Regular Room Research Articles

EDUCAÇÃO INCLUSIVA: A ATUAÇÃO DO PROFESSOR DE APOIO

Este artigo propõe realizar análise e reflexão a respeito do professor de apoio como coparticipante no processo de escolarização de crianças com deficiências dentro da escola inclusiva. Sua participação neste processo é ainda incipiente, uma vez que muitas escolas regulares não sabem que podem contar com este profissional, ou negligenciam na busca de melhores condições de aprendizagem para estas crianças. O trabalho de pesquisa aqui exposto evidenciou estes aspectos. A escola que mantinha o professor de apoio para um aluno com deficiência intelectual se encontrava em vantagem relativa quanto ao desenvolvimento da aprendizagem. Este docente tem um papel bastante importante quando seu trabalho é feito em parceria com o professor da classe. O professor de apoio deve ser um profissional habilitado ou especializado em educação especial, que trabalha com o aluno deficiente que precise de apoio intenso e contínuo e que esteja inserido em salas regulares. Deve auxiliar a criança deficiente, o professor regente e a equipe técnica que por vezes presta atendimento às crianças deficientes. Deve ser detentor de conhecimentos específicos como código de linguagens e técnicas que possibilitem ao aluno o aprendizado dos conteúdos ensinados.

Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden

BackgroundAn important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden.Methods/designFollowing ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms.DiscussionThe findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care.Trial registrationClinicalTrials.gov NCT03948815. Registered 13 May 2019—retrospectively registered.

Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods.

We evaluated environmental contamination by carbapenem-resistant Acinetobacter baumannii (CRAB), the effectiveness of cleaning practices, the performance of aerosolized hydrogen-peroxide (aHP) technology, and the correlation between measures of cleaning and environmental contamination. Serial testing of environmental contamination during a 7-month period. Single-patient rooms in intensive care units (ICUs) and multipatient step-up and regular rooms in internal medicine wards in a tertiary-care hospital with endemic CRAB. CRAB environmental contamination was determined semiquantitatively using sponge sampling. In step-up rooms, 91% of patient units (56% of objects) were contaminated, and half of them were heavily contaminated. In regular rooms, only 21% of patient units (3% of objects) were contaminated. In ICUs, 76% of single-patient rooms (24% of objects) were contaminated. Cleaning did not reduce the number of contaminated objects or patient units in step-up rooms. After refresher training, cleaning reduced the proportion of contaminated objects by 2-fold (P = .001), but almost all patient units remained contaminated. Using aerosolized hydrogen peroxide (aHP) disinfection after discharge of a known CRAB-carrier decreased room contamination by 78%, similar to the reduction achieved by manual hypochloride cleaning. Measuring cleaning efficacy using fluorescent gel did not correlate with recovery of CRAB by sponge cultures. In step-up rooms, the high number of objects contaminated combined with poor efficacy of cleaning resulted in failure to eliminate CRAB in patient units. Fluorescent gel is a poor detector of CRAB contamination. The role of aHP is still unclear. However, its use in multipatient rooms is limited because it can only be used in unoccupied rooms.

End-of-Life Aspects in a Hematopoietic Stem Cell Transplantation Unit: The Integration of Palliative Care Group in the Transplant Process

Topic Significance & Study Purpose/Background/Rationale Patients submitted to Hematopoietic Stem Cell Transplantation (HSCT) are affected by a burden of symptoms arising from conditioning treatment, clinical complications such infections, bleeding disorders, leading to physical and psychological suffering. The understanding of how hematological patients are managed in the end-of-life may provide improvement in the quality of care since it seems hematological patients have less access to palliative care (PC) when compared to solid tumors. The aim of this study was evaluate the end-of-life scenario of our patients that died after HSCT followed or not by PC team and try to improve the care practice of this patients Methods, Intervention, & Analysis We retrospectively analyzed patients submitted to HSCT who died between January, 2010 and July, 2018 in a single private hospital in Sao Paulo, Brazil. It was recorded cause of death: if TRM (Transplant related Mortality) or relapse/ disease progression (DP) related; the local of death ICU (intensive care unit) or regular room and PC team intervention. For statistical analysis was used Chi-square and likelihood ratio test. Findings & Interpretation A total of 460 patients received HSCT in this period. 345 (75%) adults and 115 (25%) pediatrics. Among them 125 (27,1%) died 101 (80%) adults and 24 (20%) children. In the pediatric population 15 (62.5%) died due TRM and all died in the ICU, PC team followed just one (7%) patient. Nine (37.5%) died due DP, and just one (4%) patient was followed by PC team, and died in regular room free of invasive therapy. In the adult population 55 (54,5%) died due TRM, the PC team followed 10 (18%), of them and; 8 (14.5%) died in ICU. Forty-six (45.5%) of patients died by DP and, 26 patients (56.5%) were followed by PC team, and 16 (35%) died in regular room. Twenty patients were not followed by CP team and 17 (37%) out 20 died in the ICU. In the adult population patients who were followed by PC team have less chance of being transferred to ICU (p Discussion & Implications Our mortality rate is similar to literature, but few patients were followed by PC team. A new practice was established in January 2018 and PC team starts evaluating all adult patients undergoing HSCT. The first visits was in the pre transplant evaluation and then followed by weekly visits during admission period interfering in symptoms management, with this we hope to increase the quality of the assistance offered in the final stage of life. In respect to pediatric patients we are in the process of evaluating our gaps for service implementation. When the PC team is introduced we observed an improved management of patients, family and health team with a decrease of transfers for ICU, giving better quality at the end of life.

Hematological status and endurance performance predictors after low altitude training supported by normobaric hypoxia: a double-blind, placebo controlled study.

The benefits of altitude/hypoxic training for sea level performance are still under debate. This study examined the effects of low altitude training supported by normobaric hypoxia on hematological status and endurance performance predictors in elite female cyclists. Twenty-two female cyclists trained for 3 weeks at low altitude (<1100 m) and 2 weeks near sea level. During the first 3 weeks, 15 subjects stayed in hypoxic rooms simulating an altitude of 2200 m (+NH group, n = 8) or 1000 m (placebo group, n = 7), and 7 (control group) stayed in regular rooms. Significant increases in total hemoglobin mass (tHb-mass: p = 0.008, p = 0.025), power at 4 mmol·l-1 lactate (PAT4: p = 0.004, p = 0.005) (in absolute and relative values, respectively) and maximal power (PF: p = 0.034) (in absolute values) were observed. However, these effects were not associated with normobaric hypoxia. Changes in tHb-mass were not associated with initial concentrations of ferritin or transferrin receptor, whereas changes in relative tHb-mass (r = -0.53, p = 0.012), PF (r = -0.53, p = 0.01) and PAT4 (r = -0.65, p = 0.001) were inversely correlated with initial values. Changes in tHb-mass and PAT4 were positively correlated (r = 0.50, p = 0.017; r = 0.47, p = 0.028). Regardless of normobaric hypoxia application, low altitude training followed by sea-level training might improve hematological status in elite female cyclists, especially with relatively low initial values of tHb-mass, which could translate into enhanced endurance performance.

Multichannel Blind Sound Source Separation Using Spatial Covariance Model With Level and Time Differences and Nonnegative Matrix Factorization

This paper presents an algorithm for multichannel sound source separation using explicit modeling of level and time differences in source spatial covariance matrices (SCM). We propose a novel SCM model in which the spatial properties are modeled by the weighted sum of direction of arrival (DOA) kernels. DOA kernels are obtained as the combination of phase and level difference covariance matrices representing both time and level differences between microphones for a grid of predefined source directions. The proposed SCM model is combined with the NMF model for the magnitude spectrograms. Opposite to other SCM models in the literature, in this work, source localization is implicitly defined in the model and estimated during the signal factorization. Therefore, no localization preprocessing is required. Parameters are estimated using complex-valued nonnegative matrix factorization with both Euclidean distance and Itakura–Saito divergence. Separation performance of the proposed system is evaluated using the two-channel SiSEC development dataset and four channels signals recorded in a regular room with moderate reverberation. Finally, a comparison to other state-of-the-art methods is performed, showing better achieved separation performance in terms of SIR and perceptual measures.

The effect of dedicated exit on the evacuation of heterogeneous pedestrians

A social force model is proposed in this paper to study the effect of dedicated exit on the evacuation of heterogeneous pedestrians in a public place. In this model, pedestrians are divided into two groups—powerful pedestrians and weak pedestrians, who have different walking abilities. Several exit design schemes are compared through simulations in a regular room. The main results are: (1) Building a new exit as weak group’s dedicated exit can simultaneously reduce each group’s average evacuation time and maximum evacuation time. (2) Reconstructing an existing ordinary exit as weak group’s dedicated exit can reduce weak pedestrians’ average evacuation time but may increase their maximum evacuation time. (3) If the total number of exits is fixed, compared with the non-dedicated exit scheme, the scheme which designs dedicated exits for each group separately may reduce weak group’s evacuation speed. (4) If the sum of widths of all the exits is fixed, the ratio of width between the dedicated exit and the ordinary exit has a significant effect on each group’s evacuation. The optimal ratio depends on the proportion of weak pedestrians. Finally, a real-world example which involves the evacuation issue in a waiting hall with security checkpoints is used to show the effectiveness of women-only exits in improving the crowd evacuation efficiency. Particularly, it is found that a suitable women-only exit scheme can achieve a win-win situation for both male pedestrians and female pedestrians in the crowd evacuation.

Radioprotection Measures during the Learning Curve with Hybrid Operating Rooms

Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms (ORs) using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HORs) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose. The purpose of the present study is to determine the amount of absorbed radiation using an HOR in comparison with a portable C-arm unit and to assess whether the radioprotection awareness of the surgical team influences the radiation exposure. The primary end point was the effective dose in milliSievert (mSv) for the surgical team and the average dose-area product (ADAP) in Gray-meters squared (Gym2) for patients. The values of absorbed radiation of the surgical team's dosimeters were collected from January 2015 to May 2016. The HOR was installed in June 2015, and a radioprotection seminar was given in October 2015. The HOR-issued radiation, measured by the maximum dose-area product, ADAP, average dose (AD) per procedure, maximum dose per procedure per month, maximum fluoroscopy time, average fluoroscopic time, peak skin dose, and average skin dose (ASD), was collected monthly from September 2015 to July 2016. The timeline was divided into 3 periods: 5months pre-HOR (Pre-HOR), 5months after the HOR installation (PreS-HOR), and 5months after a radioprotection seminar (PostS-HOR). The average number of procedures per month was 22.55 (±4.9), including endovascular aneurysm repair/thoracic endovascular aneurysm repair, carotid, visceral, and upper and lower limb endovascular revascularization. The average amount of absorbed radiation by the surgeons during PreS-HOR was 1.07±0.4mSv, which was higher than the other periods (Pre-HOR 0.06±0.03mSv, P=0.002; PostS-HOR 0.14±0.09mSv, P=0.000, respectively). The ADAP during PreS-HOR was 0.016±0.01 Gym2, which was lower than the PostS-HOR (0.001±0.002 Gym2) (P=0.034). The AD during PreS-HOR was 0.78±0.3Gy and 0.39±0.3Gy during PostS-HOR (P=0.098). The ASD during PreS-HOR was 0.40±0.2Gy and 0.20±0.1Gy during PostS-HOR (P=0.099). In our experience, the HOR increases the amount of absorbed radiation for both patients and surgeons. The radioprotection seminars are of utmost importance to provide a continued training and optimize the use of ionizing radiation while using an HOR. Despite the awareness of the surgical team in the radioprotection field, the amount of absorbed radiation using an HOR is higher than the one using a C-Arm unit.

PROTOCOL FOR REDUCING TIME TO ANTIBIOTICS IN FEBRILE NEONATES PRESENTING TO THE EMERGENCY DEPARTMENT: A QUALITY IMPROVEMENT INITIATIVE

BACKGROUND: Febrile neonates are at high risk of morbidity and mortality from infectious causes. This risk further increases if antibiotics are not received in a timely manner. Current guidelines recommend early initiation (less than 1 hour) of antibiotics for patients with severe sepsis. Time-to-antibiotic administration (TAA) should also be targeted as a quality-of-care (QOC) measure for febrile neonates. A previous evaluation showed that most of these patients were not receiving antibiotics in the first hour at our emergency department (ED). OBJECTIVES: We evaluated whether a simple quality improvement protocol would improve the proportion of febrile neonates receiving antibiotics within 60 minutes of arrival to the ED. DESIGN/METHODS: This was a pre-post intervention study conducted in the ED of an academic pediatric tertiary care hospital with an annual volume of approximately 83,000 patients in 2014-2016. Participants were a random sample of all children younger than 28 days old visiting the ED for a febrile illness. The new protocol, which consisted for the nurses, after triage, to place the patients directly in the resuscitation room for immediate assessment by a physician, was implemented in February 2016. Previously, these children were triaged level 2 on the Canadian Triage and Acuity Scale (CTAS), flagged and placed in a regular examination room waiting for the physician assessment. With the new protocol, IV access, blood culture, urine analysis and culture were immediately obtained by the nurse in charge with the concomitant assessment by the attending physician. Forty charts prior to and 50 charts after protocol initiation were reviewed by an archivist using a standardized form between 2014-2015 and 2016, respectively. The primary outcome was TAA. This was defined as the time from initial ED registration to the beginning of antibiotics infusion. As a secondary outcome, all cases were reviewed individually to determine barriers to rapid antibiotic administration (day, evening, or night shifts, other treatments or investigations, number of attempts for intravenous access) and to elicit new quality improvement strategies. RESULTS: During the study periods a total of 178 (pre) and 135 (post) patients fulfilled the inclusion criteria. Among the random samples, 6/50 (12%) of patients received their antibiotics within 60 minutes in the post-intervention period compared to 0/40 (0%) in the pre-implementation period (difference 12%; 95 CI: 1-24%). Within 90 minutes, the proportion improved from 1/40 (2.5%) to 29/50 (58%) (difference 56%; 95 CI: 38-68%). Median TAA in febrile neonates decreased from 182 minutes (interquartile range, 147-219 minutes) in the pre-implementation period to 85 minutes (interquartile range, 73-115 minutes) in the post-implementation period. The main obstacle to the goal of 60 minutes for TAA was the difficulty to get IV access as well as antibiotic availability. CONCLUSION: In this study, a new protocol mandating the immediate transfer of febrile neonate from triage to the resuscitation room improved proportion of febrile neonates receiving antibiotics in less than 60 minutes in our ED. Our results suggest that simple interventions can reduce TAA in a selected group of patients presenting to the ED.

Influence of carbon nanotubes, nanosilica and nanometakaolin on some morphological-mechanical properties of oil well cement pastes subjected to elevated water curing temperature and regular room air curing temperature

Nanotechnology has shown great potential in different applications and presents solutions to some of the upstream and downstream challenges in the oil and gas industry. This research work aimed to improve the mechanical properties of oil well cement (OWC) pastes using multiwall carbon nanotubes (CNTs), nano-silica (NS) and nano-metakaolin (NMK). The effect of different curing temperatures, namely; room temperature and elevated temperature (90°C) on the hydration reaction of OWC pastes admixed with different nano materials was investigated. XRD, TG/DTG, and SEM techniques were used to investigate the phase composition and the microstructure of some selected hardened specimens. The obtained results indicated that all of the nano materials used in this study cause a notable improvement in the mechanical properties of hardened OWC pastes at both curing temperatures. In addition, NMK – OWC hardened pastes present the highest improvement in the mechanical properties among all of other tested mixes.

Proctoring to improve teaching practice

Universities organise digital summative assessments in special assessment computer rooms and they conduct strong restrictions on the resources. This policy assures safety and security of assessments but obstructs authentic problem solving where open resources are needed. A digital assessment room is also not a proper solution when students for some reason cannot attend the assessment on campus. We present three scenarios from the science and mathematics teaching practice at the University of Amsterdam in which we have used proctoring to create the flexibility of online exams that was needed. Online remote proctoring of computer screens on the campus and/or students at home enabled (1) more authentic exams by allowing open resources, (2) use of own laptops (BYOD) in a regular lecture room, (3) off campus online exams as a part of an online programme, for example, at home anywhere in the world. We have shown that proctoring is not just a different way to control students using computers, but that it enabled improvement of the quality of learning processes in which summative assessments are an integral part.

Adipose-Specific Deficiency of Fumarate Hydratase in Mice Protects Against Obesity, Hepatic Steatosis, and Insulin Resistance.

Obesity and type 2 diabetes are associated with impaired mitochondrial function in adipose tissue. To study the effects of primary deficiency of mitochondrial energy metabolism in fat, we generated mice with adipose-specific deficiency of fumarate hydratase (FH), an integral Krebs cycle enzyme (AFHKO mice). AFHKO mice have severe ultrastructural abnormalities of mitochondria, ATP depletion in white adipose tissue (WAT) and brown adipose tissue, low WAT mass with small adipocytes, and impaired thermogenesis with large unilocular brown adipocytes. AFHKO mice are strongly protected against obesity, insulin resistance, and fatty liver despite aging and high-fat feeding. AFHKO white adipocytes showed normal lipolysis but low triglyceride synthesis. ATP depletion in normal white adipocytes by mitochondrial toxins also decreased triglyceride synthesis, proportionally to ATP depletion, suggesting that reduced triglyceride synthesis may result nonspecifically from adipocyte energy deficiency. At thermoneutrality, protection from insulin resistance and hepatic steatosis was diminished. Taken together, the results show that under the cold stress of regular animal room conditions, adipocyte-specific FH deficiency in mice causes mitochondrial energy depletion in adipose tissues and protects from obesity, hepatic steatosis, and insulin resistance, suggesting that in cold-stressed animals, mitochondrial function in adipose tissue is a determinant of fat mass and insulin sensitivity.

Stridor at Birth: Congenital Laryngeal Web

Stridor at Birth: Congenital Laryngeal Web

Demand Growth in Services: A Discrete Choice Analysis of Customer Preferences and Online Selling

ABSTRACTThe selling of perishable services (e.g., hotel rooms, airline seats, and rental cars) online is increasingly popular with both retailers and consumers. Among the innovative approaches to online sales is opaque selling. First popularized by Priceline.com's name‐your‐own‐price model, opaque selling hides some attributes of the service (notably, brand and specific location) until after the purchase decision, in exchange for a discounted price. This means that a branded “product” is being sold as somewhat of a commodity, but the brand “name” is protected by the opaque model. The attraction of this model for retailers is that they are presumably able to increase their revenue stream, albeit at a lower rate, by selling rooms that otherwise would remain in inventory. In this article, we outline the development and analysis of an online choice survey to understand consumer preferences among three types of online distribution channels: regular full information sales channels, and opaque sales channels with or without consumer bidding. A Multinomial Logit model is employed to analyze the data and measure the consumer trade‐offs between price and other attributes of the product. We use the estimated model to calculate the incremental demand and revenue created by using an opaque channel simultaneously with regular full information channels. On balance, we find that correctly priced opaque channels can add to hotels revenue streams without undue cannibalization of regular room sales.

RECOMMENDATIONS FOR SCREENING AND MONITORING OF HEARING IN NEWBORNS AND YOUNG CHILDREN

The review article presents the recommendations of professional associations: American Academies of Audiology, Pediatrics, and Otolaryngology-Head and Neck Surgery; the American Speech-Language-Hearing Association; the Council on Education of the Deaf; Directors of Speech and Hearing Programs in State Health and Welfare Agencies; and the Alexander Graham Bell Association for the Deaf and Hard of Hearing for screening and monitoring of hearing in infants and young children. Hearing loss in newborns was shown to develop due to defects in sound-conducting, neurosensory and mixed types. Conductive deafness is usually due to abnormalities of the outer or middle ear, limits the amount of sound that gets access to the inner ear; neurosensory hearing loss is caused by lesions of the cochlea or auditory analyzer - the most common cause of hearing loss in newborns. It was found that children who were hospitalized in the neonatal intensive care have a high risk of auditory neuropathy as compared to those who were taken to a regular room for the newborn. Mixed loss is a combination of conductive hearing loss with neurosensory deafness. The article presents the modern and effective electrophysiological techniques used for screening: auditory brainstem evoked potentials and oto-acoustic emissions. The peculiarities of the monitoring of infant hearing before discharge from obstetric department and risk factors for neurosensory deafness are presented: hospitalization in the neonatal intensive care unit, hereditary syndromes, family history of hearing loss, craniofacial abnormalities, congenital infections, bacterial meningitis, severe hyperbilirubinemia and blood transfusion. Current data of the efficacy of single-stage and two-stage screening protocols are presented. There are present an effective screening program steps of hearing loss in infants and young children: screening at least of 95 percent of infants before their discharge from the hospital; understanding that a relative number of false-positive findings (babies with a positive screening test who do not have hearing loss) was ≤ 3 percent and the number of referrals for audiologic testing after getting a positive screening result was ≤ 4 percent, and the relative number of false-negative findings (babies with significant impairment of hearing have not been detected by the screening test) was zero; the number of infants who remained under further observation, who were referred to audiologic examination and not tested by a screening test in the hospital (the parents did not refuse screening) was not less than 95 percent; rescreening infants who were re-admitted to hospital within the first month of life due to the conditions associated with potential hearing loss (eg, hyperbilirubinemia); an effective communication system that ensures the transfer of the results of a screening test from the hospital to the parents and responsible health professionals providing primary health care, as well as the referral of babies who did not pass a screening test for audiological examination. The recommendations and the steps of sending children to surdological comprehensive examination are presented. The author focused on the absence of documents regulating the screening and hearing monitoring since the neonatal period.

Hallway Patients Reduce Overall Emergency Department Satisfaction

BackgroundPatient satisfaction impacts emergency medicine in multiple ways, including patient−physician rapport, patient compliance with medical recommendations, and individual physician and hospital reimbursement issues. ObjectiveThe objective of this study was to assess the differences, if any, in satisfaction scores among patients treated in regular treatment rooms vs. those treated in hallway treatment areas. MethodsA cross-sectional survey study of conveniently sampled participants from both regular treatment rooms and hallway treatment areas in an urban, adult community teaching emergency department (ED) was performed confidentially, measuring overall satisfaction, as well as satisfaction with regard to treatment location only, medical care only, and their willingness to return to or recommend the ED in the future based on their experience. Each of these four outcomes was measured on a 100-mm visual analog scale. ResultsOverall satisfaction scores were 8 mm lower for those patients treated in hallway treatment areas, and there was a 20-mm difference with regard to location only. After controlling for apparent baseline differences between the groups, a 7.6-mm difference for overall satisfaction remained. ConclusionsDespite differences between patients placed in regular treatment rooms vs. hallway treatment areas, overall satisfaction levels are lower for those patients treated in hallway treatment areas. This difference is likely attributable primarily to their hallway location, and stakeholders should therefore take appropriate steps to address such discrepancies.

Admission versus observation: clinically impactful or just a reimbursement shell game?

In the article “Impact of Observation Status on Hospital Use for Patients With Cancer, Lipitz-Snyderman et al show that an observation unit can reduce hospital admissions. Recent literature shows that the inceasing use of emergency rooms has resulted in increased hospital admissions. So programs targeting urgent care centers would make sense to help reduce cost and resource use. The Affordable Care Act and recent Centers for Medicare and Medicaid Services rulings have also put additional focus on the emergency room as the source of hospital admissions. One has to wonder how much reimbursement issues are driving the whole issue of inpatient versus outpatient care. In the article, the authors show a reduction in the number of patients admitted from the urgent care center from 50% in the period before use of the observation unit to 47% after the observation unit was implemented. It was noted that the total length of time within the hospital environment was decreased from 96 hours in the initial 6 months to 93 hours after the observation unit was in place. These numbersaresmall, andit isquestionablewhether,althoughstatistically significant, they are really meaningful. A point of interest in this article that was not addressed is that before the establishment of the observation unit, 50% of the patients were discharged to home from the Urgent Care Center, whereas in the post observation unit period, only 47%of thepatientswereactuallydischargedtohomefromtheUrgent Care Center. As a result, 53% of the total population actually accessed some type of hospital services. This would bring into question the conclusion that hospital use was actually reduced. In this retrospective study, cost and clinical outcomes were not addressed. It should be noted that studies in other disease entities have shown significant savings for the hospitals. Of interest is that this use of outpatient observation units can sometimes result in increased cost to the patient. Two factors that appear to be critical to be successful observation unit include a dedicated clinical team that follows the patient according to clinically vetted protocols. Also, it would appear that the most successful units are those that have a designated area and are not integrated into the general hospital setting. The term “observation unit” can have a number of different meanings in any particular institution. We need to be careful that regular inpatient hospital rooms are not randomly titled “observation” and, indeed, are not separated from the general inpatient population solely for economic considerations. The authors are to be applauded for their effort to reduce cost and resource use. In personal communications with a number of commercial carriers’ medical directors, it was noted that one of the largest drivers for rising health care costs was the increase in emergency room use and hospital admissions. Many of the services noted in the article are the types of treatments that could have been provided in officebased,privatepractice settings.Numerous studieshave shownthat it is more cost effective to provide treatments in a private practice rather than in a hospital-based system. Many of the new proposed compensation models include expanded access to patients and the provision of health care services in the outpatient practice setting. The oncology medical home is one such model that would seem to meet many of these needs in a more cost-effective way. Although the authors’ study shows a positive reduction in hospital admissions, to be truly meaningful, future studies—including those addressing practice patient programs—need to include cost and clinical outcomes as part of their analysis.

Contamination and release of nanomaterials associated with the use of personal protective clothing.

We investigated nanomaterial release associated with the contamination of protective clothing during manipulation of clothing fabrics contaminated with nanoparticles. Nanomaterials, when released as airborne nanoparticles, can cause inhalation exposure which is the route of exposure of most concern to cause adverse health effects. Measurement of such nanoparticle re-suspension has not yet been conducted. Protective clothing can be contaminated with airborne nanoparticles during handling and operating processes, typically on the arms and front of the body. The contaminated clothing could release nanoparticles in the general room while performing other activities and manipulating the clothing after work. The exposures associated with three different fabric materials of contaminated laboratory coats (cotton, polyester, and Tyvek), including the magnitude of contamination and particle release, were investigated in this study by measuring the number concentration increase and the weight change on fabric pieces. This study simulated real life occupational exposure scenarios and was performed in both regular and clean room environments to investigate the effect of background aerosols on the measurements. Concentration were measured using particle spectrometers for diameters from 10nm to 10 µm. Collected aerosol particles and contaminated fabric surfaces were characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and elemental composition analysis. The magnitude of particle release from contaminated lab coat fabric was found to vary by the type of fabric material; cotton fabric showed the highest level of contamination and particle release, followed by Tyvek and polyester fabrics. The polyester lab coat material was found to have the lowest particle release to deposition (R/D) ratio. The particle release number concentrations were in a range of 768-119 particles cm(-3) and 586-187 particles cm(-3) in regular and clean rooms, respectively. Multiple peaks were observed in the number concentration distribution data, with particle diameters peaking at 40-50 and 100-300nm. The SEM analysis of the contaminated fabric surface found test particles and other environmental particles. The elemental composition analysis presented detectable response to the studied alumina oxide particles. The laboratory coat primarily made of cotton woven material is not recommended for worker protection against nanoparticle exposure because of the highest particle contamination and release ability. In addition, the result demonstrated that a well-controlled (cleanroom) environment is critical to investigate the factors affecting nanoparticle interaction with protective clothing.

독거노인을 위한 노인공동생활시설의 유니버설 디자인 적용성 평가 연구 - 경기도 지역 '카네이션하우스'를 중심으로 -

Today, the number of the elderly living alone without any family members is on a sharp rise, and those aged people living alone are making these social issues such as solitary death, depression and suicide more popular. In order to resolve the issues, some of the local governments have been supporting the elderly living alone in common houses that would be used by senior citizens only. This study became interested in this 'carnation house' which has been carried out targeting the elderly living alone in Gyeonggi-do, and selected elementary universal design factors that should be applied to general residential environments of the aged people and analyzed the factors. As a case study, this research investigated four carnation houses as research subjects and came up with these following ideas about how to make improvements. First, the study found out that all the entrances did not have raised letters and that UD has not been satisfactorily applied to both the thresholds and the effective widths, and that is considered something to be fixed. Second, in case of regular rooms and living rooms, none of the rooms failed to have safety doorknobs which should have been installed and plus, thresholds and stepped pulleys need to be removed, Third, it goes the same with the kitchens, and the thresholds should be eliminated while cabinets are secured. In addition, furniture that understands the elderly's measurements should be used. Fourth, in terms of restrooms, they should be designed to be spacious enough not to cause anyone in wheelchairs inconvenience, and the study suggests that the effective widths should be widened and that both the safety doorknobs and the emergency calls must be installed. Basically, after the test on the UD adaptability, the study concluded that the application rates in connection with the adaptability were low which led the study to assume that such result has been gained due to the lack of installation standards in relation to the common living facilities of the elderly. The study now argues that purposes of buildings should be first clarified and then, these detailed space planning guidelines that deal with general characteristics of the aged people should be established.

Regular Education Teachers’ Attitudes towards Inclusion in Oman

The objectives of the study were to investigate regular education teachers’ attitudes towards inclusion and their educational setting preferences for teaching students with disabilities. In addition, the impact of teachers’ gender and teaching experience on the attitudes towards inclusion were examined. Seven hundred three Omani regular education teachers participated in this study. The findings suggest that the Omani regular education teachers held neutral behavior, cognitive, and affective attitudes towards inclusion; and a small minority of teachers believed that full inclusion in regular education classrooms or resource rooms were the best educational settings for educating the students with disabilities in comparison with other educational settings. Finally, the results indicated that there were significant relationships between teachers’ gender, teaching experience, and educational settings preference for educating students with disabilities and teachers' attitudes towards inclusion.