Off-site Facility Research Articles

Providing Culturally Competent Acute Care Physical Therapy for a Complex Medical Patient of Amish Heritage

Background and Purpose: Health care providers, including physical therapists, should identify and incorporate sociocultural, educational, and environmental factors in their clinical decisions for patients of various cultural backgrounds—specifically Amish heritage as illustrated in this case report. The purpose of this case report is to describe how cultural beliefs affected acute care physical therapy (PT) and discharge planning for an older adult of Amish heritage. Case Description: The patient was a 65-year-old woman of Amish heritage 2 days post thoracic aortic aneurysm dissection surgery with an unexpected subsequent stroke. Due to their Amish beliefs, the patient and the family declined the physical therapist's initial postacute care discharge recommendation to an off-site skilled nursing facility. Significant discussion with multiple family members throughout the entire therapy process emphasized continued skilled services in accord with Amish cultural beliefs to promote safe reintegration into the Amish community. PT interventions primarily focused on culturally sensitive patient and family education and functional mobility to encourage safe patient resumption of activities of daily living and role in society. Outcomes: By the end of 2 weeks of PT (1 initial examination and 8 intervention sessions), the patient demonstrated improvements in all aspects of functional mobility and total Functional Independence Measure scores (21/126 to 86/126). On postoperative day 14, the patient transitioned to an on-site inpatient rehabilitation facility. After completing only 4 days in the inpatient rehabilitation facility, the family firmly advocated that the patient be discharged home with assistance from the family and Amish community. Discussion: Physical therapists may be unfamiliar with patients of Amish heritage due to the infrequency of PT services used by these individuals. This case report demonstrates a physical therapist's sensitivity to and acceptance of the Amish cultural beliefs, which ensured appropriate clinical decisions and positive patient- and family-centered outcomes. Engaging the patient's family in dialogue about realistic discharge options early in the acute care stay allowed the family time to understand the complexity of the patient's diagnoses and challenges of the health care environment as well as align decisions with their cultural beliefs.

Community-based training of medical students is associated with malaria prevention and treatment seeking behaviour for children under 5\xa0years in Uganda: a study of MESAU-MEPI COBERS in Uganda

BackgroundFour university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda.MethodsA cross-sectional survey was done to compare communities around health facilities where medical students were placed at COBERS sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). We randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. We used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. We performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependant and independent variables.ResultsFive hundred twenty-three (66.8%) of the children under 5 years in COBERS communities slept under Insecticide Treated Nets (ITNs) the night before survey compared with 1451 (57.8%) in non-COBERS communities (AOR = 0.66, p = 0.017). 100 (60.0%) of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 (47.0%) in non-COBERS communities (AOR = 0.71, P = 0.009).ConclusionThe presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with other effects of COBERS.

How to Move a Mountain: The Preparation and Transfer of One Million Volumes to an Off-Site Storage Facility

ABSTRACTIn late 2013, Hesburgh Libraries at the University of Notre Dame embarked on an audacious journey to renovate its iconic fourteen-story building. Driven by an immediate pressing need to reduce the footprint of physical collections in the library, a massive project commenced in the fall of 2014 to prepare approximately one million volumes for transfer to an off-site high-density mobile shelving storage facility. The project was carried out in two large phases that involved coordination of work and schedules between the renovation committee, vendors, and multiple library teams, including the Collections Preparation Team that was responsible for ensuring that all items moving off-site had accurate catalog records and were barcoded. This article provides background information about putting the project together and describes how the work to prepare titles for transfer was organized and completed under a very short deadline.

Evaluation of Existing Layout Improvement and Creation Algorithms for Use in the Offsite Construction Industry

Construction is traditionally depicted as a labor-intensive industry which involves considerable inefficiency inherent to the common practices. Offsite construction offers a change to the current stigma, in which most of the work is transferred to a facility with a controlled environment and later transported to its destination, considerably reducing the amount of movement required by people and materials. Proper planning for such a facility is crucial for the success of offsite construction operations, since the effectiveness of such a space will determine the efficiency of the process and the quality of the final product. Several methods exist for layout creation and improvement in the manufacturing industry; however, there are advantages and disadvantages to using the different methods in an offsite construction facility. A review of the literature is conducted to summarize commonly used methods and respective considerations of each. The identified methods are then applied to an existing case study plant to create the optimized layout for each. The resulting layouts are then compared and evaluated based on the ease of transporting modules and components within the facility, and the estimated waste reduction and productivity increase. This evaluation will identify the usefulness of each method and identify common issues related to facility layouts that should be taken into consideration in future layout planning for offsite construction facilities.

Modular Industry Characteristics and Barriers to its Increased Market Share

Modular and offsite construction reduces project duration and cost by synchronizing offsite and onsite work. Project activities are constructed in a controlled offsite facility to minimize effects of inclement weather and site disruptions, while meeting safety and quality requirements. In recent years, many organizations have conducted questionnaires to study characteristics of modular and offsite construction, such as the Modular Building Institute (MBI), Buildoffsite campaigning organisation in the UK, Canadian Manufactured Housing Institute (CMHI), National Institute of Building Sciences, McGraw-Hill Construction, and Fails Management Institute (FMI). This paper introduces a summary of results for a new questionnaire carried out in collaboration between the Department of Building, Civil and Environmental Engineering (BCEE) at Concordia University, MBI, Niagara Relocatable Buildings, Inc. (NRB) in Canada, and the Nasseri School of Building Science and Engineering at the University of Alberta. This questionnaire focuses on two issues: (1) the characteristics of the modular and offsite construction industry, and (2) detected barriers to the increased market share of this industry. For the latter, effort was made to address five factors emanated from a workshop on äóěChallenges and opportunities for modular construction in Canadaäóť held in Montreal in October 2015 to analyze barriers to growth of modular construction in Canada. Key findings of this questionnaire include requests for use of a separate code of modular construction design, innovative financing and insurance solutions, standards that consider procurement regulations, and lending institutions that partner with financial houses to create special lending programs for modular construction.

Under Threat: One Archive's Tale from the 2017 Napa and Sonoma County Fires

Under ThreatOne Archive’s Tale from the 2017 Napa and Sonoma County Fires James Mockoski (bio) and Courtney Garcia (bio) Francis Ford Coppola and George Lucas founded American Zoetrope as an independent film company in the San Francisco Bay Area in 1969. It was created to bring together talented young filmmakers at a distance from the traditional ways of filmmaking that were entrenched in Hollywood. Zoetrope provided a welcoming space in which to experiment and craft stories in a much different way, appealing to filmmakers like Walter Murch, John Milius, and Carroll Ballard. Films made there left their mark, including American Graffiti (1973), The Conversation (1974), Apocalypse Now (1979), and The Black Stallion (1979), to name only a few. In its almost fifty-year history, Zoetrope has amassed an archive of film, artwork, and movie memorabilia, including the acquisition of the old RKO Research Library.1 While these items are stored in various locations, the bulk of the collection is housed in the Napa Valley, on the famed Inglenook Estate.2 FIRESTORM In early October 2017, wildfires quickly spread throughout Napa and Sonoma Counties in the middle of the night, catching everyone off guard. According to the California Department of Forestry and Fire Protection (CAL FIRE), 11,000 firefighters combated the fires that would burn more than 245,000 acres.3 In addition to Inglenook in Napa County, the Coppola family owns two properties in Sonoma County. At the start of the firestorm, neither was in immediate danger. As the hours went on, however, and the aggressive winds fed the flames, we began implementing a disaster plan, which would mean evacuating the property in the Napa Valley. Our disaster plan wasn’t one that was codified and kept in a binder; instead, it had been developed orally by long-standing colleagues over the last fifteen years. We had discussed what we would do in case of emergency and how we would provide geographical separation by storing our most valuable, unique, and irreplaceable items in off-site vaults more appropriate for assets such as negatives and sound masters. We discussed how we would prioritize our property assets, how to secure the site if assets were to remain on property, the need to find a safe haven for evacuated items, and how we would transport these items to the selected refuge. We were very fortunate that our company has a wealth of resources— transportation key among them. We had an amazing fleet of vehicles at our service. What’s more, we had a wonderful group of dedicated employees who worked hard and diligently to relocate materials from a total of ten buildings (from family homes to production facilities), with assets ranging from the smallest video tape to the largest painting. One of our safe havens was a wine cave on the property, situated far enough away from the fire area that we could use it to safely store our paper documents and other archival materials too large to transport off property; we also used it to store our Ford Model T from The Godfather: Part II (1974). Mr. Coppola is a car enthusiast and has several rare vehicles in his collection, and when the garage where many [End Page 67] of these cars are housed became threatened by the fires, we moved the majority of them to the front of the property, where they could be stored outside of the immediate danger area and covered to protect them from the falling ash. Our off-site facility was a roomy, versatile airport hangar that we used as our designated evacuation area—a place we also could occupy as a command post and set priorities from as the situation unfolded. There, we processed all the materials that had been evacuated from the property, photographing, cataloging, and packing each item securely so that the collection would be safe during the emergency and could be returned to the property efficiently once we received the all-clear. Click for larger view View full resolution Figure 1. The famed Inglenook Estate on a normal day. Photograph by Gundolf Pfotenhauer. Courtesy of American Zoetrope. We have experienced threats to our collections due to natural disasters in the past...

Efficacy of telecytopathology for preliminary assessment of fine-needle aspirations performed at a remote facility

The need for real time anatomic pathology services has grown as healthcare systems, traditionally found at large medical centers, expand into smaller communities. The placement of a pathologist is not cost-, time-, or resource-efficient. Telecytopathology can provide rapid offsite evaluation of cytology tissues. This study evaluated the accuracy rate of rendered preliminary assessments for telecytopathology of ultrasound (US)-guided fine-needle aspirations (FNAs) for an offsite facility by comparing preliminary assessment results with the final diagnosis. The pathology database was searched for telecytopathology US-guided FNAs with rapid offsite evaluation performed at a regional care center from August 2014 to June 2016. A total of 674 consecutive US-guided FNAs from 444 patients were obtained. FNA sites included lymph node (345 cases), breast (178 cases), thyroid gland (71 cases), and others (80 cases). Preliminary assessments of the 674 FNAs were adequate/benign in 275 (41%) cases, adequate/malignant in 182 (27%) cases, adequate/further review needed in 162 (24%) cases, indeterminate/borderline cellularity in 37 (5%) cases, and nondiagnostic in 18 (3%) cases. Final FNA diagnoses rendered included 391 (58%) negative for malignancy, 205 (30%) malignant, 34 (5%) atypical/suspicious for malignancy, 26 (4%) indeterminate cellularity-favor benign, and 18 (3%) nondiagnostic specimens. Concurrent core biopsy was performed in 42 cases and 83 cases were triaged for ancillary studies. The majority (99%) of US-guided FNAs demonstrated concordant preliminary assessments with the final diagnoses. A major discrepancy occurred in 1 case; 5 cases had minor discrepancies. Remote facility telecytopathology can be utilized as an accurate modality in guiding appropriate tissue acquisition and final diagnosis.

Optical Measurement of Radiocarbon below Unity Fraction Modern by Linear Absorption Spectroscopy.

High-precision measurements of radiocarbon (14C) near or below a fraction modern 14C of 1 (F14C ≤ 1) are challenging and costly. An accurate, ultrasensitive linear absorption approach to detecting 14C would provide a simple and robust benchtop alternative to off-site accelerator mass spectrometry facilities. Here we report the quantitative measurement of 14C in gas-phase samples of CO2 with F14C < 1 using cavity ring-down spectroscopy in the linear absorption regime. Repeated analysis of CO2 derived from the combustion of either biogenic or petrogenic sources revealed a robust ability to differentiate samples with F14C < 1. With a combined uncertainty of 14C/12C = 130 fmol/mol (F14C = 0.11), initial performance of the calibration-free instrument is sufficient to investigate a variety of applications in radiocarbon measurement science including the study of biofuels and bioplastics, illicitly traded specimens, bomb dating, and atmospheric transport.

Genome Sequences of 30 Escherichia coli O157:H7 Isolates Recovered from a Single Dairy Farm and Its Associated Off-Site Heifer-Raising Facility.

ABSTRACTCattle are the primary reservoir of Escherichia coli O157:H7, the most frequently isolated serotype of enterohemorrhagic E. coli infections among humans in North America. To evaluate the diversity of E. coli O157:H7 isolates within a single dairy herd, the genomes of 30 isolates collected over a 7-year period were sequenced.

New Discoveries and New Directions for the Archaeological Archives at the Autry Museum of the American West

ABSTRACTIn 2003, the Autry Museum of the American West merged with the Southwest Museum of the American Indian, which housed the second largest collection of Native American objects in the country. Included within this collection is the Braun Research Library Collection, which consists of works of art on paper, rare books, scholarly publications, manuscripts, photographs, correspondences, maps and sound recordings, and other archival materials, many of which relate to the early development of the disciplines of archaeology and anthropology in the United States. For over a century, both national and international researchers have used the museum's collections and archival materials with a relative open access. However, due to the culturally sensitive nature of many of these collections and the growth of how information can be made accessible, the Autry institution is currently developing procedures that affect access, especially for those researchers who wish to study archaeological archives. Staff from multiple departments are collaborating on addressing these concerns, including developing new policies while improving access to Native American tribes, communities, and researchers in preparation for the new off-site Autry Resources Center and storage facility where the collection will be housed in the future.

Managing Library Software Development: A Case Study in Developing an Inventory Management System for Off-Site Storage Using an Outside Contractor

Hesburgh Libraries of Notre Dame established an off-site storage facility in 2015, with only one year to transfer 450,000 items. This necessitated the implementation of an inventory management system (IMS) to track the location of and efficiently retrieve individual items. After conducting an environmental scan of other institutions, the library decided to develop an open source IMS and to contract a developer for the purposes of implementing a working prototype. Working with a contractor required a well-planned development process and a close working relationship. This article describes the project management challenges, development workflow, and lessons learned.

Moving and Transforming Care of One of the Largest Southwest Archaeological Collections: The Museum of Indian Arts and Culture's Move to the Center for New Mexico Archaeology

Abstract After over two decades of planning and five years of conserving, packing, and moving, the Museum of Indian Arts and Culture has finished the first two phases of the largest move of archaeological artifacts in the museum's history and quite possibly in the American Southwest. Framed within the historical background of evolving collection storage over many decades, the Archaeological Research Collections were moved from the Laboratory of Anthropology and another off-site storage location to a new state of the art off-site facility at the Center for New Mexico Archaeology (CNMA). Decisions that eased the overall move, including issues resulting from the move and how they were remedied, are discussed. Overall, this particular collections move demonstrates the capabilities that a small staff can have if given enough time, volunteers, and grant resources.

What intracranial pathologies are most likely to receive intervention? A preliminary study on referrals from an emergency centre with no on-site neurosurgical capabilities.

IntroductionAccess to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities.MethodsA one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted.ResultsA total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention.DiscussionBased on this study’s findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.

Application of discrete-event simulation to investigate effects of client order behaviour on off-site manufacturing performance in Australia

ABSTRACTOff-site manufacturing (OSM) has implied capabilities that could enhance housing supply in Australia. The OSM system requires the efficient management of two concurrent working locations: the off-site fabrication facility and the construction site. Client order behaviour impacts on the OSM system. Accordingly, client order information flow is an essential component for efficiently managing this system. This paper investigates the effects of client order behaviour on the performance of OSM within the Australian housebuilding context using discrete-event simulation (DES). The data used to develop the conceptual model were based on a review of 21 related technical documents and interviews with 13 OSM experts in Australia. The operational data used for executing the simulation model were collected through a questionnaire survey of 30 builders as well as three one-day site visits to the fabrication facilities and construction sites of three major building organisations in Australia. The simulation model assisted in experimentation with four scenarios that represent client order interaction in the OSM system in Australia. The model simulation results showed noteworthy improvements in house completion time and the number of completed client orders per year.

“Cleansing the air at the expense of waterways?” Empirical evidence from the toxic releases of coal-fired power plants in the United States

Environmental policies in the United States have primarily taken the form of media-specific regulations that emphasize end-of-pipe pollution control. This can lead to the shifting of pollution across environmental media, thereby having the potential to solve one environmental problem by creating a new problem. This study uses data from 228 coal-fired power plants that report to the Toxics Release Inventory to conduct an empirical examination of the extent to which media-specific regulation has caused power plants to shift their toxic air releases to waterways, land, or transfers for offsite recycling facilities. Controlling for plant-level fixed effects, scale of production, and environmental inspections and enforcement under air regulation, this study finds that adopting tougher air pollution regulation that designates counties as being in nonattainment status with the National Ambient Air Quality Standards significantly increased toxic releases to waterways and land.

Moving the New York University Abu Dhabi Library

ABSTRACTUsing Steven Carl Fortriede's method in Moving Your Library: Getting the Collection From Here to There as a framework, we successfully moved the New York University Abu Dhabi Library from a library and off-site storage facility to one new library. While we generally followed Fortriede's advice, we deviated from his plan in three important ways: We created a color-coding system for the boxes, which eliminated the need to keep the boxes in strict order; we integrated two collections during the move (rather than before); and we created phantom books to create space for lengthy multivolume sets in the smaller collection.

Parallelisation of an interactive lattice-Boltzmann method on an Android-powered mobile device

Engineering simulation is essential to modern engineering design, although it is often a computationally demanding activity which can require powerful computer systems to conduct a study. Traditionally the remit of large desktop workstations or off-site computational facilities, potential is now emerging for mobile computation, whereby the unique characteristics of portable devices are harnessed to provide a novel means of engineering simulation. Possible use cases include emergency service assistance, teaching environments, augmented reality or indeed any such case where large computational resources are unavailable and a system prediction is needed. This is particularly relevant if the required accuracy of a calculation is relatively low, such as cases where only an intuitive result is required. In such cases the computational resources offered by modern mobile devices may already be adequate. This paper proceeds to discuss further the possibilities that modern mobile devices might offer to engineering simulation and describes some initial developments in this direction. We focus on the development of an interactive fluid flow solver employing the lattice Boltzmann method, and investigate both task-based and thread-based parallel implementations. The latter is more traditional for high performance computing across many cores while the former, native to Android, is more simple to implement and returns a slightly higher performance. The performance of both saturates when the number of threads/tasks equal three on a quad-core device. Execution time is improved by a further 20% by implementing the kernel in C++ and cross-compiling using the Android NDK.

Nested logit model formation to analyze airport parking behavior based on stated preference survey studies

The rapid growth of private car ownership and utilization has resulted in significant parking-related congestion problems at large-scale international airports. Parking facilities located in the peripheral areas of airports could be more efficiently used to mitigate congestion and reduce delays due to dramatically increasing traffic demands and inferiorly designed parking lot configurations. In order to analyze the travelers' parking choice preferences for the off-site airport parking activities, a stated preference survey study was conducted around Terminal 3 at Beijing Capital International Airport. Two nested logit models were formulated to analyze the correlation between travelers' parking behavior and their travel characteristics. The research results indicate that travelers prefer to choose off-site parking facilities for long-term parking. A free and fast operation of connections should be provided in consideration of the long-distance layouts of parking facilities. A classification analysis of travelers with different preferences was conducted and the potential changes in travelers' parking choices to off-site parking lots were quantified. The research findings are helpful for traffic management agencies to develop practical guidelines for the establishment of new parking facilities with multiple access points at airports.

How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis

Local Mentor: Stephanie Teal, MD, MPH ASL Advisor: Nancy Hueppchen, MD, MSc PURPOSE: To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions. BACKGROUND: OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services. METHODS: We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved. RESULTS: 15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&amp;Cs and/or inpatient D&amp;Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities. DISCUSSION: OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.

Performance of on-site Medical waste disinfection equipment in hospitals of Tabriz, Iran.

Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative.