Implementing pediatric inpatient asthma pathways.

ObjectivePathways are succinct, operational versions of evidence-based guidelines. Studies have demonstrated pathways improve quality of care for children hospitalized with asthma, but we have limited information on other key factors to guide hospital leaders and clinicians in pathway implementation efforts. Our objective was to evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways.MethodsThis was a mixed-methods study of hospitals participating in a national collaborative to implement pathways. Data sources included electronic surveys of implementation leaders and staff, field observations, and chart review of children ages 2-17 years admitted with a primary diagnosis of asthma. Outcomes included adoption by hospitals, pathway implementation factors, and reach of pathways to children hospitalized with asthma. Quantitative data were analyzed using descriptive statistics and multivariable regression. Qualitative data were analyzed using thematic content analysis.ResultsEighty-five hospitals enrolled; 68 (80%) adopted/completed the collaborative. These 68 hospitals implemented pathways with overall high fidelity, implementing a median of 5 of 5 core pathway components (Interquartile Range [IQR] 4-5) in a median of 5 months (IQR 3-9). Implementation teams reported a median time cost of 78 h (IQR: 40-120) for implementation. Implementation leaders reported the values of pathway implementation included improvements in care, enhanced interdisciplinary collaboration, and access to educational resources. Leaders reported barriers in modifying electronic health records (EHRs), and only 63% of children had electronic pathway orders placed.ConclusionsHospitals implemented pathways with high fidelity. Barriers in modifying EHRs may have limited the reach of pathways to children hospitalized with asthma

Lining of Perennial Canals Under Flowing Conditions by Ulomat Grouted Mattress Technique

Irrigation water is made available to the farmers by means of construction of a dam/weir and a canal system taking off from the reservoir impounded behind the dam. This water is therefore very precious. If the canal system is not lined, about 25 to 30 per cent of water released in the canal is lost by way of seepage through canals. Canals should therefore be lined not only to save this water but also to irrigate additional area. A pilot project of providing such lining on experimental basis was taken up for the first time in India by Irrigation Department of the Government of Gujarat. The lining has been provided on their canals of different capacities in the Ukai-Kakrapar command. Also a special experimental model has been developed in the laboratory to evaluate the interacted efficiency of grout and geotextile mattress from the consideration of strength and permeability

ENVIROMENTALLY BENIGN ACCOUSTICAL AUTOMOTIVE NONWOVEN FLOOR COVERINGS

Abstract It is important to automobile manufacturers to eliminate unwanted noise in passenger compartments of vehicles. The ability to reduce noise inside the vehicle enhances the perceived value of the vehicle to the consumer. One of the methods to make passenger compartments free from noise is to use sound absorbing materials such as floor coverings, package trays, door panels and luggage compartments in auto interiors. Natural fibers are noise absorbing materials that are renewable and biodegradable. Floor coverings made with natural fibers (kenaf, jute, waste cotton, and flax) in blends with polypropylene (PP) and polyester (PET) were developed as carded needlepunched nonwovens. The acoustic properties of these floor coverings, used either alone or in combination with (a) a rebonded polyurethane foam underpad or (b) a soft cotton nonwoven underpad, were test evaluated by ASTM E 1050 "Impedance and Absorption of Acoustical Materials Using A Tube, Two Microphones and Digital Frequency Analysis System." The measurements demonstrated that each of the natural fiber based nonwoven floor coverings contributed to noise reduction

Emerging stronger? Assessing the outcomes of Habitat for Humanity’s housing reconstruction programmes following the Indian Ocean tsunami

Habitat for Humanity (HFH) built, rehabilitated or repaired homes for 25,000 families in four countries in the five years following the Indian Ocean tsunami in 2004. As part of a broader organizational and learning review in 2009-2010, HFH commissioned Arup International Development to carry out an assessment of its post-tsunami housing reconstruction programmes in India, Sri Lanka, Thailand, and Indonesia. The purpose of this assessment was to investigate the extent to which HFH’s tsunami-response housing reconstruction programmes had contributed to the development of sustainable communities and livelihoods. Arup International Development undertook the assessment using the ASPIRE tool they had developed with Engineers Against Poverty. Basing their assessment on programme documentation and key informant interviews, household questionnaires and workshops with communities in each country, they completed one assessment for each country and a fifth assessment covering all four countries. This enabled comparison of both the impact of these four programmes and how the outcomes varied as a result of varying approaches and contextual issues. / The assessment found that HFH’s programme had made a significant contribution to the development of sustainable communities and livelihoods. The provision of high quality core homes had reduced household vulnerability and increased the standard of living, while HFH’s participatory process had increased community cohesion and developed positive relationships between communities and a range of external actors. There were also areas for improvement such as: the incorporation of hazard assessment, settlement planning and infrastructure at settlement level; greater community participation in decision-making regarding settlement planning, house design and the choice of appropriate construction techniques and technologies; greater focus on livelihood support and diversification both during construction and after completion of the housing programme; and complementing HFH’s experience in housing construction with the specialist expertise of other actors to maximize the impact of its work

Very hard states in neutron star low-mass X-ray binaries

We report on unusually very hard spectral states in three confirmed neutron-star low-mass X-ray binaries (1RXS J180408.9-342058, EXO 1745-248, and IGR J18245-2452) at a luminosity between ~ 10^{36-37} erg s^{-1}. When fitting the Swift X-ray spectra (0.5 - 10 keV) in those states with an absorbed power-law model, we found photon indices of \Gamma ~ 1, significantly lower than the \Gamma = 1.5 - 2.0 typically seen when such systems are in their so called hard state. For individual sources very hard spectra were already previously identified but here we show for the first time that likely our sources were in a distinct spectral state (i.e., different from the hard state) when they exhibited such very hard spectra. It is unclear how such very hard spectra can be formed; if the emission mechanism is similar to that operating in their hard states (i.e., up-scattering of soft photons due to hot electrons) then the electrons should have higher temperatures or a higher optical depth in the very hard state compared to those observed in the hard state. By using our obtained \Gamma as a tracer for the spectral evolution with luminosity, we have compared our results with those obtained by Wijnands et al. (2015). We confirm their general results in that also our sample of sources follow the same track as the other neutron star systems, although we do not find that the accreting millisecond pulsars are systematically harder than the non-pulsating systems.Comment: Accepted for publication in MNRA

Scattering and Diffraction in Magnetospheres of Fast Pulsars

We apply a theory of wave propagation through a turbulent medium to the scattering of radio waves in pulsar magnetospheres. We find that under conditions of strong density modulation the effects of magnetospheric scintillations in diffractive and refractive regimes may be observable. The most distinctive feature of the magnetospheric scintillations is their independence on frequency. Results based on diffractive scattering due to small scale inhomogeneities give a scattering angle that may be as large as 0.1 radians, and a typical decorrelation time of $10^{-8}$ seconds. Refractive scattering due to large scale inhomogeneities is also possible, with a typical angle of $10^{-3}$ radians and a correlation time of the order of $10^{-4}$ seconds. Temporal variation in the plasma density may also result in a delay time of the order of $10^{-4}$ seconds. The different scaling of the above quantities with frequency may allow one to distinguish the effects of propagation through a pulsar magnetosphere from the interstellar medium. In particular, we expect that the magnetospheric scintillations are relatively more important for nearby pulsars when observed at high frequencies.Comment: 19 pages, 1 Figur

Multiwavelength observations of MASTER OT 075353.88+174907.6: a likely superoutburst of a long period dwarf nova system

MASTER OT 075353.88+174907.6 was a blue optical transient reported by the MASTER-Net project on 2017 Oct 31. This source was previously detected by {\it GALEX} in its NUV band but not by the Sloan Digital Sky Survey (in the optical). We carried out multiwavelength follow-up observations of this source during its 2017 outburst using {\it Swift} and RATIR. The source was found to be $\gtrsim$4.4 mag above its quiescent level during the peak of the outburst and the outburst lasted $\gtrsim$19 days. Our observations suggest that it was a superoutburst of a long orbital period U Geminorum type dwarf nova system. The spectral energy distribution during the initial slow decay phase of the outburst was consistent with a disk-dominated spectra (having spectral indices $\Gamma \! \sim$1.5--2.3). After this phase, the UV flux decreased slower than the optical and the spectral energy distribution was very steep with indices $\Gamma \! \sim$3.7$\pm$0.7. This slow decay in the UV may be the emission from a cooling white dwarf heated during the outburst. The spectral shape determined from the assumed pre-outburst quiescent level was also steep ($\Gamma \! \gtrsim$2.5) indicating that the white dwarf is still hot in quiescence (even after the cooling due to the potential accretion-induced heating has halted). No X-ray emission was detected from the source since it is likely located at a large distance $>$2.3 kpc.Comment: accepted by RMxAA, to appear in Volume 5

Always Better Control-Vital Essential Desirable analysis of the drugs used in health centres of Ahmedabad district

Background: The basic principle of inventory control is Always Better Control (ABC) based on cost criteria and Vital Essential Desirable (VED) on criticality. Inequity in drug prioritization and expenses directly affects the health of the community. Study design: Based on ABC-VED matrix, inventory analysis was done. Study area: Community health centre (CHC) - Singarva, two primary health centres (PHC) - Kanbha and Sanathal and two urban health centre (UHC) - Amraiwadi and Sabarmati. Study period: December 2012 to December 2013.Methods: The drugs were first categorized by ABC method and then by VED method. On coupling the two techniques, ABC-VED matrix was made and drugs were classified in to Category I (AV + BV +CV + AE + AD), Category II (BE + CE + BD) and Category III (CD).Results: According to VED analysis large amount of money was spent on D category that is; 35% of annual drug expenditure (ADE) from CHC, 7.6% and 23.4% from both the PHC respectively, 20.1% and 24.7% from both the UHCs. On considering the ABC-VED matrix analysis the ADE spent on Class III was 6.6% among CHC, 1.2% and 1.5% among PHC, 2.6% and 7.2% among the UHC.Conclusion: The ADE used among the ABC-VED Class III should be avoided and the ADE on Class II drugs should be controlled and used judiciously

Problems with Tunneling of Thin Shells from Black Holes

It is shown that $exp(-2 Im(\int p dr))$ is not invariant under canonical transformations in general. Specifically for shells tunneling out of black holes, this quantity is not invariant under canonical transformations. It can be interpreted as the transmission coefficient only in the cases in which it is invariant under canonical transformations. Although such cases include alpha decay, they do not include the tunneling of shells from black holes. The simplest extension to this formula which is invariant under canonical transformations is proposed. However it is shown that this gives half the correct temperature for black holes.Comment: 25 pages, 3 figures; v4: Made changes for publicatio

Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff and mental health providers

Background Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. Methods We completed semi-structured interviews and focus group discussions with adolescents (n=191), parents (n=9), teachers (n=78), school counsellors (n=15), clinical psychologists and psychiatrists (n=7). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. Results All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and preferred practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. This contrasted with adolescents’ preferences for limited involvement from parents and teachers, to maintain confidentiality. Face-to-face counselling was the most acceptable delivery format; self-help was less frequently recommended but was more acceptable when blended with guidance or delivered as digital interventions. Structured sensitization was recommended to ensure adolescent engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. Conclusion SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health need, and a suite of interventions are needed to target these needs effectively and efficiently