August 4th: Despite the heavy overcast conditions, Raffles Marina was a hive of activity, with the Red Bull chilling tent taking center stage and today's sponsor Barclay's Bank bringing groups of handicapped kids and orphans on a guided tour and providing sailing joy rides, creating a vibrant festival atmosphere onshore while the sailors battled it out offshore. This year the increase in entries and the diverse class line-up called for two separate racing areas, which inevitably caused some confusion and a number of late starters in the IRC A and B classes that was laid further West, almost at the entrance to the Johor Strait. Maybe more attention should be paid at the skippers briefing and an earlier departure from the marina to allow for the strong incoming tide. Remnants of yesterdays stormy conditions lingered around with isolated rain clouds on both sides of the Strait producing 8 to 12 knots of SSW wind, which varied with every passing cloud system and faded away towards the end of the day.
Only three of the seven IRC A boats were on time for the Race 1 start and left it to Bill Bremner's Mills King 40 Foxy Lady 6, Sarab Jeet Singh's Sydney 40 Windsikher and Steve Manning's Sydney GTS 43 Walawala 2 to fight it out for the top spots. The others progressively joined in but made little difference as the leading pack had already bolted. At one stage the breeze picked up to 18 knots with the passing storm front and kept tacticians on their toes picking out the wind shifts and favoured tacks. Hot off winning the RSYC regatta a couple weeks ago, Bremner's Foxy Lady 6 showed no remorse to convincingly win Race 1 and end the day with a 1, 2, 1 scoreline to take the overall lead. The strong current also played a pivotal role and Singh's Windsikher worked it to perfection to claim Race 2 handicap honours and second overall. Herman Bake's ESSE 850 IMP jumped up into second place in Race 3 and Manning's Walawala 2 exchanged third and fourth places with Chris Furness / Guz Wilkinson's Rikki Tikki Tavi to hold down third overall.
In the IRC B class, Ad Smit's X99 Power Partners nailed the start line in Race 1 and led around the course to claim the daily double but two sixth places in subsequent races left them down in third overall. Gordon Maxted's Young 840 Shoon Fung Too showed there is still life in the old girl yet and with a 2, 1, 1 scoreline are pleased to end up on top of the leaderboard. Both the SMU Platu's were late for the first start but made up for it with Alexi Lim's SMUve ending the day in second overall and Fidelis Tan on SMUmad in fourth. Joe Lombardo's Dufour 34 Shardana snagged third place in Race 1 and Simon Piff's Lavranos 34 Rainbow Dream finally came good with second place in Race 3.
On Course 1 in front of Raffles Marina the J24, Club Racer, Corsair Trimarans, Off the beach Catamaran and SB20 classes all enjoyed three races before calling it a day. Different courses for different horses. saw the Club, Corsairs and Cats on lengthy courses around harbour marks while the J24 and SB20's on traditional windward/leeward courses.
Goh Jian Guang's Juno broke the ice in the first J24 race and clung on with second and third places to take the overall lead. Starting out with fifth place, Winfrid Wong must have stirred the Shengli crew into action as they won the next two races and trail the leaders by one point. The juggling of places helped Daryl Chan's RSYC Dua score 2, 3, 2 and end up tied on seven points with second placed Shengli.
Three Dash 750 and one F-31R make up the Cosair Trimaran Class. Three bullets for Scott McCook on The Dash places the Singapore sales agents on top of the leaderboard. Close behind Nicolas Gillier/ Jeremy Perrier on Dash Boot could not climb the mountain and pulled up in second overall. The same goes for Richard Wallace Kaze III who are also looking to strike out on the next few races. Although sailing on the bigger F-31R Koh Joo Kim's newly acquired One Sails have been outclassed on this occasion, but watch when they get acclimatised and complete some further fine tuning.
There is no stopping Martin Pickrodt's Nacra Carbon 20 Rantanplan in the Catamaran Class with three bullets out of three races. Greg Smith Viper F16 Allon5 - Y followed suite with three second places. Lin Josua also on a Viper F16 put up a good showing to slot into third overall.
With 3, 1, 1 scoreline Jeremy Chase Glasgow Kiss leads the way in the hotly contested SB20 Class. Not to be outdone Jonathan Mahony's Scumbag kept up the pressure with 1, 2, 2 to be tied on five points with the leader. Jayant Dhobley's Du Mei Dai holds onto third overall but will have to go harder as two boats behind them are only one point adrift.
The radio controlled IOM class and Access 2.3 for disabled sailors kicked of their campaigns in fine style and will conclude their series tomorrow.
Racing continues tomorrow with the IRC classes contesting the SMU President's Cup while other classes set sail on passage races in the Johor Strait. Prize giving and dinner will be held in the evening on the lawn in front of the clubhouse.


text:
Table 1. Characteristics of the Study Hospitals, Overall and by Educational Composition of the Nurse Workforce
Table 2. Characteristics of Surgical Patients in the Study Hospitals, Overall and by Educational Composition of Staff Registered Nurses*
Table 3. Odds Ratios Estimating the Effects of Nurse and Physician Variables on Patient Mortality and Failure to Rescue*
Table 4. Estimated Rates of Mortality and Failure to Rescue per 1000 Patients, by Levels of Nurse Education and Staffing
Blendon RJ, DesRoches CM, Brodie M. et al. Views of practicing physicians and the public on medical errors. N Engl J Med.2002;347:1933-1940.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12477944&dopt=AbstractGoogle Scholar
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA.2002;288:1987-1993.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12387650&dopt=AbstractGoogle Scholar
Buerhaus PI, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. JAMA.2000;283:2948-2954.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10865272&dopt=AbstractGoogle Scholar
Clarke SP, Aiken LH. Failure to rescue. Am J Nurs.2003;103:42-47.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12544057&dopt=AbstractGoogle Scholar
American Nurses Association. Nurse Staffing and Patient Outcomes: In the Inpatient Hospital Setting. Washington, DC: American Nurses Association; 2000.
Blegen MA, Goode CJ, Reed L. Nurse staffing and patient outcomes. Nurs Res.1998;47:43-50.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9478183&dopt=AbstractGoogle Scholar
Unruh L. Licensed nurse staffing and adverse events in hospitals. Med Care.2003;41:142-152.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12544551&dopt=AbstractGoogle Scholar
Hartz AJ, Krakauer H, Kuhn EM. et al. Hospital characteristics and mortality rates. N Engl J Med.1989;321:1720-1725.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2594031&dopt=AbstractGoogle Scholar
Kovner C, Gergen PJ. Nurse staffing levels and adverse events following surgery in US hospitals. Image J Nurs Sch.1998;30:315-321.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9866290&dopt=AbstractGoogle Scholar
Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med.2002;346:1715-1722.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12037152&dopt=AbstractGoogle Scholar
Source Book-Nursing Personnel . Hyattsville, Md: US Dept of Health and Human Services; 1981.
National Council of State Boards of Nursing. Annual report 2001. Available at: http://www.ncsbn.org/public/about/res/AnnRpt_FY01.pdf. Accessed May 2, 2003.
Hickam DH, Severance S, Feldstein A. et al. The Effect of Health Care Working Conditions on Patient Safety. Rockville, Md: Agency for Healthcare Research and Quality; 2003. Evidence Report/Technology Assessment 74. AHRQ publication 03-E031.
Minnick AF, Roberts MJ, Young WB. et al. What influences patients' reports of three aspects of hospital services? Med Care.1997;35:399-409.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9107207&dopt=AbstractGoogle Scholar
Young WB, Lehrer EL, White WD. The effect of education on the practice of nursing. Image J Nurs Sch.1991;23:105-108.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2060948Google Scholar
Johnson JH. Differences in the performances of baccalaureate, associate degree, and diploma nurses: a meta-analysis. Res Nurs Health.1988;11:183-197.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3399699&dopt=AbstractGoogle Scholar
Blegen MA, Vaughn T, Goode CJ. Nurse experience and education: effect on quality of care. J Nurs Adm.2001;31:33-39.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11198839&dopt=AbstractGoogle Scholar
American Hospital Association. Hospital Statistics 1999 Edition. Chicago, Ill: Health Forum; 1999.
Hospital Questionnaire: Reporting Period July 1, 1998-June 30, 1999 . Harrisburg: Pennsylvania Dept of Health, Division of Statistics; July 1999.
Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol.1997;50:1129-1136.Google Scholar
The Registered Nurse Population: Findings From the National Sample Survey of Registered Nurses . Rockville, Md: US Dept of Health and Human Services; March 2000.
Silber JH, Rosenbaum PR, Trudeau ME. et al. Multivariate matching and bias reduction in the surgical outcomes study. Med Care.2001;39:1048-1064.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11567168&dopt=AbstractGoogle Scholar
Silber JH, Kennedy SK, Even-Shoshan O. et al. Anesthesiologist direction and patient outcomes. Anesthesiology.2000;93:152-163.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10861159&dopt=AbstractGoogle Scholar
Silber JH, Kennedy SK, Even-Shoshan O. et al. Anesthesiologist board certification and patient outcomes. Anesthesiology.2002;96:1044-1052.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11981141&dopt=AbstractGoogle Scholar
Silber JH, Rosenbaum PR, Schwartz JS, Ross RN, Williams SV. Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. JAMA.1995;274:317-323.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7609261&dopt=AbstractGoogle Scholar
Silber JH, Rosenbaum PR. A spurious correlation between hospital mortality and complication rates: the importance of severity adjustment. Med Care.1997;35(10 suppl):OS77-OS92.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9339779&dopt=AbstractGoogle Scholar
American Board of Medical Specialties. The Official ABMS Directory of Board Certified Medical Specialists. 32nd ed. New Providence, NJ: Marquis Who's Who; 2000.
Bishop YMM, Fienberg SE, Holland PW. Discrete Multivariate Analysis: Theory and Practice. Cambridge, Mass: MIT Press; 1975.
Iezzoni LI. Risk Adjustment for Measuring Healthcare Outcomes. 2nd ed. Chicago, Ill: Health Administration Press; 1997.
Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat.1985;39:33-38.Google Scholar
Goode CJ, Pinkerton S, McCausland MP. et al. Documenting chief nursing officers' preference for BSN-prepared nurses. J Nurs Adm.2001;31:55-59.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11271678&dopt=AbstractGoogle Scholar
American Association of Colleges of Nursing. Though enrollments rise at US nursing colleges and universities, increase is insufficient to meet the demand for new nurses. December 2002. Available at: http://www.aacn.nche.edu/media/newsreleases/enrl02.htm. Accessed May 2, 2003.
The Registered Nurse Population: Findings from the National Sample Survey of Registered Nurses, March 1992 Washington, DC: US Dept of Health and Human Services; 1992 . USDHHS 55/4872.
Seventh Report to the President and Congress on the Status of Health Personnel in the United States . Rockville, Md: US Dept of Health and Human Services; 1990.
National Advisory Council on Nurse Education and Practice. Report to the Secretary of the Department of Health and Human Services on the Basic Registered Nurse Workforce. Washington, DC: US Dept of Health and Human Services, Division of Nursing; October 1996.
Recreating Health Professional Practice for a New Century: The Fourth Report of the Pew Health Professions Commission . San Francisco, Calif: Pew Health Professions Commission; 1998.
Health Care Quality Nursing Surgery
Citations 1,006
Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA. 2003;290(12):1617–1623. doi:10.1001/jama.290.12.1617
Educational Levels of Hospital Nurses and Surgical Patient Mortality
Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Robyn B. Cheung, PhD, RN; et al Douglas M. Sloane, PhD; Jeffrey H. Silber, MD, PhD
Author Affiliations: Center for Health Outcomes and Policy Research, School of Nursing (Drs Aiken, Clarke, Cheung, and Sloane), Leonard Davis Institute of Health Economics (Drs Aiken, Clarke, and Silber), Department of Sociology (Dr Aiken), Population Studies Center (Drs Aiken, Clarke, and Sloane), and Departments of Pediatrics and Anesthesia, School of Medicine (Dr Silber), University of Pennsylvania, Philadelphia; and Center for Outcomes Research, Children's Hospital of Philadelphia (Dr Silber).
JAMA. 2003;290(12):1617-1623. doi:10.1001/jama.290.12.1617
Context Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.
Objective To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).
Design, Setting, and Population Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.
Main Outcome Measures Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.
Results The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).
Conclusion In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.
Nurse understaffing is ranked by the public and physicians as one of the greatest threats to patient safety in US hospitals.1 Last year we reported the results of a study of 168 Pennsylvania hospitals showing that each additional patient added to the average workload of staff registered nurses (RNs) increased the risk of death following common surgical procedures by 7%, and that the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients.2 These findings are daunting given the widespread shortage of nurses, increasing concern about recruiting an adequate supply of new nurses to replace those expected to retire over the next 15 years,3 and constrained hospital budgets. These findings also raise questions about whether characteristics of the hospital RN workforce other than ratios of nurses to patients are important in achieving excellent patient outcomes.
Nurses constitute the surveillance system for early detection of complications and problems in care, and they are in the best position to initiate actions that minimize negative outcomes for patients.4 That the exercise of clinical judgment by nurses, as well as staffing adequacy, is key to effective surveillance may explain the link between higher nursing skill mix (ie, a higher proportion of RNs among the nursing personnel of a hospital) and better patient outcomes.5-10
Registered nurses in the United States generally receive their basic education in 1 of 3 types of programs: 3-year diploma programs in hospitals, associate degree nursing programs in community colleges, and baccalaureate nursing programs in colleges and universities. In 1950, 92% of new RNs graduated from hospital diploma programs,11 whereas by 2001, only 3% graduated from hospital diploma programs, 61% came from associate degree programs, and 36% were baccalaureate program graduates.12 Surprisingly little is known about the benefits, if any, of the substantial growth in the numbers of nurses with bachelor's degrees. Indeed the conventional wisdom is that nurses' experience is more important than their educational levels.
Despite the diversity of educational programs preparing RNs, and a logical (but unconfirmed) connection between education and clinical judgment, little if anything is known about the impact of nurses' education on patient outcomes.13 Results of some studies have suggested that baccalaureate-prepared nurses are more likely to demonstrate professional behaviors important to patient safety such as problem solving, performance of complex functions, and effective communication.14-16 However, few studies have examined the effect of nurse education on patient outcomes, and their findings have been inconclusive.17
The 168 Pennsylvania hospitals included in our previous study2 of patient-to-nurse staffing and patient mortality varied substantially in the proportion of staff nurses holding baccalaureate or higher degrees. This variability provides an opportunity to conduct a similar study examining the association between the educational composition of a hospital's RN staff and patient outcomes. Specifically, we tested whether hospitals with higher proportions of direct-care RNs educated at the baccalaureate level or above have lower risk-adjusted mortality rates and lower rates of failure to rescue (deaths in patients with serious complications). We also examined whether the educational backgrounds of hospital RNs are a predictor of patient mortality beyond factors such as nurse staffing and experience. These findings offer insights into the potential benefits of a more highly educated nurse workforce.
Data Sources, and Variables
We analyzed outcomes data derived from hospital discharge abstracts that were merged with information on the characteristics of the treating hospitals, including unique data obtained from surveys of hospital nurses.2 The institutional review board of the University of Pennsylvania approved the study protocol.
Hospitals. The sample consisted of 168 (80%) of the 210 adult acute-care general hospitals operating in Pennsylvania in 1999 that (1) reported surgical discharges to the Pennsylvania Health Care Cost Containment Council in the specific categories studied here, (2) had data on structural characteristics available from 2 external administrative databases (American Hospital Association [AHA] annual survey18 and Pennsylvania Department of Health Hospital Questionnaire19), and (3) had at least 10 nurses responding to our questionnaire, which previous empirical work demonstrated was sufficient to provide reliable estimates of survey-based organizational characteristics of the hospitals. Six of the excluded hospitals were Veterans Affairs hospitals, which do not report discharge data to the state. Twenty-six hospitals were excluded because of missing data, most often because their reporting to external administrative sources was done as aggregate multihospital entities. Ten small hospitals, most of which had 50 or fewer beds, had an insufficient number of nurses responding to the questionnaire to be included.
A 50% random sample of RNs residing in Pennsylvania and on the rolls of the Pennsylvania Board of Nursing received questionnaires at their homes in the spring of 1999. Surveys were completed by 10 184 nurses, an average of more than 60 nurses per hospital, and the 52% response rate compares favorably with other voluntary, anonymous surveys of health professionals.20 We compared our data with information from the AHA annual survey and found that the number of nurses from each hospital responding to our survey was directly proportional to the number of RN positions in each hospital. This suggests similar response rates across hospitals and no response bias at the hospital level. Moreover, demographic characteristics of the respondents paralleled those of Pennsylvania hospital nurses in the National Sample Survey of Registered Nurses.21 For example, the mean ages of Pennsylvania hospital nurses in our sample and in the National Sample Survey of Registered Nurses were 40 and 41 years, respectively; the percentages of Pennsylvania hospital nurses working full-time were 66% and 69%, respectively; and those having earned bachelor of science in nursing (BSN) degrees were 30% and 31%, respectively.
Hospital staff nurses were asked to indicate whether their highest credential in nursing was a hospital school diploma, an associate degree, a bachelor's degree, a master's degree, or another degree. The proportion of nurses in each hospital who held each type of credential was computed. Because the educational preparation of the 4.3% of nurses who checked "other" was unknown, their answers were not included in our hospital-level measures of educational qualifications. It was later verified that this decision did not bias the results. Because there was no evidence that the relative proportions of nurses holding diplomas and associate degrees affected the patient outcomes studied, those 2 categories of nurses were collapsed into a single category and the educational composition of the hospital staff was characterized in terms of the percentage of nurses holding bachelor's or master's degrees.
Two further variables were derived from the nurse survey. Nursing workload was computed as the mean number of patients assigned to all staff nurses who reported caring for at least 1 but fewer than 20 patients on the last shift they worked. Because nurse experience was an important potential confounding variable related to both clinical judgment and education, the mean number of years of experience working as an RN for nurses from each hospital was also calculated and used in the analyses.
Three hospital characteristics were used as control variables: size, teaching status, and technology. Hospital-level data were obtained from the 1999 AHA annual survey and the 1999 Pennsylvania Department of Health Hospital Survey. Three size categories (<100 beds, 101-250 beds, ≥251 beds) were used. Hospitals without any postgraduate medical residents or fellows (nonteaching) were distinguished from those with 1:4 or smaller trainee-to-bed ratios (minor teaching) and those with ratios higher than 1:4 (major teaching). High-technology hospitals were those that had facilities for either open-heart surgery, major organ transplantations, or both.
Patients and Patient Outcomes. Discharge abstracts for the universe of 232 342 patients aged 20 to 85 years who underwent general surgical, orthopedic, or vascular procedures from April 1, 1998, to November 30, 1999, in the 168 nonfederal hospitals were obtained from the Pennsylvania Health Care Cost Containment Council, which checks the data for completeness and quality. A list of the diagnosis related groups studied was provided previously.2
We examined the association between the educational attainments of nurses across hospitals and both deaths within 30 days of hospital admission (derived by linking discharge abstract data and Pennsylvania vital statistics data) and deaths within 30 days of admission among patients who experienced complications (failure to rescue). Patient complications were determined with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the secondary diagnosis and procedure fields of discharge abstracts indicative of 39 clinical events using protocols drawing on expert consensus as well as empirical evidence to distinguish complications from preexisting comorbidities.22-24
The 2 patient outcomes studied were risk-adjusted by including 133 variables in our models, including age, sex, whether the admission was a transfer from another hospital, whether it was an emergency admission, a series of 48 variables indicating surgery type, dummy variables indicating the presence of 28 chronic preexisting conditions as classified by ICD-9-CM codes, and interaction terms chosen on the basis of their ability to predict mortality and failure to rescue in the present data set. Construction of the patient risk adjustment models used an approach similar to that reported by Silber and colleagues.22-26 The c statistic for the mortality risk adjustment model was 0.89 and for the failure to rescue model, 0.81.
We also estimated and controlled for the effect of having a board-certified surgeon on risk for mortality and failure to rescue. For each patient, the license number of the operating physician of record was matched to a physician's name using a public use file from the Pennsylvania Bureau of Professional and Occupational Affairs, and subsequently to records from the American Board of Medical Specialties directory of board-certified medical specialists.27 A dummy variable was constructed to indicate whether or not the operating physician was board-certified in general surgery or another surgical specialty. A second dummy variable was used to identify patients (8% of all patients) with operating physicians whose license numbers could not be linked to names to determine board-certification status. Use of these 2 variables in tandem produced a reasonable way of controlling for surgeon qualifications in our models.
Descriptive statistics (means, SDs, and percentages) and significance tests (χ2 and F tests) were computed to compare groups of hospitals that varied in terms of their educational composition on hospital characteristics, including nurse experience and nurse staffing, and patient characteristics. Logistic regression models were used to estimate the effects of a 10% increase in the proportion of nurses who had a bachelor's or master's degree on patient mortality and failure to rescue, and to estimate the effects of nurse staffing, nurse experience, and surgeon board certification. The associations of educational composition, staffing, experience of nurses, and surgeon board certification with patient outcomes were computed before and after controlling for patient characteristics (demographic characteristics, nature of the hospital admission, comorbidities, and relevant interaction terms) and hospital characteristics (bed size, teaching status, and technology).
To account for the clustering of patients within hospitals in our sample, all model estimates were computed using Huber-White (robust) procedures to adjust the SEs of the estimated parameters. Direct standardization estimates derived from the final model are presented to indicate the size of the effects of educational composition of nursing staff independently of and jointly with nurse staffing levels. With all patients and using the final fully adjusted models for predicting death and failure to rescue, the probabilities of poor outcomes were calculated for patients in hospitals assuming that 20%, 40%, and 60% of the hospital RNs held bachelor's or master's degrees and under various patient-to-nurse ratios (4, 6, and 8 patients per nurse), with all other patient and hospital characteristics unchanged.28 All analyses were conducted using STATA version 7.0 (STATA Corp, College Station, Tex), using P<.05 as the level of statistical significance.
Characteristics of Hospitals and Patients
Table 1 provides information on characteristics of the 168 hospitals in our sample. About 19% of the hospitals had more than 250 beds, 36% were teaching hospitals, and 28% had high-technology facilities. Across all hospitals, nurses had a mean (SD) of 14.2 (2.7) years of experience and a mean (SD) workload on their last shift of 5.7 (1.1) patients. The proportion of staff nurses with bachelor's degrees or higher degrees ranged from 0% to 70% across the hospitals. In 20% of the hospitals (34/168) less than 20% of staff nurses had BSN or higher degrees, while in 11% of the hospitals (19/168) 50% or more of the nurses had BSN or higher degrees. Hospitals with higher percentages of nurses with BSN or master's degrees tended to be larger and have postgraduate medical training programs, as well as high-technology facilities. Hospitals with higher proportions of baccalaureate- and master's-prepared nurses also had slightly less experienced nurses on average and significantly lower mean workloads. The strong association between the educational composition of hospitals and other hospital characteristics, including nurse workloads, makes clear the need to control for these latter characteristics in estimating the effects of nurse education on patient mortality.
Table 2 describes characteristics of the patients in our sample and how they varied across hospitals with different nurse educational compositions. Of the patients studied, 43.7% were men and the mean (SD) age was 59.3 (16.9) years. Of the 232 342 patients, 53 813 (23.2%) experienced a major complication not present on admission, 4535 (2.0%) died within 30 days of admission, and the death rate among patients with complications (failure to rescue) was 8.4%. The 2 largest categories of surgical procedures patients underwent were orthopedic (51.2%) and digestive tract/hepatobiliary (36.4%) procedures.
The most common patient comorbidities were hypertension (34.4%) and diabetes (13.5%). While the largest proportion of patients (58 329 or 25%) were cared for in hospitals in which 30% to 39% of the nurses were at least BSN-educated, the numbers ranged across the sample (Table 2). Moreover, characteristics of patients, including whether the operating physician was a board-certified surgeon, differed across the groups of hospitals defined by the percentage of nurses with BSN or higher degrees, although few of these characteristics varied across groups in a consistent pattern.
Effects of Hospital RN Education on Mortality and Failure to Rescue
Table 3 presents odds ratios (ORs) representing the raw or unadjusted effects of nurse education, staffing, and experience, and the effect of a board-certified surgeon as operating physician. Also in Table 3 the adjusted ORs show the effects of those factors in a model controlling for all of these factors and for other hospital and patient characteristics. There was a statistically significant relationship between the proportion of nurses in a hospital with bachelor's and master's degrees and the risks of both mortality and failure to rescue, both before and after controlling for other hospital and patient characteristics.
Each 10% increase in the proportion of nurses with higher degrees decreased the risk of mortality and of failure to rescue by a factor of 0.95, or by 5%, after controlling for patient and hospital characteristics. This adjusted OR of 0.95 (95% confidence interval, 0.91-0.99) is a multiplicative parameter. To estimate how much of a difference would be expected between hospitals in which 20% vs 60% of the nurses had at least BSNs, it should be taken to the fourth power (since the difference between 20% and 60% is equivalent to four 10% intervals). The resultant ratio (0.954 = 0.81) indicates that all else being equal, the odds of 30-day mortality and failure to rescue would be 19% lower in hospitals where 60% of the nurses had BSNs or higher degrees than in hospitals where only 20% of nurses did.
All 3 of the other clinician characteristics studied (nurse staffing, experience, and board-certified surgeon as operating physician) had significant associations with mortality before controlling for each other, the educational composition of RNs, and all other patient and hospital characteristics. The final model indicates only very slight changes in the parameters estimating the nurse staffing effect that we previously reported2 when nurse education is added (from a 7% increase in risk of both negative outcomes with a 1 patient-per-nurse increase in mean workload originally reported to a 6% increase in mortality risk and a 5% increase in risk of failure to rescue).
Nurses' years of experience were not found to be a significant predictor of mortality or failure to rescue in the full models. The strong and significant decrease in mortality associated with having a board-certified surgeon as operating physician is largely explained by the tendency of patients with board-certified surgeons to be treated at hospitals with other characteristics associated with better outcomes. None of the interaction terms created by combining these 4 variables achieved statistical significance, suggesting that nurse education, nurse staffing, and surgeon board certification operate independently of each other in predicting mortality and failure to rescue.
These effects imply that altering the educational background of hospital nurses by increasing the percentage of those earning a BSN would produce substantial decreases in mortality rates for surgical patients generally and for patients who develop complications. Direct standardization techniques were used to predict the excess deaths in all patients and patients with complications that would be expected with varying levels of nurse educational levels and workloads. As Table 4 shows, if the proportion of BSN nurses in all hospitals was 60% rather than 20%, 3.6 fewer deaths per 1000 patients (21.1 − 17.5) and 14.2 fewer deaths per 1000 patients with complications (failure to rescue) would be expected. Moreover, Table 4 indicates that the effect on mortality of a 20% increase in the percentage of BSNs in the workforce would be roughly equivalent to the effect of a reduction in mean nurse workload of 2 patients, and that both the mortality and failure-to-rescue rates would be decidedly lower if both the workloads were lighter and the workforce were composed of higher percentages of BSN-prepared nurses.
To our knowledge, this study provides the first empirical evidence that hospitals' employment of nurses with BSN and higher degrees is associated with improved patient outcomes. Our findings indicate that surgical patients cared for in hospitals in which higher proportions of direct-care RNs held bachelor's degrees experienced a substantial survival advantage over those treated in hospitals in which fewer staff nurses had BSN or higher degrees. Similarly, surgical patients experiencing serious complications during hospitalization were significantly more likely to survive in hospitals with a higher proportion of nurses with baccalaureate education.
When the proportions of RNs with hospital diplomas and associate degrees as their highest educational credentials were examined separately, the particular type of educational credential for nurses with less than a bachelor's degree was not a factor in patient outcomes. Furthermore, mean years of experience did not independently predict mortality or failure to rescue, nor did it alter the association between educational background or of staffing and either patient outcome. These findings suggest that the conventional wisdom that nurses' experience is more important than their educational preparation may be incorrect. The improved outcomes associated with higher levels of BSNs in a hospital was found to be independent of and additive to the associations of superior outcomes in hospitals with better nurse staffing we reported previously.2 Thus, both lower patient-to-nurse ratios and having a majority of RNs educated at the baccalaureate level appear to be jointly associated with substantially lower mortality and failure-to-rescue rates for patients undergoing common surgical procedures.
In our sample of 168 Pennsylvania hospitals in which the proportion of nurses with bachelor's degrees and mean patient-to-nurse ratios varied widely, 2% (4535/232 342) of the surgical patients undergoing the procedures we studied died within 30 days of hospital admission. Our results imply that had the proportion of nurses with BSN or higher degrees been 60% and had the patient-to-nurse ratio been 4:1, possibly 3810 of these patients (725 fewer) might have died, and had the proportion of baccalaureate nurses been 20% and had staffing uniformly been at 8:1 patient-to-nurse ratios, 5530 (995 more) might have died. While this difference of more than 1700 deaths across 2 educational and staffing scenarios is approximate, it represents a conservative estimate of preventable deaths potentially attributable to nurses' education and RN staffing levels because our patient sample represents only about half of all surgical cases in the study hospitals.
One limitation of our analysis is the potential for response bias in the education and staffing measures derived from the nurse survey, given a 52% response rate. However, examining the Pennsylvania respondents in the probability-based National Sample Survey of Registered Nurses conducted in 2000,21 we found no evidence of overall differences between our sample and Pennsylvania hospital staff nurses at large in terms of job satisfaction or demographic characteristics, including education.
A second limitation relates to study design. Longitudinal data sets, preferably including hospitals from more than 1 state, will be essential for establishing the generalizability of these findings as well as establishing whether and how levels of baccalaureate-prepared nurses and nurse staffing in a hospital are causally related to patient outcomes. Also, as in any research drawing on administrative patient outcomes data, there is a potential for differences in completeness and consistency of diagnostic coding across hospitals to influence risk adjustment.29
A number of checks on the validity of these findings were completed. Allowing nurse education to have a nonlinear effect and testing whether the effect of education varied across levels of educational composition using quadratic and dummy variables did not significantly improve model fit, suggesting that incremental increases in more educated nurses in a hospital were associated with progressively better outcomes. Including the small proportion of nurses who checked "other" as their highest degree with nurses in the baccalaureate or higher category or in the associate degree or diploma category rather than omitting them from calculations yielded no change in the estimated associations between education and patient outcomes. In an attempt to determine whether unobserved variables that distinguished patients treated in hospitals with different levels of nurse education, we computed propensity scores30 representing the likelihood that patients with various characteristics were treated in hospitals with high and low levels of baccalaureate nurses. These scores were not a significant predictor of mortality or of failure to rescue, nor did they significantly alter our estimates of the association between education and outcomes.
Research suggests that nurse executives in university teaching hospitals prefer a nurse workforce with approximately 70% prepared at the baccalaureate level and estimate that current levels average 51%. Also, community hospital nurse executives prefer to have 55% of their RNs educated at the baccalaureate level.31 Data are not currently available to estimate the proportion of hospitals nationally that have 50% or more of their RN workforces prepared at the BSN level or higher, but since only 11% of Pennsylvania hospitals met this standard in our sample there appears to be a wide gap between the preferences of hospital executives and current staffing patterns.
Only 43% of all hospital staff nurses nationally in 2000 were prepared at the BSN level or higher. Enrollments in baccalaureate nursing programs declined by almost 10% from 1995 to 2000, although the past few years have seen an upturn.21,32 The return of diploma- and associate degree–prepared RNs to colleges and universities after their initial preparation has been an important source of baccalaureate-prepared nurses. About 22% of currently employed hospital RNs with BSN or higher degrees received them after their basic educations.21 However, the proportion of hospital nurses pursuing further studies declined from 14% in 1984 to 9% in 2000, as did the proportion of hospital nurses who received tuition assistance from their employers (from 66% in 1992 to 53% in 2000).21,33 Meeting the demand for baccalaureate-prepared hospital nurses requires renewed support and incentives by employers to encourage nurses to pursue education to the level of baccalaureate and beyond.
In the current nurse shortage, as in previous ones, public policy discussion has centered on how to increase the supply of RNs. However, little attention has been paid to considering where investments in public funds in the 2 major educational pathways into nursing practice—associate or bachelor's degree programs—will best serve the public good and the interests of employers. Nursing education policy reports published in the past decade concluded that the United States has an imbalance in the educational preparation of its nurse workforce with too few RNs with BSN and higher degrees.34-36 Our findings provide sobering evidence that this imbalance may be harming patients.
Our documentation of significantly better patient outcomes in hospitals with more highly educated RNs at the bedside underscores the importance of placing greater emphasis in national nurse workforce planning on policies to alter the educational composition of the future nurse workforce toward a greater proportion with baccalaureate or higher education as well as ensuring the adequacy of the overall supply. Public financing of nursing education should aim at shaping a workforce best prepared to meet the needs of the population. Finally, our results suggest that employers' efforts to recruit and retain baccalaureate-prepared nurses in bedside care and their investments in further education for nurses may lead to substantial improvements in quality of care.

redpajama_set_name: RedPajamaCommonCrawl


Skin care products must be readily available when they are needed, which poses demands on flexible and practical dispenser solutions. Our dispensers are available in various sizes and designs and can be made to fit 1 or more products, thus simplifying the appropriate choice of products customised to your needs.
Dispensers are easily cleaned and used with airtight bottle, bag and bag-in-box packages, limiting both bacteria growth and waste. The use of these systems is quite economical, user friendly and easy to refill, and they comply with strict regulatory hygiene requirements.
Single stainless steel brackets for 600 ml pump bottles.
Practical dispenser system with clear transparent or transparent casing in ABS. For 4.2 litre bag-in-box products.
Flexible dispenser system designed with aluminium rear and polycarbonate cover. For 0.7, 1.0 and 1.4 l bag-in-box products.


text:
JV Buys 128-Unit Houston Community for $11M
JLL secured financing for the acquisition of Candleridge Park Apartments, located 20 miles from downtown Houston.
Evelyn Jozsa
Candleridge Park Apartments
REEP Equities, in a partnership with Hashem Holdings, has acquired Candleridge Park Apartments, a 128-unit community in Houston for $10.6 million, according to Yardi Matrix. JLL secured a $7.9 million Fannie Mae loan, for the acquisition of the property, on behalf of the borrowers. HM Equity sold the community, however, will continue to manage it, Yardi Matrix data shows.
Situated at 1601 Wooded Pine Drive, the community is near the Hardy Toll Road and Interstate 45, around 20 miles from downtown Houston and 10 miles from George Bush Intercontinental Airport. Besides these, Candlerdige Park is also close to Lone Star College and Brightwood College, as well as several other schools, including Parker Elementary School.
Constructed in 1985, the 10-building property occupies more than 5 acres and encompasses a mix of one- and two-bedroom units, averaging 828 square feet. The units feature vaulted ceilings, washer/dryer hookups and private balconies/patios. Property amenities include a swimming pool, outdoor kitchen, business center, playground and dog park.
JLL's team included Managing Director Mark Brandenburg and Senior Vice President CW Sheehan. In June, the duo also arranged the financing for the acquisition of a 244-unit property in San Antonio.
REEP Equity
Hilltop Residential Continues Texas Expansion
MLG Capital Buys 2,700-Unit Sunbelt Portfolio
Griffin Capital Buys 238-Unit Houston-Area Community
Cortland Sells Houston Portfolio
Starwood Capital Group Sells Houston Property


Our University of East Carolina Gift Shop offers officially licensed Pirates products, East Carolina Pirates Merchandise and Pirates Gifts and Gear.
Our East Carolina University Gift Shop offers high quality East Carolina merchandise that has been expertly crafted, carefully selected and officially licensed. These East Carolina products are for discriminating PIRATES fans everywhere.


text:
Blogs > Secrecy News (2000 – 2021) > Marine Corps Commandant Accused of Improper Classification
Marine Corps Commandant Accused of Improper Classification
By Steven Aftergood • July 30, 2013
Marine Corps Commandant Gen. James Amos exercised "unlawful command influence" in an attempt to punish Marines who allegedly urinated on enemy corpses in Afghanistan in 2011, attorneys for the Marine defendants said. And then Gen. Amos improperly classified information in an effort to conceal his own misconduct, the attorneys said.
"The evidence shows that the CMC [Commandant, Marine Corps] could not resist the temptation and decided to further the concealment of his unlawful intentions by ordering…, without proper authority or basis, the imposition of a secret classification upon the testimony and materials disclosed by the previously unclassified investigations of the alleged desecration cases," defense attorneys said in a motion filed last week.
It's a sordid story all around. What makes it interesting here is that a Marine Corps official warned in 2012 that the classification action was a mistake that could backfire against the Marine Corps if it ever became public.
"If this goes to the next level of administration or judicial action, there are some additional considerations that a lawyer, versed in classification issues, might be able to use to shoot holes in our whole process and bring the whole decision making process into question," wrote William Potts in an internal email quoted in last week's motion.
Improbably enough, he then cited the FAS Project on Government Secrecy and me (at page 19). A potential court-martial of the defendants would "spread us all over the media; would probably get Steven Aftergood, Project on Government Secrecy, involved…. He'd make us look silly if he supported a defense contention that the video was improperly classified."
There is a creaky old saying to the effect that you should not do (or say or write or email) anything "if you wouldn't want to see it on the front page of the Washington Post." A similar principle might be applicable in the world of national security classification. If you couldn't justify the classification of information to an outside reviewer, then you probably shouldn't classify it.
Unfortunately, in the normal course of business, there are few occasions on which any official is ever called upon to justify his classification action to an impartial, independent observer. That's just not the way the classification system is currently structured. But it could be. Increasing the number of opportunities for independently evaluating classification actions would quickly serve to improve the quality and legitimacy of classification activity.
For more background on the Marine Corps case, see these stories in Military Times and CNN.
Categories: Oversight, Secrecy
← Court Eases Prosecutors' Burden of Proof in Leak Cases → Publishing Secrets is a Crime, OLC Said in 1942


Donald Trump's path to clinching the Republican nomination ahead of the party's July convention is looking increasingly improbable, according to FiveThirtyEight editor in chief Nate Silver.
Silver's latest delegate projection for Trump showed him finishing at 1,155 delegates -- 82 short of the 1,237 needed to secure the GOP bid heading into the convention. That number came from Silver's "deterministic" model -- which looked at the most likely outcome for Trump in each state.
In Silver's prior projection, Trump picked up 1,208 delegates, still short of the needed number but conceivably an easier difference to overcome.
That projection came before Trump suffered a crushing defeat in Wisconsin to Ted Cruz, the Texas senator nipping at his heels. Silver had Trump winning 25 delegates in the state. He ended up with only six.
In his latest model, Trump was projected to romp through New York, which holds its primaries next Tuesday, with 85 of 95 delegates expected to go his way. He also was forecast to pick up all 51 delegates in winner-take-all New Jersey and more than half of the available delegates in California, the largest prize left on the map.
But Silver had Trump's total in Indiana reduced from 37 to just nine in his latest model, projecting the state to turn from a Trump victory into an overall loss.
In order to hit the magic number of 1,237, Trump would need to have a huge win in Indiana in addition to picking up roughly 20 additional delegates in California, according to Silver.
Trump could also edge close to that total if he wins over a good chunk of Pennsylvania's unbound delegation in late April. Republican Pennsylvania voters select their delegates by congressional district, and a total of 54 will be able to vote for whomever they want on the first ballot at the Republican National Convention.
"Trump could win slightly fewer delegates than I'm expecting in New York and Connecticut but make them up with a bigger win in California," Silver wrote. "So we're not yet at the point where absolutely everything has to go right for Trump to clinch 1,237 delegates after California; although he can't afford major setbacks such as losing Indiana or Maryland."


The Chinese technology giant is in the initial stages of a U.S. stock offering. As reported by Bloomberg's Global Tech, the offering is loaded with issues. Does the inbound wave of Chinese companies promise an era of new linkages? Will the capital raise lead to an increase in M&A to the benefit of a new generation of entrepreneurs? The CTC will maintain a watching brief on these international developments.


text:
Somalia articles missing geocoordinate data, All articles needing coordinates, Articles incorporating text from Wikipedia,
Maritime incidents in 2012
2012 in Somalia
Naval battles of Operation Enduring Freedom
Naval battles post-1945
2012 in Spain
Piracy in Somalia
Naval battles involving Spain
Naval battles involving pirates
Operation Atalanta
January 2012 crimes
January 2012 events in Africa
Attack on Spanish oiler Patiño
Attack on Patiño
Part of Piracy in Somalia
A14-Patiño.jpg
Spanish replenishment oiler Patiño
off Somalia, Indian Ocean
Spanish victory
Spain Somali Pirates
1 replenishment oiler
1 helicopter 1 skiff
1 replenishment ship lightly damaged 1 killed
6 captured (5 wounded)
1 skiff damaged and captured
Operation Enduring Freedom - HOA
Action of 18 March 2006
Action of 3 June 2007
Action of 28 October 2007
Operation Thalathine
Carré d'As IV incident
Action of 11 November 2008
Ekawat Nava 5 incident
Action of 9 April 2009
Maersk Alabama hijacking
August 2009 hostage escape
Operation Ocean Shield
Action of 7 September 2009
Moscow University hijacking
Operation Dawn of Gulf of Aden
Operation Dawn 9: Gulf of Aden
Beluga Nomination incident
Operation Island Watch
Battle off Minicoy Island
Quest incident
Operation Umeed-e-Nuh
SPS Patiño attack
Action of 12 January 2012
On 12 January 2012 Somali pirates attempted to attack the Spanish Navy replenishment oiler Patiño after mistaking her for a large merchant ship. The pirate skiff hit Patiño with automatic fire before being repelled, damaged by return fire and captured after a brief chase by the vessel's helicopter. The encounter took place off the coast of Somalia and ended with the death of one pirate and the capture of six others.
Action Edit
Patiño had been deployed on the Indian Ocean for her second tour as part of the European Union's Operation Atalanta since November 2011, when she departed from her home port of Ferrol.[1] Patiño was the flagship of the EU naval forces in Somali waters.[2]
At 03:30 AM 12 January 2012, while at anchor after escorting a World Food Programme ship with humanitarian aid to Mogadishu, Somalia,[3][4] a sentry aboard the Spanish vessel gave the alert when he spotted a skiff alongside Patiño´s hull, with the obvious intention of boarding the ship. The skiff was manned by seven individuals, who opened fire on the Spanish unit with AK-47 rifles.[5] The pirates apparently mistook the warship for a freighter.[6] Patiño was hit on her hull and funnel[7] by 50 rounds in the ensuing gunbattle, which lasted up to two minutes.[6] The Spanish vessel returned fire with her light armament, but when the pirates continued the aggression, the Spanish sailors proceeded to "neutralize" the threat with what the Spanish Ministry of Defence described as "self-defense fire",[8] which forced the skiff to flee.[7]
The motor boat was then chased by one of Patiño's SH-3 Sea King helicopters for 3,000 yards (2,700 m), warned by megaphone and eventually stopped after a last burst across her bows from the helicopter's machine gun. During the pursuit the attackers threw overboard three ladders, two bags and seven rifles. The Spanish personnel captured six men of whom five were wounded, three of them seriously. The pirates declared that a seventh member of the crew was killed in the exchange of fire and that his dead body fell to the sea.[9][10] The skiff, damaged by gunfire, was confiscated by the Spanish authority.[7]
Aftermath Edit
Eloy Velasco, the judge in charge of the Audiencia Nacional of Spain ordered the arrested men taken to Spain for questioning under charges of piracy, possession of illegal weapons, damage to government property, and assault on members of the security forces. Velasco considered that the attack in international waters came under Spanish jurisdiction since the assault was carried out against Spanish citizens and no current agreement with a third country prevented a Spanish trial.[10]
An alternative trial location had been Kenya, following a May 2009 arrangement with the European Union granting Kenyan jurisdiction over acts of piracy committed in the Indian Ocean. However, in 2010 Kenya's High Court had ruled that the Kenyan government should put on trial only those subjects captured inside its territorial waters. This was overturned by the Kenyan Court of Appeal in October 2012, by which time the Spanish trial for Patiño's pirates had already commenced.[11] During their trial in Spain, all six men pleaded not guilty, claiming they were fishermen who had approached Patiño for assistance at sea.[12]
In October 2013 the men were convicted of attempted piracy by a Spanish Court and sentenced to eight years in jail. One man, Hamoud Elfaf Mahou, received an additional four and a half year term after also being convicted of belonging to an identified criminal organization.[12] In April 2014 the prosecution successfully appealed the length of sentences, arguing that the piracy constituted an actual rather than attempted attack on the ship. An additional five years was added to each sentence, extending them to between thirteen and seventeen and a half years.[13]
↑ Salgado, Raúl (21 November 2011). "El buque 'Patiño' abandona Ferrol para incorporarse a la operación `Atalanta´" (in es). El Mundo. http://www.elmundo.es/elmundo/2011/11/21/galicia/1321887014.html.
↑ Shelton, Joel (13 January 2012). "Somali pirates attack EU flagship as new commander takes over". Archived from the original on 15 January 2012. https://web.archive.org/web/20120115064450/http://www.publicserviceeurope.com/article/1350/somali-pirates-attack-eu-flagship-as-new-commander-takes-over.
↑ "El buque de la Armada volvía de un servicio de escolta para el Programa Mundial de Alimentos cuando fue atacado" (in es). Europa Press. 12 January 2011. http://www.elconfidencial.com/ultima-hora-en-vivo/2012/01/buque-armada-volvia-servicio-escolta-programa-20120112.html.
↑ Bockmann, Michelle Wiese (13 January 2012). "EU Navy Has Gunfire Exchange With Somali Pirates". Bloomberg Businessweek. http://www.businessweek.com/news/2012-01-13/eu-navy-has-gunfire-exchange-with-somali-pirates.html.
↑ Vellón, A.; Fariñas, Julio Á. (14 January 2012). "El "Patiño" cumplió las normas de la UE para repeler el ataque pirata" (in es). La Voz de Galicia. http://www.lavozdegalicia.es/noticia/galicia/2012/01/14/patino-cumplio-normas-ue-repeler-ataque-pirata/0003_201201G14P43993.htm.
↑ 6.0 6.1 Pirates attack Spanish navy ship off Somalia, prompting gunbattle and helicopter chase Associated Press, 12 January 2012
↑ 7.0 7.1 7.2 "Seis piratas detenidos y uno muerto tras intentar atacar un buque de la Armada" (in es). La Region, Vigo. 12 January 2012. http://www.atlantico.net/articulo/economia/piratas-detenidos-y-muerto-intentar-atacar-buque-armada/20120114103754160249.html.
↑ "Confundir con un mercante al buque de la Armada española Patiño explicaría el absurdo ataque del esquife de piratas" (in es). 13 January 2012. http://www.defensa.com/index.php?option=com_content&view=article&id=5111:confundir-con-un-mercante-al-buque-de-la-armada-espanola-patino-explicaria-el-absurdo-ataque-del-esquife-de-piratas&catid=64:restomundo&Itemid=187.
↑ Villarejo, Esteban (13 January 2012). "Creyeron que era un barco mercante" (in es). ABC. http://www.abc.es/20120113/espana/abcp-creyeron-barco-mercante-20120113.html.
↑ 10.0 10.1 "La Audiencia Nacional ordena encarcelar y traer a España a los piratas somalíes que atacaron el Patiño" (in es). Euro-Press. 13 January 2012. http://www.europapress.es/nacional/noticia-av-audiencia-nacional-ordena-encarcelar-traer-espana-seis-piratas-somalies-atacaron-patino-20120113200905.html.
↑ "Kenya can try Somali pirates, appeal court says". 18 October 2012. http://www.alamogordonews.com/alamogordo-news/ci_21800303/kenya-can-try-somali-pirates-appeal-court-says.
↑ 12.0 12.1 "Somali pirates convicted of attacking Spanish warship". BBC News. British Broadcasting Corporation. 30 October 2013. https://www.bbc.com/news/world-europe-24751027. Retrieved 19 July 2014.
↑ "Spanish court lengthens jail sentence for pirates". Oman Observer. Oman Establishment for Press, Publication and Advertising. 14 April 2014. Archived from the original on 29 July 2014. https://web.archive.org/web/20140729193943/http://main.omanobserver.om/?p=73167. Retrieved 19 July 2014.
Retrieved from "https://military.wikia.org/wiki/Attack_on_Spanish_oiler_Pati%C3%B1o?oldid=4265052"
Somalia articles missing geocoordinate data


How many bonds are needed for this project?
This form is for active Integrity Surety accounts when needing a new Bid Bond for an upcoming Bid Date.
Please complete form and attach copy of Invitation to Bid and any required Bid Bond Form.
This form is for active Integrity Surety accounts when needing a new Performance/Payment Bond. This also works on a low bid that we bonded.
Please complete form and attach copy of Award Letter, Contract, required Performance/Payment Bond Form (if any required).
Note: Do not use this form for Subdivision or Development.
This form is for active Integrity Surety and SBA accounts when needing a new Bid Bond for an upcoming Bid Date.
Please complete form and attach copy of Invitation to Bid and any required Bid Bond Form. We will complete and send you an SBA 990 form to sign.
This form is for active Integrity Surety and SBA accounts when needing a new Performance/Payment Bond, where no Bid Bond was issued by us.
Please complete form and attach copy of Award Letter, Contract, required Performance/Payment Bond Form (if any specific form required).
This form is for active Integrity Surety accounts when needing a Performance, Maintenance, Payment, or Other Bond, for a Plat / Subdivision / Development.
Please complete form and attach copy of Agreement / Contract with the Obligee, required Bond Form (if any specific form required), Engineer's Estimate or Obligee-approved Contractor Quote.
Note: There are several reminders to attached needed items. You may attach however is most convenient - all together, or separately, or both. You do NOT need to break the documents out.
This form is for active Integrity Surety accounts when needing an accessory bond to a Contract Bond, such as a Right-of-Way Permit Bond, or miscellaneous License Bond.
Please complete form and attach bond form, and/or documentation regarding bond requirement.
A Note of Instruction: Should you get part way through this form, and have to come back, we've built the form so that most internet browsers will remember your previously-entered data when you return, using the same browser. Attachments may or may not have to be re-attached. The form will reset all answers upon clicking "submit" at the end. We hope this helps!
Common account name - such as "Urban Dev Co"
If any; ie, "17544 Midvale Lofts LLC"
example: BXWA or FRS or "See Attached"
Did we issue a Bid Bond for this job?
Is this Maintenance for work we already bonded for Performance?
How was Bond Amount calculated?
City / Municipality / County / Utility District / State - The party requiring bond(s).
Are there other Securities already posted for this project?
What kind of bond is needed, and why?
Who is requiring you to get this "Other" bond?
Obligee-Specified-Form AIA Surety / Generic / Unspecified Federal What bond form should we use?
Please allow sufficient time to process.
Yes No Are there Penalties for Late Completion?
Agreements: In consideration of the assistance received from SBA, I agree to comply with the nondiscrimination requirements of Title 13, Code of Federal Regulations, part 113 and Executive Order 11246. I agree to pay the applicable contractor fee and submit fee payment prior to formal approval of final (payment and/or performance) bond.
(a) A bid, payment, or performance bond is required by the bid solicition or the original contract for this project.
(b) Applicant has attempted and failed to obtain bonding without SBA's guarantee.
(c) Percentage of work that applicant has subcontracted is accurate.
(d) Applicant is not delinquent on any Federal debt or Federally Guaranteed Debt.
(e) All information in this application and that relates to this application which has been submitted to SBA, agent, broker, or surety company, is complete and accurate to the best of my knowledge.
(f) If Parts I, II, and V of this application, and/or "Statement of Personal History" (SBA Form 912) have been previously submitted in connection with an earlier application, I have reviewed that information and certify that it either remains complete and accurate or that I have submitted a revised application with complete and accurate information to the best of my knowledge.
(g) I authorize any agent, broker, surety company or financial institution in possession of credit, financial, or work experience information concerning the applicant and the applicant's business to release the same to SBA, in order that SBA may evaluate the same for the purpose of bond guarantee assistance.
I understand that knowingly making a false statement or submitting false information is a violation of Federal law and could result in criminal prosecution or civil penalties under 18 USC 287, 371, 1001, 15 USC 645, or 31 USC 3729.


Singers, instrumentalists, conductors & music lovers will appreciate the lyrics on these handmade notecards reading: "harmony and friendship unite." This inspirational note card set uses an ancient Japanese design of intersecting circles in shades of blue to remind us how the parts of our lives are interconnected. The set makes a great gift for a musician, music teacher, coworker, graduate, teacher, hostess or graduation gift. The design features Japanese Chiyogami paper and each card is accented with song lyrics from vintage sheet music that say "harmony and friendship unite."
Each notecard is a one of a kind design, perfect to use for a special occasion, like a birthday or graduation, or to have on hand for thank you notes, sympathy, encouragement or just because. Each card is made from heavy felt paper and measures 4 inches x 5.5 inches with deckle edges. Cards come with matching white envelopes with a matching deckle edge. Choose a set of 5 cards or 10 cards at checkout.


text:
Encouraging News on Nuclear Power
Labels: Energy
Last month, I wrote a this post on nuclear power highlighting the manifesto positions of the various parties. Labour in Westminster were the only party unequivocally in favour of nuclear power, which put them at odds with their Welsh Labour colleagues in the Assembly who think that nuclear power is unnecessary in Wales, because we can generate all the electricity we need from renewable sources. Plaid (with the SNP and Greens) the LibDems and the Tories in the Assembly share that view, and the Tories in Westminster took the position that they would allow new nuclear power stations to be built ... provided they receive no public subsidy.
As every party in the Assembly is against building any new nuclear power stations in Wales, it was very encouraging to hear Chris Huhne make clear what the new ConDem coalition's position on nuclear is in this interview on the Today programme yesterday morning, but also reported here.
This should give those of us who are opposed to nuclear power in Wales a good idea of the grounds on which to fight to ensure that Wylfa B is never built.
In short, there seems to be no way that we can prevent it being built on planning grounds or on safety grounds. If a company or consortium wants to go ahead and build a new nuclear power station the Westminster government will allow them to do it. But they will have to pay for it and, more importantly, pay the costs of decommissioning it afterwards.
Our task has got to be to ensure that these costs are not deliberately underestimated at the outset. Personally I have no absolute objection to nuclear power and believe it might well be the "least worst" option in many parts of the world that do not have the abundance of renewable energy resources we have in Wales. The risks and dangers are great, but those risks can be kept within acceptable limits provided that strict safety regimes are adhered to, which will require a lot of money to maintain both during operation and then for hundreds of years afterwards.
The major issue is not the cost of building the stations but the cost of cleaning up the waste they produce and of decommissioning the site when it has come to the end of its productive life. These costs are much, much greater than the cost of construction. In principle, the government's idea is that the power companies would set aside money each year so as to pay the costs of decommissioning and clean up. The fundamental flaw in that approach is that a private company can either go bust or refuse to honour its contract commitments at any time, in much the same way as happened when National Express walked away from the East Coast rail franchise last year. The taxpayer will be left to pick up the bills. The very nature of private companies is that they make a profit when they can ... but when they can't they can be wound up, leaving others to pick up the pieces.
In these situations, the only way to guarantee that the costs will still be met if the company folds is for them to put the money up front, in the form of some sort of bond, perhaps backed by insurance. This happens in the construction industry, but the costs involved in nuclear clean up are way beyond that scale ... not least because it's virtually impossible to predict how much something will cost in maybe 40 years time. So the Labour Government have been trying to run with a mechanism called "Funded Decommissioning" which, in order to make the cost in any way affordable for private companies, seeks to put limits on their liabilities.
At present this is the subject of a public consultation which began last month and is set to run until June. The details are on this page. But this is the stated aim:
The purpose of this consultation is to seek views on whether or not the proposals within this document provide clarity for both operators of new nuclear power stations and the public on the financing arrangements the operator of a new nuclear power station will have to put in place to meet the full costs of decommissioning and their full share of waste management costs.
Reading the document, I have to say that the assumptions made about the cost of decommissioning and storage of waste seem inadequate. This is what the document says:
4.9 The Government's updated estimates of the costs of decommissioning, waste management and waste disposal (for a generic 1.35GW PWR operating for 40 years) are:
a. decommissioning and waste management costs in the range
£800m – £1,800m (undiscounted); and
b. waste disposal costs in the range £600m – £1,100 (undiscounted).
Compare these estimates with the 2008 estimate of a further £73bn being required to decommission the current crop of 19 nuclear stations. That averages at £3.8bn per station for generally smaller power stations ... nearly one billion more than the top range government estimate. It should be noted that at present most waste is sent to Sellafield for processing, but that it is now intended to store this on each individual site, ending any economy of scale; and that the type of waste that will be produced from new nuclear power stations is much more dangerous than that produced by the old generation of stations.
When we consider that the estimates before the £73bn were themselves wildly optimistic, I am not confident that these estimates are at all reliable. If we don't work on estimates that actually cover the cost, we the taxpayers—well, our children and grandchildren—will be left to foot the bill for any shortfall. It will be another case of private firms making a profit while they can, but the public purse having to pay for any shortfall afterwards.
Paul Williams said...
You are wrong in saying that Labour in Westminster were the only party unequivocally in favour of nuclear power - as opposed to the Tory view that they should only go ahead if they do not require public subsidy.
Philip Hunt, the ex-Labour minister of state at the Department of Energy and Cimate Change, said back in January that Labour's policy was:
"absolutely clear" that the cost of new nuclear power plants must be met in full by the commercial companies themselves, including the cost of decommissioning and waste management. (http://theenergycollective.com/TheEnergyCollective/blog/filteredlist?key=department+of+energy+and+climate+change)
So the Labour and Tory position is basically identical.
Regarding trying to stop Wylfa B: don't.
You can read the figures in Labour's consultation document, Druid. Do you think they will cover the costs?
As it seems obvious to me that they won't, the only conclusion to be drawn is that, no matter what Labour ministers said, they were fudging the issue in order to make new nuclear stations possible.
Nobody's Poodle
Canton Schools ... The flaws in the decision
Canton Schools ... The row
Canton Schools ... The facts and figures
Not suitable for a two form entry school?
Scotland 8, Wales 1
When it is right, and wrong, for polls to clash
Cymdeithas Ddysgedig Cymru
Three months too late
Ignoring Wales
Raising False Hopes
Meanwhile, down on another farm
A Bad Decision
Fair Funding for Wales? Forget it!
Incremental Change
Cheryl Gillan's attitude
Updating the Referendum Timetable
A fixed-term parliament fix
Getting what you really, really want
Honourable and Decent
Labour and Tory voters want STV
Don't be pessimistic, there is a way
Take Back Parliament
Reject Labour's Opening Bid
Straightening-out this Banana Republic
Westminster's Second Green MP
Money is the Bottom Line
A Narrow Window of Opportunity
What are Tories really like?


text:
module MPS.Math.Trie where

import MPS.Math.RedBlackTree

-- loosely based on the implementation given by Okasaki

data Trie key value = Trie (Maybe value) (RedBlackTree (key, Trie key value)) deriving Show

trempty = Trie Nothing rbempty

trlookup (Trie v t) [] = v
trlookup (Trie v t) (k:ks) =
	case (t `rblookup` k) of
	Nothing -> Nothing
	Just t' -> t' `trlookup` ks

trupdate (Trie _ t) ([],v) = Trie (Just v) t
trupdate (Trie u t) (k:ks,v) =
	let
		t' = case (t `rblookup` k) of
			Just t -> t
			Nothing -> trempty
		t'' = trupdate t' (ks,v)
	in Trie u (t `rbupdate` (k,t''))

trcount (Trie v t) =
	let
		self = case v of
			Just _ -> 1
			Nothing -> 0
		subtrees = rbtolist t
		subcounts = map (\(_,s)-> trcount s) subtrees
	in self + sum subcounts

trfromlist kvs = foldl trupdate trempty kvs

trtolist :: Trie k v -> [([k],v)]
trtolist t = dotrtolist t []
	where
		dotrtolist (Trie v t) ks =
			let
				entry = case v of
					Just v' -> [(reverse ks,v')]
					Nothing -> []
				subtrees = rbtolist t
				sublists = map (\(k,s)-> dotrtolist s (k:ks)) subtrees
			in entry ++ (concat sublists)

redpajama_set_name: RedPajamaGithub


… almost every time, this is our favourite night for a cozy get-together, finishing up the weekend with a drink or two with our new friends, and mostly enough time and space for one last dance with everyone – this year even to some great live music!
Starting directly after the classes in the same venue! There will be a possibility to get dinner right there, also showers and changing rooms are available to get ready for the dance!
Stir-It-Up is a random partner competition, which used to be called Jack'nJill. We have changed the name following a movement in the Lindy Hop / Swing community, which aims to make the competition more inclusive to everyone. Stir-It-Up is open to all genders in both roles, lead and follow. If you have any further questions, comments or concerns, please feel free to contact us at stiritfestival@gmail.com or talk to any of the organizers in person! We are happy for your input.
You can register for the competition at the party on Friday night!


ring it's first three years under Ms. Gazda, the organization expanded and grew from one thirty member orchestra to two orchestras and 100 students.
In 1993 William Hollin became the second Music Director of the Potomac Valley Youth Orchestra. Under his leadership, the program grew to include four large orchestras, a wind ensemble, a flute choir, a clarinet choir, and chamber music program. Now, after thirteen years, there are more than 350 students participating each year.
In 2002, the organization expanded again adding several new programs, including a chamber music program, clarinet choir, theory and composition classes, and a concerto competition, the winners of which perform with one of the senior orchestras. Also in the 2002-2003 season, the Potomac Valley Youth Orchestra embarked on its first international tour, performing in Norway, Denmark and Sweden.
The PVYO continues to provide young musicians the opportunity to develop personally and grow musically with new challenges and exciting new programs.
PVYO is a non-profit organization, formed to give serious young musicians an opportunity to explore the art of classical orchestral playing.