Delineating Quality Indicators of Inpatient Psychiatric Hospitalization.

BACKGROUND: Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS: To isolate and describe quality elements of inpatient psychiatric treatment. METHODS: A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS: Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit-engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients' perspectives on the treatment experience. CONCLUSIONS: The participants' responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.

The mean seasonal cycle in relative sea level from satellite altimetry and gravimetry.

Satellite altimetry and gravimetry are used to determine the mean seasonal cycle in relative sea level, a quantity relevant to coastal flooding and related applications. The main harmonics (annual, semiannual, terannual) are estimated from 25 years of gridded altimetry, while several conventional altimeter "corrections" (gravitational tide, pole tide, and inverted barometer) are restored. To transform from absolute to relative sea levels, a model of vertical land motion is developed from a high-resolution seasonal mass inversion estimated from satellite gravimetry. An adjustment for annual geocenter motion accounts for use of a center-of-mass reference frame in satellite orbit determination. A set of 544 test tide gauges, from which seasonal harmonics have been estimated from hourly measurements, is used to assess how accurately each adjustment to the altimeter data helps converge the results to true relative sea levels. At these gauges, the median annual and semiannual amplitudes are 7.1 cm and 2.2 cm, respectively. The root-mean-square differences with altimetry are 3.24 and 1.17 cm, respectively, which are reduced to 1.93 and 0.86 cm after restoration of corrections and adjustment for land motion. Example outliers highlight some limitations of present-day coastal altimetry owing to inadequate spatial resolution: upwelling and currents off Oregon and wave setup at Minamitori Island.

Quality Of Life and Associated Factors in Latin American Patients Undergoing Total Hip Arthroplasty.

BACKGROUND: The objective of this study was to determine whether individuals with hip osteoarthritis who undergo THA have higher HRQOL scores than those awaiting the procedure; An additional aim was to investigate associated factors exerting an impact on HRQOL. MATERIALS AND METHODS: A cross-sectional study was conducted. Participants were divided into two groups: pre-THA and post-THA. Functional capacity was assessed using the Harris Hip Score, and HRQOL was measured using a validated and adapted version of the WOMAC questionnaire. A multivariate analysis of the WOMAC results was used to identify the main variables associated with HRQOL in both groups. RESULTS: The post-THA group had higher HRQOL scores (100.4 ± 88.5) than the pre-THA group (197.8 ± 54.1). The domains Pain (68.0 ± 19.0 versus 34.7 ± 30.8), Stiffness (61.2 ± 28.9 versus 29.9 ± 33.1), and Physical Activity (68.6 ± 16.1 versus 36.6 ± 30.2) also had higher scores in the post-THA group. Pain was the variable most frequently associated with the increase in post-THA HRQOL scores. Other variables such as occupation, time of diagnosis, joint function, and body weight also had an impact on the HRQOL of both groups. CONCLUSIONS: 1. Individuals who underwent THA had higher scores for HRQOL compared to those still awaiting the procedure. 2. Pain was the variable most strongly associated with quality of life.

First global observations of third-degree ocean tides.

The Moon's tidal potential is slightly asymmetric, giving rise to so-called third-degree ocean tides, which are small and never before observed on a global scale. High-precision satellite altimeters have collected sea level records for almost three decades, providing a massive database from which tiny, time-coherent signals can be extracted. Here, four third-degree tides are mapped: one diurnal, two semidiurnal, and one terdiurnal. Aside from practical benefits, such as improved tide prediction for geodesy and oceanography, the new maps reveal unique ways the ocean responds to a precisely known, but hitherto unexplored, force. An unexpected example involves the two semidiurnals, where the smaller lunar force is seen to generate the larger ocean tide, especially in the South Pacific. An explanation leads to new information about an ocean normal mode that spatially correlates with the third-degree astronomical potential. The maps also highlight previously unknown shelf resonances in all three tidal bands.

Understanding of Contemporary Regional Sea-Level Change and the Implications for the Future.

Global sea level provides an important indicator of the state of the warming climate, but changes in regional sea level are most relevant for coastal communities around the world. With improvements to the sea-level observing system, the knowledge of regional sea-level change has advanced dramatically in recent years. Satellite measurements coupled with in situ observations have allowed for comprehensive study and improved understanding of the diverse set of drivers that lead to variations in sea level in space and time. Despite the advances, gaps in the understanding of contemporary sea-level change remain and inhibit the ability to predict how the relevant processes may lead to future change. These gaps arise in part due to the complexity of the linkages between the drivers of sea-level change. Here we review the individual processes which lead to sea-level change and then describe how they combine and vary regionally. The intent of the paper is to provide an overview of the current state of understanding of the processes that cause regional sea-level change and to identify and discuss limitations and uncertainty in our understanding of these processes. Areas where the lack of understanding or gaps in knowledge inhibit the ability to provide the needed information for comprehensive planning efforts are of particular focus. Finally, a goal of this paper is to highlight the role of the expanded sea-level observation network-particularly as related to satellite observations-in the improved scientific understanding of the contributors to regional sea-level change.

Quality of Life and Associated Factors in Latin American Patients Undergoing Total Hip Arthroplasty.

BACKGROUND: The objective of this study was to determine whether individuals with hip osteoarthritis who undergo THA have higher HRQOL scores than those awaiting the procedure; An additional aim was to investigate associated factors exerting an impact on HRQOL. MATERIALS AND METHODS: A cross-sectional study was conducted. Participants were divided into two groups: pre-THA and post-THA. Functional capacity was assessed using the Harris Hip Score, and HRQOL was measured using a validated and adapted version of the WOMAC questionnaire. A multivariate analysis of the WOMAC results was used to identify the main variables associated with HRQOL in both groups. RESULTS: The post-THA group had higher HRQOL scores (100.4 ± 88.5) than the pre-THA group (197.8 ± 54.1). The domains Pain (68.0 ± 19.0 versus 34.7 ± 30.8), Stiffness (61.2 ± 28.9 versus 29.9 ± 33.1), and Phy-sical Act--vity (68.6 ± 16.1 versus 36.6 ± 30.2) also had higher scores in the post-THA group. Pain was the variable most frequently associated with the increase in post-THA HRQOL scores. Other variables such as occupation, time of diagnosis, joint function, and body weight also had an impact on the HRQOL of both groups. CONCLUSIONS: 1. Individuals who had undergone THA showed higher HRQOL scores in all domains when compared to those still awaiting the procedure, and pain reduction was the variable most strongly associated with the improvement in quality of life of those patients. 2. Occupation and mobility were associated with the Stiffness domain of QOL; Occupation also had a bearing on health-related quality of life as a whole. 3. Physical Activity of the WOMAC instrument was associated with time of diagnosis, patient's body weight, and function as assessed by the HHS.

Aliased Tidal Variability in Mesoscale Sea Level Anomaly Maps.

Sea level anomaly (SLA) maps are routinely produced by objective analysis of data from the constellation of satellite altimeter missions in operation since 1992. Beginning in 2014, changes in the Data Unification and Altimeter Combination System (DUACS) used to create the SLA maps resulted in improved spatial resolution of mesoscale variability, but it also increased the levels of aliased tidal variability compared to the methodology employed prior to 2014. The present work investigates the magnitude and spatial distribution of these tidal signals, which are typically smaller than 1 cm in the open ocean but can reach tens of centimeters in the coastal ocean. In the open ocean, the signals are caused by a combination of phase-locked and phase-variable baroclinic tides. In the coastal ocean, the signals are a combination of aliased high-frequency nontidal variability and aliased variability caused by erroneous tidal corrections applied to the along-track altimetry prior to objective analysis. Several low-pass and bandpass filters are implemented to reduce the tidal signals in the mapped SLA, and independent tide gauge data are used to provide an objective assessment of the performance of the filters. The filter that attenuates both the small-scale (less than 200 km) and the high-frequency (period shorter than 108 days) components of SLA removes aliased baroclinic tidal variability and improves the accuracy of tidal analysis in the open ocean while also performing acceptably in the coastal ocean.

The Impact of Nursing Protocols on Continuous Special Observation.

BACKGROUND: Continuous Special Observation (CSO) is commonly ordered for patients at risk to injure themselves or others and involves assigning staff to monitor one patient at all times. CSO is intrusive, costly, and often has deleterious effects on patient care. Two nursing protocols were developed as alternative interventions to CSO. The first protocol, Psychiatric Nursing Availability (PNA), was designed to treat patients having suicidal or self-injurious thoughts. The second protocol, Psychiatric Monitoring and Intervention (PMI), was designed to prevent violent and impulsive behavior. These protocols had their genesis in a model that encourages nursing autonomous decision making. OBJECTIVE: Identify the impact PNA and PMI had on the number of CSO and their duration. STUDY DESIGN: Nine-year descriptive retrospective analysis of CSO, PNA, and PMI. The data were collected from the unit 15-minute rounding sheets. Descriptive analyses were performed. Interrupted time series analysis was used to determine how the protocols affected frequency and duration of CSO. RESULTS: PNA did not significantly affect CSO; however, PMI did affect its use. There was a downward trend in the number of CSOs after PMI was implemented by 0.07 episodes per month ( p = .0111). The median duration of CSO dropped from 66 hours to 33 hours after PMI was implemented ( p = .0004). CONCLUSION: PMI had the greatest impact on CSO. PMI had a secondary effect of increasing staff availability on the unit that affected CSO's use. The model of nursing care may have influenced this reduction in CSO.

The extracellular domain of myelin oligodendrocyte glycoprotein elicits atypical experimental autoimmune encephalomyelitis in rat and Macaque species.

Atypical models of experimental autoimmune encephalomyelitis (EAE) are advantageous in that the heterogeneity of clinical signs appears more reflective of those in multiple sclerosis (MS). Conversely, models of classical EAE feature stereotypic progression of an ascending flaccid paralysis that is not a characteristic of MS. The study of atypical EAE however has been limited due to the relative lack of suitable models that feature reliable disease incidence and severity, excepting mice deficient in gamma-interferon signaling pathways. In this study, atypical EAE was induced in Lewis rats, and a related approach was effective for induction of an unusual neurologic syndrome in a cynomolgus macaque. Lewis rats were immunized with the rat immunoglobulin variable (IgV)-related extracellular domain of myelin oligodendrocyte glycoprotein (IgV-MOG) in complete Freund's adjuvant (CFA) followed by one or more injections of rat IgV-MOG in incomplete Freund's adjuvant (IFA). The resulting disease was marked by torticollis, unilateral rigid paralysis, forelimb weakness, and high titers of anti-MOG antibody against conformational epitopes of MOG, as well as other signs of atypical EAE. A similar strategy elicited a distinct atypical form of EAE in a cynomolgus macaque. By day 36 in the monkey, titers of IgG against conformational epitopes of extracellular MOG were evident, and on day 201, the macaque had an abrupt onset of an unusual form of EAE that included a pronounced arousal-dependent, transient myotonia. The disease persisted for 6-7 weeks and was marked by a gradual, consistent improvement and an eventual full recovery without recurrence. These data indicate that one or more boosters of IgV-MOG in IFA represent a key variable for induction of atypical or unusual forms of EAE in rat and Macaca species. These studies also reveal a close correlation between humoral immunity against conformational epitopes of MOG, extended confluent demyelinating plaques in spinal cord and brainstem, and atypical disease induction.

Issues for storing plant-based alternative fuels in marine environments.

Two coastal seawaters (Key West, FL, USA and the Persian Gulf, Bahrain, representing oligotrophic and eutrophic environments, respectively) were used to evaluate potential biodegradation and corrosion problems during exposure to alternative and conventional fuels. Uncoated carbon steel was exposed at the fuel/seawater interface and polarization resistance was monitored. Under typical marine storage conditions, dioxygen in natural seawater exposed to fuel and carbon steel was reduced to <0.1parts-per-million within 2d due to consumption by corrosion reactions and aerobic microbial respiration. Sulfides, produced by anaerobic sulfate-reducing bacteria, and chlorides were co-located in corrosion products. Transient dioxygen influenced both metabolic degradation pathways and resulting metabolites. Catechols, indicative of aerobic biodegradation, persisted after 90d exposures. Detection of catechols suggested that initial exposure to dioxygen resulted in the formation of aerobic metabolites that exacerbated subsequent corrosion processes.

Iron cycling at corroding carbon steel surfaces.

Surfaces of carbon steel (CS) exposed to mixed cultures of iron-oxidizing bacteria (FeOB) and dissimilatory iron-reducing bacteria (FeRB) in seawater media under aerobic conditions were rougher than surfaces of CS exposed to pure cultures of either type of microorganism. The roughened surface, demonstrated by profilometry, is an indication of loss of metal from the surface. In the presence of CS, aerobically grown FeOB produced tight, twisted helical stalks encrusted with iron oxides. When CS was exposed anaerobically in the presence of FeRB, some surface oxides were removed. However, when the same FeOB and FeRB were grown together in an aerobic medium, FeOB stalks were less encrusted with iron oxides and appeared less tightly coiled. These observations suggest that iron oxides on the stalks were reduced and solubilized by the FeRB. Roughened surfaces of CS and denuded stalks were replicated with culture combinations of different species of FeOB and FeRB under three experimental conditions. Measurements of electrochemical polarization resistance established different rates of corrosion of CS in aerobic and anaerobic media, but could not differentiate rate differences between sterile controls and inoculated exposures for a given bulk concentration of dissolved oxygen. Similarly, total iron in the electrolyte could not be used to differentiate treatments. The experiments demonstrate the potential for iron cycling (oxidation and reduction) on corroding CS in aerobic seawater media.

Shewanella frigidimarina microbial fuel cells and the influence of divalent cations on current output.

The genes involved in the proposed pathway for Shewanella extracellular electron transfer (EET) are highly conserved. While extensive studies involving EET from a fresh water Shewanella microbe (S. oneidensis MR-1) to soluble and insoluble electron acceptors have been published, only a few reports have examined EET from marine strains of Shewanella. Thus, Shewanella frigidimarina (an isolate from Antarctic Sea ice) was used within miniature microbial fuel cells (mini-MFC) to evaluate potential power output. During the course of this study several distinct differences were observed between S. oneidensis MR-1 and S. frigidimarina under comparable conditions. The maximum power density with S. frigidimarina was observed when the anolyte was half-strength marine broth (1/2 MB) (0.28 µW/cm(2)) compared to Luria-Bertani (LB) (0.07 µW/cm(2)) or a defined growth minimal medium (MM) (0.02 µW/cm(2)). The systematic modification of S. frigidimarina cultured in 1/2 MB and LB with divalent cations shows that a maximum current output can be generated independent of internal ionic ohmic losses and the presence of external mediators.

Sulphide production and corrosion in seawaters during exposure to FAME diesel.

Experiments were designed to evaluate the corrosion-related consequences of storing/transporting fatty acid methyl ester (FAME) alternative diesel fuel in contact with natural seawater. Coastal Key West, FL (KW), and Persian Gulf (PG) seawaters, representing an oligotrophic and a more organic- and inorganic mineral-rich environment, respectively, were used in 60 day incubations with unprotected carbon steel. The original microflora of the two seawaters were similar with respect to major taxonomic groups but with markedly different species. After exposure to FAME diesel, the microflora of the waters changed substantially, with Clostridiales (Firmicutes) becoming dominant in both. Despite low numbers of sulphate-reducing bacteria in the original waters and after FAME diesel exposure, sulphide levels and corrosion increased markedly due to microbial sulphide production. Corrosion morphology was in the form of isolated pits surrounded by an intact, passive surface with the deepest pits associated with the fuel/seawater interface in the KW exposure. In the presence of FAME diesel, the highest corrosion rates measured by linear polarization occurred in the KW exposure correlating with significantly higher concentrations of sulphur and chlorine (presumed sulphide and chloride, respectively) in the corrosion products.

The evolution of practice changes in the use of special observations.

In acute psychiatric settings, it is common practice to increase the intensity of observations of patients who present with self-injurious thoughts, who are at risk of injuring others, or who exhibit behaviors that adversely impact the overall milieu. These intense observations are intrusive and may result in untoward stimulation of the patient. Nurses at an urban academic medical center addressed the problem of intrusive and overstimulating levels of observation by developing two practice changes using intuitive knowledge combined with input from current nursing literature. The first change was designed to move from observation to engagement. The second change was designed to decrease patient agitation related to intense observation. This article discusses the potential adverse consequences associated with the use of intense levels of observation and describes two protocols that have contributed to a reduction in the use of seclusion and restraints, as well as staff members' reported perceptions of feeling safer and experiencing improved job satisfaction.

Neutrophilic iron-oxidizing "zetaproteobacteria" and mild steel corrosion in nearshore marine environments.

Microbiologically influenced corrosion (MIC) of mild steel in seawater is an expensive and enduring problem. Little attention has been paid to the role of neutrophilic, lithotrophic, iron-oxidizing bacteria (FeOB) in MIC. The goal of this study was to determine if marine FeOB related to Mariprofundus are involved in this process. To examine this, field incubations and laboratory microcosm experiments were conducted. Mild steel samples incubated in nearshore environments were colonized by marine FeOB, as evidenced by the presence of helical iron-encrusted stalks diagnostic of the FeOB Mariprofundus ferrooxydans, a member of the candidate class "Zetaproteobacteria." Furthermore, Mariprofundus-like cells were enriched from MIC biofilms. The presence of Zetaproteobacteria was confirmed using a Zetaproteobacteria-specific small-subunit (SSU) rRNA gene primer set to amplify sequences related to M. ferrooxydans from both enrichments and in situ samples of MIC biofilms. Temporal in situ incubation studies showed a qualitative increase in stalk distribution on mild steel, suggesting progressive colonization by stalk-forming FeOB. We also isolated a novel FeOB, designated Mariprofundus sp. strain GSB2, from an iron oxide mat in a salt marsh. Strain GSB2 enhanced uniform corrosion from mild steel in laboratory microcosm experiments conducted over 4 days. Iron concentrations (including precipitates) in the medium were used as a measure of corrosion. The corrosion in biotic samples (7.4 ± 0.1 mM) was significantly higher than that in abiotic controls (5.0 ± 0.1 mM). These results have important implications for the role of FeOB in corrosion of steel in nearshore and estuarine environments. In addition, this work shows that the global distribution of Zetaproteobacteria is far greater than previously thought.

An assessment of alternative diesel fuels: microbiological contamination and corrosion under storage conditions.

Experiments were designed to evaluate the nature and extent of microbial contamination and the potential for microbiologically influenced corrosion of alloys exposed in a conventional high sulfur diesel (L100) and alternative fuels, including 100% biodiesel (B100), ultra-low sulfur diesel (ULSD) and blends of ULSD and B100 (B5 and B20). In experiments with additions of distilled water, all fuels supported biofilm formation. Changes in the water pH did not correlate with observations related to corrosion. In all exposures, aluminum 5052 was susceptible to pitting while stainless steel 304L exhibited passive behavior. Carbon steel exhibited uniform corrosion in ULSD and L100, and passive behavior in B5, B20, and B100.

A neonate with microphthalmia and median clefting of the lower lip and mandible.

Median clefts of the lower lip and mandible are very rare congenital anomalies. We report a female infant born to nonconsanguineous parents with unilateral microphthalmia and complete median clefting of the lower lip and mandible. This uncommon constellation of congenital malformations has never been reported in a liveborn infant.