A follow-up on Acute Pain Services in Germany compared to international survey data.

BACKGROUND After the introduction of instruments for benchmarking, certification and a national guideline for acute pain management, the aim of this study was to describe the current structure, processes and quality of German acute pain services (APS). METHODS All directors of German departments of anaesthesiology were invited to complete a postal questionnaire on structures und processes of acute pain management. The survey asked for staff, techniques and quality criteria, which enabled a comparison to previous data from 1999 and surveys from other countries. RESULTS Four hundred and eight (46%) questionnaires were returned. APS have increased considerably and are now available in 81% of the hospitals, mainly anaesthesia based. However, only 45% fulfilled the minimum quality criteria, such as the assignment of personnel, the organization of patient care during nights and weekends, written protocols for postoperative pain management, regular assessments and documenting pain scores. Staff resources varied considerably, but increased compared to 1999. Two daily rounds were performed in 71%, either by physicians and nurses (42%), by physicians only (25%) or by supervised nurses (31%). Most personnel assigned to the APS shared this work along with other duties. Only 53% of the hospitals had an integrated rotation for training their specialty trainees. CONCLUSIONS The availability of APS in Germany and other countries has increased over the last decade; however, the quality of nearly half of the APS is questionable. Against the disillusioning background of recently reported unfavourable pain-related patient outcomes, the structures, organization and quality of APS should be revisited.

Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial

BACKGROUND Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. RESULTS Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). CONCLUSIONS Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.

Alternative nighttime nutrition regimens in glycogen storage disease type I: a controlled crossover study

BACKGROUND Traditional approaches for nighttime glycemic control in glycogen storage disease type I (GSDI) include continuous tube feeding, or ingestion of uncooked corn starch (CS) at bedtime. A modified corn starch (MCS) has been shown to prolong euglycemia in some patients. The aim of this study was to evaluate whether stable nighttime glucose control can be achieved with other types of slowly digested carbohydrates in adult GSDI patients. METHODS In this cross-over study, nocturnal glucose control and fasting times were assessed with three different nocturnal nutrition regimens in five patients, using continuous glucose monitoring (CGMS) in an outpatient everyday life setting. For each patient, continuous glucose profiles were measured after ingestion of (1) CS, (2) MCS or (3) a pasta meal at bedtime, during 5 to 6 consecutive nights for each regimen. RESULTS Stable nocturnal glucose control was achieved for all patients with a pasta meal, with a mean duration of glycemia >3.5 mmol/l of 7.6 h (range 5.7-10.8), and >4 mmol/l of 7 h (5.2-9.2), similar to CS and MCS. Fasting glucose before breakfast on workdays (after 7.1 ± 0.8 h) was not significantly different between the three interventions (CS 4.1 ± 0.5 mmol/l, MCS 4.6 ± 0.7 mmol/l, pasta 4.3 ± 0.9 mmol/l). During prolonged fasting on weekends, longer duration of normoglycemia was achieved with CS or MCS than with pasta. CONCLUSION Consumption of cooked pasta is a suitable and more palatable alternative to uncooked corn starch to achieve nighttime glucose control in adult patients with GSDI.

The effect of triage team on time-in-department in a pediatric emergency department

Objective. To determine whether the use of a triage team would reduce the average time-in-department in a pediatric emergency department by 25%.^ Methods. A triage team consisting of a physician, a nurse, and a nurse's assistant initiated work-ups and saw patients who required minimal lab work-up and were likely to be discharged. Study days were randomized. Our inclusion criteria were all children seen in the emergency center between 6p and 2a Monday-Friday. Our exclusion criteria included resuscitations, inpatient-inpatient transfers, left without being seen, leaving against medical advice, any child seen outside of 6p-2am Monday-Friday and on the weekends. A Pearson-Chi square was used for comparison of the two groups for heterogeneity. For the time-in-department analysis, we performed a 2 sided t-test with a set alpha of 0.05 using Mann Whitney U looking for differences in time-in-department based on acuity level, disposition, and acuity level stratified by disposition. ^ Results. Among urgent and non-urgent patients, we found a statistically significant decrease in time-in-department in a pediatric emergency department. Urgent patients had a time-in-department that was 51 minutes shorter than patients seen on non-triage team days (p=0.007), which represents a 14% decrease in time-in-department. Non-urgent patients seen on triage team days had a time-in-department that was 24 minutes shorter than non-urgent patients seen on non-triage team days (p=0.009). From the disposition perspective, discharged patients seen on triage team days had a shorter time-in-department of 28 minutes as compared to those seen on non-triage team days (p=0.012). ^ Conclusion. Overall, there was a trend towards decreased time-in-department of 19 minutes (5.9% decrease) during triage team times. There was a statistically significant decrease in the time-in-department among urgent patients of 51 minutes (13.9% decrease) and among discharged patients of 28 minutes (8.4% decrease). Urgent care patients make up nearly a quarter of the emergency patient population and decreasing their time-in-department would likely make a significant impact on overall emergency flow.^

A comparison of two statistical methods for analysis of day of the week effect on births from 2005-2007 in Harris County of Texas

The pattern of the births during the week has been reported by many studies. The births occurred in weekends are found consistently less then births occurred in weekdays. This study employed two statistical methods, two-way ANOVA and two-way Friedman's test to analyse the daily variations in amount of births of 222,735 births from 2005-2007 in Harris County, Texas. The two methods were compared on their assumptions, procedures and results. Both of the tests showed a significant result which indicated that the births through the week are not uniformly distributed. The result of multiple comparison demonstrated the births occurring on weekends were significantly different than the births occurring on weekdays with least amount on Sundays.^

Evaluation of the impact of access to free influenza vaccine on immunization rates for children with cystic fibrosis

Children with cystic fibrosis are at increased risk of seasonal influenza associated complications, which makes them a judicious target of interventions designed to increase influenza vaccination rates. The Baylor College of Medicine/Texas Children's Hospital Pediatric Cystic Fibrosis (BCM/TCH CF) Care Center implemented an enhanced multi-component initiative designed to increase influenza vaccination rates in its patient population during the 2011-2012 influenza season. We evaluated the impact of specific components of this intervention on vaccination rates among the clinic's patient population via a historical medical chart review and examined the relationship between vaccination status and the number of pulmonary exacerbations requiring hospital admission during the influenza season. The multi-component intervention was comprised of providing influenza free of charge in the CF Care Center, reminders via phone call and letters, and drive through influenza vaccine clinics on nights and weekends. The intervention to increase influenza vaccination rates led to overall improved vaccination rates among the patients at the BCM/TCH CF Care Center, increasing from 90% adherence observed during the 2010-2011 season to 94% adherence during the 2011-2012 season. The availability of free influenza vaccine in the CF Care Center, combined with reminders about being vaccinated early in the season proved to be the most effective practices for improving the vaccination rate in the CF Care Center.^

Ecological assessment data of the marine flora and fauna of Point Lookout in 2014 (PLEA)

In 2014, UniDive (The University of Queensland Underwater Club) conducted an ecological assessment of the Point Lookout Dive sites for comparison with similar surveys conducted in 2001. Involvement in the project was voluntary. Members of UniDive who were marine experts conducted training for other club members who had no, or limited, experience in identifying marine organisms and mapping habitats. Since the 2001 detailed baseline study, no similar seasonal survey has been conducted. The 2014 data is particularly important given that numerous changes have taken place in relation to the management of, and potential impacts on, these reef sites. In 2009, Moreton Bay Marine Park was re-zoned, and Flat Rock was converted to a marine national park zone (Green zone) with no fishing or anchoring. In 2012, four permanent moorings were installed at Flat Rock. Additionally, the entire area was exposed to the potential effects of the 2011 and 2013 Queensland floods, including flood plumes which carried large quantities of sediment into Moreton Bay and surrounding waters. The population of South East Queensland has increased from 2.49 million in 2001 to 3.18 million in 2011 (BITRE, 2013). This rapidly expanding coastal population has increased the frequency and intensity of both commercial and recreational activities around Point Lookout dive sites (EPA 2008). Methodology used for the PLEA project was based on the 2001 survey protocols, Reef Check Australia protocols and Coral Watch methods. This hybrid methodology was used to monitor substrate and benthos, invertebrates, fish, and reef health impacts. Additional analyses were conducted with georeferenced photo transects. The PLEA marine surveys were conducted over six weekends in 2014 totaling 535 dives and 376 hours underwater. Two training weekends (February and March) were attended by 44 divers, whilst biological surveys were conducted on seasonal weekends (February, May, July and October). Three reefs were surveyed, with two semi-permanent transects at Flat Rock, two at Shag Rock, and one at Manta Ray Bommie. Each transect was sampled once every survey weekend, with the transect tapes deployed at a depth of 10 m below chart datum. Fish populations were assessed using a visual census along 3 x 20 m transects. Each transect was 5 m wide (2.5 m either side of the transect tape), 5 m high and 20 m in length. Fish families and species were chosen that are commonly targeted by recreational or commercial fishers, or targeted by aquarium collectors, and that were easily identified by their body shape. Rare or otherwise unusual species were also recorded. Target invertebrate populations were assessed using visual census along 3 x 20 m transects. Each transect was 5 m wide (2.5 m either side of the transect tape) and 20 m in length. The diver surveying invertebrates conducted a 'U-shaped' search pattern, covering 2.5 m on either side of the transect tape. Target impacts were assessed using a visual census along the 3 x 20 m transects. Each transect was 5 m wide (2.5 m either side of the transect tape) and 20 m in length. The transect was surveyed via a 'U-shaped' search pattern, covering 2.5 m on either side of the transect tape. Substrate surveys were conducted using the point sampling method, enabling percentage cover of substrate types and benthic organisms to be calculated. The substrate or benthos under the transect line was identified at 0.5m intervals, with a 5m gap between each of the three 20m segments. Categories recorded included various growth forms of hard and soft coral, key species/growth forms of algae, other living organisms (i.e. sponges), recently killed coral, and, non-living substrate types (i.e. bare rock, sand, rubble, silt/clay).

Morningness-eveningness and sleep habits among adolescents: age and gender differences

Previous research has indicated the need to use large samples in different cultural contexts in order to clarify age and gender differences on morningness-eveningness and sleep habits. The goal of our research was to study the relationship between morningness-eveningness and sleep habits in a large sample of 2,649 adolescents between 12 and 16 years. The Morningness- Eveningness Scale for Children and an adaptation of the School Sleep Habits Survey measures were used. Results indicated a greater tendency toward eveningness with age and higher eveningness in 13- and 14-year-old girls. Older adolescents claimed later rising time on weekends, later bedtime and shorter sleep length, and greater social jetlag, weekend rise time delay, and weekend bedtime delay. Girls reported earlier rising time on weekdays, later rising time on weekends, longer sleep length on weekends, and greater social jetlag and weekend rising time delay. Lastly, evening oriented adolescents claimed later rising time and bedtime, shorter sleep length on weekdays but longer sleep duration on weekends, and greater social jetlag, weekend rising time delay, and weekend bedtime delay.

Analysis of the future effects of the fuel shortage and increased small car usage upon traffic deaths and injuries. Final report. Executive summary.

Transportation Department, Office of Systems Engineering, Washington, D.C.

Impact of a driver intervention program on DWI recidivism and problem drinking. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

The Relationship of Built Environment and Weather with Bike Share –Evidence from the Pronto Bike Share System in Seattle

Thesis (Master's)--University of Washington, 2016-06

Physical activity of young children

Occupational therapists concerned with the long-term health and welfare of children need to be aware of the decline. in physical activity of children in most Western societies. The current study examined the extent of physical activity in the lives of 50 Australian children with a mean age of 7.74 years through questionnaires completed by the children's parents and pedometer (step) data collected from the children during 4 days. The current data show that higher self-perception of physical competence, child's levels of physical skill, and low parental perception of peer teasing were the best predictors of physical activity. Higher family socioeconomic status was found to be a significant predictor of more steps being taken on weekends, and partner's (usually a father's) level of exercise was an important predictor of the number of weekend steps. Children who were perceived to experience more peer teasing completed fewer steps on the weekend. The findings from this study indicate that children's physical activity levels may depend on the availability of family resources, and that children in their early school years may already experience negative effects from teasing that, combined with reduced self-confidence, may lay the foundation for their with drawing from physical activity as they get older.

Examining the needs for student services of adult learners in continuing higher education

The primary purpose of this study was to examine the availability and quality of student services offered to adult learners in selected continuing education programs in Dade County, Florida. The two basic research questions addressed in this study were: 1) What are the student services being provided to adult learners by the selected colleges and universities? 2) What is the quality of these services being provided as perceived by administrators and adult learners at their institutions? Two groups comprised the population for this study. One group sample of adult learners enrolled in credit courses being offered by the continuing education unit. The second group sample was comprised of administrators in the areas of Admissions, Financial Aid, Registration, Student Services and Continuing Education at each of the five colleges and universities in Dade County, Florida. Data were collected from 107 students and 25 administrators using the Continuing Education Student Services Questionnaire (CESSQ) developed by the researcher in a pilot study. The questionnaire, one for administrators and a similar one for adult learners, consisted of two parts. One consisted of eight demographic items and the second one of twenty items describing student services. An overview of responses by institutions showed that only the following services received a 100% response as available at one or more institutions: 1) Admissions Information, 2) Convenient Hours for Registration, 3) Assistance in Class Registration, 4) Assistance in Planning a Class Schedule, 5) Access to the Library in Evening and Weekends, 6) Parking and Security, 7) Food Services, 8) Bookstore and 9) Access to Computers.

The CCRUSH Study: Coarse and fine particulate matter measurements in northeastern Colorado 2009-2012

Coarse (PM10-2.5) and fine (PM2.5) particulate matter in the atmosphere adversely affect human health and influence climate. While PM2.5 is relatively well studied, less is known about the sources and fate of PM10-2.5. The Colorado Coarse Rural-Urban Sources and Health (CCRUSH) study measured PM10-2.5 and PM2.5 mass concentrations, as well as the fraction of semi-volatile material (SVM) in each size regime (SVM2.5, SVM10-2.5), for three years in Denver and comparatively rural Greeley, Colorado. Agricultural operations east of Greeley appear to have contributed to the peak PM10-2.5 concentrations there, but concentrations were generally lower in Greeley than in Denver. Traffic-influenced sites in Denver had PM10-2.5 concentrations that averaged from 14.6 to 19.7 µg/m**3 and mean PM10-2.5/PM10 ratios of 0.56 to 0.70, higher than at residential sites in Denver or Greeley. PM10-2.5 concentrations were more temporally variable than PM2.5 concentrations. Concentrations of the two pollutants were not correlated. Spatial correlations of daily averaged PM10-2.5 concentrations ranged from 0.59 to 0.62 for pairs of sites in Denver and from 0.47 to 0.70 between Denver and Greeley. Compared to PM10-2.5, concentrations of PM2.5 were more correlated across sites within Denver and less correlated between Denver and Greeley. PM10-2.5 concentrations were highest during the summer and early fall, while PM2.5 and SVM2.5 concentrations peaked in winter during periodic multi-day inversions. SVM10-2.5 concentrations were low at all sites. Diurnal peaks in PM10-2.5 and PM2.5 concentrations corresponded to morning and afternoon peaks of traffic activity, and were enhanced by boundary layer dynamics. SVM2.5 concentrations peaked around noon on both weekdays and weekends. PM10-2.5 concentrations at sites located near highways generally increased with wind speeds above about 3 m/s. Little wind speed dependence was observed for the residential sites in Denver and Greeley.

Musicalidades Quotidianas da Personalidade: estudo sobre o impacto da música na personalidade, comportamentos, emoções e quotidiano de jovens e adultos de língua portuguesa

Objetivos: A música, incomum pela sua ubiquidade e antiguidade, constitui uma das atividades humanas que ocupa um lugar significativo nas diversas culturas e vida diária. Geralmente agradável para grande parte das pessoas, produz numerosos e desmedidos efeitos, na sua maioria positivos para o ser humano. Esta investigação teve como objetivo principal estudar a relação entre alguns dos diferentes géneros musicais e os de traços de personalidade de jovens e de adultos com idades compreendidas entre os 18 e os 38 anos, fluentes em português. A investigação pretendeu descrever as preferências musicais em função da idade, género, estado civil e habilitações literárias; identificar os contextos, os períodos e as atividades mais comuns durante a escuta de música; reconhecer se a música é uma das atividades de lazer mais importantes para o grupo estudado; conhecer quais as razões mais frequentes apontadas pelos sujeitos para ouvir música; estudar a perceção que as pessoas têm sobre a influência da música na violência e no consumo de substâncias; verificar se os sujeitos consideram as preferências musicais como um fator importante e revelador de informações sobre a personalidade; avaliar o impacto e relação das preferências musicais com a personalidade e verificar quais os pares de emoções mais comuns, sentidos durante a escuta musical, e respetiva intensidade. Metodologia: A amostra foi constituída por 320 indivíduos com idades compreendidas entre os 18 e os 38 anos sendo a faixa etária mais comum a que se situa entre os 24 a 29 anos, maioritariamente do sexo feminino, solteiros, de nacionalidade portuguesa, detentores ou a frequentar um curso superior, nas áreas das ciências sociais/serviços ou exatas e tecnológicas. Os participantes aceitaram responder voluntariamente a uma bateria de testes (QCS, EPI, QMQEC e STOMP-PT). Para a caracterização da amostra, determinaram-se frequências absolutas e relativas ou valores médios e desvios-padrão. A normalidade da distribuição das pontuações médias dos instrumentos foi validada com o teste de Kolmogorov-Smirnov com correção de Lilliefors. A consistência interna estudou-se através do Alpha de Cronbach e da fórmula de Kuder Richarson. As diferenças entre grupos foram avaliadas recorrendo a uma ANOVA, a intensidade e magnitude das relações entre variáveis determinou-se através do coeficiente Eta quadrado (e 2) e com o coeficiente de correlação de Pearson avaliou-se a associação entre as variáveis em estudo. Resultados: Observou-se que a música energética é a mais típica dos escalões etários mais jovens, sendo que a rebelde trespassa todas as gerações, revelando os mais velhos também uma forte preferência pela música reflexiva. As escolhas musicais parecem não ser influenciadas pelo sexo e estado civil. Os indivíduos menos escolarizados parecem preferir músicas do tipo energético, excluindo as convencionais enquanto os detentores de maiores habilitações preferem os estilos reflexivos e rebeldes. É em casa, no quarto, ao fim de semana e quando estão sozinhos que os participantes mais ouvem música, constituindo esta a mais frequente atividade de lazer, por ser uma atividade essencial para a existência, não apelando à violência e ao consumo de substâncias e revelando as preferências musicais aspetos da personalidade. Encontraram-se diferenças estatisticamente significativas entre as dimensões da preferência musical e os traços de personalidade, sendo a música energética a que mais se destaca na extroversão e a rebelde no neuroticismo. Não se obtiveram resultados estatisticamente significativos entre os tipos de música e as emoções. Conclusão: Os resultados devem ser vistos a título de ensaio e como introdutórios, seguindo no entanto os referidos na literatura quer ao nível das preferências por idade, sexo e habilitações literárias, quer ao nível do contexto onde é ouvida, quer ainda entre as dimensões de preferência musical e traços de personalidade. / Aims: Music, unusual for its ubiquity and age, is one of the human activities that occupies a significant place in different cultures and daily life. Generally pleasant to most people, produces many and huge positive effects in humans. This investigation aimed to study the relationship between some of the different music preferences and personality types of young and adults aged between 18 and 38 years, fluent in Portuguese. The research intended to describe the musical preferences based on age, gender, marital status and educational attainment; identify contexts, periods and the most common activities during music listening; recognize the music as one of the most important leisure activities for the group studied; know which are the most frequent reasons given by the subjects to listen to music; study the perception that people have about the influence of music on violence and substance use; check whether the subjects consider the musical preferences as a major factor that reveals information about personality; assess the impact and relationship of musical preferences with the personality and see which pairs of most common emotions are felt during music listening, and its respective intensity. Methods: The sample consisted of 320 individuals aged between 18 and 38 years being the most common age group of between 24 to 29 years, mostly female, single, Portuguese, holders or to attend a higher education in the areas of social / services or exact science. Participants voluntarily agreed to answer a battery of tests (QCS, EPI, QMQEC and STOMP-PT). To characterize the sample, they were determined absolute and relative frequencies and mean values and standard deviations. The normality of the average scores of the instruments has been validated with the Kolmogorov-Smirnov test with Lilliefors correction. Internal consistency was studied using Cronbach's alpha and Kuder Richardson formula. Differences between groups were assessed using an ANOVA, intensity and magnitude of the relationship between variables was determined by Eta squared coefficient and the Pearson correlation coefficient evaluated the association between the study variables. Results: It was observed that the energetic music is the most usual among the younger age groups, and the rebel pierces all generations, revealing the older ones a strong preference for reflective music. The musical choices do not seem to be influenced by sex and marital status. The less educated individuals seems to prefer the energetic type songs, excluding conventional, holders of higher qualifications prefer reflective and rebellious styles. It is at home, in the room, on the weekends and when they are alone that participants listen more music, making this the most common leisure activity, the essential for existence, not calling for violence and substance use and revealing aspects of personality. We found significant differences between the dimensions of music preferences and personality traits, with the energetic music standing out in extraversion and neuroticism on rebel. We did not get significant results among the types of music and emotions. Conclusions: The results should be viewed under test and has introductory , however following the reported in the literature both in terms of preferences by age, sex and education level , both in terms of the context in which it is heard, still follows music preference dimensions and personality traits .