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Federal agencies are made responsible for managing the historic properties under their jurisdiction by the National Historic Preservation Act of 1966, as amended. A component of this responsibility is to mitigate the effect of a federal undertaking on historic properties through mitigation often through documentation. Providing public access to this documentation has always been a challenge. To address the issue of public access to mitigation information, personnel from Argonne National Laboratory created the Box Digital Display Platform, a system for communicating information about historic properties to the public. The platform, developed for the US Army Dugway Proving Ground, uses short introductory videos to present a topic but can also incorporate photos, drawings, GIS information, and documents. The system operates from a small, self-contained computer that can be attached to any digital monitor via an HDMI cable. The system relies on web-based software that allows the information to be republished as a touch-screen device application or as a website. The system does not connect to the Internet, and this increases security and eliminates the software maintenance fees associated with websites. The platform is designed to incorporate the products of past documentation to make this information more accessible to the public; specifically those documentations developed using the Historic American Building Survey/ Historic American Engineering Record (HABS/HAER) standards. Argonne National Laboratory’s Box Digital Display Platform can assist federal agencies in complying with the requirements of the National Historic Preservation Act.
It is argued that core areas of philosophy can benefit from reflection on cross-disciplinary research (CDR). We start by giving a brief account of CDR, describing its variability and some of the ways in which philosophers can interact with it. We then provide an argument in principle for the conclusion that CDR is philosophically fecund, arguing that since CDR highlights fundamental differences among disciplinary research worldviews, it can be used to motivate new philosophical problems and supply new insights into old problems. We close by providing an argument by example that uses the epistemology of peer disagreement to establish the potential of CDR for core philosophical areas. With this argument, we aim to demonstrate how the complex research contexts that CDR affords can point the way toward important avenues of epistemological research by highlighting potential limitations of key epistemological components, such as peerage and uniqueness.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Poly (methyl methacrylate)/single walled carbon nanotube (PMMA/SWNT) composites were polymerized in the presence of carbon nanotubes via three methods: heat, uv radiation and ionizing radiation (gamma). Samples were solvent processed and cast into films. Thin films with varying degrees of transparency resulted from these composites. Differential Scanning Calorimetry (DSC) characterized glass transition temperatures. Ultraviolet-visible spectroscopy (UV-VIS) quantified the transparency of composites. The dielectric constant (ε') was obtained from Dielectric Analysis (DEA) and correlated to the refractive index values using Maxwell's Relationship. Scanning Electron Microscopy (SEM) provided images of the polymer- nanotube composite.
The objective of this study was to determine the intracranial, cardiovascular and respiratory changes induced by conversion to high-frequency oscillator ventilation from conventional mechanical ventilation at increasing airway pressures.
In this study, 11 anaesthetized sheep had invasive cardiovascular and intracranial monitors placed. Lung injury was induced by saline lavage and head injury was induced by inflation of an intracranial balloon catheter. All animals were sequentially converted from conventional mechanical ventilation to high-frequency oscillator ventilation at target mean airway pressures of 16, 22, 28, 34 and 40 cm H2O. The mean airway pressure was achieved by adjusting positive end expiratory pressure while on conventional mechanical ventilation, and continuous distending pressures while on high-frequency oscillator ventilation. Cerebral lactate production, oxygen consumption and venous oximetry were measured and analysed in relation to changes in transcranial Doppler flow velocity. Transcranial Doppler profiles together with other physiological parameters were measured at each airway pressure.
Cerebral perfusion pressure was significantly lower during high-frequency oscillator ventilation than during conventional mechanical ventilation (CMV: 45, 34, 22, 6, 9 mmHg vs. HFOV: 33, 20, 19, 5, 5 mmHg at airway pressures mentioned above, P = 0.02). Intracranial pressure and cerebrovascular resistance increased with increasing intrathoracic pressures (P = 0.001). Cerebral metabolic indices demonstrated an initial increase in anaerobic metabolism followed by a decrease in cerebral oxygen consumption progressing to cerebral infarction as intrathoracic pressures were further increased in a stepwise fashion. Arterial PaCO2 increased significantly after converting from conventional mechanical ventilation to high-frequency oscillator ventilation (P = 0.001). However, no difference was observed between conventional mechanical ventilation and high-frequency oscillator ventilation when intracranial pressure, metabolic and transcranial Doppler indices were compared at equivalent mean airway pressures.
The use of high positive end expiratory pressure with conventional mechanical ventilation or high continuous distending pressure with high-frequency oscillator ventilation increased intracranial pressure and adversely affected cerebral metabolic indices in this ovine model. Transcranial Doppler is a useful adjunct to intracranial pressure and intracranial venous saturation monitoring when major changes in ventilation strategy are adopted.
Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation.
All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, “ASA classification”) of at least 3. Surgery for 45% of the patients was emergent.
In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation.
The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation.
Thirty-nine (78%) of 50 invited employees from 4 hospitals participated. Key responses highlighted the importance of pre-event planning in intra-departmental communication, identification of resources for the dependents of health-care workers, clarification of the chain of command within the hospital, establishment of a link to key governmental agencies, and advanced identification of negative pressure rooms for cohorting large numbers of patients. Almost one-fourth of the participants described their hospital departaient as poorly prepared for a bioterrorism event of moderate size. At the conclusion of the tabletop, 79% of the participants stated that the exercise had increased their knowledge of preplanning activities. Seventy-nine percent of all participants, 94% of physicians and nurses, and 95% of participants from non-university hospitals ranked the exercise as extremely or very useful. The exercise was completed in 3% hours and its total direct cost (excluding lost time from work) was $225 (U.S.).
Tabletop exercises are a feasible, well-accepted modality for hospital bioterrorism preparedness training. Hospital employees, including physicians and nurses, rank this method as highly useful for guiding preplanning activities. Infection control staff and hospital epidemiologists should play a lead role in hospital preparedness activities. Further assessment of the optimal duration, type, and frequency of tabletop exercises is needed.
Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate.
Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia.
Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention.
A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased.
HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol, which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.
Single-wall carbon nanotube (SWNT)/poly(methyl methacrylate) (PMMA) composites were fabricated and exposed to ionizing radiation for a total dose of 5.9 Mrads. Neat nanotube paper and pure PMMA were also exposed for comparison, and nonirradiated samples served as controls. A concentration of 0.26 wt% SWNT increased the glass transition temperature (Tg), the Vickers hardness number, and modulus of the matrix. Irradiation of the composite did not significantly change the Tg, the Vickers hardness number, or the modulus; however, the real and imaginary parts of the complex permittivity increased after irradiation. The dielectric properties were found to be more labile to radiation effects than mechanical properties.
We investigated the prevalence and predictors of positive tuberculin skin test (TST) results among prospective Vietnamese migrants. We interviewed and medically screened 1395 Vietnamese people aged over 15 years who had applied to migrate to Australia. Approximately 44% of applicants had an induration of 10 mm or more, and 18·6% had an induration of 15 mm or more. A positive tuberculin skin test at 5 mm, 10 mm and 15 mm of induration cut-points was significantly associated with age (OR 1·01–1·02 per year) and duration of smoking (OR 1·03–1·12 per year). Smoking appears to be an important factor associated with increased susceptibility to mycobacterial infection. It is not yet clear whether the increased tuberculin reactivity associated with smoking reflects an increased risk of tuberculosis among these migrants.
Did the growth of protection in the late nineteenth century in North America stimulate the large labour and capital inflows of that period (assuming land to have been the abundant factor)? Did the increased protection in Britain in this century stimulate capital export? Did the breakdown in international factor movements in the interwar period stimulate trade?
(Mundell, 1957, p. 335)
Robert Mundell's seminal article on ‘International Trade and Factor Mobility’ was published 40 years ago, and its conclusion threw down a challenge: Can history tell us whether (and when) trade and factor mobility are substitutes? 40 years seems long enough to wait, so this chapter finally rises to Mundell's challenge by interpreting trade theory in the light of history and by investigating empirically the connection between trade and factor flows in the Atlantic economy between 1870 and 1940. The epoch prior to the First World War is especially interesting in this regard since it is a liberal world environment providing a good natural experiment.
In the 40 years since Mundell wrote, trade theorists have come to understand that theory is ambiguous on this issue. Whether trade and factor mobility are complements or substitutes depends on the assumptions made in the theory. If ever there was an open invitation for empirical research, this surely is it. Yet, few efforts have been made to identify econometrically the complementarity or substitutability between factor flows and international trade (see Wong, 1988). Perhaps history may prove to be a valuable guide to choosing among these assumptions.
Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities.
Demand for prehospital care can be explained by demographic, health status, and economic determinants.
The study used a cross-sectional design to investigate the association of demographic, health status, and insurance factors with the use of prehospital, ambulance care. Core data items including age, gender, marital status, country of origin, triage score, diagnosis, time of presentation, method of arrival, and patient disposition were collected for every patient who pre-sented at the Emergency Department of the study hospital over a four-month period. Ambulance usage was analysed using Poisson regression.
For the 10,229 patients surveyed, only a small number were triaged as having the highest level of urgent medical need (0.8%), but the majority of these used prehospital emergency medical care (90.2%). Predictors of ambulance use included age >65years (Prevalence Ratio [Prevalence Ratio] = 2.92; 95% confidence interval [ Confidence Interval]: 2.35–3.63), being married or in a defacto relationship (Prevalence Ratio = 0.69; 95% Confidence Interval: 0.60–0.79) or divorced, separated, or widowed (Prevalence Ratio = 0.83; 95% Confidence Interval: 0.70–0.98), triage score level 1 or 2 (Prevalence Ratio = 1.95; 95% Confidence Interval: 1.68–2.28), or triage score level 3 (Prevalence Ratio = 1.54; 95% Confidence Interval: 1.38–1.72), diagnosis involving either mental (Prevalence Ratio = 4.29; 95% Confidence Interval: 1.84–10.01), nervous (Prevalence Ratio = 2.74; 95% Confidence Interval: 1.19–6.31) or trauma (Prevalence Ratio = 2.33; 95% Confidence Interval: 1.03–5.27) conditions, and insurance status (Prevalence Ratio =1.54; 95% Confidence Interval: 1.40–1.71). Ethnicity, gender, and time of day were not associated with usage.
Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.
Continuous quality improvement (CQI) is a powerful methodology for improving clinical outcomes and patient satisfaction while reducing inefficiency and costs. However, most hospitals in low- and middle-income countries have little experience with CQI methods. Hospital infection prevention is an ideal model for nascent efforts to improve the quality of hospital care because of its proven efficacy in reducing the occurrence of infections that compromise patient outcomes and increase costs. This article describes the design and implementation of a demonstration project to reduce the incidence of surgical-site infections (SSIs) for hospitals with little experience with quality-improvement methods. The project has a high likelihood of producing measurable reductions in SSI rates and hospital costs related to inefficient use of perioperative antimicrobial prophylaxis. Moreover, participating staff will gain experience that can be applied to efforts to improve the quality of other aspects of hospital care.