Stability Analyses in the Ports of Long Beach and Los Angeles

The combined Ports of Los Angeles and Long Beach (Ports) have experienced extensive growth over the last three decades. A main feature of the expansions is the creation of new land by placing hydraulic fill behind rock retention dikes. This paper presents an overview of the recent history and state of practice of slope stability analyses performed for projects related to the expansion of the Ports. The geologic and seismic setting and typical soil conditions are also described. This paper is based on a review of geotechnical reports prepared for projects in both Ports and selected published papers. The various investigators used the current state of the practice analyses, with remarkably close agreement in the basic seismic design criteria. The designs and construction practices have, however, varied significantly, particularly in the configuration of the rock dikes (full section and multilift dikes). The design approaches and construction practices in both Ports have been satisfactory as evidenced by the performance of the facilities. Because of different designs located in the same seismic setting and the abundance of quality geotechnical data, the combined Ports offer an excellent opportunity to install field instrumentation to learn from future earthquakes. The conclusions reached and statements made in this paper are solely those of the authors, and do not necessarily represent the opinions of other parties, firms, or agencies involved in any of the projects referenced

Review of Slope Stability Analysis in the Ports of Long Beach and Los Angeles

The combined San Pedro Bay, California Ports (Long Beach and Los Angeles) have been developed mostly by placing dredged material behind rock dikes to create useable land and the wharfs constructed over the rock dikes. An overview of the stability analysis of the dikes was presented in a 1991 paper that summarized slope stability and seismic criteria prior to 1991. Since that time, deeper channel depths, higher seismic criteria, and higher seismic survivability expectations by the users have resulted in higher levels of analysis. This paper provides an update of a paper presented in 1991 and presents data regarding slope stability finite element/difference method (FEM) analysis completed by different investigators that included the contribution of the wharf piles that extend through the rock dikes to slope stability and reduction of deformation. The conclusions reached and statements made in this paper are solely those of the authors and do not necessarily represent the opinions of other parties, firms, or ports in any of the projects referenced

A Profile in Population Health Management: The Sandra Eskenazi Center for Brain Care Innovation

This article describes how key aspects of the Sandra Eskenazi Center for Brain Care Innovation's (SECBCI) care model can inform other entities on the development of new models of population health management, through a framework that emphasizes social, behavioral, and environmental determinants of health, as well as biomedical aspects. The SECBCI is a collaboration with Eskenazi Health and community-based organizations such as the Central Indiana Council on Aging Area Agency on Aging and the Greater Indianapolis Chapter of the Alzheimer's Association in Central Indiana

Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study

© 2018, The Author(s). Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. Results: 2493 patients, with median age 78–80 years (DK–Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7–8.6 vs. 5.8 95% CI 5.6–5.9) and Danish mean 7.1 (95% CI 6.6–7.5 vs. 5.5 95% CI 5.4–5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL’s accuracy was only modest for in-hospital death prediction in either setting. Conclusions: The modified CriSTAL tool (with CFS instead of Fried’s frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician’s confidence in initiating earlier end-of-life discussions

Medication administration errors for older people in long-term residential care

Background Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings. Methods All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups. Results Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance. Conclusion Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety

Diabetes in Older Adults: A Consensus Report

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95492/1/jgs12035.pd