The Arbitration Alternative: Its Time Has Come

Arbitration Alternativ

The Rationale Behind and Impact of One Hospital’s Provision of Secondary School Athletic Training Services: A Five-Year Case Study

Purpose: Sports-related injuries are common and often require physician or hospital care. Since the advent of concussion laws in fifty states, hospitals across the country have come forward to partner with secondary schools in the provision of sports medicine healthcare. The outreach agreements are consistent: Hospitals hire athletic trainers (ATs) and then outsource them to schools. ATs help mitigate risk in sports programs. Onsite at the schools daily, ATs provide immediate evaluation and treatment for injuries that occur and render decisions regarding the appropriateness of an injured athlete’s return to participation. The goal of this case study was to describe the experiences of one hospital in relation to (a) the factors the contributed to its administration’s decision to provide athletic training services to area schools, (b) the program structure, (c) the annual costs, and (d) the benefits reaped. Methods: This investigation spanned the course of the first five years of the hospital’s partnership with four separate high schools. Interviews with key hospital and school district administrators along with additional tracking of the number of professional medical referrals helped to illuminate the program’s successes. Results: The partnership proved to be a win-win. It strengthened the hospital’s community relations, provided area school sports programs with much-needed medical oversight, and provided a consistent stream of revenue generation via professional medical referrals, both for the hospital and for its affiliated providers. Conclusion: Hospital administrators should look to this example as one that supports the decision to partner with local schools in the provision of athletic healthcare

Collisional excitation of singly deuterated ammonia NH2_2D by H2_2

The availability of collisional rate coefficients with H$_2$ is a pre-requisite for interpretation of observations of molecules whose energy levels are populated under non local thermodynamical equilibrium conditions. In the current study, we present collisional rate coefficients for the NH$_2$D / para--H$_2$($J_2 = 0,2$) collisional system, for energy levels up to $J_\tau = 7_7$ ($E_u$$\sim$735 K) and for gas temperatures in the range $T = 5-300$K. The cross sections are obtained using the essentially exact close--coupling (CC) formalism at low energy and at the highest energies, we used the coupled--states (CS) approximation. For the energy levels up to $J_\tau = 4_2$ ($E_u$$\sim$215 K), the cross sections obtained through the CS formalism are scaled according to a few CC reference points. These reference points are subsequently used to estimate the accuracy of the rate coefficients for higher levels, which is mainly limited by the use of the CS formalism. Considering the current potential energy surface, the rate coefficients are thus expected to be accurate to within 5\% for the levels below $J_\tau = 4_2$, while we estimate an accuracy of 30\% for higher levels

The small quinolone derived compound HT61 enhances the effect of tobramycin against Pseudomonas aeruginosa in vitro and in vivo.

HT61 is a small quinolone-derived compound previously demonstrated to exhibit bactericidal activity against gram-positive bacteria including methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA). When combined with the classical antibiotics and antiseptics neomycin, gentamicin, mupirocin and chlorhexidine, HT61 demonstrated synergistic bactericidal activity against both MSSA and MRSA infections in vitro. In this study, we investigated the individual antimicrobial activity of HT61 alongside its capability to increase the efficacy of tobramycin against both a tobramycin sensitive laboratory reference strain (PAO1) and tobramycin resistant clinical isolates (RP73, NN2) of the gram-negative bacteria Pseudomonas aeruginosa (P. aeruginosa). Using broth microdilution methods, the MICs of HT61 against all strains were assessed, as well as the effect of HT61 in combination with tobramycin using both the chequerboard method and bacterial time-kill assays. A murine model of pulmonary infection was also used to evaluate the combination therapy of tobramycin and HT61 in vivo. In these studies, we demonstrated significant synergism between HT61 and Tobramycin against the tobramycin resistant P. aeruginosa strains RP73 and NN2, whilst an additive/intermediate effect was observed for P. aeruginosa strain PA01 which was further confirmed using bacterial time kill analysis. In addition, the enhancement of tobramycin by HT61 was also evident in in vitro assays of biofilm eradication. Finally, in vivo studies revealed analogous effects to those observed in vitro with HT61 when administered in combination with tobramycin against each of the three P. aeruginosa strains at the highest tested dose (10 mg/kg)

The IRAM-30m line survey of the Horsehead PDR: III. High abundance of complex (iso-)nitrile molecules in UV-illuminated gas

Complex (iso-)nitrile molecules, such as CH3CN and HC3N, are relatively easily detected in our Galaxy and in other galaxies. We constrain their chemistry through observations of two positions in the Horsehead edge: the photo-dissociation region (PDR) and the dense, cold, and UV-shielded core just behind it. We systematically searched for lines of CH3CN, HC3N, C3N, and some of their isomers in our sensitive unbiased line survey at 3, 2, and 1mm. We derived column densities and abundances through Bayesian analysis using a large velocity gradient radiative transfer model. We report the first clear detection of CH3NC at millimeter wavelength. We detected 17 lines of CH3CN at the PDR and 6 at the dense core position, and we resolved its hyperfine structure for 3 lines. We detected 4 lines of HC3N, and C3N is clearly detected at the PDR position. We computed new electron collisional rate coefficients for CH3CN, and we found that including electron excitation reduces the derived column density by 40% at the PDR position. While CH3CN is 30 times more abundant in the PDR than in the dense core, HC3N has similar abundance at both positions. The isomeric ratio CH3NC/CH3CN is 0.15+-0.02. In the case of CH3CN, pure gas phase chemistry cannot reproduce the amount of CH3CN observed in the UV-illuminated gas. We propose that CH3CN gas phase abundance is enhanced when ice mantles of grains are destroyed through photo-desorption or thermal-evaporation in PDRs, and through sputtering in shocks. (abridged)Comment: Accepted for publication in Astronomy & Astrophysic

C2_2H observations toward the Orion Bar

C$_2$H is one of the first radicals to be detected in the interstellar medium. Its higher rotational transitions have recently become available with the Herschel Space Observatory. We aim to constrain the physical parameters of the C$_2$H emitting gas toward the Orion Bar. We analyse the C$_2$H line intensities measured toward the Orion Bar CO$^+$ Peak and Herschel/HIFI maps of C$_2$H, CH, and HCO$^+$, and a NANTEN map of [CI]. We interpret the observed C$_2$H emission using radiative transfer and PDR models. Five rotational transitions of C$_2$H have been detected in the HIFI frequency range toward the CO$^+$ peak. A single component rotational diagram gives a rotation temperature of ~64 K and a beam-averaged C$_2$H column density of 4$\times$10$^{13}$ cm$^{-2}$. The measured transitions cannot be explained by any single parameter model. According to a non-LTE model, most of the C$_2$H column density produces the lower-$N$ C$_2$H transitions and traces a warm ($T_{\rm{kin}}$ ~ 100-150 K) and dense ($n$(H$_2$)~10$^5$-10$^6$ cm$^{-3}$) gas. A small fraction of the C$_2$H column density is required to reproduce the intensity of the highest-$N$ transitions ($N$=9-8 and N=10-9) originating from a high density ($n$(H$_2$)~5$\times$10$^6$ cm$^{-3}$) hot ($T_{\rm{kin}}$ ~ 400 K) gas. The total beam-averaged C$_2$H column density in the model is 10$^{14}$ cm$^{-2}$. Both the non-LTE radiative transfer model and a simple PDR model representing the Orion Bar with a plane-parallel slab of gas and dust suggest, that C$_2$H cannot be described by a single pressure component, unlike the reactive ion CH$^+$, which was previously analysed toward the Orion Bar CO$^+$ peak. The physical parameters traced by the higher rotational transitions ($N$=6-5,...,10-9) of C$_2$H may be consistent with the edges of dense clumps exposed to UV radiation near the ionization front of the Orion Bar.Comment: Proposed for acceptance in A&A, abstract abridge