Nearby Institutions Research Articles

Legal Control of Pasturelands in the Comunidad de aldeas de Daroca (Aragon, Spain) during the 15th–16th Centuries: Tensions, Conflicts, Lawsuits and Treaties

The seizure of the territories that ended up forming the disappeared Comunidad de aldeas de Daroca began in the 12th-century, when Christian troops took these lands from the Muslims. Among the new settlers cultivating and protecting these conquered domains were many livestock owners from the north of the Kingdom of Aragon who had left their home due to increasing demographic pressure and the lack of pasture. In and around Daroca, their herding activities were regulated in the fuero (charter) of Daroca and in the successive ordinances of the Comunidad. The population increase in the 13th and 14th-centuries, along with the growing economic importance of livestock, led to disputes over the possession and exploitation of agricultural and herding spaces not only within the villages or between neighbouring villages of the Comunidad de aldeas de Daroca, but also with other nearby institutions, such as the Comunidad de aldeas de Teruel or the Casa de Ganaderos de Zaragoza. This chapter examines the tensions and treaties related to the control of pasturelands and herding activities in the Comunidad de aldeas de Daroca during the 15th and 16th-centuries. By the 15th-century, these conflicts generated numerous lawsuits and ended up being economically unsustainable for the Comunidad, which was going through many difficulties – economic and demographic crises, widespread poverty, etc. – derived from the Late Medieval crises. At the beginning of the 16th-century, a number of agreements and concords were reached, although they did not lead to a long-term easing of the problems.

Molecular surveillance of carbapenem-resistant Enterobacterales in two nearby tertiary hospitals to identify regional spread of high-risk clones in Germany, 2019–2020

Understanding the transmission dynamics of carbapenem-resistant Enterobacterales (CRE) is critical to addressing the escalating global threat of antimicrobial resistance (AMR). Although hospital transmission of CRE has been extensively studied, information on community transmission is lacking. This study aims to identify genomic clusters of CRE from two nearby institutions that may be indicative of community or inter-facility transmission. CRE isolates between 1st of January 2019 and 31st of December 2020 from two tertiary hospitals, detected in the respective routine microbiology laboratories, were collected and characterized by short-read whole genome sequencing. A total of 272 CRE were collected, with Enterobacter cloacae complex (71/192, 37%) predominant in Heidelberg and Escherichia coli (19/80, 24%) in Mannheim. The most common carbapenem resistance gene, blaOXA-48, was detected in 38% of CRE from both centres. Several putative transmission clusters were found, including 6 clusters of E. cloacae complex, 5 clusters of Klebsiella pneumoniae, 4 clusters of Citrobacter freundii, and 2 clusters each of Escherichia coli and K. aerogenes. No clusters involved isolates from both study centres, except for an ST22 C. freundii cluster. Globally circulating clones were identified between the two centres for ST131 E. coli, ST66 E. hormaechei and ST22 C. freundii. This study found no widespread transmission clusters among isolates from both centres, suggesting a hospital-specific clonal structure. This suggests that CRE clusters involving both institutions may indicate emerging or circulating clones in the community, highlighting the need for intersectoral surveillance and data sharing.

Persuasive Promotions: Leveraging Location Proximity in College Selection Strategies for Prospective Students

This study explores the critical role of location proximity in the decision-making process of prospective students when selecting higher education institutions. Drawing upon Aristotle's persuasive theories, the research aims to craft effective promotional content that leverages the significance of location proximity in attracting students to colleges and universities. Through a mixed-methods approach, including quantitative surveys and qualitative interviews, the study investigates the extent to which location proximity influences students' decisions and develops persuasive messages based on ethos, pathos, and logos theories. Findings indicate that proximity to home significantly influences students' choices, driven by factors such as convenience, accessibility, and cost-effectiveness. By recognizing and addressing the importance of location proximity, educational institutions can enhance their recruitment strategies, bolster competitiveness, and contribute to student success. This research underscores the need for institutions to tailor offerings and promotional strategies to resonate with prospective students effectively, emphasizing the benefits of attending a nearby institution.

Leonard Rowntree, Louis Wilson, Fielding Garrison, and the origins of teaching medical history at the Mayo Clinic

A visiting surgeon described his disappointment with an aspect of the Mayo Clinic in 1914, stating that there was “the almost lack of anything that could be dignified by the term ‘lecture.’” One year later, the Mayo Foundation for Medical Education and Research was founded. By 1917, the foundation declared history of medicine a graduate-level subject, and history of medicine questions were included in final oral examinations. In 1920 and 1921, lectures were given on historical topics; however, these lectures petered out, and there were no historical lectures in the official curriculum of 1923 or 1924. Enter Leonard Rowntree, who in 1926 proposed a lecture series on the history of medicine. Rowntree wrote to Fielding Garrison in early 1927 to ask for assistance selecting speakers. The two men corresponded and developed a list of eminent medical historians to invite, including Sir Charles Ballance, William Welch, and Garrison himself. These lectures served to enrich the greater Midwestern medical community as well thanks to Louis Wilson. Then head of the Mayo Foundation, Wilson wrote to nearby institutions to create a lecture circuit for speakers who traveled to the Mayo Clinic. Ultimately, the lectures were published as a book in 1933.

Abstract 13475: Implementation of a Digital Disease Management Platform for Heart Failure: AMAZE

Background: Optimal heart failure (HF) management after hospitalization requires ongoing care coordination. Digital approaches with a unified disease management platform (DMP) experience may improve patient care. Objective: A single-arm single-institution pilot study to assess feasibility of implementation and engagement with a DMP among HF patients for 60 days post-hospitalization. Methods: The DMP included a clinician electronic medical record-integrated dashboard and patient-facing smartphone app that provided patient-reported data entry, educational materials, and secure messaging. Eligible patients admitted to a cardiology service were onboarded with a smartphone DMP app at discharge. Clinical outcomes were compared between the intervention group and propensity-matched historical controls at the same institution and matched contemporary and historical controls at a nearby institution. Results: 70 of 167 eligible patients (41.9%) enrolled over the 6-month recruitment period and 51 (71.4%) completed the study. Mean age of completed participants was 65.8 (SD 12.9) years; 36 (70.6%) were male and 22 (43.1%) had HF with reduced ejection fraction. Daily DMP engagement (patient-reported data entry or in-app messaging) ranged from 35%-78% and participants engaged a median 44 (IQR 14-53) days during the 60-day study period. There was no correlation between age, sex, or clinical comorbidities and daily engagement. Compared to matched historical controls at the same institution, the study cohort had significantly fewer all-cause readmissions (HR 0.39, 95% CI 0.19 - 0.80, p=0.009). Matched contemporary and historical controls over the same time period on a cardiology service at a nearby institution had no reduction in readmission rates. Conclusions: Implementation of a post-hospitalization HF-specific DMP is feasible and may yield improvements in readmission rates, supporting the role for future randomized controlled trials (NCT04782973).

A combinatorial theory of institutional invention

AbstractFrom climate change to disruptive technologies, policymakers constantly face new problems calling for unprecedented institutional solutions. Yet, we still poorly understand the inventive process leading to the emergence of new institutional forms. Existing theories argue that exogenous changes provide incentives and opportunities for institutional invention. However, they fail to explain how the inventive process endogenously structures their emergence. Drawing from complexity theory and Brian Arthur's work on technological inventions, we develop a structural theory recasting the process of inventing new institutions as the combination of pre-existing institutions. Building on three assumptions related to this combinatorial process, we argue that the distance between institutions shapes the emergence of new institutional forms and their regime's trajectory. Following the initial take-off in the number of institutional inventions at the creation of a regime, we expect the rate of institutional inventions over replications will slow down as nearby institutions are combined and accelerate as distant ones are combined. We illustrate these expectations by looking at three regimes: data privacy, climate governance, and investment protection. Together, they showcase how our combinatorial theory can help make sense of the emergence of unprecedented institutions and, more generally, the pace of unfolding complexity in various international regimes.

A quality improvement apprenticeship: Gross anatomy in the time of Covid-19.

The study of anatomy is a team‐driven field in which anatomy instruction occurs in small groups in the laboratory with one faculty member guiding students through each anatomical region. One laboratory experience may include several small group instructors in one simultaneous learning session. In comparison, the education of future gross anatomists often happens in an apprenticeship model, where the optimal learning outcomes are met through training with an experienced mentor. It was the vision of the authors to further their education through initiating an inter‐institutional exchange to apprentice with innovative mentors in order to bring new ideas back to their own gross anatomy courses. The Southeastern Conference, a consortium of the Universities in the Southern region of the United States often associated with intercollegiate sports, has a host of academic initiatives in addition to the athletic emphasis. The Southeastern Conference Faculty Travel Program is one mechanism by which the organization promotes scholarly excellence. In this case, the Faculty Travel Program provided a way for authors from the University of Kentucky to visit a nearby institution, Vanderbilt University, and learn from like‐minded anatomy educators, with the goal of incorporating changes in their courses geared toward quality improvement. After this implementation, positive themes emerged in the student feedback on course evaluations. However, the collaboration was interrupted by the onset of the Covid‐19 pandemic. This article examines the strengths of interinstitutional apprenticeship and the benefits of such practices in a time of accelerated change in anatomical instruction.

Nanoscale: Society's Deep Impact on Science, Technology and Innovation in India by Pankaj Sekhsaria, and: Instrumental Lives: An Intimate Biography of an Indian Laboratory by Pankaj Sekhsaria (review).

Reviewed by: Nanoscale: Society's Deep Impact on Science, Technology and Innovation in India by Pankaj Sekhsaria, and: Instrumental Lives: An Intimate Biography of an Indian Laboratory by Pankaj Sekhsaria Hyungsub Choi (bio) Nanoscale: Society's Deep Impact on Science, Technology and Innovation in India By Pankaj Sekhsaria. Greater Noida: AuthorsUpFront, 2020. Pp. 182 Instrumental Lives: An Intimate Biography of an Indian Laboratory By Pankaj Sekhsaria. Oxon: Routledge, 2019. Pp. 126. As faculty member of a technical university in South Korea, I frequently receive unsolicited emails from newly minted Indian Ph.D.s in science and engineering. The standardized messages invariably come with CVs attached. Typically, the scientists possess degrees from respectable institutions in India, complete with peer-reviewed publications in indexed periodicals. Some successfully secure postdoctoral positions in South Korean universities, contributing to R&D projects funded by the national government or hightech industries. This is but a narrow slice of the global and transnational enterprise called contemporary science. The experience made me wonder about the vast scale and scope of India's scientific workforce. Thankfully, Pankaj Sekhsaria provides a valuable glimpse into the underbelly of Indian scientific research. The two books under review are products of Sekhsaria's doctoral research at Maastricht University in the Netherlands. He has conducted fieldwork in five nanoscience laboratories in Pune, Hyderabad, and Chennai, all in India. Sekhsaria's focus on nano may have been opportunistic, as at the time nanotechnology was the leading buzzword around the world. However, the survey opens a window for observing the state of scientific research in contemporary India. Nanoscale is a more popular rendition, succinctly outlining the research activities in the five labs; Instrumental Lives is a more scholarly version, focusing on one of them. In Instrumental Lives, Sekhsaria shines a spotlight on the scientific life of C. V. Dharmadhikari, a physicist at the University of Pune credited with the indigenous development of the scanning tunneling microscope (STM). Dharmadhikari completed his Ph.D. at Pune in 1979 and, like many good Indian scientists, continued his research career in the United States. By the mid-1980s, he was positioned squarely within the surface science community as the STM took off as a major scientific instrument (Mody, Instrumental Communities). When Dharmadhikari returned to Pune as faculty member, he set out to make his own STM there, successfully completing the first version by 1988. The city of Pune provided a fertile environment for Dharmadhikari to pursue his goals. Located 90 miles inland, in southeast Mumbai, Pune was [End Page 859] home to many educational and research institutions. It was also bustling with manufacturing and commercial activities in "thriving small and medium industry enterprises" and booming "junk markets" (pp. 43, 52). The lively urban environment shaped Dharmadhikari's scientific practice. Not only could he acquire diverse parts from bungee cords and stepping motors to tuning forks and bobbins (p. 40), he also had access to a wide range of experts in nearby institutions who shared his interest and would become "users" of his microscope. In short, Dharmadhikari utilized whatever resources were available to create his version of the STM, which he then used to produce scientific knowledge and skilled scientists of the nanoscale. In analyzing this case, Sekhsaria is primarily interested in identifying the nature of Dharmadhikari's work. Was it a "quintessentially Indian" (p. 10) mode of innovation, or a mere replica of original work by Western scientists? At this juncture, the recent debate on jugaad is useful. While difficult to translate into English, the term usually refers to "creative improvisation" (p. 30). An archetypal example of jugaad is the low-cost quadricycle made of wooden planks and a repurposed diesel engine. On one hand, these kuddukkas represent the ingenuity and resourcefulness of Indians under severe financial constraints. On the other hand, they are looked down on as something that falls short of "genuine innovation" (p. 32). By acknowledging Dharmadhikari's microscope as "technological jugaad" (ch. 5), Sekhsaria emphasizes the role of science and technology as solutions to mundane problems, eschewing the idolization of innovation as pursuit of high-tech agendas disengaged from everyday life. Scientists and technologists in the "underdeveloped" world (one could say postcolonial or non-Western, depending...

Clinical Implementation of DPYD Pharmacogenetic Testing to Prevent Early-Onset Fluoropyrimidine-Related Toxicity in Cancer Patients in Switzerland.

The implementation of pharmacogenetic testing into clinical practice has been a slow process so far. Here, we review the implementation of pre-treatment testing of dihydropyrimidine dehydrogenase gene (DPYD) risk variants to prevent early-onset fluoropyrimidine (FP)-related toxicity in cancer patients in Switzerland based on data of a large Swiss diagnostic center. In January 2017, the Swiss Federal Office of Public Health introduced the reimbursement of DPYD testing by the compulsory health insurance in Switzerland based on evidence for the clinical relevance of DPYD-risk variants and the cost-effectiveness of pre-treatment testing, and on the availability of international guidelines. However, we did not observe a strong increase in DPYD testing at our diagnostic center from 2017 to 2019. Only a low number of DPYD-testing requests (28–42 per year), concerning mostly retrospective investigations of suspected FP-toxicity, were received. In contrast, we observed a 14-fold increase in DPYD testing together with a strong shift from retrospective to pre-treatment test requests upon the release of recommendations for DPYD testing prior to FP-treatment in April 2020 by the European Medicines Agency. This increase was mainly driven by three geographic regions of Switzerland, where partner institutions of previous research collaborations regarding FP-related toxicity are located and who acted as early-adopting institutions of DPYD testing. Our data suggest the important role of early adopters as accelerators of clinical implementation of pharmacogenetic testing by introducing these policies to their working environment and educating health workers from their own and nearby institutions.

Retrospective observational study comparing hand-assisted, retroperitoneal and trans-abdominal laparoscopic adrenalectomy

Abstract Aim Laparoscopic adrenalectomy is considered the optimal approach for most lesions. Various subsets of minimally invasive adrenalectomy are practiced in the UK, including trans-abdominal (TLA), hand-assisted (HLA) and retroperitoneal (RLA) laparoscopic procedures. We aimed to examine the relative operative outcomes between the 3 techniques. Methods We performed a retrospective observational review of contemporaneously maintained databases from two nearby institutions to establish differences in outcomes between minimally invasive adrenalectomy for any size lesion. Statistical analysis was undertaken using R v3.6.0. Results Two hundred and ninety-seven patients underwent laparoscopic adrenalectomy and were included in the analysis (45 RLA, 77 HLA and 175 TLA). There were no significant differences between groups for institution location, wound infection, intra-operative bleeding, blood product requirements, visceral injury, open conversion, re-operation, incisional hernia, laterality of lesion, oncological outcomes and medical complications. Boxplots revealed a wider spread and increased mean operating time for TLA, with less difference in operation time between HLA and RLA groups. This was confirmed by an overall significant finding from Kruskal-Wallis rank sum test (p=<0.001) and pairwise comparisons using Wilcoxon rank sum test with a bonferroni correction for multiple testing which demonstrated significant differences between HLA and TLA, and RLA and TLA (p<0.001), but not between RLA and HLA (p=1.000). Conclusion Minimally invasive adrenalectomy can safely be performed by any of 3 techniques. TLA showed a longer mean operating time. The analysis of outcomes revealed otherwise no significant differences in operative or medical outcomes.

Folate Deficiency in an Urban Safety Net Population

PurposeSince mandatory fortification of grain products with folic acid in the United States in 1998, folate deficiency has become rare. Some have suggested that serum folate levels should be tested rarely in countries with mandatory folic acid fortification, given low rates of deficiency, high cost per deficiency diagnosis, and low rates of supplementation for those diagnosed as deficient. Given persistent racial, ethnic, and socioeconomic disparities in folate deficiency, these suggestions may not apply to all populations. We examine the rate at which serum testing detected folate deficiency in an urban safety net hospital and the characteristics of folate-deficient patients. MethodsWe reviewed the charts of all inpatients and emergency department patients with low serum folate results at a safety net hospital in Boston in 2018. We collected data concerning demographics, social determinants of health, clinical factors, and whether folate supplementation was prescribed. Finally, we performed a cost analysis. ResultsOf 1368 patients tested, 76 (5.5%) met criteria for folate deficiency. Overall, 86.8% of these patients were anemic, and 17.1% had macrocytic anemia; 42% were diagnosed with malnutrition. Common social determinants in folate-deficient patients included birth outside of the United States, homelessness, and alcohol use disorder. Of folate-deficient patients, 88% were newly prescribed folic acid supplementation at discharge. The estimated charge per deficient test was $1278. ConclusionCompared with a nearby institution, serum folate testing at our safety net hospital detected deficiency at a higher rate, incurred a lower charge per deficient test, and was more likely to impact management.

Faculty Sim: Implementation of an Innovative, Simulation-based Continuing Professional Development Curriculum for Academic Emergency Physicians.

Maintaining and enhancing competence in the breadth of emergency medicine (EM) is an ongoing challenge. In particular, resuscitative care in EM involves high-risk clinical encounters that demand strong procedural skills, effective team leadership, and up-to-date clinical knowledge. Simulation-based medical education is an effective modality for enhancing technical and nontechnical skills in crisis situations and has been effectively embedded in undergraduate and postgraduate medical curricula worldwide. To our knowledge, there are few existing systematic department-wide simulation programs to address continuing professional development (CPD) for practicing academic EM faculty. We developed our novel, simulation-based CPD program following Kern's six-step model. Based on the results of a multimodal needs assessment, a longitudinal curriculum was mapped and tailored to the available resources. Institutional support was provided in the form of a departmental grant to fund a physician program lead, monthly session instructors, and operating costs. CPD simulation sessions commenced in January 2017. Our needs assessment identified two key types of educational needs: 1) crisis resource management skills and 2) frequent practice of high-stakes critical care procedures (e.g., surgical airways). Simulation sessions involve two high-fidelity simulated resuscitations and one skills lab per day. To date, 21 sessions have been delivered, reaching 161 practicing EPs. Feedback from our faculty has been positive. We have successfully introduced a curriculum of monthly simulation-based CPD based on the educational needs of our EPs. Future work will include more detailed program evaluation linked to clinical outcomes and program expansion to support nearby institutions.

An exchange could do you good: Hosting informal meetings to foster academic librarians’ work at nearby institutions

As academic librarians support students’ learning, they often neglect their own needs as learners due to time, cost, and resource constraints. However, the need to engage in learning opportunities, especially as instructional needs and technology options evolve, is critical to their success as professionals. Librarians may look for opportunities to learn by connecting with others at conferences, workshops, and webinars. While these formats provide meaningful opportunities for academic librarians to meet and learn from each other, they are often costly for both institutions and individuals, disconnected from work environments, and do not consider the contextual factors that influence librarians’ day-to-day jobs. Moreover, the COVID-19 pandemic has restricted both travel possibilities, and travel funding—in many cases, for the foreseeable future.

Direct observations of a Mt Everest snowstorm from the world's highest surface‐based radar observations

Direct observations of a Mt Everest snowstorm from the world's highest surface‐based radar observations

Accuracy of an Electronic Health Record Patient Linkage Module Evaluated between Neighboring Academic Health Care Centers.

Patients often seek medical treatment among different health care organizations, which can lead to redundant tests and treatments. One electronic health record (EHR) platform, Epic Systems, uses a patient linkage tool called Care Everywhere (CE), to match patients across institutions. To the extent that such linkages accurately identify shared patients across organizations, they would hold potential for improving care. This study aimed to understand how accurate the CE tool with default settings is to identify identical patients between two neighboring academic health care systems in Southern California, The University of California Los Angeles (UCLA) and Cedars-Sinai Medical Center. We studied CE patient linkage queries received at UCLA from Cedars-Sinai between November 1, 2016, and April 30, 2017. We constructed datasets comprised of linkages ("successful" queries), as well as nonlinkages ("unsuccessful" queries) during this time period. To identify false positive linkages, we screened the "successful" linkages for potential errors and then manually reviewed all that screened positive. To identify false-negative linkages, we applied our own patient matching algorithm to the "unsuccessful" queries and then manually reviewed a sample to identify missed patient linkages. During the 6-month study period, Cedars-Sinai attempted to link 181,567 unique patient identities to records at UCLA. CE made 22,923 "successful" linkages and returned 158,644 "unsuccessful" queries among these patients. Manual review of the screened "successful" linkages between the two institutions determined there were no false positives. Manual review of a sample of the "unsuccessful" queries (n = 623), demonstrated an extrapolated false-negative rate of 2.97% (95% confidence interval [CI]: 1.6-4.4%). We found that CE provided very reliable patient matching across institutions. The system missed a few linkages, but the false-negative rate was low and there were no false-positive matches over 6 months of use between two nearby institutions.

Effective Educational Approaches to Training Physicians About Lung Cancer Screening.

In 2013, the U.S. Preventative Services Task Force recommended low-dose computed tomography (LDCT) for lung cancer screening (LCS) after a national trial demonstrated a 20% reduction in lung cancer mortality with LDCT. Implementation of LCS employing LDCT depends heavily on physician education regarding multiple factors, including eligibility criteria, potential benefits and harms, and shared decision-making. To date, there are no studies of educational approaches for teaching physicians about LCS. This study aims to assess the feasibility and effectiveness of implementing an interactive, group-based learning (GBL) curriculum to teach physicians about LCS. A prospective study was conducted at two nearby institutions from 2017 to 2019 comparing GBL with a lecture format as measured by total knowledge about LCS, acceptability of the educational format, and ease of implementation. We surveyed participants regarding total knowledge and format acceptance. Results were compared to determine whether GBL is an effective and feasible educational strategy for LDCT and LCS education. Residents and faculty participating in GBL demonstrated greater total knowledge compared with residents and faculty participating in the lecture format. Participants in both cohorts preferred a mix of GBL and lecture formats. All participants believed that GBL facilitates implementation of LCS better than lecture-based learning. GBL is an effective and feasible approach for educating physicians about LCS, though it is more time- and resource-intensive than a lecture approach. However, healthcare providers believe GBL will facilitate implementation of LCS more than lectures.

LO37: Reducing hemolysis of coagulation blood samples in the emergency department

Background: Hemolysis of blood samples is the leading cause of specimen rejection from hospital laboratories. It contributes to delays in patient care and disposition decisions. Coagulation tests (prothrombin time/international normalized ratio [PT/INR] and activated partial thromboplastin time [aPTT]) are especially problematic for hemolysis in our academic hospital, with at least one sample rejected daily from the emergency department (ED). Aim Statement: We aimed to decrease the monthly rate of hemolyzed coagulation blood samples sent from the ED from a rate of 2.9% (53/1,857) to the best practice benchmark of less than 2% by September 1st, 2019. Measures & Design: Our outcome measure was the rate of hemolyzed coagulation blood samples. Our process measure was the rate of coagulation blood tests sent per 100 ED visits. Our balancing measure was the number of incident reports by clinicians when expected coagulation testing did not occur. We used monthly data for our Statistical Process Control (SPC) charts, as well as Chi square and Mann-Whitney U tests for our before-and-after evaluation. Using the Model for Improvement to develop our project's framework, we used direct observation, broad stakeholder engagement, and process mapping to identify root causes. We enlisted nursing champions to develop our Plan-Do-Study-Act (PDSA) cycles/interventions: 1) educating nurses on hemolysis and coagulation testing; 2) redesigning the peripheral intravenous and blood work supply carts to encourage best practice; and 3) removing PT/INR and aPTT from automatic inclusion in our electronic chest pain bloodwork panel. Evaluation/Results: The average rate of hemolysis remained unchanged from baseline (2.9%, p = 0.83). The average rate of coagulation testing sent per 100 ED visits decreased from 41.5 to 28.8 (absolute decrease 12.7 per 100, p < 0.05), avoiding $4,277 in monthly laboratory costs. The SPC chart of our process measure showed special cause variation with greater than eight points below the centerline. Discussion/Impact: Our project reduced coagulation testing, without changing hemolysis rates. Buy-in from frontline nurses was integral to the project's early success, prior to implementing our electronic approach – a solution ranked higher on the hierarchy of intervention effectiveness – to help sustainability. This resource stewardship project will now be spread to a nearby institution by utilizing similar approaches.

Determinants of Urban unemployment in Dire Dawa Administration

In Ethiopia, urban unemployment is one of the socio-economic problems of urban population including Dire Dawa Administration where significant number of population is suffering from. According to the CSA (2018) employment-unemployment statistical survey report, the urban unemployment rate in Dire Dawa Administration is 25.3 percent. The unemployment rate among females is higher than males which accounts 33.5 percent and 17.6 percent respectively. The main purpose of this study is to assess the urban unemployment in Dire Dawa Administration. The study employed the annual statistical report of urban employment-unemployment survey (conducted from June, 2018 to July, 2018) by Ethiopian Central Statistics Agency. The study reveals that the rate of urban unemployment in Dire Dawa Administration is the highest in Ethiopia and far from the national unemployment rate which 19.0 percent. The survey report was supported with interview of individuals working in Dire Dawa economic bureau to triangulate the collected data. The unemployed population wants to work any available job to relief from their family assistance and support themselves and their families. Surprisingly, more than one third of unemployed population want to establish their own business, though still they did not do because of different constraints mainly shortage of finance, lack of training and finance and lack of place of working. Besides, the illiterate and trained urban population is more unemployed than that of the illiterate one which implies education doesn't guarantee for employment. Therefore, the Dire Dawa administration should consider this problem and take a serious measure to minimize the unemployed population. The administration should focus on labour-intensive investments that can employ huge man-power at a time. Besides, the government should create suitable working environments for those who want to establish their own business including provision of financial credit without any collateral, working place and continuous training on entrepreneurship concepts with the collaboration of nearby higher institutions.

Graduate programs at the University of Maryland

The University of Maryland has many opportunities for graduate studies in topics in acoustics, including hearing, speech and language sciences, neuroscience, physiology, bioacoustics, linguistics, and acoustical and communications engineering. Graduate training at the University of Maryland is characterized by an emphasis on multidisciplinary, collaborative research designed to enable students to develop a breadth of knowledge in addition to their focused research program. There are numerous interdisciplinary initiatives that address problems of great importance to science and society. In addition to the interdisciplinary research training on campus, students also train and collaborate with world-class researchers from nearby institutions including National Institutes of Health, Walter Reed National Military Medical Center, the University of Maryland Medical Center, and many other outstanding institutions in the area. Individuals interested in graduate training at the University of Maryland should contact faculty in their field of interest to learn more about the many opportunities available.

Characterization of atmospheric thermodynamic variables by Raman lidar in the frame of the International Network for the Detection of Atmospheric Composition Change - NDACC

In November 2012 the Raman Lidar system BASIL, located at the Univ. of Basilicata (Potenza), was approved to enter in NDACC, with the goal of providing accurate routine measurements of the vertical profiles of atmospheric temperature and water vapour mixing ratio. In this presentation we illustrate and discuss water vapour mixing ratio and temperature measurements carried out during these four years and their comparisons with the radiosondes launched from nearby Institute IMAA-CNR (7 km away).