Further evidence for a relatively high sea level during the penultimate interglacial: open-system U-series ages from La Marina (Alicante, East Spain)

The elevation and timing of high sea stands during Oxygen Isotope Stage (OIS) 7 are not as well constraíned as those of OIS 5e. Conflictíng values are reported from Medíterranean coastlines, and fossil dating is inaccurate because of ubiquitous open U-series systems. New morphostratigraphic data from La Marina (eastem Spain) supported by open-system U-series coral ages shed light on the maximum sea level duríng OIS 7. Fossil corals (Cladocora Caespitosa) underlying an OIS 5e marine unít yielded U-series ages from 178 ± (0 to 208 ± 1) ka (± 20σ n=7) with an outlier al 240 ± 18 ka. Mean open-system limit ages of 170 ± 10 (minimum age after correction for 234Th-230Th uptake) and 237 ± 20 ka (maximum ase after correction for 238U - 234U uptake) were calculated to have a probable age closer to the minimum value, for an assignment of OlS 7a or 7c. The occurrence of a warn-water "Senegalese" fauna (Strombus bubonius) in OIS5e and OIS 7 marine units confirms the arrival of tropical species to the Mediterranean before the last interglacial periodo Morpho-sedimentological and neotectonic studies suggest that the maximum paleo-sea level during OIS 7c or 7a was a few melers below that of OlS Se

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

<p>Abstract</p> <p>Background</p> <p>Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.</p> <p>Methods/design</p> <p>Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.</p> <p>Discussion</p> <p>By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00636675">NCT00636675</a></p

Ultrasonic measurement of the growth of fetal limb bones in normal pregnancy

Peer Reviewe

Prenatal diagnosis of anterior duplication anomaly (dicephalus diauchenos) by ultrasonography

Peer Reviewe

Fetal response to external mechanical stimuli

Peer Reviewe

On the incidence of errors in large epidemiology studies with comments on evaluation, interpretation, and future surveys

Peer Reviewe

Problems in using linear ultrasound parameters for the determination of fetal weight

Peer Reviewe