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A survey of hospital antimicrobial stewardship programs was performed to validate core element achievement data from the National Healthcare Safety Network’s (NHSN) Patient Safety Component Annual Survey. In total, 89% of hospitals met all 7 core elements, compared to only 68% according to the NHSN survey.
One of the seminar topics scheduled for the summer of 1955 by the Society for American Archaeology was “The American Southwest: A Problem in Cultural Isolation.” The assignment was to “… examine the assumption that these Southwestern cultures resulted from local acceptance and development of generalized and/or specific traits which can be isolated in distant cultural contexts at earlier times than their climactic developments can be observed in the Southwest.”
The West African Disaster Preparedness Initiative held a disaster preparedness tabletop exercise with representatives from the Economic Community of West African States (ECOWAS) in November 2015. The tabletop exercise was hosted by the Republic of Ghana’s National Disaster Management Organization and partners in Accra, Ghana.
ECOWAS Commission delegates and representatives from 10 member states were confronted with a series of simulated crises. Participants utilized existing national preparedness plans and web-based information technologies to research and communicate about internal disaster threats and those from neighboring countries. After each of the exercise’s three phases, facilitators distributed participant surveys.
A total of 106 individuals participated in the tabletop exercise. During the exercise, national teams utilizing well-developed disaster contingency plans and emergency operations center (EOC) standard operating procedures (SOPs) reached out to help less-prepared national teams. Key issues identified in the survey were language and cultural issues as barriers, effectiveness of disaster management agencies linked to heads of state, and the need for data sharing and real-time communication for situational awareness and multisector coordination.
This tabletop exercise helped improve and refine the ECOWAS regional and member states’ national SOPs that teams will employ to prepare for, respond to, and recover from future disasters. (Disaster Med Public Health Preparedness. 2019;13:400-404)
US Africa Command’s Disaster Preparedness Program (DPP), implemented by the Center for Disaster and Humanitarian Assistance Medicine, partnered with US Government agencies and international organizations to promote stability and security on the African continent by engaging with African Partner Nations’ (PN) civil and military authorities to improve disaster management capabilities. From 2008 to 2015, DPP conducted disaster preparedness and response programming with 17 PNs. DPP held a series of engagements with each, including workshops, strategic planning, developing preparedness and response plans, tabletop exercises, and prioritizing disaster management capability gaps identified through the engagements. DPP partners collected data for each PN to further capacity building efforts. Thus far, 9 countries have completed military pandemic plans, 10 have developed national pandemic influenza plans, 9 have developed military support to civil authorities plans, and 11 have developed disaster management strategic work plans. There have been 20 national exercises conducted since 2009. DPP was cited as key in implementation of Ebola response plans in PNs, facilitated development of disaster management agencies in DPP PNs, and trained nearly 800 individuals. DPP enhanced PNs’ ability to prepare and respond to crises, fostering relationships between international agencies, and improving civil-military coordination through both national and regional capacity building. (Disaster Med Public Health Preparedness. 2019;13:319–329)
To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs)
Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period
31 NHs in North Carolina
254 NH residents who had a urine culture ordered within the 1-month study period
We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs.
Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000–99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%).
Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available.
The Ebola outbreak demonstrated the need for improved disaster response throughout West Africa. The West Africa Disaster Preparedness Initiative was a training and assessment effort led by US Africa Command and partners to strengthen capacities among 12 West African partner nations (PNs).
Series of 3-week training sessions with representatives from each PN were held from 13 July through 20 November 2015 at the Kofi Annan International Peacekeeping Training Centre in Accra, Ghana. A team conducted Disaster Management Capabilities Assessments (DMCAs) for each PN, including a review of key data, a survey for leaders, and in-person interviews of key informants.
All 12 PNs generated a national Ebola Preparedness and Response Plan and Emergency Operations Center standard operating procedures. DMCA metrics were generated for each PN. Top performers included Ghana, with a plan rated good/excellent, and Benin and Burkina Faso, which both achieved a satisfactory rating for their plans. More than 800 people from 12 nations were trained.
PNs have improved disaster management capabilities and awareness of their strengths and weaknesses. The Economic Community of West African States has increased its lead role in this and future planned initiatives. (Disaster Med Public Health Preparedness. 2017;11:431–438)
The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan.
There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a “road map” for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants.
A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry’s role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal “gap analysis.”
Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183–189)
We examine the pulsation properties for 13 members of the pulsating subdwarf B (sdBV, or EC 14026) class of stars. By looking at the pulsation structure of an entire class of stars, it may be possible to determine the various modes of pulsations (O’Brien 1998, Kleinman 1995). Unfortunately, when we examine the ensemble of pulsation periods in EC 14026 stars, we are only able to discern a simple correlation between pulsation period and gravity, and not any structure that might help with mode identification. So we can only report on the lack of structure in the pulsation periods and present some of the work underway, which we hope will identify modes in the future.
We have used the rate of change of pulsation period for the hot (DOV) pre-white dwarf PG1159–035 and the cool (DAV) white dwarf G117–B15A to measure their evolutionary time scales. We show that, for any multiperiodic star, we must take into account the effect of all pulsations simultaneously on the times of maximum of the pulsations to get reliable measurements of periods and phases.
Culture does not change because we desire to change it. Culture changes when the organization is transformed; the culture reflects the realities of people working together every day.
– Frances Hesselbein
Have you ever had a job you loved and felt empowered to fulfill your responsibilities? If so, what was it about your co-workers, your manager/supervisor, and your work environment that made your experience so positive? Perhaps you've never felt that way about a job and, instead, you've dreaded heading to work every morning. Your boss might have rarely recognized your efforts. It's possible you weren't sure how to perform your job, but felt uncomfortable asking for help. Your co-workers might have seemed like characters from the movie Mean Girls. In this perfect storm of the forces of disengagement, we suspect you didn't last too long at that job. Or you felt overwhelmed with too much to do, with too little support, as depicted in the illustration on the next page.
According to a 2013 survey, more than half of workers in the United States were dissatisfied with their jobs. This statistic is alarming; after all, we spend approximately one-third of our waking hours and energy at work, plus dissatisfied employees tend to find new employers. Because we spend so much of our time and energy at work, the organizational culture can have a profound impact on our lives and the lives of those around us. If work cultures support interdependent, prosocial behavior instead of individualism and competition, we believe the business world, indeed our everyday lives, will be more positive and productive for almost everyone.
Any organization's mission will benefit from employees who care about their work and their colleagues. It's a win-win scenario. What factors influence employee job satisfaction? Aside from the obvious – job security, pay, and benefits (e.g., health insurance) – employees report that feeling safe at work, having a positive relationship with their immediate supervisor, and communicating openly and cooperatively with other employees and senior management contribute significantly to their work satisfaction. The bad news: In many organizational cultures, managers/supervisors struggle with these very issues, resulting in unacceptably high rates of employee dissatisfaction and turnover and a climate of distrust.
Imagine these disgruntled employees as supervisors who are responsible for mentoring newly recruited employees.
The physical mechanisms responsible for electrically-induced parametric degradation in GaN-based high electron mobility transistors are examined using a combination of experiments, device simulation, and first-principles defect analysis. A relatively simple formulation is developed under the assumption that the hot-electron scattering cross-section is independent of the electron energy. In this case, one can relate the change in defect concentration to the operational characteristics of a device, such as the spatial and energy distribution of electrons (electron temperature), electric field distribution, and electron energy loss to the lattice.
Field trials were conducted in Lubbock, TX in 2010 and 2011 to evaluate tank-mix combinations of glyphosate and glufosinate in GlyTol® LibertyLink® cotton for control of Palmer amaranth. Herbicide treatments included glyphosate and glufosinate applied at various tank-mix rate combinations (1X:1X, 1X:0.75X, 1X:0.5X, 1X:0.25X and 1X:0X of glyphosate plus glufosinate), proportional tank-mix rate combinations (1X:0X, 0.75X:0.25X, 0.5X:0.5X, 0.25X:0.75X, and 0X:1X of glyphosate plus glufosinate, where X is 0.84 kg ae ha−1 of glyphosate or 0.58 kg ai ha−1 of glufosinate ammonium), and in sequential (1X followed by 1X) applications of both herbicides in an overall weed management system. Greenhouse studies were conducted to quantify antagonistic or synergistic effects. Treatments included a nontreated control; glyphosate at 0.84, 0.63, 0.42, and 0.21 kg ha−1; glufosinate at 0.58, 0.44, 0.29, and 0.15 kg ha−1; and all tank-mix combinations of each herbicide rate. Dry weights were converted to percent growth values for each rate of the two herbicides alone, and these values were used to calculate expected responses of tank-mix combinations with the use of Colby's method. Expected values were compared to observed percent growth values using an augmented mixed-model method. Results of field studies indicated that tank mixes of glyphosate and glufosinate were less effective at controlling Palmer amaranth than glyphosate applied alone. The addition of any rate of glufosinate to a 1X rate of glyphosate reduced Palmer amaranth control compared to glyphosate alone. Greenhouse studies confirmed antagonism seen in the field. These results indicate that sequential applications of these two herbicides are a better option for Palmer amaranth weed management.