Electrodynamics of Media

Contains reports on two research projects.Joint Services Electronics Programs (U. S. Army, U. S. Navy, and U. S. Air Force) under Contract DA 28-043-AMC-02536(E)U.S. Air Force (ESD) Contract F19628-70-C-006

Shoreline for the public: a handbook of social and legal considerations regarding public recreational use of the nation's coastal shoreline.

n.p.No abstract availablehttp://gbic.tamug.edu/request.ht

Reduction in coronary artery bypass grafting surgery mortality and morbidity during a 3-year multicenter quality improvement project.

OBJECTIVE: Risk-adjusted operative mortality is a key quality measure for isolated coronary artery bypass grafting. Through a multicenter quality improvement initiative, we sought to improve this measure at 14 surgical programs within a large and geographically dispersed health care system. METHODS: Observed mortality and combined mortality/morbidity rates for isolated coronary artery bypass grafting were collected from January 2014 to June 2017. Expected mortality and mortality/morbidity rates were determined using the Society of Thoracic Surgeons risk models. The observed/expected ratios during the baseline (2014) and final 12-month outcome period were compared. The quality improvement intervention was multifaceted and surgeon led, and consisted of (1) regular sharing of unblinded data, (2) standardized quality improvement processes, (3) regular system-wide quality improvement meetings, (4) annual observed/expected mortality targets, (5) identification of underperforming institutions and creation of nonpunitive quality improvement action plans, and (6) implementation of checklists to drive perioperative care standardization. RESULTS: The observed/expected ratio of mortality was 1.19 during the baseline period and decreased to 0.59 for the outcome period (P = .004) without a change in expected mortality or case volume. The observed/expected ratio decreased for mortality/morbidity, and mortality without antecedent morbidity was almost eliminated. CONCLUSIONS: A significant and clinically meaningful 50% reduction in the observed/expected ratio for isolated coronary artery bypass grafting mortality was observed during a multifaceted quality improvement initiative across a large multicenter health care system. Morbidity also decreased. Keys to success included surgeon leadership and engagement, frequent unblinded data sharing, development of standardized quality improvement processes, improvement and standardization of care delivery, setting of quality improvement targets, and a shared vision for improved patient outcomes

‘Sustainable City’ requires ‘recognition’—The example of environmental education under pressure from the compact city

The compact city is advocated as a key strategy to establish sustainable cities. Compact city policy implies urban densification, sometimes with elimination of green space. Citizen’s valuable arguments in urban densification developments in green space are easily ignored, as is explored in a case study in Amsterdam, the Netherlands. Place making decisions are more often legitimized with sustainability claims, and arguments from less convinced residents are denied or remain unexamined. About green space these also concern environmental qualities significant for long term sustainability of cities. This is illustrated by presenting empirical evidence about environmental education, an argument emerging from the explorative study. Environmental education should be seen as an important element in longterm sustainability, but the educational relevance of proximity of green space to schools had remained unknown. Empirical evidence of the negative effect of larger distances to green space on environmental education is presented in a geographical survey. The results suggest that close proximity to urban green space also reinforces fieldwork activities further away. As the validity of this argument was denied in the case study, this illustrates the need to establish frameworks that foster recognition and learning in open processes in urban densification