Volume 2: Integrity and Corrosion; Offshore Issues; Pipeline Automation and Measurement; Rotating Equipment, Oct 1, 2000
The oil and gas pipelines are spread around the world in all nations as complex networks. The inc... more The oil and gas pipelines are spread around the world in all nations as complex networks. The increased usage of gas is rapidly increasing this network. These networks are generally made from various diameters of pipes. The pipelines are serviced on as required basis, using pig launcher and receivers to suit the pipe diameter. Pigs of different types may be launched in different sequences, to clean the pipes and to obtain various data related to pipe condition and location. The pig launching and receiving process uses rapid pressure changes in the launcher and receiver and some magnitude of impact may be experienced by the unit. This process also requires frequent access to the launcher/receiver unit. To have an efficient and cost effective usage of the launcher/receiver unit, it is essential to have a door mcchanism, which is safe, robust, capable of the above loading conditions, requires minimum service and is easy to use. PECO has recendy developed & designed a door, which incorporates ail the above requirements. The door was put to high pressure testing and the test results were so encouraging that PECO named it SafeLock® Closure. The design was developed with gas pipelines in mind. However it is equally applicable to vessels, exchangers and other metal openings where quick, frequent and easy access is required. Safety has been the prime concern through out the design and development process of this closure. Therefore the final product has resulted in a very safe closure. The initial design of the SafeLock® door / closure used a spring load to make it easy in operation. This was removed in the later design. The segmental blocks, usually called C-ring segments, are operated to move in and out of the shell-sub annulus. The closure opening and closing is performed by the use of a single lever ami. This way only one person can operate (open and close) the door / closure. For opening and closing, the lever-arm needs to be rotated less than 40 degree angle. The rotation direction of the lever arm in closing is reverse of that in opening. The door / head can be fully retrieved from the shell-sub and rest by the side of the launcher/receiver to provide complete access to the opening. This door / closure provides quick access to launcher / receiver, pig traps, meter provers, filter vessel, scrubber, scraper, manway to pressure vessel, etc. This closure can be mounted in the vertical or horizontal position. During change of filter elements, launching a pig, quick access to container under pressure, this closure door is designed to provide a safe and fast service. The construction, operation, design details and application of the new closure door are included in this paper and explained with the help of the design diagrams and photographs.
the protein interior is not tightly packed but contains multiple cavities of varying sizes. In ac... more the protein interior is not tightly packed but contains multiple cavities of varying sizes. In accordance with that it has been shown that distribution of contacts in proteins demonstrate ''small-world topology'', i.e. proteins are comprised of densely packed regions that communicate via a set of high centrality contacts. The most important question is whether these properties have any functional importance or they are simply a consequence of the protein folding process? Recent protein dynamics studies indicate that fractal properties of proteins indeed can be intimately involved in their function. They also can serve as an underlying mechanism of the important phenomenon of allostery that is responsible for regulation of the most biological processes. It has been demonstrated that protein fractal structures are volatile and can change dramatically upon small molecule binding. This opens the door to an explanation of long distance allosteric signaling that is based solely on protein dynamics and does not involve any structural changes. Our work on protein kinases show that densely packed regions (''communities'') in fully functional kinases correspond to the well known functional elements of the kinase core. Furthermore, residues with high centrality that serve as major communicators between the communities are very well known to be critical for protein kinase function. These findings support the idea that fractal nature of protein kinases is a conserved feature in the whole protein kinase family. This makes studies of protein fractal structure an important analytical tool that can shed light on the most critical regulatory mechanisms in molecular biology.
The Joint Commission Journal on Quality Improvement, 2001
uring the past two decades, the performance of many short-term diagnostic, operative, and other i... more uring the past two decades, the performance of many short-term diagnostic, operative, and other invasive procedures has shifted from the operating room, emergency department, and intensive care areas to a variety of nontraditional settings. 1 Sedation/analgesia administered by nonanesthesiology staff is the primary method of managing procedure-related discomfort and anxiety in these settings. Although it is effective, this type of sedation can involve serious risks to patient safety. Many of the pharmacologic agents used for sedation and analgesia can cause central nervous system, respiratory, and/or cardiac depression. 2 Treatment can rapidly and unexpectedly progress from sedation/analgesia through deep sedation to general anesthesia. 3 The task force discovered major limitations to the site-specific approach to sedation guideline development and resolved to address pediatric deep sedation/analgesia issues in the framework of the basic, institutionwide sedation guideline.
To the best of my knowledge, this was tbe first article that specifically addressed the possible ... more To the best of my knowledge, this was tbe first article that specifically addressed the possible use of cyclosporine in dermatologic disorders and was the first article on cyclosporine to appear in the dermatologic literature. 1 also believe, based on conversations with Sandoz at that time, that we were the only department of dermatology to have cyclosporine for dermatologic research. Unfortunately, we decided to utilize the drug for canine and feline models of human disease rather than to immediately utilize it for human disorders. This was done because of our desire to approach treatment cautiously since it was obvious that the drug did have some major side effects. I feel that our article, which for some reason seems to have been buried in the past, deserves to be considered a historic landmark. Certainly it merits the same status as Sowden's "landmark article" on its use in atopic dermatitis, a use that we suggested in a review article, listed below, published in 1986.
Injuries sustained during flipping???a new fad activity
Pediatric Emergency Care, 1993
This article describes a small series of injuries resulting from a new fad activity among childre... more This article describes a small series of injuries resulting from a new fad activity among children in Baltimore. "Flipping" involves jumping from an elevated surface and executing an aerial flip, with the intent to land upright. Because this activity takes place frequently on hard surfaces such as concrete, injuries often result. The spectrum of injuries is described and categorized, and injuries are compared with those received during similar activities, such as break dancing or skateboarding, and with playground injuries. Pediatricians and emergency physicians should be aware of the potential for injury in this activity.
Simulation of In-Hospital Pediatric Medical Emergencies and Cardiopulmonary Arrests: Highlighting the Importance of the First 5 Minutes
Pediatrics, 2008
OBJECTIVES. Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data sugg... more OBJECTIVES. Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, “mock codes”) and (2) identify the types and frequency of errors committed during pediatric mock codes. METHODS. A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American He...
Using a Computer Kiosk to Promote Child Safety: Results of a Randomized, Controlled Trial in an Urban Pediatric Emergency Department
Pediatrics, 2007
OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke... more OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. METHODS. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4–66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics. RESULTS. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reaso...
Background. Clinical pathways for asthma are tools that have the potential to improve compliance ... more Background. Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines, but their effect on patient outcomes has not been documented. Objectives. To determine the effect of an asthma clinical pathway on patients' length of stay, use of nebulized β-agonist therapy while hospitalized, and use of acute care clinics for 2 weeks after discharge. Design/Methods. The study was a randomized, controlled trial. Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study. Patients were randomized either to a conventional ward (control group) or to a ward using the clinical pathway (intervention group). For 2 weeks after discharge, we collected data to determine whether patients visited a health care provider for worsening asthma. Results. One hundred ten patients (26%) were enrolled. Control and intervention groups had si...
Objectives: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and ... more Objectives: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission. Methods: Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emergency department (ED) between April 1, 1997 and April 30, 1999. Outcome measures consisted of time interval between ED triage and arrival to an OS bed, total hours in observation, and need for admission or transfer. Using relative risk (RR), we compared admission rates for the 4 most common diagnoses. Results: We studied 800 transfers to pediatric OS beds. Asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%) were the 4 most common diagnoses. There were 597 patients (75%) successfully discharged from observation and 174 (22%) required inpatient admission. Seventeen patients (2%) were transferred to a psychiatric facility and 12 patients (1%) were transferred to a tertiary care center for further evaluation and treatment. Compared to gastroenteritis/dehydration, patients with asthma were just as likely to be admitted/transferred (RR 1.05, 95% CI, 0.87-1.27), those with an infectious disease were 1.3 times more likely to be admitted/transferred (RR 1.35, 95% CI, 1.0-1.83), and those with bronchiolitis were 2 times more likely to be admitted/ transferred (RR 1.92, 95% CI, 1.34-2.74). Conclusions: We describe the usage of OS beds in a community hospital that we believe can be a successful model for the care of pediatric patients. Future studies are needed to delineate the clinical characteristics of patients that would benefit from this care delivery model.
Maternal and Child Factors Affecting High-volume Pediatric Emergency Department Use
Pediatric Emergency Care, 2006
To describe maternal and child characteristics associated with high-volume nonurgent pediatric em... more To describe maternal and child characteristics associated with high-volume nonurgent pediatric emergency department (ED) use. We surveyed female caregivers of children aged 1 to 14 years who were brought to the ED at an urban medical center for nonurgent conditions. We analyzed characteristics associated with low-volume (1 ED visit) or high-volume (> or = 2 ED visits) use within the past year. Independent factors included predisposing, reinforcing, and enabling factors. Logistic regression was used to model high-volume ED use. Of the 300 participants (84% response rate), 99 were low-volume users and 201 were high-volume users. Most participants were mothers (94%). In adjusted analyses, high-volume use was associated with caregivers being single [odds ratio (OR), 2.57; 95% confidence interval (CI), 1.13-5.80], having high-volume ED use for themselves (OR, 2.02; 95% CI, 1.08-3.80), seeking care primarily in the pediatric ED for "sick visits" (OR, 2.47; 95% CI, 1.12-5.49), and lack of weekend hours at their child's usual source of care (OR, 2.58; CI, 1.24-5.37). Marital status, high maternal use of the ED, perception of the ED as the place to seek care for a sick child, and lack of weekend hours for usual source of care are associated with high-volume ED use among children. Given similarities in patterns of ED use among mothers and children, further attention is needed to address clinical practice and system issues that contribute to familial use of EDs.
Objective: Children living in low income urban environments are at high risk for preventable inju... more Objective: Children living in low income urban environments are at high risk for preventable injuries, which result in thousands of Pediatric Emergency Department (PED) visits every year. The development and evaluation of written injury prevention materials used in a PED-based intervention trial are presented. The purpose is to describe the development of injury prevention materials for people with low literacy skills, and explain literacy and comprehension abilities among a sample of parents from the PED. Methods: Materials were developed using rules of plain language and with consideration of the needs of a low literacy population. Materials were assessed using the Flesch-Kincaid and Suitability Assessment of Materials. Literacy and comprehension abilities in a PED sample were tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Cloze. Results: REALM results for n = 59 parents sampled from the PED indicated that 27% (n = 16) read below 9th grade reading level. Cloze results demonstrate that materials were appropriate for 71% (n = 21) when written for 8th grade reading level and 80% (n = 23) when rewritten for 6th grade reading level. Conclusion: Others designing similar interventions can use these methods to develop interventions for low literacy populations. Practice implications: When developing injury prevention materials for use with PED populations, health professionals should consider reading ability, reading level, content, and design of materials.
Fluoride distribution in the facial surfaces of human maxillary central incisors
Journal of Oral Pathology and Medicine, 1979
The fluoride distributions in the incisal, middle and cervical regions of the facial surfaces of ... more The fluoride distributions in the incisal, middle and cervical regions of the facial surfaces of six maxillary central incisors were determined by three successive acid etch biopsy procedures. The fluoride concentrations were adjusted to standardized depths of 0--10 micron, 10--20 micron and 20--30 micron. In the biopsy areas the enamel fluoride concentrations decreased with increasing depth. In all the teeth the fluoride content was lowest in the incisal region and highest at the cervical third.
transmission, such as schools and peers, were often considered less trustworthy or less accurate.... more transmission, such as schools and peers, were often considered less trustworthy or less accurate. Nine participants described ''checking out'' condoms (opening them, touching them) and/or practicing putting on a condom before first use. The type of relationship influenced planned and actual condom use. Participants reported consistent condom use with casual partners, and a drop-off in condom use as relationships evolved or if they perceived themselves ready for fatherhood with that partner. Conclusions: Improved consistency and accuracy in adolescent male condom use may require addressing existing negative perceptions of condoms, the specific relationship contexts of condom use, and the developmental need to test and try on condoms before first use.
Volume 2: Integrity and Corrosion; Offshore Issues; Pipeline Automation and Measurement; Rotating Equipment, Oct 1, 2000
The oil and gas pipelines are spread around the world in all nations as complex networks. The inc... more The oil and gas pipelines are spread around the world in all nations as complex networks. The increased usage of gas is rapidly increasing this network. These networks are generally made from various diameters of pipes. The pipelines are serviced on as required basis, using pig launcher and receivers to suit the pipe diameter. Pigs of different types may be launched in different sequences, to clean the pipes and to obtain various data related to pipe condition and location. The pig launching and receiving process uses rapid pressure changes in the launcher and receiver and some magnitude of impact may be experienced by the unit. This process also requires frequent access to the launcher/receiver unit. To have an efficient and cost effective usage of the launcher/receiver unit, it is essential to have a door mcchanism, which is safe, robust, capable of the above loading conditions, requires minimum service and is easy to use. PECO has recendy developed & designed a door, which incorporates ail the above requirements. The door was put to high pressure testing and the test results were so encouraging that PECO named it SafeLock® Closure. The design was developed with gas pipelines in mind. However it is equally applicable to vessels, exchangers and other metal openings where quick, frequent and easy access is required. Safety has been the prime concern through out the design and development process of this closure. Therefore the final product has resulted in a very safe closure. The initial design of the SafeLock® door / closure used a spring load to make it easy in operation. This was removed in the later design. The segmental blocks, usually called C-ring segments, are operated to move in and out of the shell-sub annulus. The closure opening and closing is performed by the use of a single lever ami. This way only one person can operate (open and close) the door / closure. For opening and closing, the lever-arm needs to be rotated less than 40 degree angle. The rotation direction of the lever arm in closing is reverse of that in opening. The door / head can be fully retrieved from the shell-sub and rest by the side of the launcher/receiver to provide complete access to the opening. This door / closure provides quick access to launcher / receiver, pig traps, meter provers, filter vessel, scrubber, scraper, manway to pressure vessel, etc. This closure can be mounted in the vertical or horizontal position. During change of filter elements, launching a pig, quick access to container under pressure, this closure door is designed to provide a safe and fast service. The construction, operation, design details and application of the new closure door are included in this paper and explained with the help of the design diagrams and photographs.
the protein interior is not tightly packed but contains multiple cavities of varying sizes. In ac... more the protein interior is not tightly packed but contains multiple cavities of varying sizes. In accordance with that it has been shown that distribution of contacts in proteins demonstrate ''small-world topology'', i.e. proteins are comprised of densely packed regions that communicate via a set of high centrality contacts. The most important question is whether these properties have any functional importance or they are simply a consequence of the protein folding process? Recent protein dynamics studies indicate that fractal properties of proteins indeed can be intimately involved in their function. They also can serve as an underlying mechanism of the important phenomenon of allostery that is responsible for regulation of the most biological processes. It has been demonstrated that protein fractal structures are volatile and can change dramatically upon small molecule binding. This opens the door to an explanation of long distance allosteric signaling that is based solely on protein dynamics and does not involve any structural changes. Our work on protein kinases show that densely packed regions (''communities'') in fully functional kinases correspond to the well known functional elements of the kinase core. Furthermore, residues with high centrality that serve as major communicators between the communities are very well known to be critical for protein kinase function. These findings support the idea that fractal nature of protein kinases is a conserved feature in the whole protein kinase family. This makes studies of protein fractal structure an important analytical tool that can shed light on the most critical regulatory mechanisms in molecular biology.
The Joint Commission Journal on Quality Improvement, 2001
uring the past two decades, the performance of many short-term diagnostic, operative, and other i... more uring the past two decades, the performance of many short-term diagnostic, operative, and other invasive procedures has shifted from the operating room, emergency department, and intensive care areas to a variety of nontraditional settings. 1 Sedation/analgesia administered by nonanesthesiology staff is the primary method of managing procedure-related discomfort and anxiety in these settings. Although it is effective, this type of sedation can involve serious risks to patient safety. Many of the pharmacologic agents used for sedation and analgesia can cause central nervous system, respiratory, and/or cardiac depression. 2 Treatment can rapidly and unexpectedly progress from sedation/analgesia through deep sedation to general anesthesia. 3 The task force discovered major limitations to the site-specific approach to sedation guideline development and resolved to address pediatric deep sedation/analgesia issues in the framework of the basic, institutionwide sedation guideline.
To the best of my knowledge, this was tbe first article that specifically addressed the possible ... more To the best of my knowledge, this was tbe first article that specifically addressed the possible use of cyclosporine in dermatologic disorders and was the first article on cyclosporine to appear in the dermatologic literature. 1 also believe, based on conversations with Sandoz at that time, that we were the only department of dermatology to have cyclosporine for dermatologic research. Unfortunately, we decided to utilize the drug for canine and feline models of human disease rather than to immediately utilize it for human disorders. This was done because of our desire to approach treatment cautiously since it was obvious that the drug did have some major side effects. I feel that our article, which for some reason seems to have been buried in the past, deserves to be considered a historic landmark. Certainly it merits the same status as Sowden's "landmark article" on its use in atopic dermatitis, a use that we suggested in a review article, listed below, published in 1986.
Injuries sustained during flipping???a new fad activity
Pediatric Emergency Care, 1993
This article describes a small series of injuries resulting from a new fad activity among childre... more This article describes a small series of injuries resulting from a new fad activity among children in Baltimore. "Flipping" involves jumping from an elevated surface and executing an aerial flip, with the intent to land upright. Because this activity takes place frequently on hard surfaces such as concrete, injuries often result. The spectrum of injuries is described and categorized, and injuries are compared with those received during similar activities, such as break dancing or skateboarding, and with playground injuries. Pediatricians and emergency physicians should be aware of the potential for injury in this activity.
Simulation of In-Hospital Pediatric Medical Emergencies and Cardiopulmonary Arrests: Highlighting the Importance of the First 5 Minutes
Pediatrics, 2008
OBJECTIVES. Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data sugg... more OBJECTIVES. Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, “mock codes”) and (2) identify the types and frequency of errors committed during pediatric mock codes. METHODS. A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American He...
Using a Computer Kiosk to Promote Child Safety: Results of a Randomized, Controlled Trial in an Urban Pediatric Emergency Department
Pediatrics, 2007
OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke... more OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. METHODS. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4–66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics. RESULTS. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reaso...
Background. Clinical pathways for asthma are tools that have the potential to improve compliance ... more Background. Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines, but their effect on patient outcomes has not been documented. Objectives. To determine the effect of an asthma clinical pathway on patients' length of stay, use of nebulized β-agonist therapy while hospitalized, and use of acute care clinics for 2 weeks after discharge. Design/Methods. The study was a randomized, controlled trial. Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study. Patients were randomized either to a conventional ward (control group) or to a ward using the clinical pathway (intervention group). For 2 weeks after discharge, we collected data to determine whether patients visited a health care provider for worsening asthma. Results. One hundred ten patients (26%) were enrolled. Control and intervention groups had si...
Objectives: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and ... more Objectives: Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission. Methods: Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emergency department (ED) between April 1, 1997 and April 30, 1999. Outcome measures consisted of time interval between ED triage and arrival to an OS bed, total hours in observation, and need for admission or transfer. Using relative risk (RR), we compared admission rates for the 4 most common diagnoses. Results: We studied 800 transfers to pediatric OS beds. Asthma (27%), gastroenteritis/dehydration (16%), infectious disease (12%), and bronchiolitis (9%) were the 4 most common diagnoses. There were 597 patients (75%) successfully discharged from observation and 174 (22%) required inpatient admission. Seventeen patients (2%) were transferred to a psychiatric facility and 12 patients (1%) were transferred to a tertiary care center for further evaluation and treatment. Compared to gastroenteritis/dehydration, patients with asthma were just as likely to be admitted/transferred (RR 1.05, 95% CI, 0.87-1.27), those with an infectious disease were 1.3 times more likely to be admitted/transferred (RR 1.35, 95% CI, 1.0-1.83), and those with bronchiolitis were 2 times more likely to be admitted/ transferred (RR 1.92, 95% CI, 1.34-2.74). Conclusions: We describe the usage of OS beds in a community hospital that we believe can be a successful model for the care of pediatric patients. Future studies are needed to delineate the clinical characteristics of patients that would benefit from this care delivery model.
Maternal and Child Factors Affecting High-volume Pediatric Emergency Department Use
Pediatric Emergency Care, 2006
To describe maternal and child characteristics associated with high-volume nonurgent pediatric em... more To describe maternal and child characteristics associated with high-volume nonurgent pediatric emergency department (ED) use. We surveyed female caregivers of children aged 1 to 14 years who were brought to the ED at an urban medical center for nonurgent conditions. We analyzed characteristics associated with low-volume (1 ED visit) or high-volume (> or = 2 ED visits) use within the past year. Independent factors included predisposing, reinforcing, and enabling factors. Logistic regression was used to model high-volume ED use. Of the 300 participants (84% response rate), 99 were low-volume users and 201 were high-volume users. Most participants were mothers (94%). In adjusted analyses, high-volume use was associated with caregivers being single [odds ratio (OR), 2.57; 95% confidence interval (CI), 1.13-5.80], having high-volume ED use for themselves (OR, 2.02; 95% CI, 1.08-3.80), seeking care primarily in the pediatric ED for "sick visits" (OR, 2.47; 95% CI, 1.12-5.49), and lack of weekend hours at their child's usual source of care (OR, 2.58; CI, 1.24-5.37). Marital status, high maternal use of the ED, perception of the ED as the place to seek care for a sick child, and lack of weekend hours for usual source of care are associated with high-volume ED use among children. Given similarities in patterns of ED use among mothers and children, further attention is needed to address clinical practice and system issues that contribute to familial use of EDs.
Objective: Children living in low income urban environments are at high risk for preventable inju... more Objective: Children living in low income urban environments are at high risk for preventable injuries, which result in thousands of Pediatric Emergency Department (PED) visits every year. The development and evaluation of written injury prevention materials used in a PED-based intervention trial are presented. The purpose is to describe the development of injury prevention materials for people with low literacy skills, and explain literacy and comprehension abilities among a sample of parents from the PED. Methods: Materials were developed using rules of plain language and with consideration of the needs of a low literacy population. Materials were assessed using the Flesch-Kincaid and Suitability Assessment of Materials. Literacy and comprehension abilities in a PED sample were tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Cloze. Results: REALM results for n = 59 parents sampled from the PED indicated that 27% (n = 16) read below 9th grade reading level. Cloze results demonstrate that materials were appropriate for 71% (n = 21) when written for 8th grade reading level and 80% (n = 23) when rewritten for 6th grade reading level. Conclusion: Others designing similar interventions can use these methods to develop interventions for low literacy populations. Practice implications: When developing injury prevention materials for use with PED populations, health professionals should consider reading ability, reading level, content, and design of materials.
Fluoride distribution in the facial surfaces of human maxillary central incisors
Journal of Oral Pathology and Medicine, 1979
The fluoride distributions in the incisal, middle and cervical regions of the facial surfaces of ... more The fluoride distributions in the incisal, middle and cervical regions of the facial surfaces of six maxillary central incisors were determined by three successive acid etch biopsy procedures. The fluoride concentrations were adjusted to standardized depths of 0--10 micron, 10--20 micron and 20--30 micron. In the biopsy areas the enamel fluoride concentrations decreased with increasing depth. In all the teeth the fluoride content was lowest in the incisal region and highest at the cervical third.
transmission, such as schools and peers, were often considered less trustworthy or less accurate.... more transmission, such as schools and peers, were often considered less trustworthy or less accurate. Nine participants described ''checking out'' condoms (opening them, touching them) and/or practicing putting on a condom before first use. The type of relationship influenced planned and actual condom use. Participants reported consistent condom use with casual partners, and a drop-off in condom use as relationships evolved or if they perceived themselves ready for fatherhood with that partner. Conclusions: Improved consistency and accuracy in adolescent male condom use may require addressing existing negative perceptions of condoms, the specific relationship contexts of condom use, and the developmental need to test and try on condoms before first use.
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Papers by Allen Walker