This article describes the results of a feedback system designed to improve performance for a Swedish traffic police unit and examined whether such a feedback system was beneficial or detrimental to ...the attitudes of the officers. As in many Western countries, government organizations are being required to demonstrate their effectiveness with quantitative performance measures. An approach called the Productivity Measurement and Enhancement System (ProMES) was used with three groups of Swedish Traffic Police to do this. ProMES is a method for identifying unit's objectives, developing measures for these objectives, and using this information as feedback. ProMES was developed with these police units and feedback from the system was used over a four-year period. Results indicate that there were substantial increases in performance. There were also decreases in accidents, injuries, and fatalities compared both to baseline and to comparison groups in Sweden. These improvements were made with fewer and fewer police officers each year.
Cell suspensions of Methylococcus capsulatus mineralized methyl bromide (MeBr), as evidenced by its removal from the gas phase, the quantitative recovery of Br(-) in the spent medium, and the ...production of (14)CO2 from (14)CMeBr. Methyl fluoride (MeF) inhibited oxidation of methane as well as that of (14)CMeBr. The rate of MeBr consumption by cells varied inversely with the supply of methane, which suggested a competitive relationship between these two substrates. However, MeBr did not support growth of the methanotroph. In soils exposed to high levels (10,000 ppm) of MeBr, methane oxidation was completely inhibited. At this concentration, MeBr removal rates were equivalent in killed and live controls, which indicated a chemical rather than biological removal reaction. At lower concentrations (1,000 ppm) of MeBr, methanotrophs were active and MeBr consumption rates were 10-fold higher in live controls than in killed controls. Soils exposed to trace levels (10 ppm) of MeBr demonstrated complete consumption within 5 h of incubation, while controls inhibited with MeF or incubated without O2 had 50% lower removal rates. Aerobic soils oxidized (14)CMeBr to (14)CO2, and MeF inhibited oxidation by 72%. Field experiments demonstrated slightly lower MeBr removal rates in chambers containing MeF than in chambers lacking MeF. Collectively, these results show that soil methanotrophic bacteria, as well as other microbes, can degrade MeBr present in the environment
Context: Many attempts to identify hospital complications rely on secondary diagnoses from billing data. To be meaningful, diagnosis codes must distinguish between diagnoses after admission and those ...existing before admission. Objective: To assess the influence of diagnoses at admission on patient safety, comorbidity, severity measures, and case mix groupings for Medicare reimbursement. Design: Cross-sectional association of various diagnosis-based clinical and performance measures with and without diagnosis present on admission. Setting: Hospital discharges from Mayo Clinic Rochester hospitals in 2005 (N = 60,599). Patients: All hospital inpatients including surgical, medical, pediatric, maternity, psychiatric, and rehabilitation patients. About 33% of patients traveled more than 120 miles for care. Main Outcome Measures: Hospital patient safety indicators, comorbidity, severity, and case mix measures with and without diagnoses present at admission. Results: Over 90% of all diagnoses were present at admission whereas 27.1% of all inpatients had a secondary diagnosis coded in-hospital. About one-third of discharges with a safety indicator were flagged because of a diagnosis already present at admission, more likely among referral patients. In contrast, 87% of postoperative hemorrhage, 22% of postoperative hip fractures, and 54% of foreign bodies left in wounds were coded as in-hospital conditions. Severity changes during hospitalization were observed in less than 8% of discharges. Slightly over 3% of discharges were assigned to higher weight diagnosis-related groups based on an in-hospital complication. Conclusions: In general, many patient safety indicators do not reliably identify adverse hospital events, especially when applied to academic referral centers. Except as noted, conditions recorded after admission have minimal impact on comorbidity and severity measures or on Medicare reimbursement.
OBJECTIVE:
To compare the healing of stage II decubitus ulcers with topically applied phenytoin sodium with two other standard topical treatment procedures in a long-term care setting; and to assess ...the extent of systemic absorption after topical application in the phenytoin group.
METHODS:
Forty-seven nursing home patients with stage II decubitus ulcers were chosen for this study. The patients were matched for age, gender, and size and severity of wounds, and randomly assigned to each treatment group. Clinical assessment of decubitus ulcers was performed at the beginning of treatment and at each dressing change. Ulcers were examined for the presence of healthy granulation tissue, reduction in surface dimensions, and time to healing. Two phenytoin sodium plasma concentrations were to be obtained on all patients in the phenytoin group.
RESULTS:
Topical phenytoin therapy resulted in a shorter time to complete healing and formation of granulation tissue when compared with DuoDerm dressings or triple antibiotic ointment applications (p ⩽ 0.05). The mean ± SD time to healing in the phenytoin group was 35.3 ± 14.3 days compared with 51.8 ± 19.6 and 53.8 ± 8.5 days for the DuoDerm and triple antibiotic ointment groups, respectively. Healthy granulation tissue in the phenytoin group appeared within two to seven days in all subjects. Patients in the standard treatment groups required six to 21 days to produce new granulation tissue. Serum phenytoin sodium concentrations were nondetectable. No patient withdrew from the study secondary to adverse treatment effects.
CONCLUSIONS:
Both the phenytoin and standard treatment groups showed progress over the study period. However, the phenytoin group demonstrated more rapid results in all aspects of ulcer healing.
Previous studies have demonstrated increases in peak torque (PT) and decreases in acceleration time (ACC) after only 2 days of resistance training, and other studies have reported improvements in ...isokinetic performance after 5 days of creatine supplementation. Consequently, there may be a combined benefit of creatine supplementation and short-term resistance training for eliciting rapid increases in muscle strength, which may be important for short-term rehabilitation and return-to-play for previously injured athletes. The purpose of this study, therefore, was to examine the effects of 3 days of isokinetic resistance training combined with 8 days of creatine monohydrate supplementation on PT, mean power output (MP), ACC, surface electromyography (EMG), and mechanomyography (MMG) of the vastus lateralis muscle during maximal concentric isokinetic leg extension muscle actions. Twenty-five men (mean age +/- SD = 21 +/- 3 years, stature = 177 +/- 6 cm, and body mass = 80 +/- 12 kg) volunteered to participate in this 9-day, double-blind, placebo-controlled study and were randomly assigned to either the creatine (CRE; n = 13) or placebo (PLA; n = 12) group. The CRE group ingested the treatment drink (280 kcal; 68 g carbohydrate; 10.5 g creatine), whereas the PLA group received an isocaloric placebo (70 g carbohydrate). Two servings per day (morning and afternoon) were administered in the laboratory on days 1-6, with only 1 serving on days 7-8. Before (pre; day 1) and after (post; day 9) the resistance training, maximal voluntary concentric isokinetic leg extensions at 30, 150, and 270 degrees x s(-1) were performed on a calibrated Biodex System 3 dynamometer. Three sets of 10 repetitions at 150 degrees x s(-1) were performed on days 3, 5, and 7. Peak torque increased (p = 0.005; eta(2) = 0.296), whereas ACC decreased (p < 0.001; eta(2) = 0.620), from pretraining to posttraining for both the CRE and PLA groups at each velocity (30, 150, and 270 degrees x s(-1)). Peak torque increased by 13% and 6%, whereas ACC decreased by 42% and 34% for the CRE and PLA groups, respectively, but these differences were not statistically significant (p > 0.05). There were no changes in MP, EMG, or MMG amplitude; however, EMG median frequency (MDF) increased, and MMG MDF increased at 30 degrees x s(-1), from pretraining to posttraining for both the CRE and PLA groups. These results indicated that 3 days of isokinetic resistance training was sufficient to elicit small, but significant, improvements in peak strength (PT) and ACC for both the CRE and PLA groups. Although the greater relative improvements in PT and ACC for the CRE group were not statistically significant, these findings may be useful for rehabilitation or strength and conditioning professionals who may need to rapidly increase the strength of a patient or athlete within 9 days.
A broad experimental campaign to validate the final epithermal neutron beam design for the BNCT facility constructed at the University of Birmingham concluded in November 2003. The final moderator ...and facility designs are overviewed briefly, followed by a summary of the dosimetric methods and presentation of a small subset of the results from this campaign. The dual ionisation chamber technique was used together with foil activation to quantify the fast neutron, photon, and thermal neutron beam dose components in a large rectangular phantom exposed to the beam with a 12
cm diameter beam delimiter in place. After application of a normalisation factor, dose measurements agree with in-phantom MCNP4C predictions within 10% for the photon dose, within 10% for thermal neutron dose, and within 25% for the proton recoil dose along the main beam axis.
Genetic hypercalciuric stone-forming (GHS) rats, bred to maximize urine (u) calcium (Ca) excretion, demonstrate increased intestinal Ca absorption, increased bone Ca resorption, and reduced renal Ca ...reabsorption, all leading to elevated uCa compared to the parental Sprague-Dawley (SD) rats. GHS rats have increased numbers of vitamin D receptors (VDRs) at each site, with normal levels of 1,25(OH) sub(2)D sub(3) (1,25D), suggesting their VDR is undersaturated with 1,25D. We have shown that 1,25D induces a greater increase in uCa in GHS than SD rats. To examine the effect of the increased VDR on the osseous response to 1,25D, we fed GHS and SD rats an ample Ca diet and injected either 1,25D low dose (LD) 12.5 or high dose (HD) 25 ng/100 g body weight/day or vehicle (veh) daily for 16 days. Femoral areal bone mineral density (aBMD, by DEXA) was decreased in GHS+LD and GHS+HD relative to GHS+veh, while there was no effect on SD. Vertebral aBMD was lower in GHS compared to SD and further decreased in GHS+HD. Both femoral and L6 vertebral volumetric BMD (by mu CT) were lower in GHS and further reduced by HD. Histomorphometry indicated a decreased osteoclast number in GHS+HD compared to GHS+veh or SD+HD. In tibiae, GHS+HD trabecular thickness and number increased, with a 12-fold increase in osteoid volume but only a threefold increase in bone volume. Bone formation rate was decreased in GHS+HD relative to GHS+veh, confirming the mineralization defect. The loss of BMD and the mineralization defect in GHS rats contribute to increased hypercalciuria; if these effects persist, they would result in decreased bone strength, making these bones more fracture-prone. The enhanced effect of 1,25D in GHS rats indicates that the increased VDRs are biologically active.
Genetic hypercalciuric stone-forming (GHS) rats, bred to maximize urine (u) calcium (Ca) excretion, demonstrate increased intestinal Ca absorption, increased bone Ca resorption, and reduced renal Ca ...reabsorption, all leading to elevated uCa compared to the parental Sprague-Dawley (SD) rats. GHS rats have increased numbers of vitamin D receptors (VDRs) at each site, with normal levels of 1,25(OH)^sub 2^D^sub 3^ (1,25D), suggesting their VDR is undersaturated with 1,25D. We have shown that 1,25D induces a greater increase in uCa in GHS than SD rats. To examine the effect of the increased VDR on the osseous response to 1,25D, we fed GHS and SD rats an ample Ca diet and injected either 1,25D low dose (LD) 12.5 or high dose (HD) 25 ng/100 g body weight/day or vehicle (veh) daily for 16 days. Femoral areal bone mineral density (aBMD, by DEXA) was decreased in GHS+LD and GHS+HD relative to GHS+veh, while there was no effect on SD. Vertebral aBMD was lower in GHS compared to SD and further decreased in GHS+HD. Both femoral and L6 vertebral volumetric BMD (by muCT) were lower in GHS and further reduced by HD. Histomorphometry indicated a decreased osteoclast number in GHS+HD compared to GHS+veh or SD+HD. In tibiae, GHS+HD trabecular thickness and number increased, with a 12-fold increase in osteoid volume but only a threefold increase in bone volume. Bone formation rate was decreased in GHS+HD relative to GHS+veh, confirming the mineralization defect. The loss of BMD and the mineralization defect in GHS rats contribute to increased hypercalciuria; if these effects persist, they would result in decreased bone strength, making these bones more fracture-prone. The enhanced effect of 1,25D in GHS rats indicates that the increased VDRs are biologically active.PUBLICATION ABSTRACT
PDF
