scholarly journals Evaluation of the scale-up and implementation of mind, exercise, nutrition … do it! (MEND) in British Columbia: a hybrid trial type 3 evaluation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sam Liu ◽  
Joy Weismiller ◽  
Karen Strange ◽  
Lisa Forster-Coull ◽  
Jennifer Bradbury ◽  
...  
Keyword(s):  
British Columbia ◽  
Trial Type ◽  
Scale Up ◽  
Type 3 ◽  
Hybrid Trial

scholarly journals Evaluation of the Scale-up and Implementation of Mind, Exercise, Nutrition…Do It! (MEND) in British Columbia: A Hybrid Trial Type 3 Evaluation

2020 ◽  
Author(s):  
Sam Liu ◽  
Joy Weismiller ◽  
Karen Strange ◽  
Lisa Forster-Coull ◽  
Jennifer Bradbury ◽  
...  
Keyword(s):  
Physical Activity ◽  
British Columbia ◽  
Childhood Obesity ◽  
Emotional Distress ◽  
Screen Time ◽  
Program Effectiveness ◽  
Scale Up ◽  
Z Score ◽  
Study Objective ◽  
Type 3

Abstract Background The Mind, Exercise, Nutrition…Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges to implementation during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children’s body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being.Methods This prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children aged 7-13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over four years. A mixed-method approach was used to collect and analyze the data. Evaluation measures included: program reach, attendance, fidelity, acceptability, satisfaction, facilitators and challenges to implementation, and effectiveness (change in children’s BMI z-score, physical activity, screen-time, eating behaviours, self-esteem and emotional distress).Results 136 MEND B.C. programs were delivered over four years. The program reached 987 eligible children. 755 (76.5%) children completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable for their family, respectful of their family's financial situation and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score, nutrition behaviours, physical activity levels, hours of screen time per week and emotional distress (p<0.05). Challenges to continued program implementation included: recruitment, resource requirement for implementation and the need to tailor the program locally to be more flexible and culturally relevant.Conclusions Scaling up efficacious childhood obesity interventions into real-world settings is critical to combat the obesity epidemic. Future family-based childhood obesity management interventions need to explore strategies to enhance program delivery flexibility while optimizing the use of health care resources.

Alkin-Komplexe des Rheniums in hohen Oxidationsstufen / Alkyne Complexes of Rhenium in High Oxidation States

1990 ◽  
Vol 45 (6) ◽  
pp. 876-886 ◽  
Author(s):  
Wolfgang A. Herrmann ◽  
Josef K. Felixberger ◽  
Josef G. Kuchler ◽  
Eberhardt Herdtweck
Keyword(s):  
Diffraction Study ◽  
Scale Up ◽  
Oxidation States ◽  
X Ray Diffraction ◽  
X Ray ◽  
Reducing Conditions ◽  
Molar Amount ◽  
High Oxidation ◽  
Alkyne Complexes ◽  
Type 3

The class of π-alkyne complexes of metals in medium and high oxidation states has been extended by the type CH3ReO2(RC≡CR′) (3a—i). Exchange of alkyne for oxo ligands under reducing conditions has been employed as a new general synthesis. Compounds 3 are thus obtained by reaction of methyltrioxorhenium(VII) (1) with the alkynes 2a—i in the presence of a ca. 1.1-fold molar amount of polymer-bound triphenylphosphane as reducing agent (desoxygenation). The structural characterization was carried out for the example of the tolan complex 3 e by virtue of a single-crystal X-ray diffraction study at —80 °C, according to which the description of compounds 3 as “rhenacyclopropenes” seems justified. Evidence from NMR investigations of 3 a and 3 c shows that no fast rotation of the respective alkyne ligand around the axis to the metal atom occurs on the NMR time scale up to at least 105 °C. A minimal rotation barrier of approximately 20 kcal/mol is thus to be estimated. Reaction of type 3 compounds (R = R′ = CH3, b; R = R′ = C2H5, c) with polymer-bound triphenylphosphane under more drastic conditions (boiling toluene) for two days effects further reduction, with the dinuclear, diamagnetic rhenium(IV) complexes 4b and 4c, resp., being formed. Sterically demanding alkynes (e.g., R = R′ = Si(CH3)3, C6H5) seem to prevent this type of reaction. According to an X-ray diffraction study, 4b has an equilateral Re2O-triangular core geometry, with the ligands O, CH3, and butyne(2) arranged in such a way that C2-symmetry results. The alkyne complexes reported here are the first ones of tetra- and pentavalent rhenium.

scholarly journals Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up

2019 ◽  
Author(s):  
Theresa A McElroy ◽  
Erik N. Swartz ◽  
Kasra Hassani ◽  
Sina Waibel ◽  
Yasmin Tuff ◽  
...  
Keyword(s):  
British Columbia ◽  
Early Warning System ◽  
Situational Awareness ◽  
Scale Up ◽  
Warning System ◽  
Implementation Fidelity ◽  
Pediatric Care ◽  
High Fidelity ◽  
Communication Framework ◽  
Provincial Scale

Abstract Background: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. Methods: We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient charts, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. Results: The majority of charts had documented PEWS scores at triage (80%) and first bedside assessment (81.2%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of the PEWS system and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. Conclusion: Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

Eolian coastal dune deposits and surrounding marine sandstones, Rocky Mountain Supergroup (Lower Pennsylvanian), southeastern British Columbia

1980 ◽  
Vol 17 (9) ◽  
pp. 1125-1140 ◽  
Author(s):  
W. Douglas Stewart ◽  
Roger G. Walker
Keyword(s):  
United States ◽  
British Columbia ◽  
Large Scale ◽  
Scale Up ◽  
Rocky Mountain ◽  
Western United States ◽  
Fair Weather ◽  
Cross Bedding ◽  
Open Sea ◽  
Bodies Of Water

The Pennsylvanian Rocky Mountain Supergroup, in the Elk Range, B.C., includes three sandstone formations: Tyrwhitt (about 100 m thick), Storelk (about 95 m), and Tobermory (about 75). The Tyrwhitt consists mostly of structureless sandstones which prove to be bioturbated in X radiographs. There is an abundant trace fauna, as well as brachiopods. The second most abundant facies consists of medium scale (up to about 1 m) cross-bedded sandstones. The Tobermory is essentially similar to the Tyrwhitt but contains fewer structureless sandstones, and more beds with ripple cross-lamination and horizontal lamination. Both formations were probably deposited slowly in water deeper than fair-weather wave base (deeper than 10–15 m).The Storelk, sandwiched between Tyrwhitt and Tobermory, is dominated by large scale (up to 10.5 m) sets of cross-bedding. These occur in three members, separated by two structureless members. The Storelk structureless members are not mottled in X radiographs, and no trace fauna was found in the field. There is only one 1 m thick fossiliferous bed within the Storelk, which is otherwise barren of trace or body fossils. We reject fluvial and marine sandwave interpretations of the large scale cross-bedding, and suggest that the Storelk represents a coastal eolian dune complex. Paleoflow directions are dominantly toward south-southwest, similar to Pennsylvanian paleowind directions in the western United States. The Storelk structureless members possibly represent sand blown into standing bodies of water, one of which was connected to the open sea (the fossiliferous bed).

scholarly journals Implementation study of a 5-component pediatric early warning system (PEWS) in an emergency department in British Columbia, Canada, to inform provincial scale up

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Theresa McElroy ◽  
Erik N. Swartz ◽  
Kasra Hassani ◽  
Sina Waibel ◽  
Yasmin Tuff ◽  
...  
Keyword(s):  
British Columbia ◽  
Medical Records ◽  
Situational Awareness ◽  
Scale Up ◽  
Warning System ◽  
Implementation Fidelity ◽  
Pediatric Care ◽  
High Fidelity ◽  
Communication Framework ◽  
Provincial Scale

Abstract Background The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. Methods We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient medical records, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. Results The majority of medical records had documented PEWS scores at triage (80%) and first bedside assessment (81%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (> 100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of PEWS and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. Conclusion Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

The influence of mantle plume in the genesis of the Cache Creek oceanic igneous rocks: implications for the geodynamic evolution of the inner accreted terranes of the Canadian Cordillera

2001 ◽  
Vol 38 (4) ◽  
pp. 515-534 ◽  
Author(s):  
M Tardy ◽  
H Lapierre ◽  
L C Struik ◽  
D Bosch ◽  
P Brunet
Keyword(s):  
British Columbia ◽  
Rare Earth ◽  
Earth Element ◽  
Oceanic Island ◽  
Igneous Rocks ◽  
Fault System ◽  
Ultramafic Rocks ◽  
Type 3

West of Prince George, British Columbia, the Cache Creek Terrane is composed of mafic lavas interlayered with both mid-Permian pelagic limestones and Upper Triassic siliceous shales and greywackes. Gabbro, basalt, dolerites, and foliated clinopyroxene-rich ultramafic rocks are exposed within the Pinchi Fault system. The mid-Permian lavas show affinities of oceanic island tholeiites. Among the Triassic lavas, three types of rocks have been distinguished. Type 1 is geochemically similar to the mid-Permian volcanic rocks. Type 2 differs from type 1 by higher TiO2 abundances and convex rare earth element patterns. Type 3 has the highest Zr, Nb, and Ta abundances and the greatest light rare earth element enrichment. The mafic rocks within the Pinchi Fault system are similar to N-type mid-ocean-ridge basalt (N-MORB), and the foliated ultramafic rocks are characterized by very low trace element contents, similar to extremely depleted harzburgites. Permian lavas and Triassic type 1 and igneous rocks from the Pinchi Fault system have the highest εNd(i) ratios (+7.4 to +9.6) and those of type 3 alkali have the lowest ratios (+2.0 to +5.3). The εNd(i) values of type 2 are intermediate between those of type 1 (~+7) and type 3 (~+4.9). This suggests that the Triassic rocks generated from a heterogeneous plume source or the mixing between depleted N-MORB and enriched oceanic island basalt sources. If the mafic igneous rocks sampled in central British Columbia are representative of the preserved parts of an oceanic crust, within the Cache Creek Terrane, then that crust was dominated by oceanic plateau components, perhaps due to the difficulty of subducting thick crust.

scholarly journals Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up

2019 ◽  
Author(s):  
Theresa A McElroy ◽  
Erik N. Swartz ◽  
Kasra Hassani ◽  
Sina Waibel ◽  
Yasmin Tuff ◽  
...  
Keyword(s):  
British Columbia ◽  
Early Warning System ◽  
Situational Awareness ◽  
Scale Up ◽  
Warning System ◽  
Implementation Fidelity ◽  
Pediatric Care ◽  
High Fidelity ◽  
Communication Framework ◽  
Provincial Scale

Abstract Background: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. Methods: We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient charts, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. Results: The majority of charts had documented PEWS scores at triage (80%) and first bedside assessment (81.2%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of the PEWS system and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. Conclusion: Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

NiAl precipitation in Fe-12w/o Cr-5w/o Ni-4w/o Al

1983 ◽  
Vol 41 ◽  
pp. 202-203
Author(s):  
L.E. Murr ◽  
J.S. Dunning ◽  
S. Shankar
Keyword(s):  
Solid Solution ◽  
Stainless Steel ◽  
Stainless Steels ◽  
Alloy Composition ◽  
Chromium Content ◽  
Scale Up ◽  
Optical Metallography ◽  
Property Evaluation ◽  
310 Stainless Steel ◽  
Microstructural Studies

Aluminum additions to conventional 18Cr-8Ni austenitic stainless steel compositions impart excellent resistance to high sulfur environments. However, problems are typically encountered with aluminum additions above about 1% due to embrittlement caused by aluminum in solid solution and the precipitation of NiAl. Consequently, little use has been made of aluminum alloy additions to stainless steels for use in sulfur or H2S environments in the chemical industry, energy conversion or generation, and mineral processing, for example.A research program at the Albany Research Center has concentrated on the development of a wrought alloy composition with as low a chromium content as possible, with the idea of developing a low-chromium substitute for 310 stainless steel (25Cr-20Ni) which is often used in high-sulfur environments. On the basis of workability and microstructural studies involving optical metallography on 100g button ingots soaked at 700°C and air-cooled, a low-alloy composition Fe-12Cr-5Ni-4Al (in wt %) was selected for scale up and property evaluation.

Scanning Electron Microscopy of the Red Pulp of the Spleen

1971 ◽  
Vol 29 ◽  
pp. 496-497
Author(s):  
Masayuki Miyoshi
Keyword(s):  
Electron Microscope ◽  
Ringer Solution ◽  
Conclusive Evidence ◽  
Sinus Wall ◽  
Transmission Electron ◽  
Type 3 ◽  
Cytoplasmic Processes ◽  
Splenic Red Pulp ◽  
Scanning Electron ◽  
Red Pulp

In spite of various attempts, conclusive evidence to explain blood passage in the splenic red pulp does not seem to have been presented. Scanning electron microscope (SEM) observations on the rabbit spleen, originally performed by us, revealed that the sinus was lined by a perforated lattice composed of longitudinally extended rod cells and transverse cytoplasmic processes, and that perforations in the lattice were continuous to the spaces among the stellate reticulum cells of the cord. In the present study the observation was extended to the dog and rat spleens, in which the cord is more developed than in the rabbit in order to clarify the possible differences in the fine structure of the sinus wall. An attempt was also made to examine the development and distribution of macrophage in the blood passage of the red pulp.Spleens were washed and fixed by perfusion with Ringer solution and then with buffered glutaraldehyde. Small tissue cubes were dehydrated with acetone, dried in air and heated with gold. Observations were made by a JEOL SEM Type-3. One air dried tissue cube was cut into small pieces and post fixed with buffered OsO4 for examination under the transmission electron microscope (TEM).

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