How We Close the Gaps: Our Interprofessional Team Approach to Meeting Quality Measures

Define the role/function of an interprofessional team in the management of complex outpatients. Identify the types of patients that would benefit most from a team-based approach. Implement elements of our team-based patient care model into individual practices

Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners

Recent data indicate that the incidence of end-stage renal disease (ESRD) in pediatric patients (age 0–19 years) has increased over the past two decades. Similarly, the prevalence of ESRD has increased threefold over the same period. Hemodialysis (HD) continues to be the most frequently utilized modality for renal replacement therapy in incident pediatric ESRD patients. The number of children on HD exceeded the sum total of those on peritoneal dialysis and those undergoing pre-emptive renal transplantation. Choosing the best vascular access option for pediatric HD patients remains challenging. Despite a national initiative for fistula first in the adult hemodialysis population, the pediatric nephrology community in the United States of America utilizes central venous catheters as the primary dialysis access for most patients. Vascular access management requires proper advance planning to assure that the best permanent access is placed, seamless communication involving a multidisciplinary team of nephrologists, nurses, surgeons, and interventional radiologists, and ongoing monitoring to ensure a long life of use. It is imperative that practitioners have a long-term vision to decrease morbidity in this unique patient population. This article reviews the various types of pediatric vascular accesses used worldwide and the benefits and disadvantages of these various forms of access

Determination of wind loads on heliostats

By boundary layer wind tunnel measurements the wind loads on heliostats were investigated for conditions with no or only insufficient values available in literature: • Aspect ratio: For aspect ratios of the mirror plane (width / height) between 0.5 and 3.0 the wind load coefficients were determined. For the critical load cases (combinations of elevation angle and wind direction of highest wind loads) formulas for the calculation of the impact of the aspect ratio were gained. • Wide gap: By measurements of a heliostat with one wide central gap between the mirror facets it turned out that wide gaps are of impact especially on the hinge moment. • Wind fence: The impact of a wind fence at different heliostat field densities was investigated. For low field densities only small load reductions were measured. Future work should investigate the significance of the similarity of the energy spectrum at the critical scales

Wind loads on heliostats and photovoltaic trackers of various aspect ratios

For the layout of solar trackers the wind loads on the structure have to be known. They can be calculated by using wind load coefficients given in literature. But so far these values are only valid for aspect ratios of the panel (width to height) of about 1.0. Therefore the wind load coefficients for heliostats of aspect ratios between 0.5 and 3.0 were determined to close this gap. As solar trackers are exposed to the turbulent atmospheric boundary layer the turbulence of the approaching flow has to be modeled. As a reliable method at reasonable cost wind tunnel measurements were chosen. Solar trackers of 30 m2 panel size were investigated at a model scale of 1:20. Wind direction and elevation angle of the panel were varied to investigate especially the constellations at which the highest wind loads are expected (critical load cases). By spires and roughness elements a wind profile and a turbulence intensity of the modeled wind according to typical sites for solar trackers were achieved. The loads were measured by a high frequency force balance placed underneath the models. Additionally measurements of the pressure distribution on a panel with aspect ratio of 1.2 were performed to better understand the effects that lead to the peak values of the wind load coefficients. A significant impact of the aspect ratio was measured. For the critical load cases the aspect ratio dependencies of the accordant peak wind load components were determined. By these the peak wind loads on solar trackers of varies aspect ratios can be calculated. Regarding the single solar tracker components the main results are: Higher aspect ratios are advantageous for the dimensioning of the foundation, the pylon and the elevation drive but disadvantageous for the azimuth drive

A Study of Higher Education Outdoor Laboratories with Recommendations for the Outdoor Laboratory Proposed by the Recreation & Park Faculty of Western Kentucky University

This study was made in an attempt to establish a nationwide status of Outdoor Laboratories and, based on the findings, to make recommendations for the proposed Outdoor Laboratory at Western Kentucky University. Two survey instruments were developed for the two survey groups: American colleges and universities (Instrument The), and Western Kentucky University department heads (Instrument Two). Two-hundred-ninety educational institutions were mailed Instrument \u27)ne; ninety-two returned completed and useable questionnaires. The questions concerned general, geographic, facility, and activity characteristics of the Outdoor Laboratory. A majority of the respondents maintained Outdoor Laboratories with areas of one hundred acres or more, located within ten miles of the main campus. Most of the Outdoor Laboratories were operated by college departments other than recreation and parks, and were financed by college funds. The mos. commonly used facilities were hiking trails, primitive camping areas, nature centers, and general play fields. A wide variety of activities were offered through the ninety-two Outdoor Laboratories for recreation and education. Students (elementary, high school, and college) were the groups most frequently served by the Outdoor Laboratories. Twenty-six of thirty-three department heads returned Instrument Two. Their questionnaire was designed to elicit opinions and recommendations concerning the use and operation of an Outdoor Laboratory at Western Kentucky University. The recommendations called for leadership and developmental training for faculty and administrators, outdoor skills training and programs, and field trips geared toward specific outdoor-related disciplines. The recommended facilities were mainly open spaces, basic living, meeting, and eating buildings, and recreational facilities of various types