A study of two-body strong interactions of elementary particles Final technical report, 27 Jan. 1969 - 1 May 1970

Two-body strong interactions of elementary particles including kaons, pions, hyperons, and proton

Projective equivalence of ideals in Noetherian integral domains

Let I be a nonzero proper ideal in a Noetherian integral domain R. In this paper we establish the existence of a finite separable integral extension domain A of R and a positive integer m such that all the Rees integers of IA are equal to m. Moreover, if R has altitude one, then all the Rees integers of J = Rad(IA) are equal to one and the ideals J^m and IA have the same integral closure. Thus Rad(IA) = J is a projectively full radical ideal that is projectively equivalent to IA. In particular, if R is Dedekind, then there exists a Dedekind domain A having the following properties: (i) A is a finite separable integral extension of R; and (ii) there exists a radical ideal J of A and a positive integer m such that IA = J^m.Comment: 20 page

Development of a post-fall multidisciplinary checklist to evaluate the in-patient fall

Background: Falls suffered by hospitalized patients are an important reportable event. Approximately 4 - 6 % of inpatient falls result in serious injury. Recurrent falls or delayed recognition of injury can harm patients and represents a medico-legal risk. In 2010, our tertiary-care academic medical center reviewed current practice regarding falls prevention and assessment to develop a comprehensive falls prevention program. The committee found that there was no consistent practice in the assessment by nurses or physicians of inpatients who had fallen, either for injury or for conditions which might have led to the fall. A new systematic checklist for evaluation of the hospital faller was developed by a team consisting of nursing, hospitalists, and a medical unit director. Purpose: To develop an evidence-based multi-disciplinary checklist to facilitate evaluation, implementation of secondary prevention interventions and documentation following a hospital fall. Description: The hospitalist and the general medical unit director reviewed relevant literature, consulted national experts, and drafted a multidisciplinary checklist, the UNMH Post-Fall/Huddle Tool, to be used by nurses and physicians in post-fall patient evaluation. The checklist was reviewed and revised with further input from key stakeholders including hospitalists, housestaff, and the adult Medical/Surgical Shared Governance Committee. It was implemented as part of a comprehensive falls prevention program 3 month pilot. The checklist prompts a three step process: (1) an initial 7-item assessment by nursing staff to determine factors which would necessitate immediate evaluation by cross-covering physicians versus deferring evaluation to the primary team; (2) a 5-item focused physical examination to be performed by a physician to assess the likelihood of injury and suggested diagnostic tests based on this examination; and (3) an interdisciplinary face-to-face meeting between the evaluating physician and nurse to review 7 specific possible precipitating events and implement potential interventions. The UNMH Post-Fall/Huddle Tool will be adapted into the electronic health record after pilot completion and evaluation. An educational presentation about falls and how to use the checklist was developed for residents and hospitalists. Use of the checklist was implemented in November, 2010. To date, nurses and residents report that the checklist is easy to use and that it facilitates a timely, multidisciplinary evaluation of patients who have fallen in the hospital. Conclusion: A multi-disciplinary post-fall checklist facilitates a consistent and evidence-based evaluation and treatment of patients who have fallen in the hospital

Junior faculty exchange program assists mid-career clinician-educators increase scholarly activity and meet promotion requirements

Project: Our institution requires peer-review scholarly products and an extramural reputation for promotion of clinician-educators to Associate Professor. Given a lack of robust research skill training during residency and a paucity of research mentors in our Division of Hospital Medicine, meeting these two promotion requirements has been especially challenging for many of our hospitalist faculty. We established a junior faculty exchange with other institutions in order to assist individual faculty members to gain a reputation outside of their home institutions, to develop external mentorship and career advice relationships with early career faculty, and to enhance networking and project collaborations. Methods: Participants were mid-career faculty who would gain the maximal career benefit from delivering an invited visit to an external institution and who have sufficient track record to deliver effective mentoring advice to early career hospitalists. Faculty at the late Assistant Professor level or recently promoted Associate Professors were selected by their Divisions leadership to spend one day at a hosting institution, deliver an invited grand rounds or similar didactic presentation, meet with senior leadership, and provide career advice to junior faculty. The program was reciprocal with one faculty member visiting an institution in exchange for that institution hosting a faculty member for a similar invited visit. Each institution covered the cost of travel and hotel accommodations. No honoraria were paid. Results: Over the first two years, four junior academic hospitalists were exchanged between three institutions. There was a high degree of satisfaction among surveyed visiting and visited junior faculty. Two on-going collaborative relationships and one jointly authored paper have resulted to date. Conclusion: A junior faculty exchange program assisted mid-career academic hospitalists establish extramural collaborations and meet promotion requirements that have been problematic at our institution. Implication: This relatively inexpensive faculty development program is easily adaptable by other institutions and may help generalist faculty increase scholarly activity, develop extra-institutional relationships, and achieve promotion.\u2

Fall-related injury in the hospital

Background: 2 — 9% of adult patients who fall in the hospital suffer serious injury. There is little evidence-based literature to guide physicians when assessing hospitalized patients for fall-related injury. This study was designed to (1) identify demographic and/or clinical factors which predict serious fall-related injury among hospitalized adults, and (2) judge the adequacy of physician documentation related to adult patients who fell in the hospital. Methods: Nursing staff are required to report all hospital falls through our hospitals computerized Patient Safety Network (PSN). We performed a retrospective chart review of all PSN reported falls that occurred during 2010 in our 431-bed university acute care hospital. Patients less than18 years old, pregnant women, and prisoners were excluded. Results: Medical records were available for 286/293 (98%) of PSN-reported falls in 251 eligible patients. Falls occurred in 152 males (61%), and 99 females (39%). 48% of falls occurred while toileting. 25% (63/286) of falls were associated with injury, and 4% (11/286) with serious injury (laceration requiring closure or fracture). Compared to all fallers, patients with injury did not differ by gender (males 38/152 vs. females 25/99, p=0.96). Patients older than 64 years who fell were no more likely to suffer injury that younger adults (13/64 vs. 50/187, p = 0.31). In univariate analysis, patients who reported hitting their head, patients with pre-fall confusion, and patients who received narcotics on the day of fall were more likely to suffer injury (estimated odds ratios 6.04, 2.00 and 5.1, respectfully). In multivariate analysis, receiving a narcotic on the day of fall was the strongest predictor of injury (Table). 33% (21/63) of falls with injury had no physician documentation in the hospital record, and in only 21% (13/63) of cases, were falls with injury mentioned in the discharge summary. Conclusions: In this single-institution study, injury occurred in 25% of patients who fell, and serious injury in 4%. Compared to all falls, falls with injury did not vary by gender or age. Receiving a narcotic of the day of fall was the strongest predictor of injury. Physicians inconsistently provided medical record documentation of hospitalized patients who fell with injury.\u2

Narcotic administration and fall-related injury in the hospital: Implications for patient safety programs and providers

Objective: Identify factors that predict fall-related injury in hospitalized adults. Design: Retrospective cohort study. Setting: 435-bed university hospital. Participants: Inpatients with reported falls in 2010. Results: Medical records were available for 286/293 (98%) of reported falls in 251 patients. 25% (63/286) of falls were associated with injury, 4% (11/286) with serious injury. Compared to all fallers, patients with injury did not differ by gender or age. In univariate analysis, patients who reported hitting their head, had pre-fall confusion, or who received narcotics within 24 hours before falling were more likely to suffer injury (estimated odds ratios 6.04, 2.00 and 5.1, respectfully). In multivariate analysis, receiving a narcotic prior to falling was the strongest predictor of injury (estimated odds ratio 5.59; 95% confidence intervals 2.14 — 14.65, p \u3c0.001). Conclusions: In this single-institution study, 25% of patients who fell suffered injury and 4% serious injury. Neither age nor gender predicted fall-related injury. Recent narcotic administration was the strongest predictor of injury. Strategies to prevent fall-related injury in the hospital should target patients receiving narcotics. When evaluating inpatients who have fallen, providers should be especially vigilant about injury in patients who have pre-fall confusion, hit their head, or have received recent narcotics

Psychiatric Disorder Criteria and their Application to Research in Different Racial Groups

BACKGROUND: The advent of standardized classification and assessment of psychiatric disorders, and considerable joint efforts among many countries has led to the reporting of international rates of psychiatric disorders, and inevitably, their comparison between different racial groups. RESULTS: In neurologic diseases with defined genetic etiologies, the same genetic cause has different phenotypes in different racial groups. CONCLUSION: We suggest that genetic differences between races mean that diagnostic criteria refined in one racial group, may not be directly and simply applicable to other racial groups and thus more effort needs to be expended on defining diseases in other groups. Cross-racial confounds (in addition to cultural confounds) make the interpretation of rates in different groups even more hazardous than seems to have been appreciated

Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

Background: Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants. Methods and Findings: We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries). Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries. Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation. Conclusions: Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care