Man\u27s Physical Effects on the Elizabeth RIver

Man\u27s ever increasing activities in the Elizabeth River, i.e. dredging, disposal of dredged material and waterfront development, have drastically altered the river floor, reshaped the shoreline and changed the circulation. Long-continued dredging of shipping channels, which is fostered by coal export, larger ships, and military needs, has moved 220 million cu yds of sediment since 1870. As a result channel depth has increased 1.8 fold, and maintenance dredging rates have doubled about every 35 years. Open water disposal released 40 million cu yds into Hampton Roads and lower Chesapeake Bay. Landfill buried tributary creeks, moved the waterfront into the river and reduced the river area by 27%. As a consequence of reduced area and greater channel depth, current velocity has diminished and near-bottom salinity likely increased. These conditions induce faster sedimentation that in turn, creates a need for greater maintenance dredging and hence, greater disposal. The dredge and fill cycle, therefore, is self-perpetuating. The long-term trends of channel deepening, enlargement, and landfill, are expected to continue in response to larger ships, military needs and projected sea-level rise.https://scholarworks.wm.edu/vimsbooks/1155/thumbnail.jp

Effects of an educational program and a standardized insulin order form on glycemic outcomes in non-critically ill hospitalized patients

BACKGROUND: The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear. OBJECTIVE: To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic control. DESIGN: A cohort study comparing an intervention group (IG) to a concurrent control group (CCG) and an historic control group (HCG). SETTING: University of Michigan Hospital. PATIENTS: Hyperglycemic, noncritically ill hospital patients treated with insulin. INTERVENTION: Physician and nurse education and a standardized insulin order form based on the principles of physiologic insulin use. MEASUREMENTS: Glycemic control and insulin prescribing patterns. RESULTS: Patients in the IG were more likely to be treated with a combination of scheduled basal and nutritional insulin than in the other groups. In the final adjusted regression model, patients in the IG were more likely to be in the target glucose range (odds ratio [OR], 1.72; P = 0.01) and less likely to be severely hyperglycemic (OR, 0.65; P < 0.01) when compared to those in the CCG. Patients in the IG were also less likely to experience hypoglycemia than those in the CCG ( P = 0.06) or the HCG ( P = 0.01). Over 80% of all patient-days for all groups contained glucose readings outside of the target range. CONCLUSIONS: Standardized interventions encouraging the physiologic use of subcutaneous insulin can lead to significant improvements in glycemic control and patient safety in hospitalized patients. However, the observed improvements are modest, and poor metabolic control remains common, despite these interventions. Additional research is needed to determine the best strategy for safely achieving metabolic control in these patients. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78247/1/780_ftp.pd

Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System

<p>Abstract</p> <p>Background</p> <p>Mortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.</p> <p>Methods</p> <p>We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR) files.</p> <p>Results</p> <p>Using EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011). Similar declines were found for in-hospital and 90-day mortality.</p> <p>Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08).</p> <p>Conclusion</p> <p>Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.</p

Book reviews

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45645/1/11199_2004_Article_BF00287975.pd

Newsletter Networks in the Feminist History and Archives Movement

This article examines how networks have been critical to the construction of feminist histories. The author examines the publication Matrices: A Lesbian/Feminist Research Newsletter (1977–1996), to argue that a feminist network mode can be traced through the examination of small-scale print newsletters that draw on the language and function of networks. Publications such as Matrices emerge into wide production and circulation in the 1970s alongside feminist community archives, and newsletters and archives work together as interconnected social movement technologies. Newsletters enabled activist-researchers writing feminist histories to share difficult-to-access information, resources, and primary sources via photocopying and other modes of print reproduction.&nbsp; Looking from the present, the author examines how network thinking has been a feature of feminist activism and knowledge production since before the Internet, suggesting that publications such as Matrices are part of a longer history of networked communications media in feminist contexts

Growing old in a transnational social field: belonging, mobility and identity among Italian migrants

This article focuses on ageing in transnationalism. Drawing on the experiences of Italians in the UK as a paradigmatic example of settled European migrants, it explores the lived experiences of this group of older migrants. Using Levitt and Glick Schiller’s framework,it concentrates first on migrants’ways of being and then on their ways of belonging. The article argues that a transnational lens is necessary to understand the experiences of older migrants and that a focus on older people needs to be incorporated into studies of transnationalism. Through a discussion of their narratives and experiences, the article offers a long view on the migration process and brings attention to the significance of gender, time and the life course to understand both migrants’transnationalism and their integration