Impact of WWII dumpsites on Saipan (CNMI): heavy metal status of soils and sediments.

A number of dumpsites occur on the island of Saipan and in the surrounding coastal waters. Many of these sites date back to the immediate post WWII clean-up period and contain a variety of wartime wastes. Metallic debris is generally the most visible waste material and commonly includes bomb fragments, artillery shells, bullets, and other military hardware.

Influence of urban runoff, inappropriate waste disposal practices and World War II on the heavy metal status of sediments in the southern half of Saipan Lagoon, Saipan, CNMI.

Heavy metals were examined in sediments from the southern half of Saipan Lagoon. These waters provided tactical access for US troops during WWII and were heavily shelled at the time. Mercury profiles in sediments were, to some extent, reflective of this event.

Machine learning for risk prediction of acute coronary syndrome.

Acute coronary syndrome (ACS) accounts for 1.36 million hospitalizations and billions of dollars in costs in the United States alone. A major challenge to diagnosing and treating patients with suspected ACS is the significant symptom overlap between patients with and without ACS.

Neoliomera moana, a new cavernicolous species of xanthid crab from the Marquesas Islands (Crustacea: Decapoda: Brachyura).

A new crab Liomerinae, Neoliomera moana sp. nov., is described from the Marquesas Islands, based on three specimens collected by hand at the entrance of submarine caves at depths of 6-28 m.

Adopting real-time surveillance dashboards as a component of an enterprisewide medication safety strategy.

Background: High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed, and administered.

Methods: A real-time surveillance application was designed and implemented to enable pharmacy review of high-alert medication orders to complement existing computerized provider order entry and integrated clinical decision support systems in a tertiary care hospital. The surveillance tool integrated real-time data from multiple clinical systems and applied logical criteria to highlight potentially high-risk scenarios.

Evolution, insular restriction, and extinction of oceanic land crabs, exemplified by the loss of an endemic Geograpsus in the Hawaiian Islands.

Most oceanic islands harbor unusual and vulnerable biotas as a result of isolation. As many groups, including dominant competitors and predators, have not naturally reached remote islands, others were less constrained to evolve novel adaptations and invade adaptive zones occupied by other taxa on continents. Land crabs are an excellent example of such ecological release, and some crab lineages made the macro-evolutionary transition from sea to land on islands.

Impact of a medical waste incinerator on mercury levels in lagoon fish from a small tropical island in the Western Pacific.

In 2004-2005, several species of marine fish were collected for mercury (Hg) analysis from Saipan Lagoon, Saipan, Commonwealth of the Northern Mariana Islands. Relatively high concentrations were found in representatives from the Hafa Adai Beach area located some distance from known sources of Hg contamination. A follow-up investigation aimed at identifying additional land-based sources of Hg in the area was launched in early 2007.

Acute coronary syndrome pathways: alignment with a bundled care reimbursement model.

Changes in public policy, population demographics, and market dynamics are spurring innovative approaches to value-based care. Annually, hospitalizations for Acute Coronary Syndromes (ACS) account for a substantial proportion of healthcare expenditures in the United States. Vanderbilt University Medical Center has developed a framework to deliver comprehensive care incorporating inpatient and outpatient care teams for patients with ACS under an episode-based, bundled reimbursement model for a term of 6 months.

Informatics and evidence-based medicine: prescription for success.

This article reports on the experience of one organization between 2004 and 2009 to develop an effective people-process-technology system to better manage the quality of health care. The creation of this system started with creating a strategic plan for quality and then establishing a structure to implement the plan. The next phase consisted of establishing a number of simultaneous steps that ranged from identifying and leveraging the appropriate informatics tools to the oversight process, and from the implementation team to strategies for working with clinical groups.

Does the specific time of day used to capture data on ventilator-days have an impact on the documented rates of ventilator-associated pneumonia?

Definitions of ventilator-associated pneumonia do not note a preferred daily time for obtaining denominator data. We examined collecting data on the number of ventilator-days at different times of day in 7 intensive care units. Rates of ventilator-associated pneumonia did not significantly differ when denominator data were collected at midnight, 8 am, or 4 pm, supporting standard definitions.

Systems initiatives reduce healthcare-associated infections: a study of 22,928 device days in a single trauma unit.

Background: "Implementation research" promotes the systematic conversion of evidence-based principles into routine practice to improve the quality of care. We hypothesized a system-based initiative to reduce nosocomial infection would lower the incidence of ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and bloodstream infection (BSI).

Methods: From January 2006 to April 2008, 7,364 adult trauma patients were admitted, of which 1,953 (27%) were admitted to the trauma intensive care unit and comprised the study group.

Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle.

Background: Ventilator-associated pneumonia (VAP) causes significant morbidity and mortality in critically ill surgical patients. Recent studies suggest that the success of preventive measures is dependent on compliance with ventilator bundle parameters.

Hypothesis: Implementation of an electronic dashboard will improve compliance with the bundle parameters and reduce rates of VAP in our surgical intensive care unit (SICU).

A real-time ventilator management dashboard: toward hardwiring compliance with evidence-based guidelines.

Care of mechanically ventilated patients requires coordination between multiple caregivers, necessitating the availability of accurate and timely information on patient status. Researchers have documented positive effects of several interventions on the rates of developing ventilator associated complications, such as providing regular oral care and elevating the head of the bed. Informatics tools, such as electronic whiteboards, reminders, and alerts have been shown to aid in clinician compliance with guidelines or protocols.

Closing the loop in practice to assure the desired performance.

A closed loop control process assures that a system performs within control limits. In closed loop control, the system's output feeds back directly to change the system's inputs. We describe an approach to planning and monitoring care that uses closed loop control to assure the desired performance using examples from Vanderbilt University Medical Center's ventilator management initiative.

The Vanderbilt EvidenceWeb - developing tools to monitor and improve compliance with evidence-based order sets.

CPOE systems hold the promise of both reducing medical errors and improving compliance with evidence-based guidelines. Evidence-based order sets have been used to make evidence-based guidelines actionable at the point of care. Investigators have conducted research into factors effecting order set use, but little has been documented regarding order set compliance.

Chemical defenses of cryptic and aposematic Gastropterid molluscs feeding on their host sponge Dysidea granulosa.

Numerous opisthobranchs are known to sequester chemical defenses from their prey and use them for their own defense. Information on feeding biology is critical for understanding the ecology and evolution of molluscs, yet information on feeding biology is still scarce for many groups. Gastropterid molluscs are often found on sponges, but there is controversy as to whether they are true sponge feeders.