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Ethics is defined as a set of guidelines and/or rules for the conduct of individual behavior in an organization or civil society. This ethical code of conduct is intended to guide policies, practices, and decision-making for employees on behalf of the organization. This article explores the importance of ethics, the basis for making ethical decisions, and how to approach ethical situations or moral dilemmas in both meaningful and practical ways.

APPA's Facilities Management Evaluation Program (FMEP) provides an integrated system to optimize organizational performance. The criteria for evaluation not only provide a tool for organizational continuous improvement, they serve as a compelling leadership development tool essential for today's facilities management professional. The senior facilities officer (SFO) can utilize this well-designed set of performance criteria, measures, and metrics to establish a pathway for staff development and organizational continuous improvement whether formally delivered or informally applied. Utilizing the FMEP throughout the organization helps the SFO engage their staff in professional development opportunities necessary to their growth and development by virtue of their engagement in the process and seeking the desired outcomes to achieve overall success.

This article reports that since its founding in 1914, APPA has become a premier association serving its diverse membership of international educational institutions in all areas of facilities management. APPA's programs, products, and services are designed to equip facilities professionals with the technical knowledge and necessary administrative acumen to fulfill their vital role in managing educational facilities and pursuing proper organizational alignment with the institutional vision, mission, and strategy. 2013 has seen APPA actively focused on the accomplishment of numerous initiatives in support of their Strategic Plan and engaged in the launch of APPA's 100-year anniversary. The Strategic Plan is intended to strengthen the overall position of the organization, the profession, and the institutions APPA supports and represents. The plan contains "Objectives" that articulate the desired results, "Five Leading Strategies" that define actions, and "Five Foundational Elements" that buttress each strategy in the achievement of their stated objectives. By strategically targeting their actions and effectively utilizing and leveraging their resources, APPA is on track to achieve their stated Objectives: a fully engaged group of stakeholders, across an increasingly diverse membership body, where there is greater alignment and synergy amongst and between international APPA, its regions, chapters, and international alliances; thereby achieving measurable influence and credibility throughout the entire educational enterprise; and ultimately, Increasing its overall value to the members. APPA's programs, products, and services provide both a professional development career continuum and an institutional development pathway that is unparalleled in the industry. Their role is to elevate educational facilities professionals into influential leaders in education who, in turn, create inviting and supportive institutional learning environments, thus increasing the credibility and influence of the facilities profession.

Since its founding in 1914, APPA has become a premier association serving its diverse membership of international educational institutions in all areas of facilities management. APPA's programs, products, and services are designed to equip facilities professionals with the technical knowledge and necessary administrative acumen to fulfill their vital role in managing educational facilities and pursuing proper organizational alignment with the institutional vision, mission, and strategy. In this article, the executive vice president reports on the "state of the state" at APPA.

Discusses the hazards of the trend toward accumulated deferred maintenance in higher education and offers advice on tying facilities needs and issues to the core strategies and goals of the institution. (EV)

This article poses the daunting question, "Is College worth it?" " Measured in employability and salaries, employment for degreed graduates is down and student debt has surpassed a trillion dollars. Higher education does not seem to be faring any better than other sectors. Looking toward a prognosis for 2020, other factors that have thrown colleges into crisis include: (1) Student Demographics; (2) Competition; (3) Regulation, Compliance, and Sustainability; and (3) Technology. In an essay, "An Avalanche is Coming: Higher Education and the Revolution Ahead," written for the Institute for Public Policy Research in March 2013, the authors questioned whether a university education will continue to be seen as good value. This was further elucidated by David Puttnam in a speech at MIT in June 2012, where he stated: "It's tragic because, by my reading, should we fail to radically change our approach to education, the same cohort we're attempting to 'protect' could find that their entire future is scuttled by our timidity." The certainties of the past are no longer certainties and hope is not a strategy. Some strategies identified by the Thought Leaders Symposium (TLS) participants for addressing these challenges include: (1) Focus; (2) Collaboration across, between institutions, and the private sector; (3) Technology, to further increase quality, improve delivery, and contain costs; and (4) Space Management, effective and efficient utilization. Not only were these challenges and strategies distilled in the most recent thought leaders monograph, the critical facilities issues were identified with key questions to promote dialogue at other institutions.

Discusses the extent of damage being caused to colleges and universities from accumulated deferred maintenance (ADM) and why it is happening. Public policy implications are discussed along with highlights from case studies of institutions that have used practical approaches to retire their ADMs. (GR)

Trazodone is a serotonin receptor antagonist and reuptake inhibitor used extensively as an anxiolytic in human and small animal veterinary medicine. The aims of this study were to determine the pharmacokinetics of oral trazodone in experimental horses and to evaluate the effect of oral trazodone in clinical horses. Six experimental horses were administered trazodone at 7.5 or 10 mg/kg. Plasma concentrations of trazodone and its metabolite (m‐CPP) were determined via UPLC‐MS/MS. Noncompartmental pharmacokinetic analysis, sedation and ataxia scores were determined. Trazodone was rapidly absorbed after oral administration with a maximum concentration of 2.5–4.1 μg/ml and half‐life of the terminal phase of approximately 7 hr. The metabolite was present at low levels in all horses, representing only 2.5% of the total area under the curve. In experimental horses, concentration‐dependent sedation and ataxia were noted, lasting up to 12 hr. For clinical cases, medical records of horses treated with trazodone for various abnormal behaviours were reviewed and data were summarized. Trazodone was successful in modifying behavioural problems to some degree in 17 of 18 clinical cases. Tolerance and subsequent lack of drug effect occurred in two of 18 clinical cases following 14 or 21 days of use. In both populations of horses, adverse effects attributed to trazodone include oversedation, muscle fasciculations and transient arrhythmias. [ABSTRACT FROM AUTHOR]

Abstract Background Colorectal cancer screening rates are low among poor and disadvantaged patients. Patient navigation has been shown to increase breast and cervical cancer screening rates, but few studies have looked at the potential of patient navigation to increase colorectal cancer screening rates. Methods The objective was to determine the feasibility and effectiveness of a patient navigator-based intervention to increase colorectal cancer screening rates in community health centers. Patients at the intervention health center who had not been screened for colorectal cancer and were designated as "appropriate for outreach" by their primary care providers received a letter from their provider about the need to be screened and a brochure about colorectal cancer screening. Patient navigators then called patients to discuss screening and to assist patients in obtaining screening. Patients at a demographically similar control health center received usual care. Results Thirty-one percent of intervention patients were screened at six months, versus nine percent of control patients (p < .001). Conclusion A patient navigator-based intervention, in combination with a letter from the patient's primary care provider, was associated with an increased rate of colorectal cancer screening at one health center as compared to a demographically similar control health center. Our study adds to an emerging literature supporting the use of patient navigators to increase colorectal cancer screening in diverse populations served by urban health centers.

The article presents information about the Campus of the Future: A Meeting of the Minds conference to be held in Honolulu, Hawaii, during July 8-11, 2006. The 2006 conference will provide an opportunity for individuals and teams to come together as a campus administration community and experience fresh ideas and perspectives in a stimulating environment. The confluence of economic, political, technological, and competitive forces demands a collaborative approach to campus administration now and in the future. In fact, success will depend on a shared ownership across campus in meeting challenges. The program will offer insights, informed predictions, expert analysis, and proposed direction. A futures panel will kick off the program with an interactive overview of the key trends and issues driving society and higher education. With this background in mind, conference attendees will work together to uncover specific strategies to help institutions successfully plan and navigate the future.

Objective: Treatment of high-grade serous ovarian cancer (HGSOC) will benefit from early detection of cancer. Here, we provide proof-of-concept data supporting the hypothesis that circulating immune cells, because of their early recognition of tumors and the tumor microenvironment, can be considered for biomarker discovery., Methods: Longitudinal blood samples from C57BL/6 mice bearing syngeneic ovarian tumors and peripheral blood mononuclear cells (PBMC) from healthy postmenopausal women and newly diagnosed for HGSOC patients were subjected to RNASeq. The results from human immune cells were validated using Affymetrix microarrays. Differentially expressed transcripts in immune cells from tumor-bearing mice and HGSOC patients were compared to matching controls., Results: A total of 1282 transcripts (798 and 484, up- and downregulated, respectively) were differentially expressed in the tumor-bearing mice as compared with controls. Top 100 genes showing longitudinal changes in gene expression 2, 4, 7, and 18 days after tumor implantation were identified. Analysis of the PBMC from healthy post-menopausal women and HGSOC patients identified 4382 differentially expressed genes and 519 of these were validated through Affymetrix microarray analysis. A total of 384 genes, including IL-1R2, CH3L1, Infitm1, FP42, CXC42, Hdc, Spib, and Sema6b, were differentially expressed in the human and mouse datasets., Conclusion: The PBMC transcriptome shows longitudinal changes in response to the progressing tumor. Several potential biomarker transcripts were identified in HGSOC patients and mouse models. Monitoring their expression in individual PBMC subsets can serve as additional discriminator for the diagnosis of HGSOC., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

The Internet is a major source of health information for gynecologic cancer patients. In this study, we systematically explore common Google search terms related to gynecologic cancer and calculate readability of top resulting websites. We used Google AdWords Keyword Planner to generate a list of commonly searched keywords related to gynecologic oncology, which were sorted into five groups (cervical cancer, ovarian cancer, uterine cancer, vulvar cancer, vaginal cancer) using five patient education websites from sgo.org . Each keyword was Google searched to create a list of top websites. The Python programming language (version 3.5.1) was used to describe frequencies of keywords, top-level domains (TLDs), domains, and readability of top websites using four validated formulae. Of the estimated 1,846,950 monthly searches resulting in 62,227 websites, the most common was cancer.org . The most common TLD was *.com. Most websites were above the eighth-grade reading level recommended by the American Medical Association (AMA) and the National Institute of Health (NIH). The SMOG Index was the most reliable formula. The mean grade level readability for all sites using SMOG was 9.4 ± 2.3, with 23.9% of sites falling at or below the eighth-grade reading level. The first ten results for each Google keyword were easiest to read with results beyond the first page of Google being consistently more difficult. Keywords related to gynecologic malignancies are Google-searched frequently. Most websites are difficult to read without a high school education. This knowledge may help gynecologic oncology providers adequately meet the needs of their patients.

•Primary lymphoma of the female genital tract accounts for 1% of extranodal lymphomas.•Approximately 13% are diffuse large B cell lymphoma of the uterus, most often involving the endometrial stroma or cervix.•The first double-expressor diffuse large B cell lymphoma confined to a uterine leiomyoma is described.

Study Objective: To study the safety, feasibility, learning curve, and surgical outcome for single-port laparoscopic full staging of endometrial cancer., Design: A retrospective study (Canadian Task Force classification II-3)., Setting: A university academic hospital., Patients: Women with endometrial cancer undergoing single-port laparoscopic full surgical staging., Interventions: This was a single-center, retrospective consecutive study of patients undergoing single-port laparoscopic full staging of endometrial cancer from March 2012 to December 2015., Measurements and Main Results: One hundred ten consecutive cases were included in the study. The mean age was 63 years (standard deviation = 14), and the mean body mass index was 34 kg/m 2 (standard deviation = 7). Medical comorbidity was noted in 62% (68/110) of patients, and 55% (61/110) of patients had previous abdominal surgery. Preoperative histology included grade 1 (63%), grade 2 (23%), grade 3 (4%), papillary serous (6%), clear cell (3%), and mixed (1%). Postoperatively, 73% of patients were stage I, 2% were stage II, 21% were stage III, and 4% were stage IV. The conversion rate to multiple ports or to laparotomy was 6.3%. The average total surgical time was 186 minutes. Comparing the last 30 cases of our cohort with the first 20, there was a significant improvement in the reduction of the total operative time (191 vs 152 minutes, p = .036), estimated blood loss (389 vs 121 mL, p = .002), conversion rate (20 % vs 0%, p = .02), and rate of surgical complication (10% vs. 0%, p = .03). The readmission rate was 11% (12/110) with 75% of those patients being readmitted for surgical indications and 25% for medical indications. The rate of ventral hernia was 1.8% (2/110) with an average follow-up of 298 days (31-1085 days)., Conclusion: Single-port laparoscopic staging of endometrial cancer is a safe and feasible technique to introduce into a gynecologic oncology practice that is compatible with other minimally invasive modalities with similar complication rates, discharge timing, and operative times. Drastic improvement in surgical time can be seen after approximately the first 20 cases., (Copyright © 2017. Published by Elsevier Inc.)

Objective: The objective of the study was to identify the predischarge predictors of 30-day readmission and the impact of same-day discharge after laparoscopic hysterectomy., Study Design: Patients undergoing only laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy participated in the study., Results: The 30-day readmission rate was 3.1% (277 of 8890). Factors predictive of higher rates of readmission were diabetes (4.4% vs 3.0%; P = .03), chronic obstructive pulmonary disease (8.5% vs 3.1%; P = .02), disseminated cancer (20% vs 3.1%; P < .001), chronic steroid use (7.1% vs 3.1%; P = .03), daily alcohol use of more than 2 drinks (12.5% vs 2.5%; P = .04), and bleeding disorder (10.8% vs 3%; P = .001). Operative factors included surgical time of 2 hours or greater (3.5% vs 2.7%; P = .014). After surgery, patients had a higher rate of readmission when they experienced any 1 or more complications prior to discharge, (6.9% vs 3.1%; P = .01) as well as any complication after discharge (3.6% vs 1.6%; P = .01). Infections (35.7%) and surgical complications (24.2%) were the most common reasons of readmissions. Of these patients, 20.9% were discharged the same day (n = 1855) and had a similar rate of readmission (2.6% vs 3.2%; P = n.s.). Laparoscopic hysterectomy readmission score (LHRS) can be calculated by assigning 1 point to diabetes, chronic obstructive pulmonary disease, disseminated cancer, chronic steroid use, bleeding disorder, length of surgery of 2 hours or longer, and 2 points to any postoperative complication prior to discharge. Readmission rates for the LHRS score were score 1 (2.4%), score 2 (3.3%), score 3 (5.8%), or score 4 (9.5%)., Conclusion: The overall readmission rate after laparoscopic hysterectomy is low. Patients discharged the same day have similar rates of readmission. Higher LHRS is indicative of higher rates of readmission and may identify a population not suitable for same-day discharge and in need of higher vigilance to prevent readmissions., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To assess the association between the use of gelatin-thrombin matrix and the development of pelvic abscess during hysterectomy as well as factors associated with surgeons' use of this product., Methods: Data for patients undergoing hysterectomy for obstetric-gynecologic pathology were abstracted from databases at a tertiary hospital between 2009 and 2012. Open and minimally invasive hysterectomies were included and vaginal hysterectomies were excluded. Blood loss, surgery type, comorbidities, abscess formation, and use of gelatin-thrombin matrix were examined. Abscess was defined as a walled-off fluid collection (documented with computed tomography scan) with fever (greater than 38°C) or leukocytosis (greater than 11,000/microliter). Standard statistical models were used., Results: Of the 413 patients identified, 213 (51%) underwent surgery for malignancy. Gelatin-thrombin matrix was used in 166 patients (40%). The overall rate of abscess was low (3%). In bivariate analyses, blood loss greater than 500 mL (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.1-12.9, P=.021], ascites (OR 6.5, 95% CI 1.6-26.1, P=.023), drain placement (OR 4.5, 95% CI 1.3-15.1, P=.009), and gelatin-thrombin matrix use (OR 7.0, 95% CI 1.5-32.9, P=.009) were significantly associated with abscess formation. Multivariate logistic regression revealed that only gelatin-thrombin matrix use predicted the development of pelvic abscess (OR 7.0, 95% CI 1.5-32.9, P=.013)., Conclusion: We found that gelatin-thrombin matrix use was associated with an increased risk of pelvic abscess. Although these products are important in the setting of bleeding, these data suggest that the liberal use of sealants is not without risk., Level of Evidence: III.

Water safety plans (WSPs) are endorsed by the World Health Organization as the most effective method of protecting a water supply. With the increase in WSPs worldwide, several valuable resources have been developed to assist practitioners in the implementation of WSPs, yet there is still a need for a practical and standardized method of evaluating WSP effectiveness. In 2012, the Centers for Disease Control and Prevention (CDC) published a conceptual framework for the evaluation of WSPs, presenting four key outcomes of the WSP process: institutional, operational, financial and policy change. In this paper, we seek to operationalize this conceptual framework by providing a set of simple and practical indicators for assessing WSP outcomes. Using CDC's WSP framework as a foundation and incorporating various existing performance monitoring indicators for water utilities, we developed a set of approximately 25 indicators of institutional, operational, financial and policy change within the WSP context. These outcome indicators hold great potential for the continued implementation and expansion of WSPs worldwide. Having a defined framework for evaluating a WSP's effectiveness, along with a set of measurable indicators by which to carry out that evaluation, will help implementers assess key WSP outcomes internally, as well as benchmark their progress against other WSPs in their region and globally.

The American Red Cross and U.S. Centers for Disease Control and Prevention collaborated on a sustainability evaluation of post-hurricane water, sanitation and hygiene (WASH) interventions in Central America. In 2006 and 2009, we revisited six study areas in rural El Salvador, Guatemala, Honduras and Nicaragua to assess sustainability of WASH interventions finalized in 2002, after 1998's Hurricane Mitch. We used surveys to collect data, calculate indicators and identify factors that influence sustainability. Regional sustainability indicator results showed there was a statistically significant decline in access to water. The presence of sanitation facilities had not changed since the beginning of the project; however, maintenance and use of latrines declined but continued to meet the goal of 75% use after 7 years. The hygiene indicator, hand washing, initially declined and then increased. Declines in water access were due to operational problems related to storm events and population changes. Sanitation facilities were still present and sometimes used even though they reached or surpassed their original design life. Changes in hygiene practices appeared related to ongoing hygiene promotion from outside organizations. These results provide useful input for making WASH programs more sustainable and informing future, more in-depth research into factors influencing sustainability.

A Water Safety Plan (WSP) is a preventive, risk management approach to ensure drinking water safety. The World Health Organization (WHO) guidelines place WSPs within a larger 'framework for safe drinking-water' that links WSPs to health, creating an implicit expectation that implementation of WSPs will safeguard health in areas with acceptable drinking water quality. However, many intervening factors can come between implementation of an individual WSP and ultimate health outcomes. Evaluating the impacts of a WSP, therefore, requires a much broader analysis than simply looking at health improvements. Until recently, little guidance for the monitoring and evaluation of WSPs existed. Drawing examples from existing WSPs in various regions, this paper outlines a conceptual framework for conducting an overall evaluation of the various outcomes and impacts of a WSP. This framework can provide a common basis for implementers to objectively monitor and evaluate the range of outcomes and impacts from WSPs, as well as a common understanding of the time frames within which those results may occur. As implementers understand the various outcomes and impacts of WSPs beyond health, a strong evidence base for the effectiveness of WSPs will develop, further enabling the scaling up of WSP implementation and provision of better quality water.

This paper presents a novel three-dimensional (3-D) eye movement analysis algorithm for binocular eye tracking within virtual reality (VR). The user's gaze direction, head position, and orientation are tracked in order to allow recording of the user's fixations within the environment. Although the linear signal analysis approach is itself not new, its application to eye movement analysis in three dimensions advances traditional two-dimensional approaches, since it takes into account the six degrees of freedom of head movements and is resolution independent. Results indicate that the 3-D eye movement analysis algorithm can successfully be used for analysis of visual process measures in VR. Process measures not only can corroborate performance measures, but also can lead to discoveries of the reasons for performance improvements. In particular, analysis of users' eye movements in VR can potentially lead to further insights into the underlying cognitive processes of VR subjects.