computations. In this thesis, we explore two computer vision applications with a high computational complexity that precludes them from running in real time on traditional uniprocessors. However, we show that by parallelizing subtasks and implementing them on a GPU, both applications attain their goals of running at interactive frame rates. In addition, we propose a technique for fast evaluation of arbitrarily complex functions, specially designed for GPU implementation. First, we explore the application of depth-image–based rendering techniques to the unusual configuration of two convergent, wide baseline cameras, in contrast to the usual configuration used in 3D TV, which are narrow baseline, parallel cameras. By using a backward mapping approach with a depth inpainting scheme based on median filters, we show that these techniques are adequate for free viewpoint video applications. In addition, we show that referring depth information to a global reference system is ill-advised and should be avoided. Then, we propose a background subtraction system based on kernel density estimation techniques. These techniques are very adequate for modelling complex scenes featuring multimodal backgrounds, but have not been so popular due to their huge computational and memory complexity. The proposed system, implemented in real time on a GPU, features novel proposals for dynamic kernel bandwidth estimation for the background model, selective update of the background model, update of the position of reference samples of the foreground model using a multi-region particle filter, and automatic selection of regions of interest to reduce computational cost. The results, evaluated on several databases and compared to other state-of-the-art algorithms, demonstrate the high quality and versatility of our proposal. Finally, we propose a general method for the approximation of arbitrarily complex functions using continuous piecewise linear functions, specially formulated for GPU implementation by leveraging their texture filtering units, normally unused for numerical computation. Our proposal features a rigorous mathematical analysis of the approximation error in function of the number of samples, as well as a method to obtain a suboptimal partition of the domain of the function to minimize approximation error.

Identification of the local productive systems in Spain: a new approach

Paper submitted to the 44th European Congress of the European Regional Science Association, Porto, 25-29 August 2004.

A new day for the colored woman worker: a study of colored women in industry in New York City

Joint Committee to Study the Employment of Colored Women in New York City and Brooklyn.

A catalogue of books [donated by Jasper Mauduit] in the library of Harvard College [at]: Cambridge in New England, 1765

This leatherbound volume lists books donated to the Harvard College Library by Jasper Mauduit, who served as an agent in London on behalf of the Province of the Massachusetts Bay. Entries are arranged alphabetically and by format; i.e. the first page lists all folios whose author, title, or keyword begin with "A," the next page lists all quartos beginning with "A," and the following page lists all "octavo &ca" volumes beginning with "A." The volume continues in a similar manner for each letter of the alphabet. Following a devastating fire in 1764 which destroyed most of the books in the Harvard College Library, Mauduit donated books, as well as money for the purchase of books, to the College. He also acted as an agent of the Society for Propagating the Gospel in New England and Parts Adjacent, using the £300 they donated for the rebuilding of the College library to select and purchase a large number of books. It is not known if the books listed in this catalog are those donated by Mauduit himself, or if they are the donations he purchased on behalf of the Society. The creator of this volume is unknown; although all entries are made in the same hand, the identity of the writer has not been determined. The label attached to the front cover, which refers to the Lime Street address of Mauduit's business in London, suggests that the list might have been prepared by Mauduit himself.

Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.

Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.