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  1. Article: Coastal erosion and structural damage due to four consecutive-year major hurricanes: Beach projects afford resilience and coastal protection

    Bacopoulos, Peter / Clark, Ralph R

    Ocean & coastal management. 2021 Aug. 01, v. 209

    2021  

    Abstract: This paper presents a forensic analysis of the coastal erosion and structural damage associated with four consecutive-year, Atlantic-basin major hurricanes. The investigation focuses on Hurricanes Matthew (2016), Irma (2017), Michael (2018) and Dorian ( ... ...

    Abstract This paper presents a forensic analysis of the coastal erosion and structural damage associated with four consecutive-year, Atlantic-basin major hurricanes. The investigation focuses on Hurricanes Matthew (2016), Irma (2017), Michael (2018) and Dorian (2019) and their impact on the sandy shorelines and coastal construction of Florida, located in the southeastern United States. The study identifies the degree of resilience and coastal protection of different coastal construction methods and beach management programs under varied conditions associated with major hurricane impacts. The study results demonstrate a coherent relationship between observed peak storm tide and surveyed measures of coastal erosion and structural damage. The storm tide generated by the natural forcing of tropical-cyclone winds is variably influenced by the wide continental shelf of Florida's gulf coast and the meso-tidal regime of Florida's east coast. As our data show, beyond the obvious metric of storm strength, as expressed in terms of maximum wind speed, coastal impacts by hurricanes are additionally (or more predominantly) driven by storm size, as expressed in terms of wind radii for tropical storm- and hurricane-force winds. Of socioeconomic relevance, the results demonstrate that beach management projects of sand placement provide dune and berm protection as well as mitigation against damage to coastal property and infrastructure. The findings of this study are directly relevant to other coastal regions with recreational beach, dense populations and vulnerable infrastructure, subject to erosional and destructive events caused by tropical cyclones.
    Keywords coastal zone management ; coasts ; continental shelf ; forensic sciences ; hurricanes ; infrastructure ; sand ; wind speed ; Florida
    Language English
    Dates of publication 2021-0801
    Publishing place Elsevier Ltd
    Document type Article
    Note NAL-AP-2-clean
    ISSN 0964-5691
    DOI 10.1016/j.ocecoaman.2021.105643
    Database NAL-Catalogue (AGRICOLA)

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  2. Book: Physiology of crop production

    Fageria, N. K. / Baligar, Virupax C. / Clark, Ralph B.

    2006  

    Author's details N. K. Fageria ; V. C. Baligar ; R. B. Clark
    Keywords Ertragsphysiologie ; Pflanzenphysiologie ; Ernteertrag
    Subject Ertrag ; Pflanzenertrag ; Pflanzen ; Ernteertrag
    Language English
    Size X, 345 S. : Ill., graph. Darst., Kt.
    Publisher Food Products Press
    Publishing place New York u.a.
    Publishing country United States
    Document type Book
    HBZ-ID HT014406061
    ISBN 1-56022-288-3 ; 978-1-56022-288-0 ; 978-1-56022-289-7 ; 1-56022-289-1
    Database Catalogue ZB MED Nutrition, Environment, Agriculture

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    In stock of ZB MED Bonn / Germany

    Shelf markLoan statusLocation
    068/1321 available for loan (reading room) Freihandmagazin (U1)

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  3. Article ; Online: A Veterans Affairs Primary Care Same-Day Open Access for New Patients Optimized Redesigned System (VA-HONORS): A Six-Year Analysis of 22,220 Patient Records.

    Roman, Maher / Clark, Ralph / Shirwany, Najeeb / Ani, Chizobam / Beeson, W Lawrence

    Joint Commission journal on quality and patient safety

    2020  Volume 47, Issue 3, Page(s) 190–197

    Abstract: Background: Delay in primary care access for new patients to US Department of Veterans Affairs (VA) health care services has been a persistent problem. This article presents the evaluation of a quality improvement (QI) intervention that provided new ... ...

    Abstract Background: Delay in primary care access for new patients to US Department of Veterans Affairs (VA) health care services has been a persistent problem. This article presents the evaluation of a quality improvement (QI) intervention that provided new patients with same-day primary care access. It involved redesign of an intake clinic (IC) through which new patients were initially seen and referred to primary care. The redesign included changes in clinic flow and reallocation of two full-time primary care providers (PCPs) from IC to their primary care teams.
    Methods: A pre-post retrospective study evaluating a QI intervention at a VA hospital examined 22,220 administrative patient records. Specifically, 9,909 new patients seen in the three years prior to implementation of VA-HONORS (preintervention group) were compared with 12,311 patients seen in the three years after implementation (postintervention group). Study outcomes were (1) number of days to first appointment with PCP, (2) proportion of patients receiving same-day primary care access, and (3) visit cycle time.
    Results: Preintervention, median first primary care appointment delay was 96 days, compared to 0 days postintervention (p < 0.001). Preintervention, 3.1% of new patients were able to obtain same-day primary care appointment, compared with 91.5% postintervention (p < 0.001). Median visit cycle time was 140 minutes preintervention vs. 148 minutes postintervention (p < 0.001).
    Conclusions: New patients' same-day access system redesign at one VA hospital dramatically eliminated first primary care appointment delay. The redesign was feasible and sustainable for a sizable population and serves as a model for similar settings with new patients' primary care access delay.
    MeSH term(s) Access to Information ; Humans ; Primary Health Care ; Retrospective Studies ; United States ; United States Department of Veterans Affairs ; Veterans
    Language English
    Publishing date 2020-10-24
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1189890-2
    ISSN 1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
    ISSN (online) 1938-131X ; 1549-425X
    ISSN 1553-7250 ; 1070-3241 ; 1549-3741
    DOI 10.1016/j.jcjq.2020.10.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 2055: Show issues Location:
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  4. Book: CASE STUDIES IN ECHOCARDIOGRAPHY

    CLARK, RALPH D. / EDELEN, JOHN S.

    A DIAGNOSTIC WORKBOOK

    1977  

    Author's details BY RALPH D. CLARK. WITH THE ASSISTANCE OF JOHN S. EDELEN
    Keywords ELECTROCARDIOGRAPHY / CASE STUDIES
    Size X,334 S.
    Publisher SAUNDERS
    Publishing place PHILADELPHIA; LONDON ETC
    Document type Book
    Note WITH ANSWERS
    HBZ-ID HT000069589
    ISBN 0-7216-2594-0 ; 978-0-7216-2594-2
    Database Catalogue ZB MED Medicine, Health

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    In stock of ZB MED Cologne/Königswinter

    Shelf markLoan statusLocation
    1977 A 2286 order for loan Magazin

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  5. Article ; Online: Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units.

    Mishra, Vimal / Tu, Shin-Ping / Heim, Joseph / Masters, Heather / Hall, Lindsey / Clark, Ralph R / Dow, Alan W

    Journal of hospital medicine

    2018  Volume 14, Issue 1, Page(s) 9–15

    Abstract: Background: Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result ... ...

    Abstract Background: Hospitals are complex adaptive systems within which multiple components such as patients, practitioners, facilities, and technology interact. A careful approach to optimization of this complex system is needed because any change can result in unexpected deleterious effects. One such approach is discrete event simulation, in which what-if scenarios allow researchers to predict the impact of a proposed change on the system. However, studies illustrating the application of simulation in optimization of general internal medicine (GIM) team inpatient operations are lacking.
    Methods: Administrative data about admissions and discharges, data from a time-motion study, and expert opinion on workflow were used to construct the simulation model. Then, the impact of four changes: aligning medical teams with nursing units, adding a hospitalist team, adding a nursing unit, and adding both a nursing unit and hospitalist team with higher admission volume were modeled on key hospital operational metrics.
    Results: Aligning medical teams with nursing units improved team metrics for aligned teams but shifted patients to unaligned teams. Adding a hospitalist team had little benefit, but adding a nursing unit improved system metrics. Both adding a hospitalist team and a nursing unit would be required to maintain operational metrics with increased patient volume.
    Conclusion: Using simulation modeling, we provided data on the implications of four possible strategic changes on GIM inpatient units, providers, and patient throughput. Such analyses may be a worthwhile investment to study strategic decisions and make better choices with fewer unintended consequences.
    MeSH term(s) Computer Simulation ; Efficiency, Organizational ; Female ; Forecasting ; Hospitalists/statistics & numerical data ; Hospitals/statistics & numerical data ; Humans ; Internal Medicine ; Male ; Patient Admission/statistics & numerical data ; Patient Care Team/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Time and Motion Studies
    Language English
    Publishing date 2018-11-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.12788/jhm.3081
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 6276: Show issues Location:
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    Zs.MO 542: Show issues

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  6. Article ; Online: Obesity and life expectancy among long-lived Black adults.

    Singh, Pramil N / Clark, Ralph W / Herring, Patti / Sabaté, Joan / Shavlik, David / Fraser, Gary E

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2013  Volume 69, Issue 1, Page(s) 63–72

    Abstract: Background: In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine ... ...

    Abstract Background: In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults.
    Methods: The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort-half of whom attained an age of 58-108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women).
    Results: Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8-10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1- 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5-24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously.
    Conclusions: Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks.
    MeSH term(s) Adult ; African Americans ; Age Distribution ; Aged ; Aged, 80 and over ; Canada/epidemiology ; Female ; Follow-Up Studies ; Humans ; Life Expectancy/trends ; Male ; Middle Aged ; Morbidity/trends ; Obesity/ethnology ; Prospective Studies ; Risk Factors ; Sex Distribution ; Survival Rate/trends ; United States/epidemiology
    Language English
    Publishing date 2013-05-16
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glt049
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uc I Zs.242/A: Show issues Location:
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  7. Book: Physiology of crop production

    Fageria, N. K / Baligar, V. C / Clark, Ralph B

    2006  

    Author's details N. K. Fageria, V. C. Baligar, R. B. Clark
    Keywords Crop yields ; Crops/Physiology ; Pflanzenphysiologie ; Kulturpflanzen
    Language English
    Size X, 345 S., graph. Darst.
    Publisher Food Products Press
    Publishing place New York u.a.
    Document type Book
    Note Includes bibliographical references
    ISBN 1560222883 ; 1560222891 ; 9781560222880 ; 9781560222897
    Database Julius Kühn-Institute

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  8. Book: Physiology of crop production

    Fageria, N. K / Baligar, V. C / Clark, Ralph B

    2006  

    Author's details N. K. Fageria, V. C. Baligar, R. B. Clark
    Keywords Crop yields ; Crops/Physiology ; Pflanzenphysiologie ; Kulturpflanzen
    Language English
    Size X, 345 S., graph. Darst.
    Publisher Food Products Press
    Publishing place New York u.a.
    Document type Book
    Note Includes bibliographical references
    ISBN 1560222883 ; 1560222891 ; 9781560222880 ; 9781560222897
    Database Former special subject collection: coastal and deep sea fishing

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  9. Book: Physiology of crop production

    Fageria, N. K / Baligar, Virupax C / Clark, Ralph B

    2006  

    Author's details N. K. Fageria, V. C. Baligar, R. B. Clark
    Keywords Crop yields ; Crops/Physiology ; Ertragsphysiologie ; Pflanzenphysiologie ; Kulturpflanzen
    Language English
    Size X, 345 S., graph. Darst.
    Document type Book
    Note Includes bibliographical references
    ISBN 1560222883 ; 1560222891 ; 9781560222880 ; 9781560222897
    Database Leibniz Institute of Plant Genetics and Crop Plant Research

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  10. Article ; Online: Concentrating hospital-wide deaths in a palliative care unit: the effect on place of death and system-wide mortality.

    Cassel, J Brian / Hager, Mary Ann / Clark, Ralph R / Retchin, Sheldon M / Dimartino, Janet / Coyne, Patrick J / Riggins, Jerry / Smith, Thomas J

    Journal of palliative medicine

    2010  Volume 13, Issue 4, Page(s) 371–374

    Abstract: Introduction: We studied the impact of an 11-bed inpatient palliative care unit (PCU) on site of death and observed mortality in the health system, oncology, and palliative care units. Observers were concerned that an active PCU would attract dying ... ...

    Abstract Introduction: We studied the impact of an 11-bed inpatient palliative care unit (PCU) on site of death and observed mortality in the health system, oncology, and palliative care units. Observers were concerned that an active PCU would attract dying patients and worsen comparative mortality rates for Medicare and U.S. News & World Report comparisons.
    Methods: We reviewed 10 years of experience with all patients who died in the hospital before and after we opened our PCU in 2000.
    Results: The PCU concentrated dying patients on the PCU but total deaths did not change over 10 years and remained approximately 3% of admissions. Within 2 years, one quarter of all health system decedents died on the PCU. The proportion who died on the oncology floor and general units declined, but the number of intensive care unit deaths did not change.
    Conclusions: An inpatient PCU did not increase the hospital-wide death rate. The PCU did change the site of death to a more appropriate venue for one quarter of patients.
    MeSH term(s) Academic Medical Centers/statistics & numerical data ; Geography ; Hospital Mortality/trends ; Humans ; Intensive Care Units/statistics & numerical data ; Oncology Service, Hospital/organization & administration ; Oncology Service, Hospital/statistics & numerical data ; Palliative Care/organization & administration ; Palliative Care/statistics & numerical data ; Patient Care Team/organization & administration ; Patient Care Team/statistics & numerical data ; Quality of Health Care/statistics & numerical data ; Retrospective Studies ; Virginia
    Language English
    Publishing date 2010-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2009.0372
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5440: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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