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Significance & Background: Our community cancer center is one of 8 institutions in the United States chosen to participate in a 5-year cooperative grant from the Centers for Disease Control, focused on exploring, understanding, and improving our immunization processes and creating a positive impact in patient outcomes through interventions based on current, established national guidelines and recommendations. The value of immunization as a powerful tool to help patients with cancer improve outcomes is nationally recognized. However, management of immunization care gaps at our practice is generally deferred to primary care providers. This project focuses on the outpatient oncology practitioners and caregivers taking proactive steps in assessing and reconciling immunization care gaps, educating the patients and families, planning and recommending appropriate immunizations, administering vaccines or referring the patient to the primary care, and documenting interventions in the electronic medical record. Purpose: To develop sustainable interventions aimed at making management of immunization care gaps as a standard of care for the outpatient oncology setting at our cancer institute. Interventions: An immunization core team comprised of a Physician Leader, Quality Director, Project Manager, Nurse Practitioner, Clinical Nurse Specialist, and a Nursing Supervisor was organized to help lead the initiatives related to the project. PDSA model was used to guide discoveries and focus on project objectives. A strong collaborative, ongoing partnership between the immunization core team, physician leaders, caregivers, educators, nurses, pharmacists, and ancillary support worked together to address issues and develop interventions. A multi-disciplinary approach using variable methods of education and communication was utilized to address learning gaps and improve on the 3-month PDSA cycles. Surveys offered perspective on project questions and needs. Data was regularly reviewed and reported to the Council of Medical Specialty Societies platform as required by the grant, which guided ongoing and future work on the initiatives. Results: Improvement in the assessment and reconciliation of immunization care gaps as well as administration of vaccines at the cancer institute was established. Variations in practices and revelations of persisting misconceptions and roadblocks to recommendations and administration of vaccines persisted as seen in data review. Discussion: While immunization care gap assessment and reconciliation have improved, opportunities abound in further streamlining processes including onsite administration, patient referral for vaccine administration, immunization ordering, and documentation. Factors influencing vaccine hesitancy also need to be addressed in the system.

There are many reasons to evaluate your lift truck operator training program: The OSHA requirements are getting more stringent, you can save money on worker's comp costs, you can reduce equipment and product damage, and you can even increase productivity. The best reason of all, however, is that having proper and effective lift truck training is the right thing to do from a safety perspective. Every study done in the field shows that training reduces the number and severity of accidents. It is incredible to find that around 100 people a year are killed in fork lift accidents. It should be zero. Estimates of injuries vary from 40,000 to 80,000 per year in lift truck-related accidents. Many of these injuries are major. That is a large number and a concern to the industry. (excerpt)

Adult male and female Argulus melanostictus Wilson, 1935 are redescribed based on detailed examinations of a syntype and recently obtained specimens of both sexes collected from California grunion, Leuresthes tenuis, captured in nearshore Pacific waters at Monterey, California. A 14-16-hr seawater bath containing 0.5 µl/L trichlorfon administered once weekly for 3 wk killed A. melanostictus while not noticeably harming grunion.

Background/aims: Suicide is a major public health concern, yet there are very few randomized clinical trials that have been conducted to reduce suicidal ideation in patients at risk of suicide. We describe the rationale and refinements of such a trial that is designed to assess the effect of a hypnotic medication on suicidal ideation in adult outpatients currently experiencing suicidal ideation. Methods: “Reducing Suicidal Ideation Through Insomnia Treatment” is a multi-site randomized clinical trial that includes three recruiting sites and one data management site. This 4-year study is in its second year of recruitment. The purpose of the study is to compare hypnotic medication versus placebo as an add-on treatment to a selective serotonin reuptake inhibitor as a means of reducing suicidal ideation in depressed adult outpatients with insomnia and suicidal ideation. The safety features of the study follow the 2001 National Institutes of Health guidelines for studies that include patients at risk of suicide. Results: In total, 584 potential participants have undergone telephone screening; 67% of these failed the phone screen, most often due to an absence of expressed suicidal ideation (26% of the telephone screen fails). A total of 115 people appeared for a face-to-face baseline assessment, and 40 of these had completed a taper off of their ineffective psychotropic medications before the baseline assessments. In all, 64% of those who completed baseline assessments failed to proceed to randomization, most commonly because of no clinically significant suicidal ideation (51% of those excluded at baseline). One participant was offered and accepted voluntary psychiatric hospitalization in lieu of study participation. Thus far, 40 participants have been randomized into the study and 88.7% of scheduled visits have been attended, with 93.8% adherence to the selective serotonin reuptake inhibitor and 91.6% adherence to the randomized hypnotic versus placebo. None of the randomized participants have required hospitalization or had a suicide attempt. Conclusion: By carefully considering the inclusion and exclusion criteria and other safety features, the safe conduct of randomized clinical trials in suicidal adult patients is possible, including the inclusion of participants who have undergone a prescribed tapering off of psychotropic medications prior to baseline assessment.

(Abridged) This is the Maunakea Spectroscopic Explorer 2018 book. It is intended as a concise reference guide to all aspects of the scientific and technical design of MSE, for the international astronomy and engineering communities, and related agencies. The current version is a status report of MSE's science goals and their practical implementation, following the System Conceptual Design Review, held in January 2018. MSE is a planned 10-m class, wide-field, optical and near-infrared facility, designed to enable transformative science, while filling a critical missing gap in the emerging international network of large-scale astronomical facilities. MSE is completely dedicated to multi-object spectroscopy of samples of between thousands and millions of astrophysical objects. It will lead the world in this arena, due to its unique design capabilities: it will boast a large (11.25 m) aperture and wide (1.52 sq. degree) field of view; it will have the capabilities to observe at a wide range of spectral resolutions, from R2500 to R40,000, with massive multiplexing (4332 spectra per exposure, with all spectral resolutions available at all times), and an on-target observing efficiency of more than 80%. MSE will unveil the composition and dynamics of the faint Universe and is designed to excel at precision studies of faint astrophysical phenomena. It will also provide critical follow-up for multi-wavelength imaging surveys, such as those of the Large Synoptic Survey Telescope, Gaia, Euclid, the Wide Field Infrared Survey Telescope, the Square Kilometre Array, and the Next Generation Very Large Array.