Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative.

PubMed

Goyal, Neera K; Rome, Martha G; Massie, Julie A; Mangeot, Colleen; Ammerman, Robert T; Breckenridge, Jye; Lannon, Carole M

2017-02-01

Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants <6 months. Of 110 agencies, eight sites were selected based on volume, geography, and agency leadership. Our adapted Breakthrough Series model included monthly calls with performance feedback and cross-agency learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.

Correspondence between Video CD-ROM and Community-Based Job Preferences for Individuals with Developmental Disabilities

ERIC Educational Resources Information Center

Ellerd, David A.; Morgan, Robert L.; Salzberg, Charles L.

2006-01-01

This study examined correspondence in selections of job preference across a video CD-ROM assessment program, community jobs observed during employment site visits, and photographs of employment sites. For 20 participants ages 18 - 22 with developmental disabilities, the video CD-ROM program was initially administered to identify preferred jobs,…

Second Year Site Visits to Milwaukee Urban Systemic Initiative Schools. Report for the Milwaukee Public Schools.

ERIC Educational Resources Information Center

Huinker, DeAnn; Coan, Cheryl

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Retention in care, resource utilization, and costs for adults receiving antiretroviral therapy in Zambia: a retrospective cohort study

PubMed Central

2014-01-01

Background Of the estimated 800,000 adults living with HIV in Zambia in 2011, roughly half were receiving antiretroviral therapy (ART). As treatment scale up continues, information on the care provided to patients after initiating ART can help guide decision-making. We estimated retention in care, the quantity of resources utilized, and costs for a retrospective cohort of adults initiating ART under routine clinical conditions in Zambia. Methods Data on resource utilization (antiretroviral [ARV] and non-ARV drugs, laboratory tests, outpatient clinic visits, and fixed resources) and retention in care were extracted from medical records for 846 patients who initiated ART at ≥15 years of age at six treatment sites between July 2007 and October 2008. Unit costs were estimated from the provider’s perspective using site- and country-level data and are reported in 2011 USD. Results Patients initiated ART at a median CD4 cell count of 145 cells/μL. Fifty-nine percent of patients initiated on a tenofovir-containing regimen, ranging from 15% to 86% depending on site. One year after ART initiation, 75% of patients were retained in care. The average cost per patient retained in care one year after ART initiation was $243 (95% CI, $194-$293), ranging from $184 (95% CI, $172-$195) to $304 (95% CI, $290-$319) depending on site. Patients retained in care one year after ART initiation received, on average, 11.4 months’ worth of ARV drugs, 1.5 CD4 tests, 1.3 blood chemistry tests, 1.4 full blood count tests, and 6.5 clinic visits with a doctor or clinical officer. At all sites, ARV drugs were the largest cost component, ranging from 38% to 84% of total costs, depending on site. Conclusions Patients initiate ART late in the course of disease progression and a large proportion drop out of care after initiation. The quantity of resources utilized and costs vary widely by site, and patients utilize a different mix of resources under routine clinical conditions than if they were receiving fully guideline-concordant care. Improving retention in care and guideline concordance, including increasing the use of tenofovir in first-line ART regimens, may lead to increases in overall treatment costs. PMID:24684772

Occupational exposures to styrene vapor in a manufacturing plant for fiber-reinforced composite wind turbine blades.

PubMed

Hammond, Duane; Garcia, Alberto; Feng, H Amy

2011-07-01

A utility-scale wind turbine blade manufacturing plant requested assistance from the National Institute for Occupational Safety and Health (NIOSH) in controlling worker exposures to styrene at a plant that produced 37 and 42 m long fiber-reinforced wind turbine blades. The plant requested NIOSH assistance because previous air sampling conducted by the company indicated concerns about peak styrene concentrations when workers entered the confined space inside of the wind turbine blade. NIOSH researchers conducted two site visits and collected personal breathing zone and area air samples while workers performed the wind turbine blade manufacturing tasks of vacuum-assisted resin transfer molding (VARTM), gelcoating, glue wiping, and installing the safety platform. All samples were collected during the course of normal employee work activities and analyzed for styrene using NIOSH Method 1501. All sampling was task based since full-shift sampling from a prior Occupational Safety and Health Administration (OSHA) compliance inspection did not show any exposures to styrene above the OSHA permissible exposure limit. During the initial NIOSH site visit, 67 personal breathing zone and 18 area air samples were collected while workers performed tasks of VARTM, gelcoating, glue wipe, and installation of a safety platform. After the initial site visit, the company made changes to the glue wipe task that eliminated the need for workers to enter the confined space inside of the wind turbine blade. During the follow-up site visit, 12 personal breathing zone and 8 area air samples were collected from workers performing the modified glue wipe task. During the initial site visit, the geometric means of the personal breathing zone styrene air samples were 1.8 p.p.m. (n = 21) for workers performing the VARTM task, 68 p.p.m. (n = 5) for workers installing a safety platform, and 340 p.p.m. (n = 14) for workers performing the glue wipe task, where n is the number of workers sampled for a given mean result. Gelcoating workers included job categories of millers, gelcoat machine operators, and gelcoaters. Geometric mean personal breathing zone styrene air samples were 150 p.p.m. (n = 6) for millers, 87 p.p.m. (n = 2) for the gelcoat machine operators, and 66 p.p.m. (n = 19) for gelcoaters. The geometric mean of the personal breathing zone styrene air samples from the glue wipe task measured during the follow-up site visit was 31 p.p.m. (n = 12). The closed molding VARTM process was very effective at controlling worker exposures to styrene. Personal breathing zone styrene air samples were reduced by an order of magnitude after changes were made to the glue wipe task. The company used chemical substitution to eliminate styrene exposure during the installation of the safety platform. Recommendations were provided to reduce styrene concentrations during gelcoating.

Preceptor Perceptions of Virtual Quality Assurance Experiential Site Visits.

PubMed

Clarke, Cheryl L; Schott, Kathryn A; Arnold, Austin D

2018-05-01

Objective. To determine preceptor perceptions of the value of experiential quality assurance site visits between virtual and onsite visits, and to gauge preceptor opinions of the optimal method of site visits based on the type of visit received. Methods. Site visits (12 virtual and 17 onsite) were conducted with 29 APPE sites located at least 200 miles from campus. Participating preceptors were invited to complete an online post-visit survey adapted from a previously validated and published survey tool measuring preceptor perceptions of the value of traditional onsite visits. Results. Likert-type score averages for survey questions ranged from 4.2 to 4.6 in the virtual group and from 4.3 to 4.7 in the onsite group. No statistically significant difference was found between the two groups. Preceptors were more inclined to prefer the type of visit they received. Preceptors receiving onsite visits were also more likely to indicate no visit type preference. Conclusion. Preceptors perceived value from both onsite and virtual site visits. Preceptors who experienced virtual site visits highly preferred that methodology. This study suggests that virtual site visits may be a viable alternative for providing experiential quality assurance site visits from a preceptor's perspective.

Partnership in employee health. A workplace health program for British Columbia Public Service Agency (Canada).

PubMed

Tarride, J E; Harrington, K; Balfour, R; Simpson, P; Foord, L; Anderson, L; Lakey, W

2011-01-01

To evaluate the My Health Matters! (MHM) program, a multifaceted workplace intervention relying on education and awareness, early detection and disease management with a focus on risk factors for metabolic syndrome. The MHM program was offered to 2,000 public servants working in more than 30 worksites in British Columbia, Canada. The MHM program included a health risk assessment combined with an opportunity to attend an on-site screening and face-to-face call back visits and related on-site educational programs. Clinical and economic outcomes were collected over time in this one-year prospective study coupled with administrative and survey data. Forty three per cent of employees (N=857) completed the online HRA and 23 per cent (N=447) attended the initial clinical visit with the nurse. Risk factors for metabolic syndrome were identified in more than half of those attending the clinical visit. The number of risk factors significantly decreased by 15 per cent over six months (N=141). The cost per employee completing the HRA was $205 while the cost per employee attending the initial clinical visit was $394. Eighty-two per cent of employees would recommend the program to other employers. This study supports that workplace interventions are feasible, sustainable and valued by employees. As such, this study provides a new framework for implementing and evaluating workplace interventions focussing on metabolic disorders.

Use patterns of a state health care price transparency web site: what do patients shop for?

PubMed

Mehrotra, Ateev; Brannen, Tyler; Sinaiko, Anna D

2014-01-01

To help people shop for lower cost providers, several states have created their own price transparency Web sites or passed legislation mandating health plans provide such information. New Hampshire's HealthCost Web site is on the forefront of such initiatives. Despite the growing interest in price transparency, little is known about such efforts, including how often these tools are used and for what reason. We examined the use of New Hampshire HealthCost over a 3-year period. Approximately 1% of the state's residents used the Web site, and the most common searches were for outpatient visits, magnetic resonance imaging (MRI) or computed tomography (CT) scans, and emergency department visits. The results provide a cautionary note on the level of potential interest among consumers in this information but may guide others on practically what are the most "shop-able" services for patients. © The Author(s) 2014.

Effects of industrial and investigator disturbance on Arctic-nesting geese

USGS Publications Warehouse

Meixell, Brandt W.; Flint, Paul L.

2017-01-01

Oil and gas development on the Arctic Coastal Plain (ACP) of Alaska, USA may have effects on Arctic-nesting birds. To estimate effects of industrial activity and investigator disturbance on avian productivity, we monitored nests of greater white-fronted geese (Anser albifrons) with digital cameras and periodic nest visits during 2013–2014 at 2 sites on the ACP. A disturbed site was adjacent to human-made infrastructure and industrial clean-up activities initiated at the onset of the study and a control site was >2 km from sources of industrial disturbance. We assessed variation in estimates of incubation constancy, nest survival, and predator behavior relative to site, year, and distance from industrial activity using nest photographs obtained at 1-minute intervals. We compared analysis of hourly nest survival informed by intensive monitoring with cameras to analysis of daily nest survival informed by traditional nest visit data obtained at intervals of 5–7 days to assess how method and time scale of sampling affect ecological inference. Geese in both sites exhibited high levels of nest attendance and initiated incubation breaks less than once per day. Observer-caused incubation breaks associated with nest visits ( = 37.8 min) were longer than other types of incubation breaks ( = 8.7 min), demonstrating a differential response by nesting geese to direct human encroachment versus indirect vehicular and aircraft traffic. During both years, geese were absent from nests more frequently in the disturbed ( = 0.9 breaks/day) than control ( = 0.6 breaks/day) site, and this break frequency was slightly higher for nests closer to industrial activity. In the year with high rates of depredation, nest survival was positively related to distance from industrial activity and abandoned infrastructure, consistent with predictions of industry-caused effects. This relationship, however, was not evident in the year with reduced predation pressure, likely because of annual variation in arctic fox (Vulpes lagopus) behavior. Analysis of nest survival probability informed by camera data allowed for detection of detailed patterns of variation that were not supported when using only visit data for the same nests. Observer visits were responsible for reductions of 7–35% in nest survival probability, highlighting the importance of minimizing, and controlling for, observer effects in studies of avian productivity. Indirect vehicular and aircraft disturbance posed less risk to nest survival than direct encroachment by observers at nest sites. Therefore, effects of industrial activities on avian productivity in the Arctic can be minimized through practices that limit direct encounters with nests. 

An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta

PubMed Central

Thanh, Nguyen X.; Chuck, Anderson W.; Wasylak, Tracy; Lawrence, Jeannette; Faris, Peter; Ljungqvist, Olle; Nelson, Gregg; Gramlich, Leah M.

2016-01-01

Background In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000–$3 391 000), or $1768 (range $920–$2619) per patient. The probability for the program to be cost-saving was 73%–83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4–$5.1) in return. Conclusion The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites. PMID:28445024

Implementation of a Wisconsin Division of Public Health Surgical Site Infection Prevention Champion Initiative.

PubMed

Borlaug, Gwen; Edmiston, Charles E

2018-05-01

Approximately 900 surgical site infections (SSIs) were reported to the Wisconsin Division of Public Health annually from 2013 to 2015, representing the most prevalent reported health care-associated infection in the state. Personnel at the Wisconsin Division of Public Health launched an SSI prevention initiative in May 2015 using a surgical care champion to provide surgical team peer-to-peer guidance through voluntary, nonregulatory, fee-exempt onsite visits that included presentations regarding the evidence-based surgical care bundle, tours of the OR and central processing areas, and one-on-one discussions with surgeons. The surgical care champion visited 10 facilities from August to December 2015, and at those facilities, SSIs decreased from 83 in 2015 to 47 in 2016 and the overall SSI standardized infection ratio decreased by 45% from 1.61 to 0.88 (P = .002), suggesting a statewide SSI prevention champion model can help lead to improved patient outcomes. © AORN, Inc, 2018.

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.

PubMed

Sword, Wendy A; Krueger, Paul D; Watt, M Susan

2006-01-01

To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

PubMed

Heany, Julia; Torres, Jennifer; Zagar, Cynthia; Kostelec, Tiffany

2018-06-05

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

Home Reading: The Key to Proficiency.

ERIC Educational Resources Information Center

Henderson, Bill

2000-01-01

A Boston principal reflects on decade-long efforts to get students and their families to read together. Initiatives ranged from reading contests and upgraded reading materials to reading contracts, literacy shows, parent/home visiting programs, pizza parties, and off-site tutors. Persistence paid off in higher reading scores. (MLH)

Workplace Literacy: A Labour Perspective.

ERIC Educational Resources Information Center

Nesbit, Tom

The policies and practices of Canadian labor unions in the area of workplace literacy were examined through a comprehensive literature review and site visits to an unspecified number of labor-initiated workplace literacy programs representing different geographic areas, industries and types of occupations, levels of participation of equity groups,…

Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial.

PubMed

Ngure, Kenneth; Heffron, Renee; Mugo, Nelly; Irungu, Elizabeth; Celum, Connie; Baeten, Jared M

2009-11-01

To evaluate a multipronged approach to promote dual contraceptive use by women within heterosexual HIV-1-serodiscordant partnerships. For 213 HIV-1-serodiscordant couples in Thika, Kenya, participating in an HIV-1 prevention clinical trial, contraceptive promotion was initiated through a multipronged intervention that included staff training, couples family planning sessions, and free provision of hormonal contraception on-site. Contraceptive use and pregnancy incidence were compared between two time periods (before versus after June 2007, when the intervention was initiated) and between Thika and other Kenyan trial sites (Eldoret, Kisumu, and Nairobi). Generalized estimating equations and Andersen-Gill proportional hazards modeling were used. Nonbarrier contraceptive use increased after implementation of the intervention: from 31.5 to 64.7% of visits among HIV-1-seropositive women [odds ratio 4.0, 95% confidence interval (CI) 3.0-5.3] and from 28.6 to 46.7% of visits among HIV-1-seronegative women (odds ratio 2.2, 95% CI 1.4-3.5). In comparison, at the other Kenyan sites, where the intervention was not implemented, contraceptive use changed minimally, from 15.6 to 22.3% of visits for HIV-1-seropositive women and from 13.6 to 12.7% among HIV-1-seronegative women. Self-reported condom use remained high during follow-up. Pregnancy incidence at the Thika was significantly lower after compared with before June 2007 (hazard ratio 0.2, 95% CI 0.1-0.6) and was approximately half that at other Kenyan sites during the intervention period (hazard ratio 0.5, 95% CI 0.3-0.8). A multipronged family planning intervention can lead to high nonbarrier contraceptive uptake and reduced pregnancy incidence among women in HIV-1-serodiscordant partnerships.

The asthma ePrompt: a novel electronic solution for chronic disease management.

PubMed

Lim, Kaiser G; Rank, Matthew A; Cabanela, Rosa L; Furst, Joseph W; Rohrer, James E; Liesinger, Juliette; Muller, Lisa; Wagie, Amy E; Naessens, James M

2012-03-01

This study tested the ability of an electronic prompt to promote an asthma assessment during primary care visits. We performed a prospective study of all eligible adult patients with previously diagnosed asthma in three geographically distinct ambulatory family medicine clinics within a 4-month period. The usual clinic visit process was performed at two geographically distinct control sites (n = 75 and n = 55 patients, respectively). The intervention group site (n = 64) had an electronic flag embedded in the Patient Check-in Locator field which prompted the distribution of a self-administered Asthma Management Questionnaire (AMQ) in the waiting room. The primary outcome measure was a documented asthma severity assessment. The front desk distributed the AMQ successfully in 100% of possible opportunities and the AMQ was completed by 84% of patients. Providers in the intervention group were significantly more likely than providers in the two non-intervention groups to document asthma severity in the medical record during a non-asthma ambulatory clinic visit (63.3% vs. 18.7% vs. 3.6%; p < .001). The provision of standardized asthma information triggered by an electronic prompt at the time of check-in effectively initiates an asthma assessment during the primary care visits.

Service-Learning from a Distance: Partnering Multiple Universities and Local Governments in a Large Scale Initiative

ERIC Educational Resources Information Center

Poindexter, Sandra; Arnold, Pamela; Osterhout, Christopher

2009-01-01

Service-learning can be academically effective even when the distances between students and client organizations prevent face-to-face interchanges and site visits. Working with the State of Michigan and Michigan Townships Association, Michigan students from five universities learned about local government while helping Michigan townships develop…

Use of the Internet by patients and their families to obtain genetics-related information.

PubMed

Taylor, M R; Alman, A; Manchester, D K

2001-08-01

To characterize use of the Internet by patients and their families referred to general genetics clinics. We developed a survey to assess Internet use among patients visiting urban and rural clinics in Colorado and Wyoming. One hundred eighty-nine surveys were distributed to patients and their family members visiting outpatient general genetics clinics in spring 2000. The 8-page anonymous survey instrument asked about use of the Internet to obtain genetics-related information (GRI). All participants were asked whether a physician or health professional had referred them to the Internet for GRI. Subjects who had previously used the Internet to search for GRI were asked to rate whether they considered the GRI they encountered to be accurate, inaccurate, easy to understand, confusing, or trustworthy. One hundred fifty-seven surveys (83%) were returned (52% urban; 48% rural). Ninety (60%) of 149 respondents were at the clinic for a new-patient visit, and 59 (40%) were follow-up visits. All respondents were older than 17 years; 141 (91%) of 155 respondents were the patient's parent or guardian. Seventy-three (47%) of 155 respondents had searched the Internet for GRI prior to their clinic visit. The patients and families themselves initiated the majority of such efforts; only 8 (5%) of 148 respondents had been referred to a site on the World Wide Web by a physician. Interestingly, 136 (92%) of 147 respondents indicated that they would be likely to visit a Web site that was recommended by a geneticist. The most compelling reasons for searching the Internet for GRI were to get information in layperson's terms (60/131 [46%]); to get information about treatment (16/131 [12%]); and to get information about genetic research (16/131 [12%]). Among respondents who reported visiting GRI Web sites, 24 (41%) of 58 agreed that information was confusing or difficult to understand, 35 (53%) of 66 agreed that information was accurate and trustworthy, and 44 (77%) of 57 agreed that using the Internet was a positive experience. Internet use among patients referred to general genetics clinics and their family members appears to be widespread. Respondents reported that they found some of the information confusing and questioned its accuracy. Referral to Web sites by physicians was reported rarely, although the majority of respondents said they would visit a Web site recommended by a genetics physician. Further studies are needed to establish the accuracy of Internet information and how best to integrate and/or accommodate the data into the genetics clinic.

Strategies to reduce nonurgent emergency department use: experience of a Northern Virginia Employer Group.

PubMed

DeVries, Andrea; Li, Chia-Hsuan; Oza, Manish

2013-03-01

This administrative claims analysis evaluated the impact of a health plan-sponsored Emergency Room Utilization Management Initiative (ERUMI), which combined increased patient copays for ED visits with educational outreach to reduce inappropriate ED use and encourage use of retail health clinics (RHCs) and other alternative treatment sites among a commercially insured population. Emergency department (ED) utilization rates for select acute but nonurgent conditions that could be treated appropriately in an RHC were compared for members of an employer group with (intervention group) and without (comparators) ERUMI. Utilization was compared for baseline period (January-June 2009) and ERUMI implementation period (January-June 2010). A total of 56,896 members (14,224 intervention, 42,672 matched comparators) were included. ED utilization for conditions that could be treated appropriately by RHCs decreased by 10.39 visits/1000 members in the intervention group versus 6.29 visits in comparators. RHC visits rose for both the groups, with a greater increase in the intervention group (22.61 visits/1000 members, P<0.001) versus comparison (1.64/1000, P=0.064). After ERUMI implementation, intervention group members were nearly 5 times more likely than comparators to choose RHCs over ED for nonurgent care. The health plan-sponsored ERUMI program, consisting of both financial and educational components, decreased nonurgent ED utilization while increasing the use of alternative treatment sites.

Functional role of long-lived flowers in preventing pollen limitation in a high elevation outcrossing species

PubMed Central

Pacheco, Diego Andrés; Dudley, Leah S

2017-01-01

Abstract Low pollinator visitation in harsh environments may lead to pollen limitation which can threaten population persistence. Consequently, avoidance of pollen limitation is expected in outcrossing species subjected to habitually low pollinator service. The elevational decline in visitation rates on many high mountains provides an outstanding opportunity for addressing this question. According to a recent meta-analysis, levels of pollen limitation in alpine and lowland species do not differ. If parallel trends are manifested among populations of alpine species with wide elevational ranges, how do their uppermost populations contend with lower visitation? We investigated visitation rates and pollen limitation in high Andean Rhodolirium montanum. We test the hypothesis that lower visitation rates at high elevations are compensated for by the possession of long-lived flowers. Visitation rates decreased markedly over elevation as temperature decreased. Pollen limitation was absent at the low elevation site but did occur at the high elevation site. While initiation of stigmatic pollen deposition at high elevations was not delayed, rates of pollen arrival were lower, and cessation of pollination, as reflected by realized flower longevity, occurred later in the flower lifespan. Comparison of the elevational visitation decline and levels of pollen limitation indicates that flower longevity partially compensates for the lower visitation rates at high elevation. The functional role of flower longevity, however, was strongly masked by qualitative pollen limitation arising from higher abortion levels attributable to transference of genetically low-quality pollen in large clones. Stronger clonal growth at high elevations could counterbalance the negative fitness consequences of residual pollen limitation due to low visitation rates and/or difficult establishment under colder conditions. Visitation rates on the lower part of the elevational range greatly exceeded community rates recorded several decades ago when the planet was cooler. Current pollen limitation for some species in some habitats might underestimate historical levels. PMID:29225762

Strengthening Pennsylvania's Charter School Reform: Findings From the Statewide Evaluation and Discussion of Relevant Policy Issues. Year Five Report.

ERIC Educational Resources Information Center

Miron, Gary; Nelson, Christopher; Risley, John

In 2001, the Pennsylvania Department of Education contracted with Western Michigan University to evaluate Pennsylvania's charter schools and charter school initiative over two years. The study used site visits, work sample review, document review, focus groups, portfolios and surveys to gather data regarding the movement's effectiveness, progress,…

Creating a Seamless Web of Services for Youth: The DC Children and Youth Investment Partnership.

ERIC Educational Resources Information Center

Keegan, Sinead; Chaplin, Duncan

This report describes the DC Children and Youth Investment Partnership, which helps improve outcomes for DC youth by building a sustainable partnership to increase the quality and quantity of youth services. Data from interviews with key actors, attendance at Partnership meetings, and site visits with affiliated initiatives show progress in…

Preliminary checklist of amphibians and reptiles from Baramita, Guyana

USGS Publications Warehouse

Reynolds, R.P.; MacCulloch, R.D.

2012-01-01

We provide an initial checklist of the herpetofauna of Baramita, a lowland rainforest site in the Northwest Region of Guyana. Twenty-five amphibian and 28 reptile species were collected during two separate dry-season visits. New country records for two species of snakes are documented, contributing to the knowledge on the incompletely known herpetofauna of Guyana.

Development of a subspecialty cardiology curriculum for paediatric registrars in Malawi: Implementation of a long-distance hybrid model.

PubMed

Newberry, Laura; Kennedy, Neil; Greene, Elizabeth A

2016-06-01

Malawi has a high burden of paediatric cardiac disease but a limited number of health providers familiar with these chronic diseases. Given the rising number of Malawian postgraduate paediatric trainees at the University of Malawi College of Medicine, we sought to remedy this lack of basic cardiology training with a long-distance, module-based curriculum that could be utilised independently, as needed, with on-site teaching. We also wished to evaluate the initial modules for utility and improvement in knowledge and confidence in each topic. After an initial site visit to determine curriculum needs, online modules with interactive evaluations and quizzes were developed by a paediatric cardiologist in the United States, in collaboration with paediatric registrar training directors in Malawi. This online interactive curriculum was followed by several site visits to Malawi, by the United States-based paediatric cardiologist, to provide bedside teaching, case-based discussions and hands-on skill training in cardiac ultrasound and electrocardiogram interpretation. Evaluation of the curriculum model included post-module quizzes on cardiac topics as well as registrar self-assessments regarding confidence in content areas. The average post-module quiz score was 93.6%. Repeat testing with the same questions four months later yielded an average score of 78%, with a range from 60 to 100%. Pre- and post-module registrar self-assessment regarding confidence in content areas showed a substantial gain in knowledge and confidence mean. In their qualitative feedback, registrars noted that the modules were helpful in studying for their certifying examinations, and all four of the registrars sitting Part I of their Malawian and South African paediatric certifying examinations passed. Our innovative hybrid approach, combining online educational modules with in-person teaching visits, is a useful approach in expanding paediatric cardiology subspecialty education in Malawi.

Site Guidelines for a "Making Middle Grades Work" Technical Review Visit

ERIC Educational Resources Information Center

Southern Regional Education Board, 2004

2004-01-01

The purpose of the Technical Review Visit (TRV) is to follow up on the actions taken to implement the recommendations indicated for each challenge in the most recent Technical Assistance Visit (TAV) report. This document provides the following: (1) Site Guidelines for the Making Middle Grades Work (MMGW) Technical Review Visit; (2) Site Checklist;…

The value of crime scene and site visitation by forensic psychologists and psychiatrists.

PubMed

Mohandie, Kris; Meloy, J Reid

2013-05-01

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after-the-fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision-making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations. © 2013 American Academy of Forensic Sciences.

Successful increase in contraceptive uptake among Kenyan HIV-1 serodiscordant couples enrolled in an HIV-1 prevention trial

PubMed Central

Ngure, Kenneth; Heffron, Renee; Mugo, Nelly; Irungu, Elizabeth; Celum, Connie; Baeten, Jared

2016-01-01

Objective To evaluate a multi-pronged approach to promote dual contraceptive use by women within heterosexual HIV-1 serodiscordant partnerships. Methods For 213 HIV-1 serodiscordant couples in Thika, Kenya participating in an HIV-1 prevention clinical trial, contraceptive promotion was initiated through a multi-pronged intervention that included staff training, couples family planning sessions, and free provision of hormonal contraception on-site. Contraceptive use and pregnancy incidence were compared between two time periods (before versus after June 2007, when the intervention was initiated) and between Thika and other Kenyan trial sites (Eldoret, Kisumu, and Nairobi). Generalized estimating equations and Andersen-Gill proportional hazards modeling were used. Results Non-barrier contraceptive use increased after implementation of the intervention: from 31.5% to 64.7% of visits among HIV-1 seropositive women (odds ratio [OR] 4.0, 95% confidence interval [CI] 3.0–5.3) and from 28.6% to 46.7% of visits among HIV-1 seronegative women (OR 2.2, 95% CI 1.4–3.5). In comparison, at the other Kenyan sites, where the intervention was not implemented, contraceptive use changed minimally, from 15.6% to 22.3% of visits for HIV-1 seropositive women and from 13.6% to 12.7% among HIV-1 seronegative women. Self-reported condom use remained high during follow-up. Pregnancy incidence at the Thika was significantly lower after compared with before June 2007 (hazard ratio [HR] 0.2, 95% CI 0.1–0.6), and was approximately half that at other Kenyan sites during the intervention period (HR 0.5, 95% CI 0.3–0.8). Conclusions A multi-pronged family planning intervention can lead to high non-barrier contraceptive uptake and reduced pregnancy incidence among women in HIV-1 serodiscordant partnerships. PMID:20081393

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities.

PubMed

Kim, Young Mi; Chilila, Maureen; Shasulwe, Hildah; Banda, Joseph; Kanjipite, Webby; Sarkar, Supriya; Bazant, Eva; Hiner, Cyndi; Tholandi, Maya; Reinhardt, Stephanie; Mulilo, Joyce Chongo; Kols, Adrienne

2013-09-08

The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities' infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers' PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers' ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.

Prescribed Fire: The Influence of Site Visits on Citizen Attitudes

ERIC Educational Resources Information Center

Toman, Eric; Shindler, Bruce; Reed, Michelle

2004-01-01

This research employed a panel design to measure the effect of site visits on public perceptions of prescribed fire. On-site survey questions were devised to compare answers to a mail questionnaire previously completed by the same respondents. Questions were designed to examine how site visits influence public opinion and affect acceptance of…

A 13-year cohort study of musculoskeletal disorders treated in an autoplant, on-site physiotherapy clinic.

PubMed

Sadi, Jackie; MacDermid, Joy C; Chesworth, Bert; Birmingham, Trevor

2007-12-01

The purpose of this study was to describe the rate and distribution of treatment visits provided in an on-site, automotive plant, physiotherapy clinic over a 13-year period. A retrospective cohort study was conducted using data collected at an on-site physiotherapy clinic (1990-2002, 65,977 visits; n = 2,636 workers). The average age of workers was 43 +/- 9 years; most remained at work (85%) when treated. Disorders most commonly affected the shoulder, lumbar, and cervical regions; the median number of visits for these was 7, 6, and 5, respectively. Elbow disorders occurred commonly only for work-related complaints and required a median of eight visits. Rate of utilization was higher for women, with 47% of the plant's female workers attending physiotherapy in 1 year. Women had higher rates of cervical spine (12 vs. 22%) and wrist (5 vs. 10%) disorders. The two most common causes of injury reported by workers with an industrial injury were "frank injury arising out of normal employment" (51%) and "gradual onset/no frank injury" (37%). The diagnosis most often reported by the physiotherapist after initial assessment was "strain" which was similar for both industrial (43%) and non-industrial (49%) injuries. The six main departments in this automotive plant account for 93% of all industrial injuries reported. Final Assembly accounted for the largest number and highest rate of injury, although shift variability was noted in utilization rates (13 vs. 26%), despite the same tasks, shift schedules, and demographics. Although there was no control group, the number of visits to discharge was lower than reported in the literature for off-site physical therapy; there was a large reduction in claims (441-275) following introduction of the clinic and reduced duration/costs of lost time were identified by the employer as a rationale to continue and enhance the service over time. On-site physiotherapy services can provide early, cost-effective management of WRMSD in the automotive sector. Service utilization reflects the influence of gender, job task, and shift-dynamics on rates and location of WRMSD.

The value of redundant measurements - highlights from AmeriFlux site visits using a portable eddy covariance system

NASA Astrophysics Data System (ADS)

Chan, S.; Billesbach, D. P.; Hanson, C. V.; Dengel, S.; Polonik, P.; Biraud, S.

2016-12-01

The AmeriFlux network conducts independent site visits using a portable eddy covariance system (PECS). Short-term (<2 weeks), side-by-side comparisons enable the network to evaluate inter-comparability between sites, improve data quality, and assess measurement uncertainty across the network. The PECS includes commonly used sensors for turbulent flux, radiation, and meteorological measurements which are maintained and calibrated using established best practices at levels at or above the manufacturer's recommendations. The importance of site visits was realized at the inception of the AmeriFlux network with the first site visit in 1997. Since that time, more than 180 site visits at over 120 different sites have been conducted. Site visit reports over the years have led to many key findings and important advances within the flux community which are highlighted in the presentation. Furthermore, we summarize and synthesize results from recent site comparisons that were conducted with the latest generation of the PECS (2013-present). The presentation quantifies observed differences between the PECS and network sites for key flux, radiation, and meteorological metrics. The aggregated comparisons provide insight into comparability amongst network sites as well as areas for improvement. We identify common errors and issues and discuss some best practices.

The Direction of Migrant Education as Revealed by Site Visits in Selected Counties of Six States.

ERIC Educational Resources Information Center

Reiser, Emanuel

Field workers initially observed selected migrant programs in 30 counties in Arizona, California, Georgia, Florida, New Mexico, and Texas during a two-week period in early 1968. A two-day conference was then held, during which recommendations were made as to future direction in migrant education. Major strengths of the observed programs included a…

The California Conservation Corps: A Case Study. Working Paper #5. The State Youth Initiatives Project.

ERIC Educational Resources Information Center

Bailin, Michael A.

Through site visits, a case study was made of the California Conservation Corps (CCC) in order to provide a description of its history, objectives, program features, participants, funding patterns, future plans, and key issues scheduled to be addressed by the program. Descended from similar earlier programs, the CCC was established in 1976. After…

The National Visitor Use Monitoring methodology and final results for round 1

Treesearch

S.J. Zarnoch; E.M. White; D.B.K. English; Susan M. Kocis; Ross Arnold

2011-01-01

A nationwide, systematic monitoring process has been developed to provide improved estimates of recreation visitation on National Forest System lands. Methodology is presented to provide estimates of site visits and national forest visits based on an onsite sampling design of site-days and last-exiting recreationists. Stratification of the site days, based on site type...

Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: a randomized trial.

PubMed

Bernard, Caitlin; Wan, Leping; Peipert, Jeffrey F; Madden, Tessa

2018-05-17

To investigate whether an early 3-week postpartum visit in addition to the standard 6-week visit increases LARC initiation by 8weeks postpartum compared to the routine 6-week visit alone. We enrolled pregnant and immediate postpartum women into a prospective randomized, non-blinded trial comparing a single 6-week postpartum visit (routine care) to two visits at 3 and 6weeks postpartum (intervention), with initiation of contraception at the 3-week visit, if desired. All participants received structured contraceptive counseling. Participants completed surveys in-person at baseline and at the time of each postpartum visit. A sample size of 200 total participants was needed to detect a 2-fold difference in LARC initiation (20% vs. 40%). Between May 2016 and March 2017, 200 participants enrolled; outcome data are available for 188. The majority of LARC initiation occurred immediately postpartum (25% of the intervention arm and 27% of the routine care arm). By 8weeks postpartum,34% of participants in the intervention arm initiated LARC, compared to 41% in the routine care arm (p=.35). Overall contraceptive initiation by 8weeks was 83% and84% in the intervention and routine care arms, respectively (p=.79). There was no difference between the arms in the proportion of women who attended at least one postpartum visit (70% vs. 74%, p=.56). The addition of a 3-week postpartum visit to routine care does not increase LARC initiation by 8weeks postpartum. The majority of LARC users desired immediate rather than interval postpartum initiation. Clinicaltrials.govNCT02769676 Implications. The addition of a 3-week postpartum visit to routine care does not increase LARC or overall contraceptive initiation by 8weeks post-partum when the option of immediate postpartum placement is available. The majority of LARC users desired immediate rather than interval postpartum initiation. Copyright © 2018. Published by Elsevier Inc.

76 FR 17427 - Notice of Submission of Proposed Information Collection to OMB; Emergency Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... (HPRP) grantees, as well as the site visit interview guide that will serve as the protocol for 15-18... site visit interview guide that will serve as the protocol for 15-18 site visits to be conducted to...

Hot Spots on the Web for Teacher Librarians: A Selection of Recommended Web Sites for TLs To Visit.

ERIC Educational Resources Information Center

1996

Six papers review and recommend sites on the Web as resources for teacher librarians include: "Just Do It: A Guide to Getting Out There and Doing It Yourself" (Catherine Ryan); "A Selection of Recommended Web Sites for TLs To Visit" (Karen Bonanno); "A Selection of Recommended Web Sites for TLs To Visit" (Sandra…

19 CFR 10.553 - Textile and apparel site visits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Singapore Free...) Visits to enterprises of Singapore. U.S. officials may undertake to conduct site visits to enterprises in the territory of Singapore. U.S. officials will conduct such visits together with responsible...

Characterizations of Hydrogen Energy Technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Energetics Inc

2003-04-01

In 1996, Dr. Ed Skolnik of Energetics, Incorporated, began a series of visits to the locations of various projects that were part of the DOE Hydrogen Program. The site visits/evaluations were initiated to help the DOE Program Management, which had limited time and limited travel budgets, to get a detailed snapshot of each project. The evaluations were soon found to have other uses as well: they provided reviewers on the annual Hydrogen Program Peer Review Team with an in-depth look at a project--something that is lacking in a short presentation--and also provided a means for hydrogen stakeholders to learn aboutmore » the R&D that the Hydrogen Program is sponsoring. The visits were conducted under several different contract mechanisms, at project locations specified by DOE Headquarters Program Management, Golden Field Office Contract Managers, or Energetics, Inc., or through discussion by some or all of the above. The methodology for these site-visit-evaluations changed slightly over the years, but was fundamentally as follows: Contact the Principal Investigator (PI) and arrange a time for the visit; Conduct a literature review. This would include a review of the last two or three years of Annual Operating Plan submittals, monthly reports, the paper submitted with the last two or three Annual Peer Review, published reviewers' consensus comments from the past few years, publications in journals, and journal publications on the same or similar topics by other researchers; Send the PI a list of questions/topics about a week ahead of time, which we would discuss during the visit. The types of questions vary depending on the project, but include some detailed technical questions that delve into some fundamental scientific and engineering issues, and also include some economic and goal-oriented topics; Conduct the site-visit itself including--Presentations by the PI and/or his staff. This would be formal in some cases, informal in others, and merely a ''sit around the table'' discussion in others; The format was left to the discretion of the PI; A tour of the facility featuring, whenever possible, a demonstration of the process in operation; Detailed discussions of the questions sent to the PI and other topics; and Writing a report on the visit. This compilation presents the reports for all the site-visits held between February 1996 and July 2001, each written shortly after the visit. While nothing has been changed in the actual content of any of the reports, reformatting for uniformity did occur. In each report, where the questions and their respective answers are discussed, the questions are shown in bold. In several cases, the PI chose to answer these questions in writing. When this occurs, the PI's answers are produced ''verbatim, in quotes, using a different font.'' Discussion of the questions, tour/demonstration, and anything else raised during the visit is presented in normal type. Comments that represent the opinion of Dr. Skolnik, including those added during the writing of the report are shown in italics. The reports compiled here, as stated, covers a period through July 2001. Since then, site-visits to various project locations and the accompanying evaluations have continued. Thus, a second compilation volume should follow in the fall of 2003. Following the compilation of reports, is an afterward that briefly discusses what has happened to some of the projects or project personnel since that particular report was written.« less

Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits.

PubMed

Trueger, Nathan Seth; Chua, Kao-Ping; Hussain, Aamir; Liferidge, Aisha T; Pitts, Stephen R; Pines, Jesse M

2017-07-01

Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed. To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability." Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria. Use of the combined basic hours/basic capabilities criteria and extended hours/extended capabilities generated lower and upper bounds of estimates. Our criteria classified 5.5%-27.1%, 7.6%-20.4%, and 10.6%-46.0% of visits as substitutable in primary care offices, retail clinics, and urgent care centers, respectively. Alternative care sites vary widely in operating hours and functional capabilities. Methods such as ours may help incorporate this variability into estimates of ED visit substitutability.

Environmental restoration and waste management: Robotics technology development program: Robotics 5-year program plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

In FY 1990 Robotics Technology Development Program (RTDP) planning teams visited five DOE sites. These sites were selected by the Office of Technology Development to provide a needs basis for developing a 5-Year Plan. Visits to five DOE sites provided identification of needs for robotics technology development to support Environmental Restoration and Waste Management (ER WM) projects at those sites. Additional site visits will be conducted in the future to expand the planning basis. This volume summarizes both the results of the site visits and the needs and requirements of the priority ER WM activities at the sites, including potentialmore » needs for robotics and remote systems technology. It also discusses hazards associated with the site activities and any problems or technical uncertainties associated with dealing with the hazards in the performance of the ER WM work. Robotic or remote systems currently under development for remediation projects or waste operations are also discussed. The information in this document is organized principally by site, activity, and priority. Section 2.0, Site Needs, is based on information from the site visit reports and provides a summary which focuses on the site needs and requirements for each priority activity. Section 2.0 also records evaluations and discussions by the RTDP team following the site visit. Section 3.0, Commonality Assessment, documents similar site needs where common, or cross-cutting, robotics technology might be applied to several activities. Section 4.0 contains a summary of the site needs and requirements in tabular form. 1 tab.« less

Case Study of Home-School Visits

ERIC Educational Resources Information Center

Aguerrebere, Yolanda

2009-01-01

This case study evaluated one site of a California teacher home visit program. Home visits have been an important means of connecting families and schooling. In 1999, California inaugurated a statewide home visit program to promote effective partnership between home and school for low-achieving schools. At this site, families in 3 kindergarten…

A reliable facility location design model with site-dependent disruption in the imperfect information context

PubMed Central

Yun, Lifen; Wang, Xifu; Fan, Hongqiang; Li, Xiaopeng

2017-01-01

This paper proposes a reliable facility location design model under imperfect information with site-dependent disruptions; i.e., each facility is subject to a unique disruption probability that varies across the space. In the imperfect information contexts, customers adopt a realistic “trial-and-error” strategy to visit facilities; i.e., they visit a number of pre-assigned facilities sequentially until they arrive at the first operational facility or give up looking for the service. This proposed model aims to balance initial facility investment and expected long-term operational cost by finding the optimal facility locations. A nonlinear integer programming model is proposed to describe this problem. We apply a linearization technique to reduce the difficulty of solving the proposed model. A number of problem instances are studied to illustrate the performance of the proposed model. The results indicate that our proposed model can reveal a number of interesting insights into the facility location design with site-dependent disruptions, including the benefit of backup facilities and system robustness against variation of the loss-of-service penalty. PMID:28486564

Vision into Reality: Planning and Budgeting Processes Implemented at NMSU-Carlsbad through the Year 2000.

ERIC Educational Resources Information Center

Cowen, Sonia S.

Prepared for a site visit by the North Central Association (NCA), this report describes the goals and vision of New Mexico State University's two-year branch campus at Carlsbad (NMSU-C) through the year 2000. The first section states the mission, goals, and purposes of NMSU-C, while the second describes six campus-wide initiatives to be completed…

Targeted Radiation Therapy for Cancer Initiative

DTIC Science & Technology

2016-09-01

grant continues to facilitate continuing medical education for the staff at MAMC on image -guided radiotherapy. A site visit to the Varian Medical ...CONTRACTING ORGANIZATION: Geneva Foundation Tacoma, WA REPORT DATE: September 2016 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research...98402 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort

Designing a Marketing Course with Field Site Visits

ERIC Educational Resources Information Center

Van Doren, Doris; Corrigan, Hope Bober

2008-01-01

A key goal of including field site visits in marketing courses is to give business students increased interaction with industry professionals and community leaders. Site visits give students a concrete idea of how different marketing disciplines work in the business world. Business students gain greater insight into a career in marketing from this…

76 FR 38383 - Albany Engineering Corporation, Town of Stuyvesant, NY; Notice of Site Visit and Technical Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [ Project No. 2696-033] Albany Engineering Corporation, Town of Stuyvesant, NY; Notice of Site Visit and Technical Meeting On July 12, 2011, Office of Energy Projects staff will participate in a site visit and technical meeting for the Stuyvesant...

Expert Panel Reviews of Research Centers: The Site Visit Process

ERIC Educational Resources Information Center

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-01-01

Site visits are used extensively in a variety of settings within the evaluation community. They are especially common in making summative value decisions about the quality and worth of research programs/centers. However, there has been little empirical research and guidance about how to appropriately conduct evaluative site visits of research…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maheras, Steven J.; Best, Ralph E.; Ross, Steven B.

This report presents a preliminary evaluation of removing used nuclear fuel (UNF) from 12 shutdown nuclear power plant sites. At these shutdown sites the nuclear power reactors have been permanently shut down and the sites have been decommissioned or are undergoing decommissioning. The shutdown sites are Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, Zion, Crystal River, Kewaunee, and San Onofre. The evaluation was divided into four components: characterization of the UNF and greater-than-Class C low-level radioactive waste (GTCC waste) inventory; a description of the on-site infrastructure and conditions relevant to transportationmore » of UNF and GTCC waste; an evaluation of the near-site transportation infrastructure and experience relevant to shipping transportation casks containing UNF and GTCC waste, including identification of gaps in information; and, an evaluation of the actions necessary to prepare for and remove UNF and GTCC waste. The primary sources for the inventory of UNF and GTCC waste are the U.S. Department of Energy (DOE) RW-859 used nuclear fuel inventory database, industry sources such as StoreFUEL and SpentFUEL, and government sources such as the U.S. Nuclear Regulatory Commission. The primary sources for information on the conditions of site and near-site transportation infrastructure and experience included observations and information collected during visits to the Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion sites; information provided by managers at the shutdown sites; Facility Interface Data Sheets compiled for DOE in 2005; Services Planning Documents prepared for DOE in 1993 and 1994; industry publications such as Radwaste Solutions; and Google Earth. State and Regional Group representatives, a Tribal representative, and a Federal Railroad Administration representative participated in six of the shutdown site visits. Every site was found to have at least one off-site transportation mode option for removing its UNF and GTCC waste; some have multiple options. Experience removing large components during reactor decommissioning provided an important source of information used to identify the transportation mode options for the sites. Especially important in conducting the evaluation were site visits, through which information was obtained that would not have been available otherwise. Extensive photographs taken during the site visits proved to be particularly useful in documenting the current conditions at or near the sites. Additional conclusions from this evaluation include: The 12 shutdown sites use designs from 4 different suppliers involving 9 different (horizontal and vertical) dry storage systems that would require the use of 8 different transportation cask designs to remove the UNF and GTCC waste from the shutdown sites; Although there are common aspects, each site has some unique features and/or conditions; Although some regulatory actions will be required, all UNF at the initial 9 shutdown sites (Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion) is in licensed systems that can be transported, including a small amount of high-burnup fuel; Each site indicated that 2-3 years of advance time would be required for its preparations before shipments could begin; Most sites have more than one transportation option, e.g., rail, barge, or heavy haul truck, as well as constraints and preferences. It is expected that additional site visits will be conducted to add to the information presented in the evaluation.« less

Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: A qualitative study.

PubMed

Sawan, Mouna; Jeon, Yun-Hee; Fois, Romano A; Chen, Timothy F

Research concerning the overprescribing of psychotropic medicines in nursing homes suggests that organizational climate plays a significant role in the use of psychotropic medicines. Organizational climate refers to how members of the organization perceive their work environment as well as interactions with each other or outsiders. This study aimed to explore the key dimensions of organizational climate and their subsequent influence on the use of psychotropic medicines. Semi-structured interviews were conducted with 40 on-site and visiting staff from eight nursing homes in Sydney, Australia. Purposive sampling was used to recruit participants representing a broad range of health disciplines and roles. Transcripts were content coded for participants' perceptions related to the work environment and descriptions of psychotropic medicines use. Thematic analysis was used to derive key concepts. Three salient dimensions of organizational climate were linked to the use of psychotropic medicines in nursing homes: staffing, managerial expectations and teamwork among visiting and on-site staff. Inadequate staffing levels were perceived to influence on-site staff requests for initiation of psychotropic medicines to cope with high workload. Participants reported managers that prioritized the non-pharmacological management of behavioral disturbances led other on-site staff to have a reduced preference for psychotropic medicines. In addition, trust and open communication among on-site and visiting staff facilitated the cessation of psychotropic medicines. This study illustrates that organizational climate is an important factor influencing the use of psychotropic medicines. Furthermore, the study highlights what aspects of organizational climate need to be addressed to reduce the inappropriate prescribing of psychotropic medicines. Copyright © 2016 Elsevier Inc. All rights reserved.

76 FR 79675 - Pomperaug Hydro Project Andrew Peklo III; Notice of Site Visit and Technical Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 12790-001] Pomperaug Hydro Project Andrew Peklo III; Notice of Site Visit and Technical Meeting On January 18, 2012, Office of Energy Projects staff will hold a site visit and technical meeting for the proposed Pomperaug Hydro Project (FERC...

SUMMARY REPORT FOR THE NATIONAL ATMOSPHERIC DEPOSITION PROGRAM/NATIONAL TRENDS NETWORK (NADP/NTN) SITE VISITATION PROGRAM FOR THE PERIOD OCTOBER 1987 THROUGH SEPTEMBER 1988

EPA Science Inventory

The U.S Environmental Protection Agency (EPA) provides technical assistance to the NADP/NTN network through a site visitation program. esearch Triangle Institute, as contractor to EPA, conducts these visits. f deficiencies or nonstandard procedures are noted, the site operator an...

Longitudinal Hypertension Outcomes at Four Student-Run Free Clinic Sites.

PubMed

Smith, Sunny D; Rojas, Steven M; Huang, Junwen; Yang, Kuangyi; Vaida, Florin

2017-01-01

Student-Run Free Clinics (SRFCs) play a significant role in medical education yet there is minimal information about patient outcomes over time in this setting. The purpose of this study was to assess longitudinal outcomes of hypertension management during routine care at four SRFC sites, while comparing control rates with national standards, and examining for characteristics independently associated with uncontrolled hypertension. The authors conducted a retrospective medical record review of visits from January 2004 through April 2016 with an initial visit for hypertension and a follow-up visit 9 to 15 months later. Hypertension control was analyzed using descriptive statistics, paired t tests, logistic regression, and a longitudinal linear mixed-effects model. This study included 496 patients and 4,798 visits. The mean age was 50.9 (SD 10.8) years old, 71.2% (346) were Latinos, 63.3% (314) were Spanish speaking, and 15.5% (72) were homeless. Mean blood pressure was reduced from 141.6 (SD 21.8)/85.1 (SD 13.2) to 132.1 (SD 17.3)/79.4 (SD10.8), a decrease of 9.5 (CI 7.4, 11.5)/5.7 (CI 4.4, 7.0) mmHg. Blood pressure was significantly reduced within the first month of treatment, and this reduction was sustained throughout the follow-up period. Using the National Health and Nutrition Examination Survey (NHANES) definition (<140/<90), blood pressure was controlled in 59.7% (296/496) of patients. No significant differences in control were noted based on gender, ethnicity, language, housing status, or clinic site. SRFCs can provide effective long-term hypertension management and achieve rates of control that exceed national averages despite serving those least likely to be controlled.

Effects of Site Visits on Innovation Adoption.

ERIC Educational Resources Information Center

Fleischer, Mitchell

An attempt to increase adoption of the Community Lodge program through the use of a site visit was investigated. The sample of 24 state mental hospitals agreed to have a workshop about the Lodge. At the conclusion of the workshop, 12 of the hospitals were told they would have the opportunity to send one staff member on an expense-paid site visit,…

Privacy Policy | NOAA Gulf Spill Restoration

Science.gov Websites

personal information about you when you visit our Web site unless you choose to provide that information to us. Here is how we handle information about your visit to our Web site: If you do nothing during your visit but browse through the Web site, read pages, Fishnews articles, or download information, we will

Does Digital Ad Exposure Influence Information-Seeking Behavior Online? Evidence From the 2012 Tips From Former Smokers National Tobacco Prevention Campaign

PubMed Central

Hansen, Heather; Duke, Jennifer; Davis, Kevin; Alexander, Robert; Rowland, Amy; Mitchko, Jane

2016-01-01

Background Measuring the impact of online health campaigns is challenging. Ad click-through rates are traditionally used to measure campaign reach, but few Internet users ever click on ads. Alternatively, self-reported exposure to digital ads would be prone to recall bias. Furthermore, there may be latency effects whereby people do not click on ads when exposed but visit the promoted website or conduct campaign-related searches later. Online panels that unobtrusively collect panelists’ Web behavior data and link ad exposure to website visits and searches can more reliably assess the impact of digital ad exposure. From March to June 2012, the Centers for Disease Control and Prevention aired the national Tips From Former Smokers (Tips 2012) media campaign designed to encourage current smokers to quit. Advertisements ran across media channels, and the digital ads directed users to the Tips 2012 campaign website. Objective Our aim was to examine whether exposure to Tips 2012 digital ads influenced information-seeking behaviors online. Methods ComScore mined its panelists’ Web behavior data for unique codes that would indicate exposure to Tips 2012 ads, regardless of whether panelists clicked the ad or not. A total of 15,319 US adults were identified as having been exposed to a Tips 2012 campaign ad. An equal number of unexposed adults (N=15,319) were identified and matched on demographics and Internet use behavior to the exposed group. Panelists’ Web behavior data were mined for up to 4 weeks after initial Tips 2012 ad exposure to determine whether they visited the Tips 2012 campaign website or other cessation-related websites (eg, nicotine replacement therapy site) or conducted searches for campaign-related topics (eg, quit smoking). Results The proportion of exposed adults visiting the Tips 2012 sites increased from 0.4% in Week 1 to 0.9% 4 weeks after ad exposure, and these rates were significantly higher than in the unexposed group (0.1% in Week 1 to 0.4% in Week 4, P<.001) across all weeks examined. The proportion of exposed panelists visiting other cessation websites increased from 0.2% in Week 1 to 0.3% 4 weeks after initial ad exposure, and these rates were significantly higher than in the unexposed group (0.0% in Week 1 to 0.2% in Week 4, P=.001 to P=.019) across all weeks examined. There were no significant differences in searches for campaign-related topics between the exposed and unexposed group during most of the weeks examined. Conclusions These results suggest that online ad exposure is associated with confirmed visits to the Tips 2012 campaign sites and visits to other cessation websites and that these information-seeking behaviors occur up to several weeks after ad exposure. Web behavior data from online panels are useful for examining exposure and behavioral responses to digital campaign ads. PMID:26983849

Does Digital Ad Exposure Influence Information-Seeking Behavior Online? Evidence From the 2012 Tips From Former Smokers National Tobacco Prevention Campaign.

PubMed

Kim, Annice; Hansen, Heather; Duke, Jennifer; Davis, Kevin; Alexander, Robert; Rowland, Amy; Mitchko, Jane

2016-03-16

Measuring the impact of online health campaigns is challenging. Ad click-through rates are traditionally used to measure campaign reach, but few Internet users ever click on ads. Alternatively, self-reported exposure to digital ads would be prone to recall bias. Furthermore, there may be latency effects whereby people do not click on ads when exposed but visit the promoted website or conduct campaign-related searches later. Online panels that unobtrusively collect panelists' Web behavior data and link ad exposure to website visits and searches can more reliably assess the impact of digital ad exposure. From March to June 2012, the Centers for Disease Control and Prevention aired the national Tips From Former Smokers (Tips 2012) media campaign designed to encourage current smokers to quit. Advertisements ran across media channels, and the digital ads directed users to the Tips 2012 campaign website. Our aim was to examine whether exposure to Tips 2012 digital ads influenced information-seeking behaviors online. ComScore mined its panelists' Web behavior data for unique codes that would indicate exposure to Tips 2012 ads, regardless of whether panelists clicked the ad or not. A total of 15,319 US adults were identified as having been exposed to a Tips 2012 campaign ad. An equal number of unexposed adults (N=15,319) were identified and matched on demographics and Internet use behavior to the exposed group. Panelists' Web behavior data were mined for up to 4 weeks after initial Tips 2012 ad exposure to determine whether they visited the Tips 2012 campaign website or other cessation-related websites (eg, nicotine replacement therapy site) or conducted searches for campaign-related topics (eg, quit smoking). The proportion of exposed adults visiting the Tips 2012 sites increased from 0.4% in Week 1 to 0.9% 4 weeks after ad exposure, and these rates were significantly higher than in the unexposed group (0.1% in Week 1 to 0.4% in Week 4, P<.001) across all weeks examined. The proportion of exposed panelists visiting other cessation websites increased from 0.2% in Week 1 to 0.3% 4 weeks after initial ad exposure, and these rates were significantly higher than in the unexposed group (0.0% in Week 1 to 0.2% in Week 4, P=.001 to P=.019) across all weeks examined. There were no significant differences in searches for campaign-related topics between the exposed and unexposed group during most of the weeks examined. These results suggest that online ad exposure is associated with confirmed visits to the Tips 2012 campaign sites and visits to other cessation websites and that these information-seeking behaviors occur up to several weeks after ad exposure. Web behavior data from online panels are useful for examining exposure and behavioral responses to digital campaign ads.

Instructions for Using Traffic Counters to Estimate Recreation Visits and Use

Treesearch

George A. James; Thomas H. Ripley

1963-01-01

Every manager of a recreation site needs three essential statistics: man-hours of use, number of visits, and peak loads. Man-hours of use are a good gauge of site wear and tear and service reaquirements. Visits reflect the number of impressions gained by people and hence provide an index to public approval or dissatisfaction, depending upon site condition. Peak load...

Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

PubMed

Jankowski, Irene M; Nadzam, Deborah Morris

2011-06-01

Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

Timing of initial arrival at the breeding site predicts age at first reproduction in a long-lived migratory bird

PubMed Central

Becker, Peter H.; Dittmann, Tobias; Ludwigs, Jan-Dieter; Limmer, Bente; Ludwig, Sonja C.; Bauch, Christina; Braasch, Alexander; Wendeln, Helmut

2008-01-01

In long-lived vertebrates, individuals generally visit potential breeding areas or populations during one or more seasons before reproducing for the first time. During these years of prospecting, they select a future breeding site, colony, or mate and improve various skills and their physical condition to meet the requirements of reproduction. One precondition of successful reproduction is arrival in time on the breeding grounds. Here, we study the intricate links among the date of initial spring arrival, body mass, sex, and the age of first breeding in the common tern Sterna hirundo, a long-lived migratory colonial seabird. The study is based on a unique, individual-based, long-term dataset of sexed birds, marked with transponders, which allow recording their individual arrival, overall attendance, and clutch initiation remotely and automatically year by year over the entire lifetime at the natal colony site. We show that the seasonal date of initial arrival at the breeding grounds predicts the individual age at first reproduction, which mostly occurs years later. Late first-time arrivals remain delayed birds throughout subsequent years. Our findings reveal that timing of arrival at the site of reproduction and timing of reproduction itself are coherent parameters of individual quality, which are linked with the prospects of the breeding career and may have consequences for fitness. PMID:18711134

Asymptotic shape of the region visited by an Eulerian walker.

PubMed

Kapri, Rajeev; Dhar, Deepak

2009-11-01

We study an Eulerian walker on a square lattice, starting from an initial randomly oriented background using Monte Carlo simulations. We present evidence that, for a large number of steps N , the asymptotic shape of the set of sites visited by the walker is a perfect circle. The radius of the circle increases as N1/3, for large N , and the width of the boundary region grows as Nalpha/3, with alpha=0.40+/-0.06 . If we introduce stochasticity in the evolution rules, the mean-square displacement of the walker, approximately approximately N2nu, shows a crossover from the Eulerian (nu=1/3) to a simple random-walk (nu=1/2) behavior.

Preliminary Evaluation of Removing Used Nuclear Fuel from Shutdown Sites

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maheras, Steven J.; Best, Ralph E.; Ross, Steven B.

A preliminary evaluation of removing spent nuclear fuel (SNF) from 13 shutdown nuclear power plant sites was performed. At these shutdown sites the nuclear power reactors have been permanently shut down and the sites have been decommissioned or are undergoing decommissioning. The shutdown sites were Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, Zion, Crystal River, Kewaunee, San Onofre, and Vermont Yankee. The evaluation was divided into four components: Characterization of the SNF and greater-than-Class C low-level radioactive waste (GTCC waste) inventory A description of the on-site infrastructure at the shutdown sitesmore » An evaluation of the near-site transportation infrastructure and transportation experience at the shutdown sites An evaluation of the actions necessary to prepare for and remove SNF and GTCC waste. The primary sources for the inventory of SNF and GTCC waste were the U.S. Department of Energy (DOE) spent nuclear fuel inventory database, industry publications such as StoreFUEL, and government sources such as the U.S. Nuclear Regulatory Commission. The primary sources for information on the conditions of on-site infrastructure and near-site transportation infrastructure and experience included information collected during site visits, information provided by managers at the shutdown sites, Facility Interface Data Sheets compiled for DOE in 2005, Services Planning Documents prepared for DOE in 1993 and 1994, industry publications such as Radwaste Solutions, and Google Earth. State staff, State Regional Group representatives, a Tribal representative, and a Federal Railroad Administration representative have participated in nine of the shutdown site visits. Every shutdown site was found to have at least one off-site transportation mode option for removing its SNF and GTCC waste; some have multiple options. Experience removing large components during reactor decommissioning provided an important source of information used to identify the transportation mode options for the sites. Especially important in conducting the evaluation were site visits, through which information was obtained that would not have been available otherwise. Extensive photographs taken during the site visits proved to be particularly useful in documenting the current conditions at or near the sites. Additional conclusions from this evaluation include: The 13 shutdown sites use designs from 4 different suppliers involving 11 different (horizontal and vertical) dry storage systems that would require the use of 9 different transportation cask designs to remove the SNF and GTCC waste from the shutdown sites. Although some changes to transportation certificates of compliance will be required, the SNF at the initial 9 shutdown sites (Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, and Zion) is in dual purpose dry storage canisters that can be transported, including a small amount of high-burnup fuel. Most sites indicated that 2-3 years of advance time would be required for its preparations before shipments could begin. Some sites could be ready in less time. As additional sites such as Fort Calhoun, Clinton, Quad Cities, Pilgrim, Oyster Creek, and Diablo Canyon shut down, these sites will be included in updates to the evaluation.« less

Viewership of pro-anorexia websites in seventh, ninth and eleventh graders.

PubMed

Custers, Kathleen; Van den Bulck, Jan

2009-05-01

To examine the prevalence of visiting pro-anorexia websites by 13-, 15- and 17-year old adolescents and to explore correlates of visiting such websites and predictors of anorexia nervosa (AN). Questionnaire in a sample of 711 secondary school children from the 7th, 9th and 11th grade in Flanders, Belgium. 12.6% of the girls and 5.9% of the boys had visited such websites. In girls, visiting pro-anorexia websites was associated with a higher drive for thinness, worse perception of appearance and more perfectionism. The prevalence of visiting pro-anorexia sites is non-trivial and the significant correlations between viewership of pro-ana sites and predictors of AN suggest a potential for negative impact of exposure to pro-ana sites. We conclude with some speculative remarks on the potential threat of the existence of pro-ana sites to organized health care.

FIELD STUDIES OF GEOMEMBRANE INSTALLATION TECHNIQUES

EPA Science Inventory

Fourteen construction sites where geomembranes were being installed were visited to observe subgrade preparation and liner installation techniques. These sites were visited during a study conducted for the U.S. EPA, Solid and Hazardous Waste Research Division. The sites included ...

Effect of Promotional Initiatives on Visits to a Dedicated Website for Physical Activity and Non-Communicable Disease in Luxembourg: An Event Study

PubMed Central

Lion, Alexis; Thornton, Jane S.; Vaillant, Michel; Pertuy, Juliette; Besenius, Eric; Hardy, Cyrille; Delagardelle, Charles; Seil, Romain; Urhausen, Axel; Theisen, Daniel

2017-01-01

The Sport-Santé project and its website (www.sport-sante.lu) promote physical activity for individuals with non-communicable diseases (NCDs) in Luxembourg. Our purpose was to perform an event study analysis to evaluate the effects of communication and promotional initiatives on the number of visits to the Sport-Santé website. Between September 2015 and May 2016, the Sport-Santé website was promoted during different initiatives, including participation in health-related events or publication of articles in local journals. The daily number of visits to www.sport-sante.lu website (i.e., our outcome) was recorded using Google Analytics and compared to a counterfactual collected with its benchmarking tool. The counterfactual was defined as the daily number of visits to websites in the same field. A model was created to evaluate the relationship between the number of visits to www.sport-sante.lu website and the number of visits to similar websites during a control period with no promotional initiatives (from July 2015 to September 2015). The effect of promotional initiatives was subsequently tested, by comparing the actual number of visits to our website (up to 2 days after each event) with the theoretical number of visits predicted by the model. Twenty-two initiatives were identified, of which 11 were participations at major health-related events and 11 publications of popular science articles. Of these 22 initiatives, the event study identified 2 popular science articles and 1 interactive workshop that significantly increased the daily number of visits to the www.sport-sante.lu website. One of the two articles was published on the day before the workshop was held, which did not allow us to distinguish its specific impact. The second article was published in the main national newspaper. This is the first time to our knowledge that an event study analysis has been used to evaluate the impact of promotional initiatives on the number of visits to a dedicated website for physical activity and NCDs. Our results indicate that some initiatives can aid in the number of visits, but in general their impact is limited. To observe an increased rate of participation in physical activity, additional promotional and evaluative strategies should be explored. PMID:28611975

Solid Earth and Natural Hazards (SENH) Research and Applications Program and Internation

NASA Technical Reports Server (NTRS)

2001-01-01

This is a final report for grant NAG5-8627 entitled 'Joint UNAVCO and JPL proposal to NASA for support of the Solid Earth and Natural Hazards Research and Applications Program and Internation'. This report consists of the following sections: (1) new installations (with site visits); (2) upgrades (with site visits; (3) upcoming upgrades (with site visits); and (4) data management and archive efforts during the performance period.

Surfing for thinness: a pilot study of pro-eating disorder Web site usage in adolescents with eating disorders.

PubMed

Wilson, Jenny L; Peebles, Rebecka; Hardy, Kristina K; Litt, Iris F

2006-12-01

Pro-eating disorder Web sites are communities of individuals who engage in disordered eating and use the Internet to discuss their activities. Pro-recovery sites, which are less numerous, express a recovery-oriented perspective. This pilot study investigated the awareness and usage of pro-eating disorder Web sites among adolescents with eating disorders and their parents and explored associations with health and quality of life. This was a cross-sectional study of 698 families of patients (aged 10-22 years) diagnosed with an eating disorder at Stanford between 1997 and 2004. Anonymous surveys were mailed and offered in clinic. Survey content included questions about disease severity, health outcomes, Web site usage, and parental knowledge of eating disorder Web site usage. Surveys were returned by 182 individuals: 76 patients and 106 parents. Parents frequently (52.8%) were aware of pro-eating disorder sites, but an equal number did not know whether their child visited these sites, and only 27.6% had discussed them with their child. Most (62.5%) parents, however, did not know about pro-recovery sites. Forty-one percent of patients visited pro-recovery sites, 35.5% visited pro-eating disorder sites, 25.0% visited both, and 48.7% visited neither. While visiting pro-eating disorder sites, 96.0% reported learning new weight loss or purging techniques. However, 46.4% of pro-recovery site visitors also learned new techniques. Pro-eating disorder site users did not differ from nonusers in health outcomes but reported spending less time on school or schoolwork and had a longer duration of illness. Users of both pro-eating disorder and pro-recovery sites were hospitalized more than users of neither site. Pro-eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this. Although use of these sites was not associated with other health outcomes, usage may have a negative impact on quality of life and result in adolescents' learning about and adopting disordered eating behaviors.

Optimizing Visits to the Site of Death for Bereaved Families After Disasters and Terrorist Events.

PubMed

Kristensen, Pål; Dyregrov, Atle; Weisæth, Lars; Straume, Marianne; Dyregrov, Kari; Heir, Trond; Bugge, Renate Grønvold

2017-09-13

In recent years it has been common after disasters and terrorist events to offer bereaved families the opportunity to visit the place where their loved ones died. Many report that such visits are beneficial in processing their loss. Various factors, both cognitive (eg, counteracting disbelief) and existential or emotional (eg, achieving a sense of closeness to the deceased), are associated with the experienced benefit. Nonetheless, exacerbations of trauma and grief reactions (eg, re-enactment fantasies) are common, with some of the bereaved also reporting adverse reactions after the visit. Subsequently, proper preparations are a prerequisite before such visits take place. This article describes how to optimize collective visits to the site of death after disasters or terrorist events for bereaved families. Important questions-for example, concerning those who should be responsible for organizing a visit and those who should be invited, the timing of the visit, what can be done at the site, the need for support personnel, and other practical issues-are discussed and general guidelines are recommended. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

QL-10NEURO-ONCOLOGY TELEMEDICINE FOLLOW-UP VISITS

PubMed Central

Green, Richard; Woyshner, Emily

2014-01-01

We report our 18 month experience with the use of a videoconferencing system to perform neuro-oncology follow-up visits. The Neuro-oncology Program at the Kaiser Permanente-Los Angeles Medical center serves the majority of Kaiser HMO patients in the Southern California region. We installed a videoconferencing system (Cisco TelePresence EX90, Cisco Systems, San Jose, CA) in our office in Los Angeles and in a medical office building in Anaheim, CA at a distance of 35 miles. Established neuro-oncology patients from Orange County chose between in-person and remote visits. Patients were seated in an examination room and the neuro-oncology provider alerted by text page. A focused history and physical examination was performed, followed by desktop sharing of clinical and laboratory data using an electronic medical record (Epic Systems Corporation, Verona, WI) and of neuroimages (Phillips iSite PACS, Andover, MA). Patients were asked, but not required, to complete an anonymous online 16 question satisfaction survey after each visit. Visits were performed by either a neuro-oncologist (179) or a Physician's Assistant (12). Of the 191 visits, 174 included evaluation of neuroimaging and 77 included evaluation of response to ongoing chemotherapy. During 12 visits chemotherapy was initiated, and during 15 visits the chemotherapy regimen was changed based on imaging findings. One-hundred and eleven surveys (58% of visits) were completed. Patients reported a high level of satisfaction with the visits (average 9.6, on a 1-10 scale). The average estimated travel time saved was 118 minutes per visit. Four surveys reported technical problems and 1 indicated a preference for an in-person visit. No adverse events could be attributed to use of the telemedicine system. These data suggest that neuro-oncology follow-up visits can be practiced safely and effectively using a telemedicine system, with high levels of patient satisfaction.

Expert panel reviews of research centers: the site visit process.

PubMed

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-08-01

Site visits are used extensively in a variety of settings within the evaluation community. They are especially common in making summative value decisions about the quality and worth of research programs/centers. However, there has been little empirical research and guidance about how to appropriately conduct evaluative site visits of research centers. We review the processes of two site visit examples using an expert panel review: (1) a process to evaluate four university research centers and (2) a process to review a federally sponsored research center. A set of 14 categories describing the expert panel review process was obtained through content analysis and participant observation. Most categories were addressed differently through the two processes highlighting the need for more research about the most effective processes to use within different contexts. Decisions about how to structure site visits appear to depend on the research context, practical considerations, the level at which the review is being conducted and the intended impact of the report. Future research pertaining to the selection of site visitors, the autonomy of the visitors in data collection and report writing, and the amount and type of information provided would be particularly valuable. Copyright © 2012 Elsevier Ltd. All rights reserved.

Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World.

PubMed

Alfonso, César A; Michael, Marco Christian; Elvira, Sylvia Detri; Zakaria, Hazli; Kalayasiri, Rasmon; Adlan, Aida Syarinaz A; Moinalghorabaei, Mahdieh; Lukman, Petrin Redayani; San'ati, Mohammad; Duchonova, Katerina; Sullivan, Timothy B

2018-06-01

Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere. Copyright © 2018 Elsevier Inc. All rights reserved.

Long-term follow-up of HIV seroconverters in microbicide trials - rationale, study design, and challenges in MTN-015.

PubMed

Riddler, Sharon A; Husnik, Marla; Gorbach, Pamina M; Levy, Lisa; Parikh, Urvi; Livant, Edward; Pather, Arendevi; Makanani, Bonus; Muhlanga, Felix; Kasaro, Margaret; Martinson, Francis; Elharrar, Vanessa; Balkus, Jennifer E

2016-09-01

As the effect of biomedical prevention interventions on the natural history of HIV-1 infection in participants who seroconvert is unknown, the Microbicide Trials Network (MTN) established a longitudinal study (MTN-015) to monitor virologic, immunological, and clinical outcomes, as well as behavioral changes among women who become HIV-infected during MTN trials. We describe the rationale, study design, implementation, and enrollment of the initial group of participants in the MTN seroconverter cohort. Initiated in 2008, MTN-015 is an ongoing observational cohort study enrolling participants who acquire HIV-1 infection during effectiveness studies of candidate microbicides. Eligible participants from recently completed and ongoing MTN trials are enrolled after seroconversion and return for regular follow-up visits with clinical and behavioral data collection. Biologic samples including blood and genital fluids are stored for future testing. MTN-015 was implemented initially at six African sites and enrolled 100/139 (72%) of eligible women who seroconverted in HIV Prevention Trials Network protocol 035 (HPTN 035, conducted by the MTN). The median time from seroconversion in HPTN 035 to enrollment in MTN-015 was 18 months. Retention was good with >70% of visits completed. Implementation challenges included regulatory reviews, translation, and testing of questionnaires, and site readiness. Enrollment of HIV-seroconverters into a longitudinal observational follow-up study is feasible and acceptable to participants. Data and samples collected in this protocol will be used to assess safety of investigational HIV microbicides and answer other important public health questions for HIV infected women.

Health care utilization of refugee children after resettlement.

PubMed

Watts, Delma-Jean; Friedman, Jennifer F; Vivier, Patrick M; Tompkins, Christine E A; Alario, Anthony J

2012-08-01

Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.

Strategies to improve chronic disease management in seven metro Boston community health centers.

PubMed

Ndumele, Chima D; Russell, Beverley E; Ayanian, John Z; Landon, Bruce E; Keegan, Thomas; O'Malley, A James; Hicks, Leroi S

2009-01-01

The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.

A regional survey of malformed frogs in Minnesota (USA) (Minnesota malformed frogs).

PubMed

Vandenlangenberg, Susan M; Canfield, Jeffrey T; Magner, Joseph A

2003-02-01

In late 1995, school children discovered malformed frogs in a south central Minnesota pond. Press coverage resulted in numerous citizen reports of frog malformation across Minnesota in 1996. After some initial site investigation, 3 affected frog sites and 4 nearby reference sites were selected for more detailed evaluation. Field biologists made 89 visits to study sites beginning spring 1997 through fall 1999 to examine the number and type of frog malformations. Over 5,100 Leopard frogs (Rana pipiens) were captured and examined at all study sites. Water elevations and associated littoral inundation were recorded from 1997-2000. Results indicate that malformation occurred at all study sites above historical background levels. Rana pipiens malformation across all sites over three seasons averaged 7.9% and ranged from 0 to 7% at reference sites and 4 to 23% at affected sites. At one northern Minnesota site, mink frog (Rana septentrionalis) malformation was 75% in 1998. A site characteristic common to the most affected sites was an elastic zone of littoral inundation. Climate driven hydrologic variation likely influenced water depth and associated breeding locations.

7 CFR 3015.94 - Site visits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Site visits. 3015.94 Section 3015.94 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Monitoring and Reporting Program Performance § 3015.94 Site...

Father Attendance in Nurse Home Visitation

PubMed Central

Holmberg, John R.; Olds, David L.

2015-01-01

Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707

42 CFR 409.46 - Allowable administrative costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... billable include, but are not limited to, the following: (a) Registered nurse initial evaluation visits. Initial evaluation visits by a registered nurse for the purpose of assessing a beneficiary's health needs... be an administrative cost. (b) Visits by registered nurses or qualified professionals for the...

Integrating Telemedicine in Urban Pediatric Primary Care: Provider Perspectives and Performance

PubMed Central

Wood, Nancy; Herendeen, Neil; ten Hoopen, Cynthia; Denk, Larry; Neuderfer, Judith

2010-01-01

Abstract Background: Health-e-Access, an urban telemedicine service, enabled 6,511 acute-illness telemedicine visits over a 7-year period for children at 22 childcare and school sites in Rochester, NY. Objectives: The aims of this article were to (1) describe provider attitudes and perceptions about efficiency and effectiveness of Health-e-Access and (2) assess hypotheses that (a) providers will complete a large proportion of the telemedicine visits attempted and (b) high levels of continuity with the primary care practice will be achieved. Design/Methods: This descriptive study focused on the 24-month Primary Care Phase in the development of Health-e-Access, initiated by the participation of 10 primary care practices. Provider surveys addressed efficiency, effectiveness, and overall acceptability. Performance measures included completion of telemedicine visits and continuity of care with the medical home. Results: Among survey respondents, the 30 providers who had completed telemedicine visits perceived that decision-making required slightly less time and total time required was slightly greater than for in-person visits. Confidence in diagnosis was somewhat less for telemedicine visits. Providers were comfortable collaborating with telemedicine assistants and confident that communications met parent needs. Among the 2,554 consecutive telemedicine visits attempted during the Primary Care Phase, 2,475 (96.9%) were completed by 47 providers. For visits by children with a participating primary care practice, continuity averaged 83.2% among practices (range, 28.1–92.9%). Conclusions: Providers perceived little or no advantage in efficiency or effectiveness to their practice in using telemedicine to deliver care; yet they used it effectively in serving families, completing almost all telemedicine visits requested, providing high levels of continuity with the medical home, and believing they communicated adequately with parents. PMID:20406114

The CACREP Site Visit Process

ERIC Educational Resources Information Center

Lee, Courtland C.

2013-01-01

An important step in the CACREP review process is the campus site visit. The visit involves a team, usually from comparable institutions, coming to a campus for a review of the counselor training program(s). The role of the team is to be the CACREP Board's representative on campus to verify the self-study. In this article, the author reviews…

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

MULTIPLE NONSPECIFIC SITES OF JOINT PAIN OUTSIDE THE KNEES DEVELOP IN PERSONS WITH KNEE PAIN

PubMed Central

Felson, David T.; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara; Lewis, Cora E.; Law, Laura Frey; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

2017-01-01

Objective Many persons with knee pain have joint pain outside the knee but despite the impact and high frequency of this pain, its distribution and causes have not been studied. Those studying gait abnormalities have suggested that knee pain causes pain in adjacent joints but pain adaptation strategies are highly individualized. Methods We studied persons age 50-79 years with or at high risk of knee osteoarthritis drawn from two community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and followed for 5-7 years. We excluded those with knee pain at baseline and compared those who developed and did not develop knee pain at the first follow-up examination (the index visit). We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint specific pain adjusted for age, sex, BMI, depression with sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, there were 693 persons with index visit knee pain vs. 2793 without it. 79.6% of those with bilateral and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee vs. 49.9% of those without knee pain. An increased risk of pain was present in most extremity joint sites without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusions Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. PMID:27589036

77 FR 28351 - Agency Information Collection Activities: Proposed Collection; Comment Request-Study of the Food...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... State-administered FDPIR programs, participating households will be selected for data collection. Data... operations and experiences of FDPIR participants and eligible nonparticipants. Site visit data collection... providers; visits to FDPIR enrollment sites, warehouses, and distribution sites; and discussion groups with...

School site visits for community-based participatory research on healthy eating.

PubMed

Patel, Anisha I; Bogart, Laura M; Uyeda, Kimberly E; Martinez, Homero; Knizewski, Ritamarie; Ryan, Gery W; Schuster, Mark A

2009-12-01

School nutrition policies are gaining support as a means of addressing childhood obesity. Community-based participatory research (CBPR) offers an approach for academic and community partners to collaborate to translate obesity-related school policies into practice. Site visits, in which trained observers visit settings to collect multilevel data (e.g., observation, qualitative interviews), may complement other methods that inform health promotion efforts. This paper demonstrates the utility of site visits in the development of an intervention to implement obesity-related policies in Los Angeles Unified School District (LAUSD) middle schools. In 2006, trained observers visited four LAUSD middle schools. Observers mapped cafeteria layout; observed food/beverage offerings, student consumption, waste patterns, and duration of cafeteria lines; spoke with school staff and students; and collected relevant documents. Data were examined for common themes and patterns. Food and beverages sold in study schools met LAUSD nutritional guidelines, and nearly all observed students had time to eat most or all of their meal. Some LAUSD policies were not implemented, including posting nutritional information for cafeteria food, marketing school meals to improve student participation in the National School Lunch Program, and serving a variety of fruits and vegetables. Cafeteria understaffing and costs were obstacles to policy implementation. Site visits were a valuable methodology for evaluating the implementation of school district obesity-related policies and contributed to the development of a CBPR intervention to translate school food policies into practice. Future CBPR studies may consider site visits in their toolbox of formative research methods.

Rescreening for abnormal vaginal flora in pregnancy and re-treating with clindamycin vaginal cream significantly increases cure and improvement rates.

PubMed

Lamont, R F; Taylor-Robinson, D; Bassett, P

2012-08-01

We investigated 199 pregnant women with bacterial vaginosis (BV) who received clindamycin vaginal cream (CVC) for three days and compared with 205 women treated with placebo. The vaginal flora was assessed at each visit. At the second visit, 71% in the CVC group were cured/improved, compared with 12% in the placebo group (P < 0.001). At visit 3 about 90% who responded to initial CVC treatment were still cured/improved. Of women who initially failed to respond to CVC and were given an additional seven-day course, 33% were cured/improved by the third visit, compared with 15% who failed to respond to placebo initially and were given a further seven-day course (P = 0.02). By visit 4, half the women in the CVC group who received additional treatment remained cured/improved, compared with 26% who had additional placebo (P = 0.004). In the CVC group, a change from abnormal to normal rose from 71% (visit 2) to 76% (visit 3) and 79% (visit 4). A similar trend was seen in women who received placebo but the proportions were significantly lower (12%, 24% and 33%, respectively). There is value in rescreening and re-treating women who remain BV-positive after initial clindamycin treatment.

Timing and adequate attendance of antenatal care visits among women in Ethiopia.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael; Shah, Vaibhav; Kadio, Bernard; Udenigwe, Ogochukwu

2017-01-01

Although ANC services are increasingly available to women in low and middle-income countries, their inadequate use persists. This suggests a misalignment between aims of the services and maternal beliefs and circumstances. Owing to the dearth of studies examining the timing and adequacy of content of care, this current study aims to investigate the timing and frequency of ANC visits in Ethiopia. Data was obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design to provide estimates for the health and demographic variables of interest for the country. Our study focused on a sample of 10,896 women with history of at least one childbirth event. Percentages of timing and adequacy of ANC visits were conducted across the levels of selected factors. Variables which were associated at 5% significance level were examined in the multivariable logistic regression model for association between timing and frequency of ANC visits and the explanatory variables while controlling for covariates. Furthermore, we presented the approach to estimate marginal effects involving covariate-adjusted logistic regression with corresponding 95%CI of delayed initiation of ANC visits and inadequate ANC attendance. The method used involved predicted probabilities added up to a weighted average showing the covariate distribution in the population. Results indicate that 66.3% of women did not use ANC at first trimester and 22.3% had ANC less than 4 visits. The results of this study were unique in that the association between delayed ANC visits and adequacy of ANC visits were examined using multivariable logistic model and the marginal effects using predicted probabilities. Results revealed that older age interval has higher odds of inadequate ANC visits. More so, type of place of residence was associated with delayed initiation of ANC visits, with rural women having the higher odds of delayed initiation of ANC visits (OR = 1.65; 95%CI: 1.26-2.18). However, rural women had 44% reduction in the odds of having inadequate ANC visits. In addition, multi-parity showed higher odds of delayed initiation of ANC visit when compared to the primigravida (OR = 2.20; 95%CI: 1.07-2.69). On the contrary, there was 36% reduction in the odds of multigravida having inadequate ANC visits when compared to the women who were primigravida. There were higher odds of inadequacy in ANC visits among women who engaged in sales/business, agriculture, skilled manual and other jobs when compared to women who currently do not work, after adjusting for covariates. From the predictive margins, assuming the distribution of all covariates remained the same among respondents, but everyone was aged 15-19 years, we would expect 71.8% delayed initiation of ANC visit. If everyone was aged 20-24years, 73.4%; 25-29years, 66.5%; 30-34years, 64.8%; 35-39years, 65.6%; 40-44years, 59.6% and 45-49years, we would expect 70.1% delayed initiation of ANC visit. If instead the distribution of age was as observed and for other covariates remained the same among respondents, but no respondent lived in the rural, we would expect about 61.4% delayed initiation of ANC visit; if however, everyone lived in the rural, and we would expect 71.6% delayed initiation in ANC visit. Model III revealed the predictive margins of all factors examined for delayed initiation for ANC visits, while Model IV presented the predictive marginal effects of the determinants of adequacy of ANC visits. The precise mechanism by which these factors affect ANC visits remain blurred at best. There may be factors on the demand side like the women's empowerment, financial support of the husband, knowledge of ANC visits in the context of timing, frequency and the expectations of ANC visits might be mediating the effects through the factors found associated in this study. Supply side factors like the quality of ANC services, skilled staff, and geographic location of the health centers also mediate their effects through the highlighted factors. Irrespective of the knowledge about the precise mechanism of action, policy makers could focus on improving women's empowerment, improving women's education, reducing wealth inequity and facilitating improved utilization of ANC through modifications on the supply side factors such as geographic location and focus on hard to reach women.

A Pilot Sampling Design for Estimating Outdoor Recreation Site Visits on the National Forests

Treesearch

Stanley J. Zarnoch; S.M. Kocis; H. Ken Cordell; D.B.K. English

2002-01-01

A pilot sampling design is described for estimating site visits to National Forest System lands. The three-stage sampling design consisted of national forest ranger districts, site days within ranger districts, and last-exiting recreation visitors within site days. Stratification was used at both the primary and secondary stages. Ranger districts were stratified based...

76 FR 51022 - Juneau Hydropower, Inc.; Notice of Scoping Meeting and Site Visit and Soliciting Scoping Comments...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... Creek; (7) a new approximately 0.6-mile long road from the powerhouse to the dock/ landing site; (8) a new dock/landing site for boat, seaplane, and/or helicopter access, located on the east shore of... Hydropower, Inc.; Notice of Scoping Meeting and Site Visit and Soliciting Scoping Comments for an Applicant...

Visiting the Site of Death: Experiences of the Bereaved after the 2004 Southeast Asian Tsunami

ERIC Educational Resources Information Center

Kristensen, Pal; Tonnessen, Arnfinn; Weisaeth, Lars; Heir, Trond

2012-01-01

The authors examined how many bereaved relatives of Norwegian tourists who perished in the 2004 Southeast Asian Tsunami had visited the site of death and the most important outcome from the visit. We conducted in-depth interviews (n = 110) and used self-report questionnaires (Impact of Event Scale--Revised, Inventory of Complicated Grief, and…

Site Visits in Interfaith and Religious Studies Pedagogy: Reflections on Visiting a Hindu Temple in Central Pennsylvania

ERIC Educational Resources Information Center

Long, Jeffery D.

2018-01-01

Site visits provide an irreplaceable learning experience to students in both religious studies and the emerging field of interfaith studies. The conceptual core of this thesis is the claim, drawn from feminist epistemology, that an embodied pedagogy--a pedagogy which engages students not only intellectually, but as embodied beings who inhabit a…

On-site programmatic attendance to cardiac rehabilitation and the healthy-adherer effect.

PubMed

Alter, David A; Zagorski, Brandon; Marzolini, Susan; Forhan, Mary; Oh, Paul I

2015-10-01

On-site attendance to prescheduled cardiac rehabilitation visits has been shown to be associated with improved outcomes following cardiac rehabilitation. The extent to which on-site programmatic attendance represents a healthy-adherer effect remains unknown. This retrospective cohort study consisted of 17,000 consecutively referred patients to a cardiac rehabilitation program in Ontario, Canada. On-site attendance at prescheduled visits was our primary exposure variable. The primary outcome was all-cause death or hospitalization at two years following the expected program completion date, irrespective of drop-out. Secondary outcomes included adherence to statins, health-seeking preventative health visits, and changes in clinical risk-profiles. Cox proportional hazards adjusted for baseline sociodemographic, clinical and comorbid characteristics. Among the 12,440 patients who attended at least one prescheduled on-site visit, on-site attendance was inversely correlated with baseline smoking rates and body mass index at program entry. After adjustment for baseline factors, the risk of death or hospitalization progressively fell with incremental increases in on-site attendance (adjusted hazard ratio for each 10% increase in on-site attendance: 0.96; 95% confidence interval: 0.93-0.99, p = 0.007). Such associations were driven predominantly by differences in non-cardiovascular hospitalizations. Incremental increases in on-site attendance were associated with improvements in cardiopulmonary fitness and body mass index (both p < 0.001), better attendance of preventative care physician visits (p < 0.001) and higher medication adherence to statins (p = 0.007). Associations between on-site attendance at cardiac rehabilitation and outcomes may represent a healthy-adherer effect. Future research must evaluate the clinical utility of on-site attendance as a behavioral health-adherence metric for cardiac rehabilitation monitoring and surveillance. © The European Society of Cardiology 2014.

Knowledge-based systems in Japan

NASA Technical Reports Server (NTRS)

Feigenbaum, Edward; Engelmore, Robert S.; Friedland, Peter E.; Johnson, Bruce B.; Nii, H. Penny; Schorr, Herbert; Shrobe, Howard

1994-01-01

This report summarizes a study of the state-of-the-art in knowledge-based systems technology in Japan, organized by the Japanese Technology Evaluation Center (JTEC) under the sponsorship of the National Science Foundation and the Advanced Research Projects Agency. The panel visited 19 Japanese sites in March 1992. Based on these site visits plus other interactions with Japanese organizations, both before and after the site visits, the panel prepared a draft final report. JTEC sent the draft to the host organizations for their review. The final report was published in May 1993.

Hosting Teacher Development at Historical Sites: The Benefits for Classroom Teaching

ERIC Educational Resources Information Center

Burns, Adam

2017-01-01

Many previous contributors to "Teaching History" have demonstrated the power of site visits to stimulate young people's engagement and enrich their understanding of history. It is usually assumed, however, that the young people themselves will have the opportunity to visit the site in question--an assumption that cannot always be…

Ethnographic Observational Study of the Biologic Initiation Conversation Between Rheumatologists and Biologic-Naive Rheumatoid Arthritis Patients.

PubMed

Kottak, Nicholas; Tesser, John; Leibowitz, Evan; Rosenberg, Melissa; Parenti, Dennis; DeHoratius, Raphael

2018-01-30

This ethnographic market research study investigated the biologic initiation conversation between rheumatologists and biologic-naive patients with rheumatoid arthritis to assess how therapy options, particularly mode of administration, were discussed. Consenting rheumatologists (n = 16) and patients (n = 48) were videotaped during medical visits and interviewed by a trained ethnographer. The content, structure, and timing of conversations regarding biologic initiation were analyzed. The mean duration of physician-patient visits was approximately 15 minutes; biologic therapies were discussed for a mean of 5.6 minutes. Subcutaneous (SC) and intravenous (IV) therapy options were mentioned in 45 and 35 visits, respectively, out of a total of 48 visits. All patients had some familiarity with SC administration, but nearly half of patients (22 of 48) were unfamiliar with IV therapy going into the visit. IV administration was not defined or described by rheumatologists in 77% of visits (27 of 35) mentioning IV therapy. Thus, 19 of 22 patients who were initially unfamiliar with IV therapy remained unfamiliar after the visit. Disparities in physician-patient perceptions were revealed, as all rheumatologists (16 of 16) believed IV therapy would be less convenient than SC therapy for patients, while 46% of patients (22 of 48) felt this way. In post-visit interviews, some patients seemed confused and overwhelmed, particularly when presented with many treatment choices in a visit. Some patients stated they would benefit from visual aids or summary sheets of key points. This study revealed significant educational opportunities to improve the biologic initiation conversation and indicated a disparity between patients' and rheumatologists' perception of IV therapy. © 2018 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

PubMed Central

Zhang, Shun; Holloway, Kelvin; Tyler-Hill, Yasmin

2015-01-01

Abstract Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICS-Rx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits. Population Health Management 2015;18:54–60. PMID:25046059

Does the invasive Lupinus polyphyllus increase pollinator visitation to a native herb through effects on pollinator population sizes?

PubMed

Jakobsson, Anna; Padrón, Benigno

2014-01-01

Invasive plants may compete with native species for abiotic factors as light, space and nutrients, and have also been shown to affect native pollination interactions. Studies have mainly focused on how invasive plants affect pollinator behaviour, i.e. attraction of pollinators to or away from native flowers. However, when an invasive plant provides resources utilized by native pollinators this could increase pollinator population sizes and thereby pollination success in natives. Effects mediated through changes in pollinator population sizes have been largely ignored in previous studies, and the dominance of negative interactions suggested by meta-analyses may therefore be biased. We investigated the impact of the invasive Lupinus polyphyllus on pollination in the native Lotus corniculatus using a study design comparing invaded and uninvaded sites before and after the flowering period of the invasive. We monitored wild bee abundance in transects, and visit rate and seed production of potted Lotus plants. Bumblebee abundance increased 3.9 times in invaded sites during the study period, whereas it was unaltered in uninvaded sites. Total visit rate per Lotus plant increased 2.1 times in invaded sites and decreased 4.4 times in uninvaded sites. No corresponding change in seed production of Lotus was found. The increase in visit rate to Lotus was driven by an increase in solitary bee visitation, whereas mainly bumblebees were observed to visit the invasive Lupinus. The mechanism by which the invasive increases pollinator visit rates to Lotus could be increased availability of other flower resources for solitary bees when bumblebees forage on Lupinus.

School Site Visits for Community-Based Participatory Research on Healthy Eating

PubMed Central

Patel, Anisha I.; Bogart, Laura M.; Uyeda, Kimberly E.; Martinez, Homero; Knizewski, Ritamarie; Ryan, Gery W.; Schuster, Mark A.

2010-01-01

Background School nutrition policies are gaining support as a means of addressing childhood obesity. Community-based participatory research (CBPR) offers an approach for academic and community partners to collaborate to translate obesity-related school policies into practice. Site visits, in which trained observers visit settings to collect multilevel data (e.g., observation, qualitative interviews), may complement other methods that inform health promotion efforts. This paper demonstrates the utility of site visits in the development of an intervention to implement obesity-related policies in Los Angeles Unified School District (LAUSD) middle schools. Methods In 2006, trained observers visited four LAUSD middle schools. Observers mapped cafeteria layout; observed food/beverage offerings, student consumption, waste patterns, and duration of cafeteria lines; spoke with school staff and students; and collected relevant documents. Data were examined for common themes and patterns. Results Food and beverages sold in study schools met LAUSD nutritional guidelines, and nearly all observed students had time to eat most or all of their meal. Some LAUSD policies were not implemented, including posting nutritional information for cafeteria food, marketing school meals to improve student participation in the National School Lunch Program, and serving a variety of fruits and vegetables. Cafeteria understaffing and cost were obstacles to policy implementation. Conclusions Site visits were a valuable methodology for evaluating the implementation of school district obesity-related policies and contributed to the development of a CBPR intervention to translate school food policies into practice. Future CBPR studies may consider site visits in their toolbox of formative research methods. PMID:19896033

ACOG Committee Opinion no. 598: Committee on Adolescent Health Care: The initial reproductive health visit.

PubMed

2014-05-01

: The initial visit for screening and the provision of reproductive preventive health care services and guidance should take place between the ages of 13 years and 15 years. The initial reproductive health visit provides an excellent opportunity for the obstetrician-gynecologist to start a patient-physician relationship, build trust, and counsel patients and parents regarding healthy behavior while dispelling myths and fears. The scope of the initial reproductive health visit will depend on the individual's need, medical history, physical and emotional development, and the level of care she is receiving from other health care providers. A general exam, a visual breast exam, and external pelvic examination may be indicated. However, an internal pelvic examination generally is unnecessary during the initial reproductive health visit, but may be appropriate if issues or problems are discovered in the medical history. Health care providers and office staff should be familiar with state and local statutes regarding the rights of minors to consent to health care services and the federal and state laws that affect confidentiality.

Rapid effects of corticosterone on cache recovery in mountain chickadees (Parus gambeli).

PubMed

Saldanha, C J; Schlinger, B A; Clayton, N S

2000-03-01

Environmental perturbations increase adrenal activity in several vertebrates. Increases in corticosterone may serve as a proximate trigger whereby organisms can rapidly adapt their behavior to survive environmental fluctuations. In food-caching songbirds, inclement weather may present the need to alter caching and/or retrieval behaviors to ensure food supplies. We hypothesized that corticosterone may increase the rate of caching and/or retrieval behaviors in the mountain chickadee, a food-storing songbird, and tested if these potential effects were mediated by alterations in appetite, activity, or memory for cache sites. Corticosterone or vehicle was administered to subjects 5 min prior to either caching or recovery in a naturalistic laboratory paradigm during which we recorded the number of caching events, sites visited, and seeds eaten (caching) or caches recovered, total sites visited, cache-related visits, and non-cache-related visits (recovery). Data were analyzed using nested ANOVA for treatment within sequential trial. There was no effect on any caching behaviors following treatment. However, birds treated with corticosterone during retrieval recovered more seeds and tended to visit more cache-related sites than did controls. Since groups did not differ in the number of seeds eaten or the total number of sites visited, it seems unlikely that corticosterone affected appetite or activity. Rapid surges in corticosterone may increase the efficacy of an underlying memory process for cache sites which is reflected in higher cache recovery in corticosterone-treated birds than in controls. Thus, rapid alterations in plasma corticosterone following environmental change may alter memory-reliant behaviors which promote survival in the food-caching mountain chickadee. Copyright 2000 Academic Press.

Understanding the Experience of CACREP On-Site Visiting Review Team Chairpersons

ERIC Educational Resources Information Center

Minor, Amanda J.

2012-01-01

Understanding the experience of CACREP on-site review team members provides insight into the phenomenon of four counselor educators who have each served as a CACREP on-site visiting review team chairperson a minimum of three times. In total, the participants had been within the counselor education field for approximately 95 years and active within…

First Contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit

PubMed Central

CHILDRESS, Krista J.; LAWSON, Angela K.; GHANT, Marissa S.; MENDOZA, Gricelda; CARDOZO, Eden R.; CONFINO, Edmond; MARSH, Erica E.

2015-01-01

Objective To determine the impact of the initial infertility visit on treatment-related knowledge, patient anxiety, and appraisals of treatment. Study Design Prospective survey. Setting Academic medical center. Patients 234 English-speaking women, ages 18-50, attending their first infertility visit Intervention(s) Participants completed a survey assessing health literacy, knowledge, anxiety, and appraisals of the treatment process before and after their infertility visit. Main Outcome Measure(s) 1) Knowledge of infertility and treatment and, 2) Anxiety and appraisal scores. Results Most participants were white and earned >$100,000/year and had at least a college education. Baseline knowledge of reproductive anatomy, ART, and fertility factors was modest, but improved after the initial visit. Factors associated with higher knowledge included higher education and income, White or Asian ethnicity, and English as their primary language. Patient appraisals of treatment represented by the positive (Challenge) and negative (Threat and Loss) subscale scores on the Appraisal of Life Events (ALE) scale, changed from the pre-visit survey to the post-visit survey. Negative appraisals of treatment and anxiety scores decreased and positive appraisals of treatment increased after the initial visit. Lower knowledge was associated with higher positive appraisal scores lower health literacy was associated with higher anxiety and appraisal scores (positive and negative) post-visit. Black women had higher Challenge scores compared to White and Asian women. Hispanic women had higher anxiety scores than non-Hispanic women. Conclusions Infertility patients have modest baseline knowledge of fertility and infertility treatment. The initial infertility visit can improve this knowledge and decrease both negative appraisals of treatment and anxiety levels. Differences in knowledge and appraisal were seen across ethnic groups and other demographic variables. Physicians should individualize patient counseling to improve patients’ knowledge and provide realistic treatment expectations, while also reducing patient anxiety. PMID:26003271

Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria

PubMed Central

Agaba, Patricia A; Genberg, Becky L; Sagay, Atiene S; Agbaji, Oche O; Meloni, Seema T; Dadem, Nancin Y; Kolawole, Grace O; Okonkwo, Prosper; Kanki, Phyllis J; Ware, Norma C

2018-01-01

Objective Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at “hub” (central) and “spoke” (decentralized) sites in a large public HIV treatment program in north central Nigeria. Methods This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables. Results Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (−4.5%, 95% CI: −3.5, −5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08). Conclusion Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures. PMID:29682399

Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria.

PubMed

Agaba, Patricia A; Genberg, Becky L; Sagay, Atiene S; Agbaji, Oche O; Meloni, Seema T; Dadem, Nancin Y; Kolawole, Grace O; Okonkwo, Prosper; Kanki, Phyllis J; Ware, Norma C

2018-01-01

Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at "hub" (central) and "spoke" (decentralized) sites in a large public HIV treatment program in north central Nigeria. This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables. Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (-4.5%, 95% CI: -3.5, -5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08). Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures.

Multiple Nonspecific Sites of Joint Pain Outside the Knees Develop in Persons With Knee Pain.

PubMed

Felson, David T; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara L; Lewis, Cora E; Frey Law, Laura; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

2017-02-01

Many persons with knee pain have joint pain outside the knee, but despite the impact and high frequency of this pain, its distribution and causes have not been studied. We undertook this study to test the hypothesis of those studying gait abnormalities who have suggested that knee pain causes pain in adjacent joints but that pain adaptation strategies are highly individualized. We studied persons ages 50-79 years with or at high risk of knee osteoarthritis who were recruited from 2 community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, and we followed them up for 5-7 years. We excluded those with knee pain at baseline and compared those who had developed knee pain at the first follow-up examination (the index visit) with those who had not. We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint-specific pain adjusted for age, sex, body mass index, and symptoms of depression, and we performed sensitivity analyses excluding those with widespread pain. In the combined cohorts, 693 persons had knee pain at the index visit and 2,793 did not. A total of 79.6% of those with bilateral knee pain and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee, compared with 49.9% of those without knee pain. There was an increased risk of pain at most extremity joint sites, without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. © 2016, American College of Rheumatology.

Improved decision making in construction using virtual site visits.

DOT National Transportation Integrated Search

2003-01-01

This study explored the dynamics of information exchange involving field issues relating to construction and the assistance that a virtual site visit can provide to the field decision-making process. Such a process can be used for inspection and surv...

Timing and adequate attendance of antenatal care visits among women in Ethiopia

PubMed Central

Bishwajit, Ghose; Ekholuenetale, Michael; Shah, Vaibhav; Kadio, Bernard; Udenigwe, Ogochukwu

2017-01-01

Introduction Although ANC services are increasingly available to women in low and middle-income countries, their inadequate use persists. This suggests a misalignment between aims of the services and maternal beliefs and circumstances. Owing to the dearth of studies examining the timing and adequacy of content of care, this current study aims to investigate the timing and frequency of ANC visits in Ethiopia. Methods Data was obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design to provide estimates for the health and demographic variables of interest for the country. Our study focused on a sample of 10,896 women with history of at least one childbirth event. Percentages of timing and adequacy of ANC visits were conducted across the levels of selected factors. Variables which were associated at 5% significance level were examined in the multivariable logistic regression model for association between timing and frequency of ANC visits and the explanatory variables while controlling for covariates. Furthermore, we presented the approach to estimate marginal effects involving covariate-adjusted logistic regression with corresponding 95%CI of delayed initiation of ANC visits and inadequate ANC attendance. The method used involved predicted probabilities added up to a weighted average showing the covariate distribution in the population. Results Results indicate that 66.3% of women did not use ANC at first trimester and 22.3% had ANC less than 4 visits. The results of this study were unique in that the association between delayed ANC visits and adequacy of ANC visits were examined using multivariable logistic model and the marginal effects using predicted probabilities. Results revealed that older age interval has higher odds of inadequate ANC visits. More so, type of place of residence was associated with delayed initiation of ANC visits, with rural women having the higher odds of delayed initiation of ANC visits (OR = 1.65; 95%CI: 1.26–2.18). However, rural women had 44% reduction in the odds of having inadequate ANC visits. In addition, multi-parity showed higher odds of delayed initiation of ANC visit when compared to the primigravida (OR = 2.20; 95%CI: 1.07–2.69). On the contrary, there was 36% reduction in the odds of multigravida having inadequate ANC visits when compared to the women who were primigravida. There were higher odds of inadequacy in ANC visits among women who engaged in sales/business, agriculture, skilled manual and other jobs when compared to women who currently do not work, after adjusting for covariates. From the predictive margins, assuming the distribution of all covariates remained the same among respondents, but everyone was aged 15–19 years, we would expect 71.8% delayed initiation of ANC visit. If everyone was aged 20-24years, 73.4%; 25-29years, 66.5%; 30-34years, 64.8%; 35-39years, 65.6%; 40-44years, 59.6% and 45-49years, we would expect 70.1% delayed initiation of ANC visit. If instead the distribution of age was as observed and for other covariates remained the same among respondents, but no respondent lived in the rural, we would expect about 61.4% delayed initiation of ANC visit; if however, everyone lived in the rural, and we would expect 71.6% delayed initiation in ANC visit. Model III revealed the predictive margins of all factors examined for delayed initiation for ANC visits, while Model IV presented the predictive marginal effects of the determinants of adequacy of ANC visits. Conclusion The precise mechanism by which these factors affect ANC visits remain blurred at best. There may be factors on the demand side like the women’s empowerment, financial support of the husband, knowledge of ANC visits in the context of timing, frequency and the expectations of ANC visits might be mediating the effects through the factors found associated in this study. Supply side factors like the quality of ANC services, skilled staff, and geographic location of the health centers also mediate their effects through the highlighted factors. Irrespective of the knowledge about the precise mechanism of action, policy makers could focus on improving women’s empowerment, improving women’s education, reducing wealth inequity and facilitating improved utilization of ANC through modifications on the supply side factors such as geographic location and focus on hard to reach women. PMID:28922383

Multi-hierarchical movements in self-avoiding walks

NASA Astrophysics Data System (ADS)

Sakiyama, Tomoko; Gunji, Yukio-Pegio

2017-07-01

A self-avoiding walk (SAW) is a series of moves on a lattice that visit the same place only once. Several studies reported that repellent reactions of foragers to previously visited sites induced power-law tailed SAWs in animals. In this paper, we show that modelling the agent's multi-avoidance reactions to its trails enables it to show ballistic movements which result in heavy-tailed movements. There is no literature showing emergent ballistic movements in SAWs. While following SAWs, the agent in my model changed its reactions to marked patches (visited sites) by considering global trail patterns based on local trail patterns when the agent was surrounded by previously visited sites. As a result, we succeeded in producing ballistic walks by the agents which exhibited emergent power-law tailed movements.

Quantifying exciton hopping in disordered media with quenching sites: Application to arrays of quantum dots

NASA Astrophysics Data System (ADS)

Miyazaki, Jun

2013-10-01

We present an analytical method for quantifying exciton hopping in an energetically disordered system with quenching sites. The method is subsequently used to provide a quantitative understanding of exciton hopping in a quantum dot (QD) array. Several statistical quantities that characterize the dynamics (survival probability, average number of distinct sites visited, average hopping distance, and average hopping rate in the initial stage) are obtained experimentally by measuring time-resolved fluorescence intensities at various temperatures. The time evolution of these quantities suggests in a quantitative way that at low temperature an exciton tends to be trapped at a local low-energy site, while at room temperature, exciton hopping occurs repeatedly, leading to a large hopping distance. This method will serve to facilitate highly efficient optoelectronic devices using QDs such as photovoltaic cells and light-emitting diodes, since exciton hopping is considered to strongly influence their operational parameters. The presence of a dark QD (quenching site) that exhibits fast decay is also quantified.

Fire Promotes Pollinator Visitation: Implications for Ameliorating Declines of Pollination Services

PubMed Central

Van Nuland, Michael E.; Haag, Elliot N.; Bryant, Jessica A. M.; Read, Quentin D.; Klein, Robert N.; Douglas, Morgan J.; Gorman, Courtney E.; Greenwell, Trey D.; Busby, Mark W.; Collins, Jonathan; LeRoy, Joseph T.; Schuchmann, George; Schweitzer, Jennifer A.; Bailey, Joseph K.

2013-01-01

Pollinators serve critical roles for the functioning of terrestrial ecosystems, and have an estimated annual value of over $150 billion for global agriculture. Mounting evidence from agricultural systems reveals that pollinators are declining in many regions of the world, and with a lack of information on whether pollinator communities in natural systems are following similar trends, identifying factors which support pollinator visitation and services are important for ameliorating the effects of the current global pollinator crisis. We investigated how fire affects resource structure and how that variation influences floral pollinator communities by comparing burn versus control treatments in a southeastern USA old-field system. We hypothesized and found a positive relationship between fire and plant density of a native forb, Verbesina alternifolia, as well as a significant difference in floral visitation of V. alternifolia between burn and control treatments. V. alternifolia density was 44% greater and floral visitation was 54% greater in burned treatments relative to control sites. When the density of V. alternifolia was experimentally reduced in the burn sites to equivalent densities observed in control sites, floral visitation in burned sites declined to rates found in control sites. Our results indicate that plant density is a proximal mechanism by which an imposed fire regime can indirectly impact floral visitation, suggesting its usefulness as a tool for management of pollination services. Although concerns surround the negative impacts of management, indirect positive effects may provide an important direction to explore for managing future ecological and conservation issues. Studies examining the interaction among resource concentration, plant apparency, and how fire affects the evolutionary consequences of altered patterns of floral visitation are overdue. PMID:24265787

The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women.

PubMed

Shellhaas, Cynthia; Conrey, Elizabeth; Crane, Dushka; Lorenz, Allison; Wapner, Andrew; Oza-Frank, Reena; Bouchard, Jo

2016-11-01

Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.

Mesopredator behavioral response to olfactory signals of an apex predator.

PubMed

Wikenros, Camilla; Jarnemo, Anders; Frisén, Marielle; Kuijper, Dries P J; Schmidt, Krzysztof

2017-01-01

Olfactory signals constitute an important mechanism in interspecific interactions, but little is known regarding their role in communication between predator species. We analyzed the behavioral responses of a mesopredator, the red fox ( Vulpes vulpes ), to an olfactory cue (scat) of an apex predator, the lynx ( Lynx lynx ) in Białowieża Primeval Forest, Poland, using video camera traps. Red fox visited sites with scats more often than expected and the duration of their visits was longer at scat sites than at control sites (no scat added). Vigilant behavior, sniffing and scent marking (including over-marking) occurred more often at scat sites compared to control sites, where foxes mainly passed by. Vigilance was most pronounced during the first days of the recordings. Red fox behavior was also influenced by foxes previously visiting scat sites. They sniffed and scent marked (multiple over-marking) more frequently when the lynx scat had been over-marked previously by red fox. Fox visits to lynx scats may be seen as a trade-off between obtaining information on a potential food source (prey killed by lynx) and the potential risk of predation by an apex predator.

Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment.

PubMed

Pesevska, Snezana; Nakova, Marija; Ivanovski, Kiro; Angelov, Nikola; Kesic, Ljiljana; Obradovic, Radmila; Mindova, Sonja; Nares, Salvador

2010-09-01

The aim of this study is to compare the effectiveness of low-level laser irradiation to traditional topical fluoride treatment for treatment choices of dentinal hypersensitivity following scaling and root planing. The experimental group (15 patients) was treated with low-energy-level diode laser at each site of dentinal hypersensitivity following scaling and root planning. The control group (15 patients) received topical fluoride treatment (protective varnish for desensitization). All the patients were treated at baseline visit, and then at day 2 and 4 after the initial treatment; the pain was subjectively assessed by the patients as strong, medium, medium low, low, or no pain. Total absence of the dental hypersensitivity was reported in 26.66% of the examined group even after the second visit, compared to the control group where complete resolution of the hypersensitivity was not present after the second visit in any of the treated cases. Complete absence of pain was achieved in 86.6% of patients treated with laser and only in 26.6% in the fluoride treated group, after the third visit. Based on our findings, we conclude that low-energy biostimulative laser treatment can be successfully used for treatment of dental hypersensitivity following scaling and root planing.

Constructing a Global Learning Partnership in Physiotherapy: An Ireland-Uganda Initiative.

PubMed

O'Sullivan, Cliona; Kazibwe, Herman; Whitehouse, Zillah; Blake, Catherine

2017-01-01

There is a strong correlation between disability and poverty and it is acknowledged that until disability issues are addressed, the goal of poverty reduction in low-income countries is unlikely to be achieved. Despite the high prevalence of disability in developing countries, there remains a significant shortage of rehabilitation professionals as highlighted by the WHO report, Human resources for Health (2006). The purpose of this project was to develop a collaborative and sustainable partnership to strengthen educational and research capacity in global health, disability, and rehabilitation between two physiotherapy schools; University College Dublin, Ireland, and Mbarara University of Science and Technology, Uganda. This article aims to describe the approach used and initial project outcomes. This project involved a bilateral visit to both institutions by two members of staff of respective physiotherapy programs. These visits entailed stakeholder meetings, clinical site visits, and workshops to identify the priorities for the partnership and shape the collaboration going forward. Appreciative inquiry methodology was used during the workshops and the four-dimensional framework for curriculum development was used to guide analysis and underpin findings. The key priorities identified were (i) development of joint global health learning initiative, (ii) to explore the possibility of postgraduate learning and research opportunities for Ugandan colleagues, and (iii) to develop joint clinical placements. The rationale and context and a plan of action is described. The project is ambitious and in order to be sustainable, the importance of long-term interinstitutional commitment and further funding cannot be ignored. This work provides a framework for other universities and institutions wishing to undertake similar activities. Such partnerships provide rich learning opportunities for students and health professionals and facilitate a deeper understanding of global health issues, social and cultural health determinants, and development of enhanced professional skills.

Post-approval monitoring and oversight of U.S.-initiated human subjects research in resource-constrained countries.

PubMed

Brown, Brandon; Kinsler, Janni; Folayan, Morenike O; Allen, Karen; Cáceres, Carlos F

2014-06-01

The history of human subjects research and controversial procedures in relation to it has helped form the field of bioethics. Ethically questionable elements may be identified during research design, research implementation, management at the study site, or actions by a study's investigator or other staff. Post-approval monitoring (PAM) may prevent violations from occurring or enable their identification at an early stage. In U.S.-initiated human subjects research taking place in resource-constrained countries with limited development of research regulatory structures, arranging a site visit from a U.S. research ethics committee (REC) becomes difficult, thus creating a potential barrier to regulatory oversight by the parent REC. However, this barrier may be overcome through the use of digital technologies, since much of the world has at least remote access to the Internet. Empirical research is needed to pilot test the use of these technologies for research oversight to ensure the protection of human subjects taking part in research worldwide.

Report: American Recovery and Reinvestment Act Site Visit of Wastewater Treatment Plant, Village of Itasca, Illinois

EPA Pesticide Factsheets

Report #12-R-0377, March 30, 2012. We conducted an unannounced site visit of the Recovery Act project to build a new wastewater treatment plant in the Village of Itasca, Illinois, in April and May 2011.

76 FR 4919 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0046] Regulatory Site Visit Training Program AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration's (FDA's) Center for Biologics Evaluation and Research (CBER) is...

75 FR 6404 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2008-N-0045] (formerly Docket No. 2004N-0408) Regulatory Site Visit Training Program AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration's (FDA's) Center for Biologics...

Long-term ecology of euglossine orchid-bees (Apidae: Euglossini) in Panama.

PubMed

Roubik, D W; Ackerman, J D

1987-09-01

Abundance patterns during 6-7 years and orchid visitation were determined for 51 species of the 57 local euglossine bees. Male bees were counted at 3 chemical attractants presented in the same manner each month. Sites were separated by 75 km but included wet Atlantic forest at 500 m elevation, moist forest at 180 m near Barro Colorado Island, and cloud forest at 900 m near the Pacific ocean. 1. From 15 to 30 euglossine species of 4 genera were active in each month and site; monthly species number and general bee abundance were positively correlated. Many species had 3 annual abundance peaks (range 1-4) and were active throughout the year, but peak annual abundances rarely occurred during late wet or early dry seasons. In contrast, Eufriesea generally were present as adults only 1-2 months in a year. 2. Euglossine populations were exceptionally stable. Species at each site were more stable than any known insect population, and stability and abundance were positively associated. However, year-to-year population stability and the degree of seasonality were not correlated. Among the three sites, the more diverse (species rich) bee assemblages displayed lower stability; these were the wetter and upland sites. 3. The most abundant bees visited more orchid species. Eg. and El. each visited and average of 4 orchid species (range 0-13); Ex. and Ef. visited 0-3. Stable populations did not visit more or fewer orchid species than did unstable populations. 4. Less than 68% of species at each site visited orchid flowers; less than a few dozen of the 100-800 bees counted in a day carried orchid pollinaria. Over 20% of the euglossine species never were seen with pollinaria at any site and probably seldom visit orchids in central Panama. 5. Most bee species visited 1 or no fragrance orchids in a given habitat. Orchids tended to utilize common pollinators that seldom included more than 1 species, and they utilized stable or unstable, seasonal or aseasonal bees. However, the most stable and abundant bee, Eg. imperialis, rarely pollinated orchids; fewer than 10 of ca. 20000 bees carried pollinaria. 6. Orchids may interact primarily with discrete seasonal bee population peaks-probably the emerging adults. Although specialized orchid preferences are implicated for species that visit few or no local orchids but pollinate other species and carry pollinaria in other areas, euglossine bees do not need orchids to survive or reproduce.

A longitudinal study of exposure to retail cigarette advertising and smoking initiation.

PubMed

Henriksen, Lisa; Schleicher, Nina C; Feighery, Ellen C; Fortmann, Stephen P

2010-08-01

Accumulating evidence suggests that widespread advertising for cigarettes at the point of sale encourages adolescents to smoke; however, no longitudinal study of exposure to retail tobacco advertising and smoking behavior has been reported. A school-based survey included 1681 adolescents (aged 11-14 years) who had never smoked. One measure of exposure assessed the frequency of visiting types of stores that contain the most cigarette advertising. A more detailed measure combined data about visiting stores near school with observations of cigarette advertisements and pack displays in those stores. Follow-up surveys 12 and 30 months after baseline (retention rate: 81%) documented the transition from never to ever smoking, even just a puff. After 12 months, 18% of adolescents initiated smoking, but the incidence was 29% among students who visited convenience, liquor, or small grocery stores at least twice per week and 9% among those who reported the lowest visit frequency (less than twice per month). Adjusting for multiple risk factors, the odds of initiation remained significantly higher (odds ratio: 1.64 [95% confidence interval: 1.06-2.55]) for adolescents who reported moderate visit frequency (0.5-1.9 visits per week), and the odds of initiation more than doubled for those who visited > or = 2 times per week (odds ratio: 2.58 [95% confidence interval: 1.68-3.97]). Similar associations were observed for the more detailed exposure measure and persisted at 30 months. Exposure to retail cigarette advertising is a risk factor for smoking initiation. Policies and parenting practices that limit adolescents' exposure to retail cigarette advertising could improve smoking prevention efforts.

Experience with a Spanish-language laparoscopy website.

PubMed

Moreno-Sanz, Carlos; Seoane-González, Jose B

2006-02-01

Although there are no clearly defined electronic tools for continuing medical education (CME), new information technologies offer a basic platform for presenting training content on the internet. Due to the shortage of websites about minimally invasive surgery in the Spanish language, we set up a topical website in Spanish. This study considers the experience with the website between April 2001 and January 2005. To study the activity of the website, the registry information was analyzed descriptively using the log files of the server. To study the characteristics of the users, we searched the database of registered users. We found a total of 107,941 visits to our website and a total of 624,895 page downloads. Most visits to the site were made from Spanish-speaking countries. The most frequent professional profile of the registered users was that of general surgeon. The development, implementation, and evaluation of Spanish-language CME initiatives over the internet is promising but presents challenges.

Integrated optimization of planetary rover layout and exploration routes

NASA Astrophysics Data System (ADS)

Lee, Dongoo; Ahn, Jaemyung

2018-01-01

This article introduces an optimization framework for the integrated design of a planetary surface rover and its exploration route that is applicable to the initial phase of a planetary exploration campaign composed of multiple surface missions. The scientific capability and the mobility of a rover are modelled as functions of the science weight fraction, a key parameter characterizing the rover. The proposed problem is formulated as a mixed-integer nonlinear program that maximizes the sum of profits obtained through a planetary surface exploration mission by simultaneously determining the science weight fraction of the rover, the sites to visit and their visiting sequences under resource consumption constraints imposed on each route and collectively on a mission. A solution procedure for the proposed problem composed of two loops (the outer loop and the inner loop) is developed. The results of test cases demonstrating the effectiveness of the proposed framework are presented.

Report: American Recovery and Reinvestment Act Site Visit of the Wastewater Treatment Facility Improvements Project, Perkins, Oklahoma

EPA Pesticide Factsheets

Report #11-R-0214, May 2, 2011. We conducted an unannounced visit of the construction site of the Perkins Public Works Authority’s wastewater treatment facility improvements project in Perkins, Oklahoma, on April 19–22, 2010.

A Solid Foundation: Key Capacities of Construction Pre-Apprenticeship Programs

ERIC Educational Resources Information Center

Helmer, Matt; Blair, Amy; Gerber, Allison

2012-01-01

This publication shares research from site visits conducted to construction pre-apprenticeship programs in Baltimore, Hartford, Milwaukee and Portland (OR). Findings from the site visits, which included interviews and focus groups with pre-apprenticeship program staff, public officials, philanthropic leaders, construction industry leaders and…

Evidence-based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana.

PubMed

Brantuo, Mary N A; Cristofalo, Elizabeth; Meheš, Mira M; Ameh, Juliana; Brako, Nana Okai; Boahene, Frederick; Adjei, Stella B; Opoku, Ernest; Banda, Harriet; Wang, Yu T; Forgor, Abdulai A; Punguire, Damien; Brightson, Kennedy; Sottie, Cynthia; Owusu-Agyei, Seth; Williams, John E; Sulemana, Abubakari; Oduro, Abraham R; Gyampong, Margaret; Sarpong, Doris; Andrews, Edith; Gyansa-Lutterodt, Martha; Hodgson, Abraham; Bannerman, Cynthia; Abdullah, Fizan

2014-04-01

To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence. Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance. © 2014 John Wiley & Sons Ltd.

Effective Implementation of Collaborative Care for Depression: What is Needed?

PubMed Central

Whitebird, Robin R.; Solberg, Leif I.; Jaeckels, Nancy A.; Pietruszewski, Pamela B.; Hadzic, Senka; Unützer, Jürgen; Ohnsorg, Kris A.; Rossom, Rebecca C.; Beck, Arne; Joslyn, Ken; Rubenstein, Lisa V.

2014-01-01

Objective To identify the care model factors that were key for successful implementation of collaborative depression care in a statewide Minnesota primary care initiative. Study Design We used a mixed-methods design incorporating both qualitative data from clinic site visits and quantitative measures of patient activation and 6-month remission rates. Methods Care model factors identified from the site visits were tested for association with rates of activation into the program and remission rates. Results Nine factors were identified as important for successful implementation of collaborative care by the consultants who had trained and interviewed participating clinic teams. Factors correlated with higher patient activation rates were: strong leadership support (0.63), well-defined and implemented care manager roles (0.62), a strong primary care physician champion (0.60), and an on-site and accessible care manager (0.59). However, remission rates at six months were correlated with: an engaged psychiatrist (0.62), not seeing operating costs as a barrier to participation (0.56), and face-to-face communication (warm handoffs) between the care-manager and primary care physician for new patients (0.54). Conclusions Care model factors most important for successful program implementation differ for patient activation into the program versus remission at six months. Knowing which implementation factors are most important for successful implementation will be useful for those interested in adopting this evidence-based approach to improve primary care for patients with depression. PMID:25365745

Monitoring worksite clinic performance using a cost-benefit tool.

PubMed

Tao, Xuguang; Chenoweth, David; Alfriend, Amy S; Baron, David M; Kirkland, Tracie W; Scherb, Jill; Bernacki, Edward J

2009-10-01

The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance. Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic's opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size. A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at approximately 4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at approximately 3 months after a clinic's opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served. Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic's cost effectiveness.

Barriers and enablers to a physician-delivered educational initiative to reduce low-acuity visits to the pediatric emergency department.

PubMed

Huyer, Gregory; Chreim, Samia; Michalowski, Wojtek; Farion, Ken J

2018-01-01

Use of the pediatric emergency department (PED) for low-acuity health issues is a growing problem, contributing to overcrowding, longer waits and higher health system costs. This study examines an educational initiative aimed at reducing low-acuity PED visits. The initiative, implemented at an academic pediatric hospital, saw PED physicians share a pamphlet with caregivers to educate them about appropriate PED use and alternatives. Despite early impacts, the initiative was not sustained. This study analyzes the barriers and enablers to physician participation in the initiative, and offers strategies to improve implementation and sustainability of similar future initiatives. Forty-two PED physicians were invited to participate in a semi-structured individual interview assessing their views about low-acuity visits, their pamphlet use, barriers and enablers to pamphlet use, and the initiative's potential for reducing low-acuity visits. Suggestions were solicited for improving the initiative and reducing low-acuity visits. Constant comparative method was used during analysis. Codes were developed inductively and iteratively, then grouped according to the Theoretical Domains Framework (TDF). Efforts to ensure study credibility included seeking participant feedback on the findings. Twenty-three PED physicians were interviewed (55%). Barriers and enablers for pamphlet use were identified and grouped according to five of the 14 TDF domains: social/professional role and identity; beliefs about consequences; environmental context and resources; social influences; and emotions. The TDF provided an effective approach to identify the key elements influencing physician participation in the educational initiative. This information will help inform behavior change interventions to improve the implementation of similar future initiatives that involve physicians as the primary educators of caregivers.

Assessing the Benefits of a Geropsychiatric Home-Visit Program for Medical Students

ERIC Educational Resources Information Center

Roane, David M.; Tucker, Jennifer; Eisenstadt, Ellen; Gomez, Maria; Kennedy, Gary J.

2012-01-01

Objective: Authors assessed the benefit of including medical students on geropsychiatric home-visits. Method: Medical students, during their psychiatry clerkship, were assigned to a home-visit group (N=43) or control group (N=81). Home-visit participants attended the initial visit of a home-bound geriatric patient. The Maxwell-Sullivan Attitude…

Data Management and Site-Visit Monitoring of the Multi-Center Registry in the Korean Neonatal Network.

PubMed

Choi, Chang Won; Park, Moon Sung

2015-10-01

The Korean Neonatal Network (KNN), a nationwide prospective registry of very-low-birth-weight (VLBW, < 1,500 g at birth) infants, was launched in April 2013. Data management (DM) and site-visit monitoring (SVM) were crucial in ensuring the quality of the data collected from 55 participating hospitals across the country on 116 clinical variables. We describe the processes and results of DM and SVM performed during the establishment stage of the registry. The DM procedure included automated proof checks, electronic data validation, query creation, query resolution, and revalidation of the corrected data. SVM included SVM team organization, identification of unregistered cases, source document verification, and post-visit report production. By March 31, 2015, 4,063 VLBW infants were registered and 1,693 queries were produced. Of these, 1,629 queries were resolved and 64 queries remain unresolved. By November 28, 2014, 52 participating hospitals were visited, with 136 site-visits completed since April 2013. Each participating hospital was visited biannually. DM and SVM were performed to ensure the quality of the data collected for the KNN registry. Our experience with DM and SVM can be applied for similar multi-center registries with large numbers of participating centers.

DELAY on first antenatal care visit and its associated factors among pregnant women in public health facilities of Debre Markos town, North West Ethiopia.

PubMed

Ewunetie, Atsede Alle; Munea, Alemtsehay Mekonnen; Meselu, Belsity Temesgen; Simeneh, Muluye Molla; Meteku, Bekele Tesfaye

2018-05-16

Delay on timely initiation of antenatal care has a great impact on adverse pregnancy out comes. However, evidences in Ethiopia revealed that majority of pregnant mothers did not start their first visit as recommrnded by WHO. The aim of this study was to assess delay and associated factors of first antenatal care visit among pregnant mothers at public health facilities of Debremarkos town, North West Ethiopia. An institutional based crosss-sectional study was conducted from February to March, 2014 in public health facilities of Debremarkos town North west Ethiopia. A total of 320 pregnant mothers who were sure of their last menstrual periods were interviewed with a structured questionnaire. Data entry was done using Epi data 3.1 and analysis was done using SPSS version 20. Descriptive statistics, binary and multivariable logistic regression analyses were employed to identify the magnitude and factors associated with delay on timely initiation of the first antenatal care visit. The proportion of respondents who made their first antenatal care visit after 16 weeks of gestation was found to be 33.4%. Mothers residing in rural settings (AOR = 2.8 [95% CI:1.54-5.44]), not attained formal education(AOR = 2.2 [95% CI:1.10-4.68]),with unintended pregnancy (AOR = 3.6 [95% CI:2.00-6.80]) and who perceived that the right initiation time of the first antenatal care visit is beyond 16 weeks of gestation (AOR = 3.9 [95% CI:1.61-9.76]) were more likely delayed on their first antenatal care visit . Residence, educational status, intention of pregnancy and perception on the right time of first antenatal care visit initiation were found to be predictors of delay on timely initiatin of first antenatal care visit. Therefore, the Zonal health department should strengthen awareness creation about timely initiation of first antenatal care visit and family planning to prevent unintended pregnancy in the community especially in the rural settings.

Rates and Reasons for Early Change of First HAART in HIV-1-Infected Patients in 7 Sites throughout the Caribbean and Latin America

PubMed Central

Cesar, Carina; Shepherd, Bryan E.; Krolewiecki, Alejandro J.; Fink, Valeria I.; Schechter, Mauro; Tuboi, Suely H.; Wolff, Marcelo; Pape, Jean W.; Leger, Paul; Padgett, Denis; Madero, Juan Sierra; Gotuzzo, Eduardo; Sued, Omar; McGowan, Catherine C.; Masys, Daniel R.; Cahn, Pedro E.

2010-01-01

Background HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%–70%) of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. Methodology Antiretroviral-naïve patients > = 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals) was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. Principal Findings Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31–44), and median CD4 count was 105 cells/uL (IQR, 38–200). Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI) 15–17%) and 28% (95% CI 27–29%), respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR) = 1.7 (95% CI 1.1–2.6) and 2.1 (95% CI 1.7–2.5) comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1–1.5) for clinical AIDS at HAART initiation). The primary reason for change among HAART initiators were adverse events (14%), death (5.7%) and failure (1.3%) with specific toxicities varying among sites. After change, most patients remained in first line regimens. Conclusions Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed and require further investigation. PMID:20531956

CyberHunt: Head Off to Antarctica.

ERIC Educational Resources Information Center

Kloza, Brad

2001-01-01

Explains how to take an elementary class on a cyber visit to the continent of Antarctica, the highest, driest, and coldest continent on earth. A student reproducible page presents eight web sites to visit in this quest as well as questions to answer about each site. Answers to the questions are included. (SM)

77 FR 22613 - Proposal Review Panel for Chemistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-16

... NATIONAL SCIENCE FOUNDATION Proposal Review Panel for Chemistry; Notice of Meeting In accordance with the Federal Advisory Committee Act (Pub. L. 92- 463, as amended), the National Science Foundation announces the following meeting: Name: Centers for Chemical Evolution (CCE) Site Visit 2012 Site Visit, 1191...

Report: American Recovery and Reinvestment Act Site Visit of the Clifton Street Sewer Separation and Water Main Replacement Projects, Portland, Maine

EPA Pesticide Factsheets

Report #11-R-0248, June 7, 2011. We conducted an unannounced site visit of the Clifton Street Sewer Separation and Water Main Replacement Projects in the City of Portland, Maine, from June 15 through June 17, 2009.

White-tailed Deer Visitation Rates at Medicated Bait Sites in Southern Texas

USDA-ARS?s Scientific Manuscript database

The cattle fever tick, Rhipicephalus (Boophilus) microplus, has been found on white-tailed deer (Odocoileus virginianus) complicating eradication efforts of the USDA’s Cattle Fever Tick Eradication Program. Our objective was to assess patterns of deer visitation to medicated bait sites used to treat...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Butler, Nicholas; McCaw, Erica E.; Wright, Kyle A.

The Global Threat Reduction Initiative (GTRI) reduces and protects vulnerable nuclear and radiological material located at civilian sites worldwide from sabotage, theft or diversion. The GTRI has worked successfully with foreign countries to remove and protect nuclear and radioactive materials including high-activity sources used in medical, commercial, and research applications. There are many barriers to successful bilateral cooperation that must be overcome including language, preconceived perceptions, long distances, and different views on the threat and protection requirements. Successful cooperation is often based on relationships and building trusting relationships takes time. In the case of Dominican Republic, the GTRI first receivedmore » contact in 2008 from the Government of Dominican Republic. They requested cooperation that was similar to the tri-partite cooperation between Colombia, Mexico and the United States. Throughout the region it was widely known that the GTRI’s cooperation with the Government of Colombia was a resounding success resulting in the securing of forty sites; the consolidation of numerous disused/orphan sources at a secure national storage facility; and, the development of a comprehensive approach to security including, inter alia, training and sustainability. The Government of Colombia also showcased this comprehensive approach to thirteen Central American and Caribbean countries at a GTRI regional security conference held in Panama in October 2004. In 2007, Colombia was an integral component of GTRI multi-lateral cooperation initiation in Mexico. As a result, twenty two of Mexico’s largest radioactive sites have been upgraded in the past eighteen months. These two endeavors served as catalysts for cooperation opportunities in the Dominican Republic. Representatives from the Colombian government were aware of GTRI’s interest in initiating cooperation with the Government of Dominican Republic and to facilitate this cooperation, they traveled to the Dominican Republic and provided briefings and presentations which demonstrated its successful cooperation with the GTRI. Shortly after that visit, the Government of Dominican Republic agreed to move forward and requested that the cooperative efforts in Dominican Republic be performed in a tripartite manner, leveraging the skills, experience, and resources of the Colombians, and the financial and technical support of the United States. As a result, two of Dominican Republic’s largest radioactive sites had security upgrades in place within 90 days of the cooperation visit in December 2008.« less

Integrating Parenting Support Within and Beyond the Pediatric Medical Home.

PubMed

Linton, Julie M; Stockton, Maria Paz; Andrade, Berta; Daniel, Stephanie

2018-01-01

Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.

Genital Herpes - Initial Visits to Physicians' Offices, United States, 1966-2012

MedlinePlus

... Archive Data & Statistics Sexually Transmitted Diseases Figure 48. Genital Herpes — Initial Visits to Physicians’ Offices, United States, 1966 – ... Statistics page . NOTE : The relative standard errors for genital herpes estimates of more than 100,000 range from ...

Genital Warts -- Initial Visits to Physicians' Offices, United States, 1966 - 2012

MedlinePlus

... 46. Genital Warts — Initial Visits to Physicians’ Offices, United States, 1966 – 2012 Recommend on Facebook Tweet Share Compartir ... OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO (800-232-4636) , TTY: 888- ...

A Longitudinal Study of Exposure to Retail Cigarette Advertising and Smoking Initiation

PubMed Central

Henriksen, Lisa; Schleicher, Nina C.; Feighery, Ellen C.; Fortmann, Stephen P.

2011-01-01

OBJECTIVES Accumulating evidence suggests that widespread advertising for cigarettes at the point of sale encourages adolescents to smoke; however, no longitudinal study of exposure to retail tobacco advertising and smoking behavior has been reported. METHODS A school-based survey included 1681 adolescents (aged 11–14 years) who had never smoked. One measure of exposure assessed the frequency of visiting types of stores that contain the most cigarette advertising. A more detailed measure combined data about visiting stores near school with observations of cigarette advertisements and pack displays in those stores. Follow-up surveys 12 and 30 months after baseline (retention rate: 81%) documented the transition from never to ever smoking, even just a puff. RESULTS After 12 months, 18% of adolescents initiated smoking, but the incidence was 29% among students who visited convenience, liquor, or small grocery stores at least twice per week and 9% among those who reported the lowest visit frequency (less than twice per month). Adjusting for multiple risk factors, the odds of initiation remained significantly higher (odds ratio: 1.64 [95% confidence interval: 1.06–2.55]) for adolescents who reported moderate visit frequency (0.5–1.9 visits per week), and the odds of initiation more than doubled for those who visited ≥2 times per week (odds ratio: 2.58 [95% confidence interval: 1.68–3.97]). Similar associations were observed for the more detailed exposure measure and persisted at 30 months. CONCLUSIONS Exposure to retail cigarette advertising is a risk factor for smoking initiation. Policies and parenting practices that limit adolescents’ exposure to retail cigarette advertising could improve smoking prevention efforts. PMID:20643725

When to Start Antiretroviral Therapy in Children Aged 2–5 Years: A Collaborative Causal Modelling Analysis of Cohort Studies from Southern Africa

PubMed Central

Schomaker, Michael; Egger, Matthias; Ndirangu, James; Phiri, Sam; Moultrie, Harry; Technau, Karl; Cox, Vivian; Giddy, Janet; Chimbetete, Cleophas; Wood, Robin; Gsponer, Thomas; Bolton Moore, Carolyn; Rabie, Helena; Eley, Brian; Muhe, Lulu; Penazzato, Martina; Essajee, Shaffiq; Keiser, Olivia; Davies, Mary-Ann

2013-01-01

Background There is limited evidence on the optimal timing of antiretroviral therapy (ART) initiation in children 2–5 y of age. We conducted a causal modelling analysis using the International Epidemiologic Databases to Evaluate AIDS–Southern Africa (IeDEA-SA) collaborative dataset to determine the difference in mortality when starting ART in children aged 2–5 y immediately (irrespective of CD4 criteria), as recommended in the World Health Organization (WHO) 2013 guidelines, compared to deferring to lower CD4 thresholds, for example, the WHO 2010 recommended threshold of CD4 count <750 cells/mm3 or CD4 percentage (CD4%) <25%. Methods and Findings ART-naïve children enrolling in HIV care at IeDEA-SA sites who were between 24 and 59 mo of age at first visit and with ≥1 visit prior to ART initiation and ≥1 follow-up visit were included. We estimated mortality for ART initiation at different CD4 thresholds for up to 3 y using g-computation, adjusting for measured time-dependent confounding of CD4 percent, CD4 count, and weight-for-age z-score. Confidence intervals were constructed using bootstrapping. The median (first; third quartile) age at first visit of 2,934 children (51% male) included in the analysis was 3.3 y (2.6; 4.1), with a median (first; third quartile) CD4 count of 592 cells/mm3 (356; 895) and median (first; third quartile) CD4% of 16% (10%; 23%). The estimated cumulative mortality after 3 y for ART initiation at different CD4 thresholds ranged from 3.4% (95% CI: 2.1–6.5) (no ART) to 2.1% (95% CI: 1.3%–3.5%) (ART irrespective of CD4 value). Estimated mortality was overall higher when initiating ART at lower CD4 values or not at all. There was no mortality difference between starting ART immediately, irrespective of CD4 value, and ART initiation at the WHO 2010 recommended threshold of CD4 count <750 cells/mm3 or CD4% <25%, with mortality estimates of 2.1% (95% CI: 1.3%–3.5%) and 2.2% (95% CI: 1.4%–3.5%) after 3 y, respectively. The analysis was limited by loss to follow-up and the unavailability of WHO staging data. Conclusions The results indicate no mortality difference for up to 3 y between ART initiation irrespective of CD4 value and ART initiation at a threshold of CD4 count <750 cells/mm3 or CD4% <25%, but there are overall higher point estimates for mortality when ART is initiated at lower CD4 values. Please see later in the article for the Editors' Summary PMID:24260029

Progression of trunk imbalance in adolescent idiopathic scoliosis with a thoracolumbar/lumbar curve: is it predictable at the initial visit?

PubMed

Hwang, Chang Ju; Lee, Choon Sung; Lee, Dong-Ho; Cho, Jae Hwan

2017-11-01

OBJECTIVE Progression of trunk imbalance is an important finding during follow-up of patients with adolescent idiopathic scoliosis (AIS). Nevertheless, no factors that predict progression of trunk imbalance have been identified. The purpose of this study was to identify parameters that predict progression of trunk imbalance in cases of AIS with a structural thoracolumbar/lumbar (TL/L) curve. METHODS This study included 105 patients with AIS and a structural TL/L curve who were followed up at an outpatient clinic. Patients with trunk imbalance (trunk shift ≥ 20 mm) at the initial visit were excluded. All patients were followed up for more than 2 years. Patients were divided into the following groups according to progression of trunk imbalance: 1) Group P, trunk shift ≥ 20 mm at the final visit and degree of progression ≥ 10 mm; and 2) Group NP, trunk shift < 20 mm at the final visit or degree of progression < 10 mm. Radiological parameters included Cobb angle, upper end vertebrae and lower end vertebrae (LEV), LEV tilt, disc wedge angle between LEV and LEV+1, trunk shift, apical vertebral translation, and apical vertebral rotation (AVR). Each parameter was compared between groups. Radiological parameters were assessed at every visit using whole-spine standing anteroposterior radiographs. RESULTS Among the 105 patients examined, 13 showed trunk imbalance with progression ≥ 10 mm at the final visit (Group P). Multivariate logistic regression analysis identified a lower Risser grade (p = 0.002) and a greater initial AVR (p = 0.020) as predictors of progressive trunk imbalance. A change in LEV tilt during follow-up was associated with trunk imbalance (p = 0.001). CONCLUSIONS Risser grade and AVR measured at the initial visit may predict progression of trunk imbalance. Surgeons should consider the risk of progressive trunk imbalance if patients show skeletal immaturity and a greater AVR at the initial visit.

Mortuary Science Programs: Examination of the External Evaluation Team

ERIC Educational Resources Information Center

Reinhard, D. Elaine

2010-01-01

The purpose of this study is to expand the literature on mortuary science accreditation site visit teams. This study used a mixed methodology design to examine: (1) who serves on the American Board of Funeral Service Education accreditation external site visit teams; (2) reasons for involvement in accreditation; (3) perceptions of important site…

76 FR 9356 - Intent To Request Approval From OMB of One New Public Collection of Information: Baseline...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

... during site visits with security and operating officials of transit systems. The STSIs capture and... assessments during site visits with security and operating officials of transit agencies. DATES: Send your... distance passenger railroad providers operate in the United States.\\1\\ Mass transit and passenger rail...

Levels of Nature and Stress Response

PubMed Central

2018-01-01

A growing number of studies have shown that visiting green spaces and being exposed to natural environments can reduce psychological stress. A number of questions concerning the effects of natural environments on levels of stress remain including, “Are activities engaged in natural environments more or less beneficial at reducing stress when compared to those done in more urban settings?” This study examined this question from the perspective of “levels of nature”. That is, data on levels of stress were collected from three sites, one site having wilderness-like characteristics, a second site representing a municipal-type park, and a third site representing a built environment (indoor exercise facility) within a city. Data were generated using biophysical markers (cortisol and amylase) and a psychological measure within a pre- and post-visit format. Findings suggest that visiting natural environments can be beneficial in reducing both physical and psychological stress levels, with visitors to a natural environment reporting significantly lower levels of stress than their counterparts visiting a more urbanized outdoor setting or indoor exercise facility. PMID:29772763

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

PubMed Central

Rust, George; Baltrus, Peter; Ye, Jiali; Daniels, Elvan; Quarshie, Alexander; Boumbulian, Paul; Strothers, Harry

2009-01-01

CONTEXT Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. PURPOSE We compared uninsured ED visit rates between rural counties in Georgia which have a community health center clinic site vs. counties without a CHC presence. METHODS We analyzed data from 100% of ED visits occurring in 117 rural (non-metropolitan statistical area [MSA]) counties in Georgia from 2003-2005. Counties were classified as having a CHC presence if a federally funded (Section 330) community health center had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all-cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and presence of a CHC. To assure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. FINDINGS Counties without a community health center primary care clinic site had 33% higher rates of uninsured all-cause ED visits per 10,000 uninsured population compared with non-CHC counties (rate ratio=1.33, 95% CI=1.11-1.59). Higher ED visit rates remained significant (RR=1.21, 95% CI=1.02-1.42) after adjustment for percent of population below poverty level, percent black, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR=1.22, 95% CI=1.01-1.47). No such relationship was found for ED visit rates of insured patients (RR=1.06, 95% CI=0.92-1.22). CONCLUSIONS Absence of a community health center is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured. PMID:19166556

The effectiveness of visitation proxy variables in improving recreation use estimates for the USDA Forest Service

Treesearch

Donald B.K. English; Susan M. Kocis; J. Ross Arnold; Stanley J. Zarnoch; Larry Warren

2003-01-01

In estimating recreation visitation at the National Forest level in the US, annual counts of a number of types of visitation proxy measures were used. The intent was to improve the overall precision of the visitation estimate by employing the proxy counts. The precision of visitation estimates at sites that had proxy information versus those that did not is examined....

Is there a weekend bias in clutch-initiation dates from citizen science? Implications for studies of avian breeding phenology.

PubMed

Cooper, Caren B

2014-09-01

Accurate phenology data, such as the timing of migration and reproduction, is important for understanding how climate change influences birds. Given contradictory findings among localized studies regarding mismatches in timing of reproduction and peak food supply, broader-scale information is needed to understand how whole species respond to environmental change. Citizen science-participation of the public in genuine research-increases the geographic scale of research. Recent studies, however, showed weekend bias in reported first-arrival dates for migratory songbirds in databases created by citizen-science projects. I investigated whether weekend bias existed for clutch-initiation dates for common species in US citizen-science projects. Participants visited nests on Saturdays more frequently than other days. When participants visited nests during the laying stage, biased timing of visits did not translate into bias in estimated clutch-initiation dates, based on back-dating with the assumption of one egg laid per day. Participants, however, only visited nests during the laying stage for 25% of attempts of cup-nesting species and 58% of attempts in nest boxes. In some years, in lieu of visit data, participants provided their own estimates of clutch-initiation dates and were asked "did you visit the nest during the laying period?" Those participants who answered the question provided estimates of clutch-initiation dates with no day-of-week bias, irrespective of their answer. Those who did not answer the question were more likely to estimate clutch initiation on a Saturday. Data from citizen-science projects are useful in phenological studies when temporal biases can be checked and corrected through protocols and/or analytical methods.

Is there a weekend bias in clutch-initiation dates from citizen science? Implications for studies of avian breeding phenology

NASA Astrophysics Data System (ADS)

Cooper, Caren B.

2014-09-01

Accurate phenology data, such as the timing of migration and reproduction, is important for understanding how climate change influences birds. Given contradictory findings among localized studies regarding mismatches in timing of reproduction and peak food supply, broader-scale information is needed to understand how whole species respond to environmental change. Citizen science—participation of the public in genuine research—increases the geographic scale of research. Recent studies, however, showed weekend bias in reported first-arrival dates for migratory songbirds in databases created by citizen-science projects. I investigated whether weekend bias existed for clutch-initiation dates for common species in US citizen-science projects. Participants visited nests on Saturdays more frequently than other days. When participants visited nests during the laying stage, biased timing of visits did not translate into bias in estimated clutch-initiation dates, based on back-dating with the assumption of one egg laid per day. Participants, however, only visited nests during the laying stage for 25 % of attempts of cup-nesting species and 58 % of attempts in nest boxes. In some years, in lieu of visit data, participants provided their own estimates of clutch-initiation dates and were asked "did you visit the nest during the laying period?" Those participants who answered the question provided estimates of clutch-initiation dates with no day-of-week bias, irrespective of their answer. Those who did not answer the question were more likely to estimate clutch initiation on a Saturday. Data from citizen-science projects are useful in phenological studies when temporal biases can be checked and corrected through protocols and/or analytical methods.

Manual of Procedures for Evaluation Visits under Standards for Accreditation, 1972. Revised 1977.

ERIC Educational Resources Information Center

American Library Association, Chicago, IL. Committee on Accreditation.

This fully revised manual of procedures for evaluation visits presents guidelines for site visits to library schools seeking accreditation for their programs of study. Visits to such schools provide the Committee on Accreditation with data to assist in reaching a judgment whether to grant accredited status. The area of responsibility for the…

Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

PubMed

Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

2017-03-01

To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; p<0.001] per child per year. Compared with the no KD children, children on the diet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [p<0.001]. Patients initiated on ketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

Extreme Morphologic and Venting Changes in Methane Seeps at Southern Hydrate Ridge, Cascadia Margin

NASA Astrophysics Data System (ADS)

Bigham, K.; Kelley, D. S.; Solomon, E. A.; Delaney, J. R.

2017-12-01

Two highly active methane hydrate seeps have been visited over a 7-year period as part of the construction and operation of NSF's Ocean Observatory Initiative's Regional Cable Array at Southern Hydrate Ridge. The site is located 90 km west of Newport, Oregon, at a water depth of 800 m. The seeps, Einstein's Grotto (OOI instrument deployment site) and Smokey Tavern (alternate site to the north), have been visited yearly from 2010 to 2017 with ROVs. Additionally, a digital still camera deployed from 2014 to 2017 at Einstein's Grotto, has been documenting the profound morphologic and biological changes at this site. A cabled pressure sensor, Acoustic Doppler Current Profiler, hydrophone, seismometer array, and uncabled fluid samplers have also been operational at the site for the duration of the camera's deployment. During this time, Einstein's Grotto has evolved from a gentle mound with little venting, to a vigorously bubbling pit bounded by a near vertical wall. Early on bubble emissions blew significant amounts of sediment into the water column and thick Beggiatoa mats coverd the mound. Most recently the face of the pit has collapsed, although bubble plumes are still emitted from the site. The Smokey Tavern site has undergone more extreme changes. Similar to Einstein's Grotto it was first characterized by gentle hummocks with dispersed bacterial mats. In subsequent years, it developed an extremely rugged, elongated collapsed area with vertical walls and jets of methane bubbles rising from small pits near the base of the collapse zone. Meter-across nearly sediment-free blocks of methane hydrate were exposed on the surface and in the walls of the collapse zone. In 2016, this area was unrecognizable with a much more subdued topography, and weak venting of bubbles. Exposed methane hydrate was not visible. From these observations new evolutionary models for methane seeps are being developed for Southern Hydrate Ridge.

Burden of medically attended influenza infection and cases averted by vaccination — United States, 2013/14 through 2015/16 influenza seasons

PubMed Central

Jackson, Michael L.; Phillips, C. Hallie; Benoit, Joyce; Jackson, Lisa A.; Gaglani, Manjusha; Murthy, Kempapura; McLean, Huong Q.; Belongia, Edward A.; Malosh, Ryan; Zimmerman, Richard; Flannery, Brendan

2018-01-01

Background In addition to preventing hospitalizations and deaths due to influenza, influenza vaccination programs can reduce the burden of outpatient visits for influenza. We estimated the incidence of medically-attended influenza at three geographically diverse sites in the United States, and the cases averted by vaccination, for the 2013/14 through 2015/16 influenza seasons. Methods We defined surveillance populations at three sites from the United States Influenza Vaccine Effectiveness Network. Among these populations, we identified outpatient visits laboratory-confirmed influenza via active surveillance, and identified all outpatient visits for acute respiratory illness from healthcare databases. We extrapolated the total number of outpatient visits for influenza from the proportion of surveillance visits with a positive influenza test. We combined estimates of incidence, vaccine coverage, and vaccine effectiveness to estimate outpatient visits averted by vaccination. Results Across the three sites and seasons, incidence of medically attended influenza ranged from 14 to 54 per 1,000 population. Incidence was highest in children aged 6 months to 9 years (33 to 70 per 1,000) and lowest in adults aged 18-49 years (21 to 27 per 1,000). Cases averted ranged from 9 per 1,000 vaccinees (Washington, 2014/15) to 28 per 1,000 (Wisconsin, 2013/14). Discussion Seasonal influenza epidemics cause a considerable burden of outpatient medical visits. The United States influenza vaccination program has caused meaningful reductions in outpatient visits for influenza, even in years when the vaccine is not well-matched to the dominant circulating influenza strain. PMID:29249545

A Study of Operator and Mechanic Training Needs in the Transit Industry. Volume I, Findings and Conclusions. Final Report.

ERIC Educational Resources Information Center

Henderson, Harold L.; And Others

Surveys of 188 transit properties and on-site visits were conducted to determine training needs of operators and mechanics in the urban mass transportation industry. Volume I presents findings and conclusions of the study with reference to survey methodology, site visit interviews and observations, questionnaire results, and specific…

77 FR 23764 - Comment Request for Information Collection for Site Visit Data Collection; American Recovery and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

... data will affect our ability to conduct rigorous evaluations of these grants. For example, site visits are the only way the research team can observe the training programs in operation and collect real... Development and Research, Room N-5641, Employment and Training Administration, U.S. Department of Labor, 200...

Female Faculty Members in University Chemistry Departments: Observations and Conclusions Based on Site Visits

ERIC Educational Resources Information Center

Chapman, Sally; Dixon, Felicia F.; Foster, Natalie; Kuck, Valerie J.; McCarthy, Deborah A.; Tooney, Nancy M.; Buckner, Janine P.; Nolan, Susan A.; Marzabadi, Cecilia H.

2011-01-01

Oral interviews in focus groups and written surveys were conducted with 877 men and women, including administrators, faculty members, postdoctoral associates, and graduate students, during one-day site visits to chemistry and chemical engineering departments at 28 Ph.D.-granting institutions. This report is a preliminary review of the perceptions…

Resource utilization after introduction of a standardized clinical assessment and management plan.

PubMed

Friedman, Kevin G; Rathod, Rahul H; Farias, Michael; Graham, Dionne; Powell, Andrew J; Fulton, David R; Newburger, Jane W; Colan, Steven D; Jenkins, Kathy J; Lock, James E

2010-01-01

A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs. We retrospectively reviewed resource utilization in the first 93 arterial switch operation (ASO) SCAMP patients and 186 age-matched control ASO patients. We compared diagnostic and laboratory testing obtained at the initial SCAMP clinic visit and control patient visits. To evaluate the effect of the SCAMP over time, the number of clinic visits per patient year and echocardiograms per patient year in historical control ASO patients were compared to the projected rates for ASO SCAMP participants. Cardiac magnetic resonance imaging (MRI), stress echocardiogram, and lipid profile utilization were higher in the initial SCAMP clinic visit group than in age-matched control patients. Total echocardiogram and lung scan usage were similar. Chest X-ray and exercise stress testing were obtained less in SCAMP patients. ASO SCAMP patients are projected to have 0.5 clinic visits and 0.5 echocardiograms per year. Historical control patients had more clinic visits (1.2 vs. 0.5 visits/patient year, P<.01) and a higher echocardiogram rate (0.92 vs. 0.5 echocardiograms/patient year, P<.01) Implementation of a SCAMP may initially lead to increased resource utilization, but over time resource utilization is projected to decrease.

75 FR 54296 - Information Collection; Trends in Use and Users in the Boundary Waters Canoe Area Wilderness, MN

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

.... Interview questions will cover number of visits, length of visits, and plans (if any) for future visits...-to-face, on-site interviews with visitors as they enter the System and will send mail-back survey...

Direct Molecular Detection and Genotyping of Borrelia burgdorferi from Whole Blood of Patients with Early Lyme Disease

PubMed Central

Eshoo, Mark W.; Crowder, Christopher C.; Rebman, Alison W.; Rounds, Megan A.; Matthews, Heather E.; Picuri, John M.; Soloski, Mark J.; Ecker, David J.; Schutzer, Steven E.; Aucott, John N.

2012-01-01

Direct molecular tests in blood for early Lyme disease can be insensitive due to low amount of circulating Borrelia burgdorferi DNA. To address this challenge, we have developed a sensitive strategy to both detect and genotype B. burgdorferi directly from whole blood collected during the initial patient visit. This strategy improved sensitivity by employing 1.25 mL of whole blood, a novel pre-enrichment of the entire specimen extract for Borrelia DNA prior to a multi-locus PCR and electrospray ionization mass spectrometry detection assay. We evaluated the assay on blood collected at the initial presentation from 21 endemic area patients who had both physician-diagnosed erythema migrans (EM) and positive two-tiered serology either at the initial visit or at a follow-up visit after three weeks of antibiotic therapy. Results of this DNA analysis showed detection of B. burgdorferi in 13 of 21 patients (62%). In most cases the new assay also provided the B. burgdorferi genotype. The combined results of our direct detection assay with initial physician visit serology resulted in the detection of early Lyme disease in 19 of 21 (90%) of patients at the initial visit. In 5 of 21 cases we demonstrate the ability to detect B. burgdorferi in early Lyme disease directly from whole blood specimens prior to seroconversion. PMID:22590620

Racial/ethnic differences in initiation of and engagement with addictions treatment among patients with alcohol use disorders in the veterans health administration.

PubMed

Bensley, Kara M; Harris, Alex H S; Gupta, Shalini; Rubinsky, Anna D; Jones-Webb, Rhonda; Glass, Joseph E; Williams, Emily C

2017-02-01

Specialty addictions treatment can improve outcomes for patients with alcohol use disorders (AUD). Thus, initiation of and engagement with specialty addictions treatment are considered quality care for patients with AUD. Previous studies have demonstrated racial/ethnic differences in alcohol-related care but whether differences exist in initiation of and engagement with specialty addictions treatment among patients with clinically recognized alcohol use disorders is unknown. We investigated racial/ethnic variation in initiation of and engagement with specialty addictions treatment in a national sample of Black, Hispanic, and White patients with clinically recognized alcohol use disorders (AUD) from the US Veterans Health Administration (VA). National VA data were extracted for all Black, Hispanic, and White patients with a diagnosed AUD during fiscal year 2012. Mixed effects regression models estimated the odds of two measures of initiation (an initial visit within 180days of diagnosis; and initiation defined consistent with Healthcare Effectiveness Data and Information Set (HEDIS) as a documented visit ≤14days after index visit or inpatient admission), and three established measures of treatment engagement (≥3 visits within first month after initiation; ≥2 visits in each of the first 3months after initiation; and ≥2 visits within 30days of HEDIS initiation) for Black and Hispanic relative to White patients after adjustment for facility- and patient-level characteristics. Among 302,406 patients with AUD, 30% (90,879) initiated treatment within 180days of diagnosis (38% Black, 32% Hispanic, and 27% White). Black patients were more likely to initiate treatment than Whites for both measures of initiation [odds ratio (OR) for initiation: 1.4, 95% confidence interval (CI) 1.4-1.4; OR for HEDIS initiation: 1.1, 95% CI: 1.1-1.1]. Hispanic patients were more likely than White patients to initiate treatment within 180days (OR: 1.2, 95% CI 1.2-1.3) but HEDIS initiation did not differ between Hispanic and White patients. Engagement results varied depending on the measure but was more likely for Black patients relative to White for all measures (OR for engagement in first month: 1.1, 95% CI: 1.0-1.1; OR for engagement in first three months: 1.2, 95% CI: 1.1-1.2; OR for HEDIS measure: 1.1, 95% CI: 1.0-1.1), and did not differ between Hispanic and White patients. After accounting for facility- and patient-level characteristics, Black and Hispanic patients with AUD were more likely than Whites to initiate specialty addictions treatment, and Black patients were more likely than Whites to engage. Research is needed to understand underlying mechanisms and whether differences in initiation of and engagement with care influence health outcomes. Published by Elsevier Inc.

Bait Preference of Free-Ranging Feral Swine for Delivery of a Novel Toxicant

PubMed Central

Snow, Nathan P.; Halseth, Joseph M.; Lavelle, Michael J.; Hanson, Thomas E.; Blass, Chad R.; Foster, Justin A.; Humphrys, Simon T.; Staples, Linton D.; Hewitt, David G.; VerCauteren, Kurt C.

2016-01-01

Invasive feral swine (Sus scrofa) cause extensive damage to agricultural and wildlife resources throughout the United States. Development of sodium nitrite as a new, orally delivered toxicant is underway to provide an additional tool to curtail growth and expansion of feral swine populations. A micro-encapsulation coating around sodium nitrite is used to minimize detection by feral swine and maximize stability for the reactive molecule. To maximize uptake of this toxicant by feral swine, development a bait matrix is needed to 1) protect the micro-encapsulation coating so that sodium nitrite remains undetectable to feral swine, 2) achieve a high degree of acceptance by feral swine, and 3) be minimally appealing to non-target species. With these purposes, a field evaluation at 88 sites in south-central Texas was conducted using remote cameras to evaluate preferences by feral swine for several oil-based bait matrices including uncolored peanut paste, black-colored peanut paste, and peanut-based slurry mixed onto whole-kernel corn. These placebo baits were compared to a reference food, whole-kernel corn, known to be readily taken by feral swine (i.e., control). The amount of bait consumed by feral swine was also estimated using remote cameras and grid boards at 5 additional sites. On initial exposure, feral swine showed reduced visitations to the uncolored peanut paste and peanut slurry treatments. This reduced visitation subsided by the end of the treatment period, suggesting that feral swine needed time to accept these bait types. The black-colored peanut paste was visited equally to the control throughout the study, and enough of this matrix was consumed to deliver lethal doses of micro-encapsulated sodium nitrite to most feral swine during 1–2 feeding events. None of the treatment matrices reduced visitations by nontarget species, but feral swine dominated visitations for all matrices. It was concluded that black-colored peanut paste achieved satisfactory preference and consumption by feral swine, and no discernable preference by non-target species, compared to the other treatments. PMID:26812148

[The social marketing models and policy advices for HIV rapid testing initiated by non-govermental organization].

PubMed

Liu, H; Cai, L P; Xue, H; Zhao, Y; Wu, D; Zhang, D P; Yin, W Y; Sun, J P

2016-10-06

Currently, a growing number of community-based organizations are providing rapid HIV testing service in various forms, some people with specific needs also purchase HIV rapid test papers through online sales channels, those imply that the demand of HIV self-test is in increasing year by year.In this paper, aims to understand the current situation of HIV rapid test led by CBOs and the approach, strategies and results of social marketing by means of expert interviews and site visits. Hope to illustrate the current situation, and make recommendations for future work.

Sensory coding of nest-site value in honeybee swarms.

PubMed

Seeley, Thomas D; Visscher, P Kirk

2008-12-01

This study investigates the first stage of the decision-making process of a honeybee swarm as it chooses a nest site: how a scout bee codes the value of a potential nest site in the waggle dances she produces to represent this site. We presented honeybee swarms with a two-alternative choice between a high-value site and a medium-value site and recorded the behavior of individually identifiable scout bees as they reported on these two alternatives. We found that bees performed equally lengthy inspections at the two sites, but that, on the swarm cluster, they performed more dance circuits per bee for the high-value site. We also found that there was much individual-level noise in the coding of site value, but that there were clear population-level differences in total dance circuits produced for the two sites. The first bee to find a site had a high probability of reporting the site with a waggle dance, regardless of its value. This discoverer-should-dance phenomenon may help ensure that a swarm gives attention to all discovered sites. There was rapid decay in the dance response; the number of dance circuits produced by a bee after visiting a site decreased linearly over sequential visits, and eventually each bee ceased visiting her site. This decay, or ;leakage', in the accumulation of bees at a site improves a swarm's decision-making ability by helping a swarm avoid making fast-decision errors.

Geo-Statistical Approach to Estimating Asteroid Exploration Parameters

NASA Technical Reports Server (NTRS)

Lincoln, William; Smith, Jeffrey H.; Weisbin, Charles

2011-01-01

NASA's vision for space exploration calls for a human visit to a near earth asteroid (NEA). Potential human operations at an asteroid include exploring a number of sites and analyzing and collecting multiple surface samples at each site. In this paper two approaches to formulation and scheduling of human exploration activities are compared given uncertain information regarding the asteroid prior to visit. In the first approach a probability model was applied to determine best estimates of mission duration and exploration activities consistent with exploration goals and existing prior data about the expected aggregate terrain information. These estimates were compared to a second approach or baseline plan where activities were constrained to fit within an assumed mission duration. The results compare the number of sites visited, number of samples analyzed per site, and the probability of achieving mission goals related to surface characterization for both cases.

Catalog of known hot springs and thermal place names for Honduras

DOE Office of Scientific and Technical Information (OSTI.GOV)

Finch, R.C.

Thermal place names were compiled from all 1:50,000 topographic quadrangle maps for the Republic of Honduras as of July 1986, from other published maps, and from several sources of unpublished data. Known hot spring sites include those visited by Empresa Nacional de Energia Electrica (Honduras) geologists, sites visited by Los Alamos geologists in 1985, and other sites known to R.C. Finch. The number of known hot spring sites in Honduras with temperatures >30/sup 0/C is 125. In addition, 56 thermal sites are suspected on the basis of thermal place names. The total number of geothermal sites, known and suspected, ismore » 181.« less

Retention strategies and predictors of attrition in an urban pediatric asthma study.

PubMed

Zook, Patricia M; Jordan, Carolina; Adams, Bernadette; Visness, Cynthia M; Walter, Michelle; Pollenz, Kathryn; Logan, Jennette; Tesson, Elizabeth; Smartt, Ernestine; Chen, Amy; D'Agostino, John; Gern, James E

2010-08-01

The Urban Environment and Childhood Asthma (URECA) study is a multicenter prospective birth cohort study designed to examine factors related to the development of childhood asthma and allergies in an inner-city population. The retention of these participants has been challenging due to high mobility, inconsistent phone service, custody issues, and stressful life situations. In this article, we describe the specific retention challenges we encountered during the first 2 years of follow-up in URECA and the strategies we utilized to address them. We also examine how selected maternal characteristics and other factors are related to retention and missed study visits. Strategies implemented to engage participants included: collecting updated and alternative contact information, after-hours phone calls to participants, culturally competent staff, flexible study event scheduling, clinic visit transportation, quarterly newsletters, retention events, drop-in home visits, and cell phone reimbursements. An internally developed web-based data management system enabled close monitoring by site teams and the coordinating center. The rate of deactivations was calculated using survival analysis. Characteristics of active and deactivated participants were compared using the chi-squared test with a Cochran-Mantel - Haenszel adjustment for study site. The proportion of missed visits of the total expected in the first 2 years was calculated and compared by family characteristics using an ANOVA model or a trend test controlling for study site. All analyses were performed using SAS version 9.1 (Cary, NC). The 2-year retention rate was 89%. Participation in the first study event predicted subsequent engagement in study activities. Mothers who did not complete the first visit were more likely to miss future events (46.1% vs. 8.9%, p<0.0001) and to be deactivated (38.5% vs. 4.5%, p<0.0001). Mothers under 18 years of age were more likely to leave the study compared to older mothers (22.7% vs. 10.1%, p = 0.02). Also, mothers who were married missed fewer events than those not married (8.8% vs. 15.6%, p = 0.01). In addition, deactivations were more common when the child had entered daycare by 3 months of age (10.9% vs. 3.6%, p = 0.05). The URECA population is predominantly minority, thus our findings might not be generalizable to other populations. Furthermore, we may not be able to observe the effects that might exist in a more diverse population. For example, 86% of the mothers are unmarried, making it difficult to reliably examine the effect of marital status. In research, successfully engaging and retaining participants is essential for achieving the study objectives. Identifying factors related to missed visits and deactivations are the initial step in recognizing the potential at-risk participants and can enable the design of targeted strategies to retain participants.

[Panorama of self-management initiatives in Spain].

PubMed

Nuño-Solinis, Roberto; Rodríguez-Pereira, Carolina; Piñera-Elorriaga, Koldo; Zaballa-González, Irune; Bikandi-Irazabal, Javier

2013-01-01

To describe the current situation of self-management initiatives in Spain. We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords «paciente experto» (expert patient), «paciente activo» (active patient) and «apoyo al autocuidado» (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks. Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems. In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: A process evaluation of a mentorship programme.

PubMed

Erlandsson, Kerstin; Doraiswamy, Sathyanarayanan; Wallin, Lars; Bogren, Malin

2018-03-01

When a midwifery diploma-level programme was introduced in 2010 in Bangladesh, only a few nursing faculty staff members had received midwifery diploma-level. The consequences were an inconsistency in interpretation and implementation of the midwifery curriculum in the midwifery programme. To ensure that midwifery faculty staff members were adequately prepared to deliver the national midwifery curriculum, a mentorship programme was developed. The aim of this study was to examine feasibility and adherence to a mentorship programme among 19 midwifery faculty staff members who were lecturing the three years midwifery diploma-level programme at ten institutes/colleges in Bangladesh. The mentorship programme was evaluated using a process evaluation framework: (implementation, context, mechanisms of impact and outcomes). An online and face-to-face blended mentorship programme delivered by Swedish midwifery faculty staff members was found to be feasible, and it motivated the faculty staff members in Bangladesh both to deliver the national midwifery diploma curriculum as well as to carry out supportive supervision for midwifery students in clinical placement. First, the Swedish midwifery faculty staff members visited Bangladesh and provided a two-days on-site visit prior to the initiation of the online part of the mentorship programme. The second on-site visit was five-days long and took place at the end of the programme, that being six to eight months from the first visit. Building on the faculty staff members' response to feasibility and adherence to the mentorship programme, the findings indicate opportunities for future scale-up to all institutes/collages providing midwifery education in Bangladesh. It has been proposed that a blended online and face-to-face mentorship programme may be a means to improving national midwifery programmes in countries where midwifery has only recently been introduced. Copyright © 2018. Published by Elsevier Ltd.

Establishment of sentinel sampling sites to monitor changes in water and sediment quality and biota related to visitor use at Lake Powell, Arizona and Utah, 2004-2006

USGS Publications Warehouse

Hart, Robert J.; Taylor, Howard E.; Anderson, G.M.

2012-01-01

Twenty sentinel sampling sites were established and sampled during 2004–06 at Lake Powell, Arizona and Utah, by the U.S. Geological Survey and the National Park Service—Glen Canyon National Recreation Area. The sentinel sampling sites provide sampling locations on Lake Powell, the Nation’s second largest reservoir that can be visited and sampled repeatedly over time to monitor changes in water and sediment quality and also biota. The sites were established in response to an Environmental Impact Statement that addressed the use of personal watercraft on Lake Powell. The use of personal watercraft can potentially introduce hydrocarbons and other contaminants and are of concern to the health of visitors and aquatic habitats of these environments. Data from this initial sampling period (2004–06) include (1) discrete measurements of water temperature, specific conductance, pH, and water clarity; (2) major ions, nutrients, and organic carbon; (3) trace elements including rare earths; (4) organic compounds including oil and grease, total petroleum hydrocarbons, and volatile organic compounds; (5) polycyclic aromatic hydrocarbons in lakebed sediments; and (6) continuous depth profile measurements of water temperature, specific conductance, pH, dissolved oxygen, and turbidity. Also, the National Park Service-Glen Canyon National Recreation Area collected bacteria samples during this initial sampling period.

Exploring Multilevel Factors for Family Engagement in Home Visiting Across Two National Models.

PubMed

Latimore, Amanda D; Burrell, Lori; Crowne, Sarah; Ojo, Kristen; Cluxton-Keller, Fallon; Gustin, Sunday; Kruse, Lakota; Hellman, Daniela; Scott, Lenore; Riordan, Annette; Duggan, Anne

2017-07-01

The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.

Evaluation of constipation by abdominal radiographs correlated with treatment outcome in children with dysfunctional elimination.

PubMed

Allen, Heidi A; Austin, J Christopher; Boyt, Margaret A; Hawtrey, Charles E; Cooper, Christopher S

2007-05-01

To analyze the utility of assessing degree of constipation by abdominal radiograph (KUB) in relation to symptoms and urodynamic data in children with dysfunctional elimination. A retrospective review of children with concomitant constipation and daytime incontinence was performed. Inclusion required at least two consecutive visits with KUB and noninvasive uroflowmetry. Patients were excluded for anticholinergic medication use or neurogenic or anatomic abnormalities. Rectal fecal quantification and presence of stool throughout the colon was assessed on KUB and categorized as "empty," "normal amount of stool," or "fecal distention of rectum (FDR)." Twenty-six patients met inclusion requirements (6 boys, 20 girls; average age, 7.7 +/- 2.2 years). The average time between the initial and subsequent visit was 12.5 +/- 7.8 weeks. Initial KUB revealed FDR in 17. No statistical significance was found between FDR on initial or final KUB and outcome of wetting symptoms, nor could a relationship between FDR uroflow parameters at either visit be demonstrated. No correlation between any uroflowmetry parameter and the presence of FDR at the initial or final visits could be demonstrated. Similarly, no statistical significance between FDR on final or initial KUB and outcome of wetting symptoms was established.

What counts for ants? How return behaviour and food search of Cataglyphis ants are modified by variations in food quantity and experience.

PubMed

Bolek, Siegfried; Wittlinger, Matthias; Wolf, Harald

2012-09-15

When finding more food than one is able to carry home, should one come back to the site to exploit it further? This question is crucial for central place foragers that provide for a home place with brood or nest mates. The benefit of returning has to be weighed against the chance of finding food elsewhere and the resources available. Desert ants Cataglyphis fortis are well-studied examples when it comes to navigating back and forth between their nest and a foraging area, due to their primary reliance on path integration in the open and featureless desert habitat. The ants use path integration not only for a safe return from their foraging trips but also for future returns to plentiful feeding sites. The direction from the nest that has previously yielded food items is preferred for future foraging trips, a phenomenon termed sector fidelity. What prompts the ants to return to a particular site, and how faithfully they search for that place, has not been well studied. We examine the evaluation of food sources in channel experiments by varying both the number of food items in a feeder and the number of visits to the feeder before testing search distances of foragers returning to the feeding site. Ants exhibited more focused searches for plentiful food sources than for sources with only few food items upon their first return visit. After several successful visits, the ants always searched thoroughly for the food source, independent of the amount of food offered. Thus, desert ants consider both food abundance and reliability of food encounter, with corroborative learning of reliability gradually overriding the initial preference for plentiful feeders. The density of food items appears to be used by the ants as a proxy for food abundance. On the level of our analysis, the searches performed in the experimental channels are indistinguishable from those performed in the open desert terrain. The present results not only demonstrate how otherwise well-studied desert ants assess yield and experience with reliability of food sources, but also establish a model system for future study of how itemised food sources are exploited.

Uptake, Outcomes, and Costs of Antenatal, Well-Baby, and Prevention of Mother-to-Child Transmission of HIV Services under Routine Care Conditions in Zambia

PubMed Central

Scott, Callie A.; Iyer, Hari S.; Lembela Bwalya, Deophine; Bweupe, Maximillian; Rosen, Sydney B.; Scott, Nancy; Larson, Bruce A.

2013-01-01

Background Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT) in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A. Methods We enrolled 99 HIV-infected/HIV-exposed (index) mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison) mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider’s perspective. Results Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART) based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included. Conclusions HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in increased service delivery costs in the short term. PMID:24015245

From Compliance to Engagement: Lessons Learned from Applying a Transformational Approach to Addressing NCATE Standard 4-Diversity

ERIC Educational Resources Information Center

Shockley, Robert; Hardman, John; Watlington, Eliah; Heydet-Kirsch, Patricia

2011-01-01

In March 2007, Florida Atlantic University hosted a joint NCATE/Florida Department of Education site visit. This successful site visit and following Unit Accreditation Board report resulted in full NCATE accreditation with only one weakness cited. The weakness related to the implementation of the College's assessment system at the Advanced Levels.…

Determinates of clustering across America's national parks: An application of the Gini coefficients

Treesearch

R. Geoffrey Lacher; Matthew T.J. Brownlee

2012-01-01

The changes in the clustering of visitation across National Park Service (NPS) sites have not been well documented or widely studied. This paper investigates the changes in the dispersion of visitation across NPS sites with the Gini coefficient, a popular measure of inequality used primarily in the field of economics. To calculate the degree of clustering nationally,...

Increasing adult Tdap vaccination rates by vaccinating infant caregivers in the pediatric office.

PubMed

Camenga, Deepa R; Kyanko, Kelly; Stepczynski, Jadwiga; Flaherty-Hewitt, Maryellen; Curry, Leslie; Sewell, Diana; Smart, Cameale; Rosenthal, Marjorie S

2012-01-01

To increase adult caregiver Tdap vaccination rates by offering Tdap vaccine during infant well-child visits. We developed a pilot vaccine initiative wherein pediatricians offered Tdap vaccine to mothers and non-mother caregivers attending the 2-week well-child visit at a hospital-based clinic serving predominantly low-income families. We evaluated this initiative by asking mothers and caregivers to participate in a survey after the 2-week visit to determine self-reported Tdap vaccination status, demographics, and the source of their adult primary care. Seventy (69%) participants received the Tdap vaccine during the newborns' 2-week well-child visit. Forty-six percent of the infants' 152 adult household contacts were vaccinated through this initiative. Of those mothers and caregivers, more caregivers reported not having insurance (38% vs 15%, P < .001), and no routine medical care (23% vs 8%, P = .007). Through this pilot initiative, we vaccinated 69% of mothers and non-mother caregivers presenting to the 2-week well-child visit. A large proportion of caregivers did not receive routine medical care or have insurance, which suggests that they otherwise may have poor access to the vaccine. Tdap vaccination in the pediatric office represents a substantial opportunity to increase vaccination rates. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Getting acquainted: Actor and partner effects of attachment and temperament on young children's peer behavior.

PubMed

McElwain, Nancy L; Holland, Ashley S; Engle, Jennifer M; Ogolsky, Brian G

2014-06-01

Guided by a dyadic view of children's peer behavior, this study assessed actor and partner effects of attachment security and temperament on young children's behavior with an unfamiliar peer. At 33 months of age, child-mother attachment security was assessed via a modified Strange Situation procedure, and parents reported on child temperament (anger proneness and social fearfulness). At 39 months, same-sex children (N = 114, 58 girls) were randomly paired, and child dyads were observed during 3 laboratory visits occurring over 1 month. Actor-partner interdependence models, tested via multilevel modeling, revealed that actor security, partner anger proneness, and acquaintanceship (e.g., initial vs. later visits) combined to predict child behavior. Actor security predicted more responsiveness to the new peer partner at the initial visit, regardless of partner anger proneness. Actor security continued to predict responsiveness at the 2nd and 3rd visits when partner anger was low, but these associations were nonsignificant when partner anger was high. Actor security also predicted a less controlling assertiveness style at the initial visit when partner anger proneness was high, yet this association was nonsignificant by the final visit. The findings shed light on the dynamic nature of young children's peer behavior and indicate that attachment security is related to behavior in expected ways during initial interactions with a new peer, but may change as children become acquainted. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Space-time clusters for early detection of grizzly bear predation.

PubMed

Kermish-Wells, Joseph; Massolo, Alessandro; Stenhouse, Gordon B; Larsen, Terrence A; Musiani, Marco

2018-01-01

Accurate detection and classification of predation events is important to determine predation and consumption rates by predators. However, obtaining this information for large predators is constrained by the speed at which carcasses disappear and the cost of field data collection. To accurately detect predation events, researchers have used GPS collar technology combined with targeted site visits. However, kill sites are often investigated well after the predation event due to limited data retrieval options on GPS collars (VHF or UHF downloading) and to ensure crew safety when working with large predators. This can lead to missing information from small-prey (including young ungulates) kill sites due to scavenging and general site deterioration (e.g., vegetation growth). We used a space-time permutation scan statistic (STPSS) clustering method (SaTScan) to detect predation events of grizzly bears ( Ursus arctos ) fitted with satellite transmitting GPS collars. We used generalized linear mixed models to verify predation events and the size of carcasses using spatiotemporal characteristics as predictors. STPSS uses a probability model to compare expected cluster size (space and time) with the observed size. We applied this method retrospectively to data from 2006 to 2007 to compare our method to random GPS site selection. In 2013-2014, we applied our detection method to visit sites one week after their occupation. Both datasets were collected in the same study area. Our approach detected 23 of 27 predation sites verified by visiting 464 random grizzly bear locations in 2006-2007, 187 of which were within space-time clusters and 277 outside. Predation site detection increased by 2.75 times (54 predation events of 335 visited clusters) using 2013-2014 data. Our GLMMs showed that cluster size and duration predicted predation events and carcass size with high sensitivity (0.72 and 0.94, respectively). Coupling GPS satellite technology with clusters using a program based on space-time probability models allows for prompt visits to predation sites. This enables accurate identification of the carcass size and increases fieldwork efficiency in predation studies.

Predicting Patients' Expectations of Hospital Chaplains: A Multisite Survey

PubMed Central

Piderman, Katherine M.; Marek, Dean V.; Jenkins, Sarah M.; Johnson, Mary E.; Buryska, James F.; Shanafelt, Tait D.; O'Bryan, Floyd G.; Hansen, Patrick D.; Howick, Priscilla H.; Durland, Heidi L.; Lackore, Kandace A.; Lovejoy, Laura A.; Mueller, Paul S.

2010-01-01

OBJECTIVE: To identify patient expectations regarding chaplain visitation, characteristics of patients who want to be visited by a chaplain, and what patients deem important when a chaplain visits. PARTICIPANTS AND METHODS: Three weeks after discharge, 4500 eligible medical and surgical patients from hospitals in Minnesota, Arizona, and Florida were surveyed by mail to collect demographic information and expectations regarding chaplain visitation. The survey was conducted during the following time periods: Minnesota participants, April 6 until April 25, 2006; Arizona participants, October 16, 2008, until January 13, 2009; Florida participants, October 16, 2008, until January 20, 2009. Categorical variables were summarized with frequencies or percentages. Associations between responses and site were examined using χ2 tests. Multivariate logistic regression was used to assess the likelihood of wanting chaplain visitation on the basis of patient demographics and perceived importance of reasons for chaplain visitation. RESULTS: About one-third of those surveyed responded from each site. Most were male, married, aged 56 years or older, and Protestant or Catholic. Of the respondents, nearly 70% reported wanting chaplain visitation, 43% were visited, and 81% indicated that visitation was important. The strongest predictor of wanting chaplain visitation was denomination vs no indicated religious affiliation (Catholic: odds ratio [OR], 8.11; 95% confidence interval [CI], 4.49-14.64; P<.001; evangelical Protestant: OR, 4.95; 95% CI, 2.74-8.91; P<.001; mainline Protestant: OR, 4.34; 95% CI, 2.58-7.29; P<.001). Being female was a weak predictor (OR, 1.48; 95% CI, 1.05-2.09; P=.03), as was site. Among the reasons given by respondents for wanting chaplain visitation, the most important were that chaplains served as reminders of God's care and presence (OR, 4.37; 95% CI, 2.58-7.40; P<.001) and that they provided prayer or scripture reading (OR, 2.54; 95% CI, 1.53-4.20; P<.001). CONCLUSION: The results of this study suggest the importance medical and surgical patients place on being visited by a chaplain while they are hospitalized. Those who valued chaplains because they reminded them of God's care and presence and/or because they prayed or read scripture with them were more likely to desire a visit. Our results also suggest that being religiously affiliated is a very strong predictor of wanting chaplain visitation. PMID:21037043

Medical Services at an International Summer Camp Event Under Hot and Humid Conditions: Experiences From the 23rd World Scout Jamboree, Japan.

PubMed

Watanabe, Takemasa; Mizutani, Keiji; Iwai, Toshiyasu; Nakashima, Hiroshi

2018-06-01

The 23rd World Scout Jamboree (WSJ) was a 10-day summer camp held in Japan in 2015 under hot and humid conditions. The attendees comprised 33,628 people from 155 countries and territories. The aim of this study was to examine the provision of medical services under such conditions and to identify preventive factors for major diseases among long-term campers. Data were obtained from WSJ medical center records and examined to clarify the effects of age, sex, and period on visit frequencies and rates. Medical records from 3215 patients were examined. Daytime temperatures were 31.5±3.2°C and relative humidity was 61±13% (mean±SD). The initial visit rates among scouts and adults were 72.2 and 77.2 per 1000 persons, respectively. No significant age difference was observed in the initial visit rate; however, it was significantly higher among female patients than male patients. Significant differences were also seen in the adjusted odds ratios by age, sex, and period for disease distributions of initial visit frequencies. In addition, a higher initial visit frequency for heat strain-related diseases was seen among the scouts. Initial visit frequencies for heatstroke and/or dehydration increased just after opening day and persisted until closing day. Our findings suggest the importance of taking effective countermeasures against heat strain, fatigue, and unsanitary conditions at the WSJ. Medical services staff should take attendees' age, sex, and period into consideration to prevent heat strain-related diseases during such camps under hot and humid conditions. Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

The Development of Long-Term Adverse Health Effects in Oil Spill Cleanup Workers of the Deepwater Horizon Offshore Drilling Rig Disaster.

PubMed

D'Andrea, Mark A; Reddy, G Kesava

2018-01-01

The purpose of this study was to assess the long-term adverse health effects of the 2010 Deepwater Horizon Gulf oil spill exposure in workers who participated in its cleanup work. Medical charts of both the oil spill exposed and unexposed subjects were reviewed. The changes in the white blood cells, platelets, hemoglobin, hematocrit, blood urea nitrogen, creatinine, alkaline phosphatase (ALP), aspartate amino transferase (AST), alanine amino transferase (ALT) levels, as well as their pulmonary and cardiac functions were evaluated. Medical records from 88 subjects (oil spill cleanup workers, n  = 44 and unexposed, n  = 44) were reviewed during initial and 7 years follow up visits after the disaster occurred. Compared with the unexposed subjects, oil spill exposed subjects had significantly reduced platelet counts (×10 3 /µL) at their initial (254.1 ± 46.7 versus 289.7 ± 63.7, P  = 0.000) and follow-up (242.9 ± 55.6 versus 278.4 ± 67.6, P  = 0.000) visits compared with the unexposed subjects (254.6 ± 51.9 versus 289.7 ± 63.7, P  = 0.008). The hemoglobin and hematocrit levels were increased significantly both at their initial and follow-up visits in the oil spill exposed subjects compared to the unexposed subjects. Similarly, the oil spill exposed subjects had significantly increased ALP, AST, and ALT levels at their initial and follow-up visits compared with those of the unexposed subjects. Illness symptoms that were reported during their initial visit still persisted at their 7-year follow-up visit. Notably, at their 7-year follow-up visit, most of the oil spill exposed subjects had also developed chronic rhinosinusitis and reactive airway dysfunction syndrome as new symptoms that were not reported during their initial visit. Additionally, more abnormalities in pulmonary and cardiac functions were also seen in the oil spill exposed subjects. This long-term follow-up study demonstrates that those people involved in the oil spill cleanup operations experiences persistent alterations or worsening of their hematological, hepatic, pulmonary, and cardiac functions. In addition, these subjects experienced prolonged or worsening illness symptoms even 7 years after their exposure to the oil spill.

Assessing site performance in the Altair study, a multinational clinical trial.

PubMed

Berthon-Jones, Nisha; Courtney-Vega, Kymme; Donaldson, Anna; Haskelberg, Hila; Emery, Sean; Puls, Rebekah

2015-04-08

Reviewing clinical trial site performance identifies strategies to control outcomes. Performance across 5 geographical regions (36 sites across Asia, Australia, Europe, North America and Latin America) was investigated in a study that randomised 322 HIV-infected individuals. Regional performance was compared using descriptive analysis for time to site opening, recruitment, quality of data and laboratory samples. Follow-up consisted of 10 visits (96 weeks), electronic data collection (EDC) within 7 days of a visit and serious adverse events (SAEs) reported within 24 hours of site awareness. Median days to site opening was 250 (188 to 266), ranging from 177 (158 to 200) (Australia) to 265 (205 to 270) (Europe). Median days to ethics and regulatory approval was 182 (120 to 241) and 218 (182 to 341) days, respectively. Within regions, time to approval ranged from 187 (91 to 205) days (Australia) to 276 (175 to 384) days (Europe). Time to first randomisation ranged from 282 (250 to 313) days (Australia) to 426 (420 to 433) days (North America). Recruitment was lower than forecasted in Asia, Australia, Europe and North America at 89%, 77%, 91% and 43%, respectively. The converse was true in Latin America where despite ethics, regulatory and contractual delays, recruitment was 104% of predicted. Median days to EDC was 7 (3 to 16), ranging from 3 (1 to 16) (Asia) to 13 (8 to 14) days (North America). Median days for initial SAE submission to sponsor was 6 (2 to 20), ranging from 4 (2 to 18) (Latin America) to 24 (5 to 46) days (Australia). Sites took longer to submit final reports, overall median of 28 (7 to 91) days, ranging from 7 days (Australia) to 67 (23 to 103) days (Europe). Population availability and time to ethics and regulatory approvals influence recruitment; therefore accurate feasibility assessments are critical to site selection. Time to ethics and regulatory approval may not limit site inclusion if compensated by rapid recruitment. Identifying potential delays and methods for reduction can decrease time and costs for sponsors. Clinical Trials.Gov identifier: NCT00335322. Date of registration: 8 June 2006.

Nurse-Initiated Telephone Follow Up after Ureteroscopic Stone Surgery.

PubMed

Tackitt, Helen M; Eaton, Samuel H; Lentz, Aaron C

2016-01-01

This article presents findings of a quality improvement (QI) project using the DMAIC (define, measure, analyze, improve, and control) model designed to decrease the rate of emergency department (ED) visits and nurse advice line calls after ureteroscopic stone surgery. Results indicated that nurse-initiated follow- up phone calls can decrease ED visits.

Maryland Department of Natural Resources Camp Initiatives Program

Treesearch

Kelly R. Schaeffer

1992-01-01

The Camp Initiatives Program was developed to increase revenue and visitation through a series of policy changes. During the summer of 1990, the program was evaluated at six Maryland State Parks and found to increase revenue and visitation by 3% and 16%, respectively. More intensive marketing efforts, implementation of a computerized reservation system, increased...

Social networking among upper extremity patients.

PubMed

Rozental, Tamara D; George, Tina M; Chacko, Aron T

2010-05-01

Despite their rising popularity, the health care profession has been slow to embrace social networking sites. These are Web-based initiatives, designed to bring people with common interests or activities under a common umbrella. The purpose of this study is to evaluate social networking patterns among upper extremity patients. A total of 742 anonymous questionnaires were distributed among upper extremity outpatients, with a 62% response rate (462 were completed). Demographic characteristics (gender, age, level of education, employment, type of health insurance, and income stratification) were defined, and data on computer ownership and frequency of social networking use were collected. Social network users and nonusers were compared according to their demographic and socioeconomic characteristics. Our patient cohort consisted of 450 patients. Of those 450 patients, 418 had a high school education or higher, and 293 reported a college or graduate degree. The majority of patients (282) were employed at the time of the survey, and income was evenly distributed among U.S. Census Bureau quintiles. A total of 349 patients reported computer ownership, and 170 reported using social networking sites. When compared to nonusers, social networking users were younger (p<.001), more educated (p<.001), and more likely to be employed (p = .013). Users also had higher income levels (p=0.028) and had high rates of computer ownership (p<.001). Multivariate regression revealed that younger age (p<.001), computer ownership (p<.001), and higher education (p<.001) were independent predictors of social networking use. Most users (n = 114) regularly visit a single site. Facebook was the most popular site visited (n=142), followed by MySpace (n=28) and Twitter (n=16). Of the 450 upper extremity patients in our sample, 170 use social networking sites. Younger age, higher level of education, and computer ownership were associated with social networking use. Physicians should consider expanding their use of social networking sites to reach their online patient populations. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Buzz in Paris: flower production and plant-pollinator interactions in plants from contrasted urban and rural origins.

PubMed

Desaegher, James; Nadot, Sophie; Dajoz, Isabelle; Colas, Bruno

2017-12-01

Urbanisation, associated with habitat fragmentation, affects pollinator communities and insect foraging behaviour. These biotic changes are likely to select for modified traits in insect-pollinated plants from urban populations compared to rural populations. To test this hypothesis, we conducted an experiment involving four plant species commonly found in both urban and rural landscapes of the Île-de-France region (France): Cymbalaria muralis, Geranium robertianum, Geum urbanum and Prunella vulgaris. The four species were grown in four urban and four rural experimental sites in 2015. For each species and each experimental site, plants were grown from seeds collected in five urban and five rural locations. During flowering, we observed flower production and insect-flower interactions during 14 weeks and tested for the effects of experimental site location and plant origin on flower production and on the number of floral visits. The study species had various flower morphology and hence were visited by different floral visitors. The effect of experimental sites and seed origin also varied among study species. We found that (1) insect visits on P. vulgaris were more frequent in rural than in urban sites; (2) for C. muralis, the slope relating the number of pollinator visits to the number of flowers per individual was steeper in urban versus rural sites, suggesting a greater benefit in allocating resources to flower production in urban conditions; (3) as a likely consequence, C. muralis tended to produce more flowers in plants from urban versus rural origin.

Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina.

PubMed

Eastman, Alexander L; Rinnert, Kathy J; Nemeth, Ira R; Fowler, Raymond L; Minei, Joseph P

2007-08-01

Hospital surge capacity has been advocated to accommodate large increases in demand for healthcare; however, existing urban trauma centers and emergency departments (TC/EDs) face barriers to providing timely care even at baseline patient volumes. The purpose of this study is to describe how alternate-site medical surge capacity absorbed large patient volumes while minimizing impact on routine TC/ED operations immediately after Hurricane Katrina. From September 1 to 16, 2005, an alternate site for medical care was established. Using an off-site space, the Dallas Convention Center Medical Unit (DCCMU) was established to meet the increased demand for care. Data were collected and compared with TC/ED patient volumes to assess impact on existing facilities. During the study period, 23,231 persons displaced by Hurricane Katrina were registered to receive evacuee services in the City of Dallas, Texas. From those displaced, 10,367 visits for emergent or urgent healthcare were seen at the DCCMU. The mean number of daily visits (mean +/- SD) to the DCCMU was 619 +/- 301 visits with a peak on day 3 (n = 1,125). No patients died, 3.2% (n = 257) were observed in the DCCMU, and only 2.9% (n = 236) required transport to a TC/ED. During the same period, the mean number of TC/ED visits at the region's primary provider of indigent care (Hospital 1) was 346 +/- 36 visits. Using historical data from Hospital 1 during the same period of time (341 +/- 41), there was no significant difference in the mean number of TC/ED visits from the previous year (p = 0.26). Alternate-site medical surge capacity provides for safe and effective delivery of care to a large influx of patients seeking urgent and emergent care. This protects the integrity of existing public hospital TC/ED infrastructure and ongoing operations.

Reproduction of Amorpha canescens (Fabaceae) and diversity of its bee community in a fragmented landscape.

PubMed

Slagle, Malinda W; Hendrix, Stephen D

2009-10-01

Loss of insect pollinators due to habitat fragmentation often results in negative effects on plant reproduction, but few studies have simultaneously examined variation in the bee community, site characteristics and plant community characteristics to evaluate their relative effects on plant reproduction in a fragmented habitat. We examined the reproduction of a common tallgrass prairie forb, Amorpha canescens (Fabaceae), in large (>40 ha) and small (<2 ha) prairie remnants in Iowa and Minnesota in relation to the diversity and abundance of its bee visitors, plant population size, and species density of the forb flowering community. We found significant positive effects of the diversity of bees visiting A. canescens on percent fruit set at a site in both years of the study and in 2002 an additional significant positive effect of plant species density. Abundance of bees visiting A. canescens had a significant positive effect on percent fruit set in 2002, but was only marginally significant in 2003. In 2003 but not 2002, the plant species density at the sites had a significant negative effect on the diversity and abundance of bees visiting A. canescens, indicating community-level characteristics can influence the bee community visiting any one species. Site size, a common predictor of plant reproduction in fragmented habitats did not contribute to any models of fruit set and was only marginally related to bee diversity one year. Andrena quintilis, one of the three oligolectic bee species associated with A. canescens, was abundant at all sites, suggesting it has not been significantly affected by fragmentation. Our results show that the diversity of bees visiting A. canescens is important for maintaining fruit set and that bee visitation is still sufficient for at least some fruit set in all populations, suggesting these small remnants act as floral resource oases for bees in landscapes often dominated by agriculture.

Healthcare utilization and costs for patients initiating Dabigatran or Warfarin.

PubMed

Reynolds, Shannon L; Ghate, Sameer R; Sheer, Richard; Gandhi, Pranav K; Moretz, Chad; Wang, Cheng; Sander, Stephen; Costantino, Mary E; Annavarapu, Srinivas; Andrews, George

2017-06-21

Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population. A retrospective matched-cohort study was conducted using data from administrative health care claims during the study period 01/01/2010-12/31/2012. Cox regression analyses were used to compare all-cause risk of first hospitalizations and emergency room (ER) visits. Medical, pharmacy, and total costs per-patient-per-month (PPPM) were compared between dabigatran and warfarin users. A total of 1110 patients initiated on dabigatran were propensity score-matched with corresponding patients initiated on warfarin. The mean number of hospitalizations (0.92 vs. 1.13, P = 0.012), ER visits (1.32 vs. 1.56, P < 0.01), office visits (21.43 vs. 29.41; P < 0.01), and outpatient visits (10.86 vs. 22.02; P < 0.01) were lower among dabigatran compared to warfarin users. Patients initiated on dabigatran had significantly lower risk of first all-cause ER visits [hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.73-0.98] compared to those initiated on warfarin. Adjusted mean pharmacy costs PPPM were significantly greater for dabigatran users ($510 vs. $250, P < 0.001); however, mean medical costs PPPM ($1912 vs. $1956, P = 0.55) and mean total costs PPPM ($2381 vs. $2183, P = 0.10) were not significantly different compared to warfarin users. Dabigatran users had significantly lower HCRU compared to warfarin users. In addition, dabigatran users had lower risk of all-cause ER visits. Despite higher pharmacy costs, the two cohorts did not differ significantly in medical or total all-cause costs.

Site Team Review: Petition for Degree-Granting Authority by National Defense University, School for Information Resources Management (iCollege)

ERIC Educational Resources Information Center

US Department of Education, 2010

2010-01-01

On November 3, 2010, a site team from the National Advisory Committee on Institutional Quality and Integrity (NACIQI) and the U.S. Department of Education conducted a visit to National Defense University's (University) School for Information Resources Management (IRMC or iCollege) at Ft. McNair in Washington, DC. The purpose of the visit was to…

Visitor behavior and resource impacts at Cadillac Mountain, Acadia National Park

Treesearch

Rex Turner; Wilbur LaPage

2002-01-01

The summit of Cadillac Mt., located in Maine's Acadia National Park, can be reached via three hiking trails and a scenic auto road. This site attracts over an estimated two million visitors per year. Most of this visitation is concentrated from Memorial Day to Labor Day. The sensitive sub-alpine nature of the site, coupled with high visitation rates, has created a...

Environmental restoration and waste management: Robotics technology development program: Robotics 5-year program plan. [Contains glossary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This plan covers robotics Research, Development, Demonstration, Testing, activities in the Program for the next five years. These activities range from bench-scale R D to fullscale hot demonstrations at DOE sites. This plan outlines applications of existing technology to near-term needs, the development and application of enhanced technology for longer-term needs, and an initiation of advanced technology development to meet those needs beyond the five-year plan. The objective of the Robotic Technology Development (RTDP) is to develop and apply robotics technologies that will enable Environmental Restoration and Waste Management operations at DOE sites to be safer, faster and cheaper. Fivemore » priority DOE sites were visited in March 1990 to identify needs for robotics technology in ER WM operations. This 5-Year Program Plan for the RTDP detailed annual plans for robotics technology development based on identified needs. This 5-Year Program Plan discusses the overall approach to be adopted by the RTDP to aggressively develop robotics technology and contains discussions of the Program Management Plan, Site Visit and Needs Summary, Approach to Needs-Directed Technical Development, Application-Specific Technical Development, and Cross-Cutting and Advanced Technology. Integrating application-specific ER WM needs, the current state of robotics technology, and the potential benefits (in terms of faster, safer, and cheaper) of new technology, the Plan develops application-specific road maps for robotics RDDT E for the period FY 1991 through FY 1995. In addition, the Plan identifies areas where longer-term research in robotics will have a high payoff in the 5- to 20-year time frame. 12 figs.« less

Evaluation of international case studies within 'Live.Learn.Laugh.': a unique global public-private partnership to promote oral health.

PubMed

Dugdill, Lindsey; Pine, Cynthia M

2011-08-01

The partnership between the Féderation Dentaire International (FDI), and Unilever Oral Care, aims to raise awareness of oral health globally; to enable FDI member associations to promote oral health; and to increase the visibility of the FDI and authority of Unilever oral care brands worldwide. Country Projects between National Dental Associations (NDAs), the member associations of FDI, and Unilever Oral Care local companies have been established as a key strand of the partnership. This paper reports on the evaluation of an in-depth sample of Country Projects (n=5) to determine their potential to impact on oral health. Five country sites were selected as being indicative of different programme delivery types. Each site received a two-day visit during Spring-Summer 2009, which enabled the evaluators to audit what was delivered in practice compared with the original written project briefs and to undertake interviews of study site staff. 39 projects in 36 countries have been initiated. In those examined by site visits, clear evidence was found of capacity building to deliver oral health. In some countries, widespread population reach had been prioritised. Effectiveness of partnership working varied depending on the strength of the relationship between the NDA and local Unilever Oral Care representatives and alignment with national marketing strategy. The quality of internal evaluation varied considerably. Over a million people had been reached directly by Country Projects and this public-private partnership has made a successful start. To move towards improving oral health rather than only awareness raising; future Country Projects would benefit from being limited to certain evidence-based intervention designs, and using an agreed core indicator set in order to allow cross-country comparison of intervention outcomes. © 2011 FDI World Dental Federation.

Capuchins, space, time and memory: an experimental test of what-where-when memory in wild monkeys

PubMed Central

2016-01-01

There is considerable controversy about the existence, extent and adaptive value of integrated multimodal memory in non-human animals. Building on prior results showing that wild capuchin monkeys in Argentina appear to recall both the location and amount of food at patches they had previously visited, I tested whether they also track and use elapsed time as a basis for decisions about which feeding patches to visit. I presented them with an experimental array of eight feeding sites, at each of which food rewards increased with increasing elapsed time since the previous visit, similar to the pattern of ripe fruit accumulation in natural feeding trees. Over the course of 68 days, comprising two distinct renewal rate treatments, one group repeatedly visited sites in the feeding array, generating 212 valid choices between sites. Comparison of observations against simulated movements and multinomial statistical models shows that the monkeys' choices were most consistent with dynamic memory for elapsed time specific to each of the eight sites. Thus, it appears that capuchin monkeys possess and use integrated memories of prior food patch use, including where the patch is relative to their current location, how productive the patch is and how long it has been since they last visited the patch. Natural selection to use such integrated memories in foraging tasks may provide an ecologically relevant basis for the evolution of complex intelligence in primates. PMID:27708145

Using MSD prevention for cultural change in mining: Queensland Government/Anglo Coal Industry partnership.

PubMed

Tilbury, Trudy; Sanderson, Liz

2012-01-01

Queensland Mining has a strong focus on safety performance, but risk management of health, including Musculoskeletal Disorders (MSDs) continues to have a lower priority. The reliance on individual screening of workers and lower level approaches such as manual handling training is part of the coal mining 'culture'. Initiatives such as the New South Wales and Queensland Mining joint project to develop good practice guidance for mining has allowed for a more consistent message on participatory ergonomics and prevention of MSD. An evidence based practice approach, including the introduction of participatory ergonomics and safe design principles, was proposed to Anglo American Coal operations in Queensland. The project consisted of a skills analysis of current health personnel, design of a facilitated participatory ergonomics training program, site visits to identify good practice and champions, and a graduated mentoring program for health personnel. Early results demonstrate a number of sites are benefiting from site taskforces with a focus on positive performance outcomes.

Preventing alcohol and drug exposed births in Washington state: intervention findings from three parent-child assistance program sites.

PubMed

Grant, Therese M; Ernst, Cara C; Streissguth, Ann; Stark, Kenneth

2005-01-01

Home visitation interventions show promise for helping at-risk mothers, yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women. This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program, a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy. Pretest-posttest comparison was made across three sites: the original demonstration (1991-1995), and the Seattle and Tacoma replications (1996-2003). In the original demonstration, the client group performed significantly better than controls. Compared to the original demonstration, outcomes at replication sites were maintained (for regular use of contraception and use of reliable method; and number of subsequent deliveries), or improved (for alcohol/drug treatment completed; alcohol/ drug abstinence; subsequent delivery unexposed to alcohol/drugs). Improved outcomes at replication sites are not attributable to enrolling lower-risk women. Public policies and programs initiated over the study period may have had a positive effect on outcomes. Study findings suggest that this community-based intervention model is effective over time and across venues.

Smoot Cosmology Group

Science.gov Websites

Visitors How to get to Lawrence Berkeley Lab Site Access New and Current Members Page For Visiting Scholars Who Will Use Computers Or Networks Procedures for visiting scholars Opportunities Mail: Lawrence

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment.

PubMed

Alonso-Marsden, Shelley; Dodge, Kenneth A; O'Donnell, Karen J; Murphy, Robert A; Sato, Jeannine M; Christopoulos, Christina

2013-08-01

As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. Findings suggest that while higher demographic risk increases families' initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Influence of attractants on behavior of screwworms (Diptera: Calliphoridae) in a tropical wet forest in Costa Rica.

PubMed

Parker, F D; Welch, J B

1991-10-01

In a mark-release-recapture study, sheep wounds and rotted liver were used as attractants to study movements of the screwworm fly, Cochliomyia hominivorax (Coquerel), in a Costa Rican tropical wet forest in the wet season. When sites were monitored for less than 1 h, liver attracted between 3 and 12.2 times more flies of both sexes than did wounds, but proportionately fewer gravid and parous females. Only 24.6% of females marked at liver sites were recaptured; seldom (3.1%) did they visit sheep wounds. Females originally marked at sheep wounds remained at the study site longer, visited both sheep and liver sites, and greater than 50% were recaptured. Some females were observed for 16 d and one laid four clutches of eggs. Only 8% of the marked males were recaptured and none was recaptured less than 2 d later. Only a small proportion of the adult screwworms at a locality visited wounds on sentinel sheep; the majority of the adults were transient.

Evaluation of nutria (Myocastor coypus) detection methods in Maryland, USA

USGS Publications Warehouse

Pepper, Margaret A.; Herrmann, Valentine; Hines, James; Nichols, James D.; Kendrot, Stephen R

2017-01-01

Nutria (Myocaster coypus), invasive, semi-aquatic rodents native to South America, were introduced into Maryland near Blackwater National Wildlife Refuge (BNWR) in 1943. Irruptive population growth, expansion, and destructive feeding habits resulted in the destruction of thousands of acres of emergent marshes at and surrounding BNWR. In 2002, a partnership of federal, state and private entities initiated an eradication campaign to protect remaining wetlands from further damage and facilitate the restoration of coastal wetlands throughout the Chesapeake Bay region. Program staff removed nearly 14,000 nutria from five infested watersheds in a systematic trapping and hunting program between 2002 and 2014. As part of ongoing surveillance activities, the Chesapeake Bay Nutria Eradication Project uses a variety of tools to detect and remove nutria. Project staff developed a floating raft, or monitoring platform, to determine site occupancy. These platforms are placed along waterways and checked periodically for evidence of nutria visitation. We evaluated the effectiveness of monitoring platforms and three associated detection methods: hair snares, presence of scat, and trail cameras. Our objectives were to (1) determine if platform placement on land or water influenced nutria visitation rates, (2) determine if the presence of hair snares influenced visitation rates, and (3) determine method-specific detection probabilities. Our analyses indicated that platforms placed on land were 1.5–3.0 times more likely to be visited than those placed in water and that platforms without snares were an estimated 1.7–3.7 times more likely to be visited than those with snares. Although the presence of snares appears to have discouraged visitation, seasonal variation may confound interpretation of these results. Scat was the least effective method of determining nutria visitation, while hair snares were as effective as cameras. Estimated detection probabilities provided by occupancy modeling were 0.73 for hair snares, 0.71 for cameras and 0.40 for scat. We recommend the use of hair snares on monitoring platforms as they are the most cost-effective and reliable detection method available at this time. Future research should focus on determining the cause for the observed decrease in nutria visits after snares were applied.

Patient and Community-Level Socio-Demographic Characteristics Associated with Emergency Department Visits for Childhood Injury; A Retrospective Analysis of Data from the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project 2004–2008

PubMed Central

Macy, Michelle L.; Zonfrillo, Mark R.; Cook, Lawrence J.; Funai, Tomohiko; Goldstick, Jason; Stanley, Rachel M.; Chamberlain, James M.; Cunningham, Rebecca M.; Lipton, Robert; Alpern, Elizabeth R.

2015-01-01

Objective To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level socio-demographic characteristics. Study design Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004–2008. Home addresses were geocoded to determine census block group and associated socio-demographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between socio-demographic characteristics and admission or transfer among injury-related ED visits. Results Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833,676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty. Conclusions Pediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Socio-demographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries. PMID:26141551

Determinants of doctors' decisions to inquire about sexual dysfunction in Malaysian primary care settings.

PubMed

Tong, Seng Fah; Low, Wah Yun; Ismail, Shaiful Bahari; Trevena, Lyndal; Wilcock, Simon

2013-12-01

Perceptions of how receptive men are to sexual health inquiry may affect Malaysian primary care doctors' decisions to initiate such a discussion with their male patients. This paper quantifies the impact of doctors' perceptions of men's receptivity on male sexual health inquiry. Sexual health inquiry is one of the five areas in a study on determinants of offering preventive health checks to Malaysian men. This was a cross sectional survey among primary care doctors in Malaysia. The questionnaire was based on an empirical model defining the determinants of primary care doctors' intention to offer health checks. The questionnaire measured: (I) perceived receptivity of male patients to sexual health inquiry; (II) doctors' attitudes towards the importance of sexual health inquiries; (III) perceived competence and, (IV) perceived external barriers. The outcome variable was doctors' intention in asking about sexual dysfunction in three different contexts (minor complaints visits, follow-up visits and health checks visits). All items were measured on the Likert scale of 1 to 5 (strongly disagree/unlikely to strongly agree/likely) and internally validated. 198 doctors participated (response rate 70.4%). Female primary care doctors constituted 54.5%. 78% of respondents were unlikely to ask about sexual dysfunction in visits for minor complaints to their male patients, 43.6% in follow up visits and 28.2% in health checks visits. In ordinal regression analysis, positive perception of men's receptivity to sexual health inquiry significantly predicted the doctors' intention in asking sexual dysfunction in all three contexts; i.e., minor complaints visits (P=0.013), follow-up visits (P<0.0001) and health checks visits (P=0.002). Perceived competence in sexual health inquiry predicted their intention in the follow-up visits (P=0.006) and health checks visits (P<0.001). Lower cost to health checks only predicted their intention in the follow-up visits (P=0.010). Whilst sexual health inquiry should be initiated in an appropriate context, 'perceived receptivity' to sexual health inquiry significantly affected doctors' intention in initiating sexual health inquiry to their male patients. Malaysian men's health may be substantially improved by strategies that assist doctors to identify patient 'receptivity'.

Public health assessment for USAF Langley Air Force Base and NASA-Langley Research Center, Hampton, York County, Virginia, Region 3. CERCLIS Number VA4570024477 and CERCLIS Number VA2800005033; Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-12-29

Langley Air Force Base (Langley AFB) and the National Aeronautics and Space Administration Langley Research Center (NASA LaRC) are located adjacent to each other on a small coastal basin of the Back River, a tidal estuary of the Chesapeake Bay. The Agency for Toxic Substances and Disease Registry (ATSDR) visited the sites in 1994 and 1997. During the 1994 visit, several potential public health concerns were raised. (1) the potential for contaminants to migrate to fish and shellfish (which might be ingested by local residents) in the adjoining estuary, (2) surface soil contamination at a former playground at Langley AFBmore » Site OT-06, (3) surface soil contamination and physical hazards at Langley AFB Sites OT-25 and FT-41, where children or youths might trespass, (4) the use of Langley AFB Site LF-12 for storing fill material, and (5) lead-contaminated soil in the housing areas at Langley AFB. ATSDR made recommendations for several of these sites. During the 1997 visit, ATSDR identified one additional potential concern at NASA LaRC Site 4, an open storage site where surface soil has not been characterized.« less

The Remote Brief Intervention and Referral to Treatment Model: Development, Functionality, Acceptability, and Feasibility

PubMed Central

Boudreaux, Edwin D.; Haskins, Brianna; Harralson, Tina; Bernstein, Edward

2015-01-01

Background Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model. Methods Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1–3. (5) Modified Patient Choice: choice of models 1–2, Electronic Referral offered if 1–2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates. Results Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ2 (4, N=50) = 34.8, p<0.001. Conclusions The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable. PMID:26297297

The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility.

PubMed

Boudreaux, Edwin D; Haskins, Brianna; Harralson, Tina; Bernstein, Edward

2015-10-01

Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model. Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1-3. (5) Modified Patient Choice: choice of models 1-2, Electronic Referral offered if 1-2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates. Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ(2) (4, N=50)=34.8, p<0.001. The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maheras, Steven J.; Best, Ralph E.; Ross, Steven B.

A preliminary evaluation of removing spent nuclear fuel (SNF) from 13 shutdown nuclear power reactor sites was conducted. At these shutdown sites the nuclear power reactors have been permanently shut down and the sites have been decommissioned or are undergoing decommissioning. The shutdown sites were Maine Yankee, Yankee Rowe, Connecticut Yankee, Humboldt Bay, Big Rock Point, Rancho Seco, Trojan, La Crosse, Zion, Crystal River, Kewaunee, San Onofre, and Vermont Yankee. The evaluation was divided into four components: (1) characterization of the SNF and greater-than-Class C low-level radioactive waste (GTCC waste) inventory, (2) a description of the on-site infrastructure and conditionsmore » relevant to transportation of SNF and GTCC waste, (3) an evaluation of the near-site transportation infrastructure and experience relevant to shipping transportation casks containing SNF and GTCC waste, including identification of gaps in information, and (4) an evaluation of the actions necessary to prepare for and remove SNF and GTCC waste. Every site was found to have at least one off-site transportation mode option for removing its SNF and GTCC waste; some have multiple options. Experience removing large components during reactor decommissioning provided an important source of information used to identify the transportation mode options for the sites. Especially important in conducting the evaluation were site visits, through which information was obtained that would not have been available otherwise. Extensive photographs taken during the site visits proved to be particularly useful in documenting the current conditions at or near the sites. It is expected that additional site visits will be conducted to add to the information presented in the evaluation.« less

The emergence of retail-based clinics in the United States: early observations.

PubMed

Laws, Margaret; Scott, Mary Kate

2008-01-01

Retail-based clinics have proliferated rapidly in the past two years, with approximately 1,000 sites in thirty-seven states representing almost three million cumulative visits. Clinic operators have evolved from a dispersed group of privately financed concerns to a concentrated, largely corporate-owned group. A major development has been the move to large-scale acceptance of insurance, deviating from the initial cash-pay model. Consumers' acceptance and the fact that the clinics appear to increase access for both the uninsured and the insured has encouraged providers and policymakers to consider this approach to basic, acute care while seeking a better understanding of these clinics.

Camping impact management on the Appalachian National Scenic Trail

USGS Publications Warehouse

Marion, J.L.

2003-01-01

This report addresses the management of overnight use and associated impacts along the Appalachian National Scenic Trail (A.T.). This effort was initiated in response to agency and Appalachian Trail Conference (ATC) management concerns regarding the resource and social impacts of increasing overnight visitation, particularly in high use areas. Report findings and recommendations are primarily based on series of on-site investigations at 17 problem areas selected by A.T. clubs and ATC staff. However, the report?s recommendations also draw on an examination of relevant A.T. legislative, agency, and organization guidance and visitor impact management knowledge derived from research and management experience.

Demographics and microbiology of otorrhea through patent tubes failing ototopical and/or oral antibiotic therapy.

PubMed

Fishman, Inessa; Sykes, Kevin J; Horvat, Rebecca; Selvarangan, Rangaraj; Newland, Jason; Wei, Julie L

2011-12-01

Posttympanostomy tube otorrhea (PTTO) results in significant health care cost and decreased satisfaction with care. The authors reviewed PTTO failing initial ototopical and/or oral antibiotic therapy and microbiology/susceptibility data from cultures. Case series with chart review. A community university satellite ambulatory clinic and the outpatient clinic of a children's hospital. Review of 202 patients with 228 discrete episodes of culture-positive otorrhea from January 2004 to January 2009. PTTO occurred an average of 13 months after tube placement. Median otorrhea duration was 21 days (mean, 42 days). A mean of 1.6 visits (range, 1-6) to the pediatric otolaryngology office was required for PTTO resolution. Ototopical therapy was reported used in 198 of 228 (87%) episodes of otorrhea prior to pediatric otolaryngology visit. Nearly 50% of patients were prescribed at least 1 or more courses of systemic antibiotics. Staphylococcus aureus accounted for 52% of the organisms cultured, with 57% methicillin-resistant S aureus (MRSA). S aureus resistance to clindamycin was high (49%) and resistance to levofloxacin was low (1.8%). MRSA was 68% clindamycin resistant, much higher than both ours and the children's hospital's clindamycin resistance rate of MRSA cultured from all other body sites. PTTO that presents as having failed ototopical and/or oral antibiotics most commonly consists of S aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa. MRSA is highly prevalent in this population. It is not necessary to culture PTTO that presents to an otolaryngology office, as resistance to levofloxacin was only 1.8%. It is unclear why the same fluoroquinolone ototopical therapy that failed initially is often successful in treating PTTO after otolaryngologist visit.

42 CFR 405.2470 - Reports and maintenance of records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... initial reporting period, the clinic or center must submit an estimate of budgeted costs and visits for..., including the allowable costs actually incurred for the period and the actual number of visits for rural... estimated costs and visits for rural health clinic services or Federally qualified health center services...

42 CFR 405.2470 - Reports and maintenance of records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... initial reporting period, the clinic or center must submit an estimate of budgeted costs and visits for..., including the allowable costs actually incurred for the period and the actual number of visits for rural... estimated costs and visits for rural health clinic services or Federally qualified health center services...

42 CFR 405.2470 - Reports and maintenance of records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... initial reporting period, the clinic or center must submit an estimate of budgeted costs and visits for..., including the allowable costs actually incurred for the period and the actual number of visits for rural... estimated costs and visits for rural health clinic services or Federally qualified health center services...

Defense Technology and Trade Initiative: Ashton Carter’s Strategy in India

DTIC Science & Technology

2016-03-01

Defense AT&L: March-April 2016 26 Defense Technology and Trade Initiative Ashton Carter’s Strategy in India Amit K. Maitra Maitra is a founding...officials to work on initiatives that were set in motion during President Obama’s January 2015 visit to India . During that visit, Obama and Indian Prime...engine technology. Modi, who has a broad vision of India as a global power, has a noticeably great affinity for the United States. Also, in the wake

Inexpensive automated paging system for use at remote research sites

USGS Publications Warehouse

Sargent, S.L.; Dey, W.S.; Keefer, D.A.

1998-01-01

The use of a flow-activated automatic sampler at a remote research site required personnel to periodically visit the site to collect samples and reset the automatic sampler. To reduce site visits, a cellular telephone was modified for activation by a datalogger. The purpose of this study was to demonstrate the use and benefit of the modified telephone. Both the power switch and the speed-dial button on the telephone were bypassed and wired to a relay driver. The datalogger was programmed to compare values of a monitored environmental parameter with a target value. When the target value was reached or exceeded, the datalogger pulsed a relay driver, activating power to the telephone. A separate relay activated the speed dial, dialing the number of a tone-only pager. The use of this system has saved time and reduced travel costs by reducing the number of trips to the site, without the loss of any data.The use of a flow-activated automatic sampler at a remote research site required personnel to periodically visit the site to collect samples and reset the automatic sampler. To reduce site visits, a cellular telephone was modified for activation by a datalogger. The purpose of this study was to demonstrate the use and benefit of the modified telephone. Both the power switch and the speed-dial button on the telephone were bypassed and wired to a relay driver. The datalogger was programmed to compare values of a monitored environmental parameter with a target value. When the target value was reached or exceeded, the datalogger pulsed a relay driver, activating power to the telephone. A separate relay activated the speed dial, dialing the number of a tone-only pager. The use of this system has saved time and reduced travel costs by reducing the number of trips to the site, without the loss of any data.

Implementation of Policy, Systems, and Environmental Community-Based Interventions for Cardiovascular Health Through a National Not-for-Profit: A Multiple Case Study.

PubMed

Garney, Whitney R; Szucs, Leigh E; Primm, Kristin; King Hahn, Laura; Garcia, Kristen M; Martin, Emily; McLeroy, Kenneth

2018-05-01

In 2014, the Centers for Disease Control and Prevention funded the American Heart Association to implement policy, systems, and environment-focused strategies targeting access to healthy food and beverages, physical activity, and smoke-free environments. To understand factors affecting implementation and variations in success across sites, evaluators conducted a multiple case study. Based on past literature, community sites were categorized as capacity-building or implementation-ready, for comparison. A sample of six communities were selected using a systematic selection tool. Through site visits, evaluators conducted interviews with program staff and community partners and assessed action plans. Evaluators identified important implications for nationally coordinated community-based prevention programming. Differences in implementation varied by the communities' readiness, with the most notable differences in how they planned activities and defined success. Existing partner relationships (or lack thereof) played a significant role, regardless of the American Heart Association's existing presence within the communities, in the progression of initiatives and the differences observed among phases. Last, goals in capacity-building sites were tied to organizational goals while goals in implementation-ready sites were more incremental with increased community influence and buy-in. Using national organizations as a mechanism to carry out large-scale community-based prevention work is a viable option that provides coordinated, wide-scale implementation without sacrificing a community's priorities or input. In funding future initiatives, the presence of relationships and the time needed to cultivate such relationships should be accounted for in the planning and implementation processes, as well as both local and national expectations.

Long-term results of oxybutynin use in treating facial hyperhidrosis.

PubMed

Wolosker, Nelson; Teivelis, Marcelo Passos; Krutman, Mariana; Campbell, Taiz Pereira Dozono de Almeida; Kauffman, Paulo; Campos, José Ribas de; Puech-Leão, Pedro

2014-01-01

Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear. To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months. 61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites. Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites. Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.

Long-term results of oxybutynin use in treating facial hyperhidrosis*

PubMed Central

Wolosker, Nelson; Teivelis, Marcelo Passos; Krutman, Mariana; Campbell, Taiz Pereira Dozono de Almeida; Kauffman, Paulo; de Campos, José Ribas; Puech-Leão, Pedro

2014-01-01

BACKGROUND Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months. METHODS 61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites. RESULTS Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites. CONCLUSION Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites. PMID:25387496

Defining quality metrics and improving safety and outcome in allergy care.

PubMed

Lee, Stella; Stachler, Robert J; Ferguson, Berrylin J

2014-04-01

The delivery of allergy immunotherapy in the otolaryngology office is variable and lacks standardization. Quality metrics encompasses the measurement of factors associated with good patient-centered care. These factors have yet to be defined in the delivery of allergy immunotherapy. We developed and applied quality metrics to 6 allergy practices affiliated with an academic otolaryngic allergy center. This work was conducted at a tertiary academic center providing care to over 1500 patients. We evaluated methods and variability between 6 sites. Tracking of errors and anaphylaxis was initiated across all sites. A nationwide survey of academic and private allergists was used to collect data on current practice and use of quality metrics. The most common types of errors recorded were patient identification errors (n = 4), followed by vial mixing errors (n = 3), and dosing errors (n = 2). There were 7 episodes of anaphylaxis of which 2 were secondary to dosing errors for a rate of 0.01% or 1 in every 10,000 injection visits/year. Site visits showed that 86% of key safety measures were followed. Analysis of nationwide survey responses revealed that quality metrics are still not well defined by either medical or otolaryngic allergy practices. Academic practices were statistically more likely to use quality metrics (p = 0.021) and perform systems reviews and audits in comparison to private practices (p = 0.005). Quality metrics in allergy delivery can help improve safety and quality care. These metrics need to be further defined by otolaryngic allergists in the changing health care environment. © 2014 ARS-AAOA, LLC.

Improvement in Context: Exploring Aims, Improvement Priorities, and Environmental Considerations in a National Sample of Programs Using "Small Data".

PubMed

Philibert, Ingrid; Beernink, John H; Bush, Barbara H; Caniano, Donna A; Chow, Andrea; Coyle, John J; Gilhooly, Joseph; Kraybill, Donald E; Larson, David; Moran, Sarah; Nace, Mary Catherine; Robertson, William W; Rubin, Judith D; Sanford, Theodore

2017-12-01

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) transitioned into a new accreditation system to reduce burden, focus on outcomes, and promote innovation and improvement. One component is a self-study that includes aims, an environmental assessment, and setting improvement priorities. The ACGME initiated voluntary site visits following the self-study. We explored common themes in program aims and assessment of their environment. Using grounded theory, inductive and deductive qualitative methods, and truth grounding, we analyzed data from voluntary site visits of 396 core and subspecialty programs between June 2015 and September 2017, with a focus on common themes. We report common themes for aims and the dimensions of the environmental assessment. Themes for strengths include a collegial, supportive learning environment; responsive leaders; and experiences that prepare residents for unsupervised practice. Improvement priorities encompass low learner engagement and "content mismatch" in didactic education, balancing education and service at a time of growing clinical volumes, and improving the utility of assessment systems. Common opportunities encompass collaborations that improve education, involving alumni and harnessing technology to enrich education, while threats include an unsustainable effort for many program leaders, clinical pressures on faculty, and loss of external sites important for education. Linked dimensions of the environmental assessment suggest benefit in a growing focus on learners, and approaches to ensure a humanistic learning environment that allows for growth, self-determination, and inclusion. The findings highlight actionable themes for the environmental assessment. We discuss implications for programs, institutions, and the ACGME.

Clinical Costs of Colorectal Cancer Screening in 5 Federally Funded Demonstration Programs

PubMed Central

Tangka, Florence K. L.; Subramanian, Sujha; Beebe, Maggie C.; Hoover, Sonja; Royalty, Janet; Seeff, Laura C.

2016-01-01

BACKGROUND The Centers for Disease Control and Prevention initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer (CRC) screening program for underserved populations in the United States. The authors of this report assessed the clinical costs incurred at each of the 5 participating sites during the demonstration period. METHODS By using data on payments to providers by each of the 5 CRCSDP sites, the authors estimated costs for specific clinical services and overall clinical costs for each of the 2 CRC screening methods used by the sites: colonoscopy and fecal occult blood test (FOBT). RESULTS Among CRCSDP clients who were at average risk for CRC and for whom complete cost data were available, 2131 were screened by FOBT, and 1888 were screened by colonoscopy. The total average clinical cost per individual screened by FOBT (including costs for screening, diagnosis, initial surveillance, office visits, and associated clinical services averaged across all individuals who received screening FOBT) ranged from $48 in Nebraska to $149 in Greater Seattle. This compared with an average clinical cost per individual for all services related to the colonoscopy screening ranging from $654 in St. Louis to $1600 in Baltimore City. CONCLUSIONS Variations in how sites contracted with providers and in the services provided through CRCSDP affected the cost of clinical services and the complexity of collecting cost data. Health officials may find these data useful in program planning and budgeting. PMID:23868481

Transmission of Mycobacterium tuberculosis through casual contact with an infectious case.

PubMed

Golub, J E; Cronin, W A; Obasanjo, O O; Coggin, W; Moore, K; Pope, D S; Thompson, D; Sterling, T R; Harrington, S; Bishai, W R; Chaisson, R E

2001-10-08

An ongoing restriction fragment length polymorphism study of Mycobacterium tuberculosis isolates from tuberculosis cases showed an identical 12-band IS6110 pattern unique to 3 unrelated patients (Patients A-C) diagnosed as having tuberculosis within a 9-month period. In an attempt to identify epidemiologic links between the 3 patients, we performed site visits to the retail business work site of patient A and conducted detailed interviews with all 3 patients and their contacts. Patient B had visited patient A's work site 3 times during patient A's infectious period, spending no more than 15 minutes each time. Patient C visited patient A's work site on 6 to 10 occasions during this period for no more than 45 minutes at any one time. There were no other epidemiologic links between these 3 cases other than the contact at the store. Contact investigation identified 4 tuberculin skin test conversions among 8 (50%) of patient A's coworkers, 6 positive tests among 15 household contacts (40%), and 8 positive tests among 16 identified customers who were casual contacts (50%). Patient B and patient C were most likely infected by patient A during one of their brief visits to patient A's work site. These data demonstrate that some tuberculosis is spread through casual contact not normally pursued in traditional contact investigations and that, in certain situations, M tuberculosis can be transmitted despite minimal duration of exposure. In addition, this outbreak emphasizes the importance of DNA fingerprinting data for identifying unusual transmission in unexpected settings.

A multicenter study of oral health behavior among adult subjects from three South American cities.

PubMed

Gómez, Mariel Viviana; Toledo, Andrés; Carvajal, Paola; Gomes, Sabrina Carvalho; Costa, Ricardo Santos Araújo; Solanes, Fernando; Oppermann, Rui Vicente; Rösing, Cassiano Kuchenbecker; Gamonal, Jorge; Romanelli, Hugo

2018-01-01

The aims of this study were to describe the self-reported oral hygiene habits, dental visit frequency, and gingival bleeding perception in adult populations from three South American cities, and also to assess the association of these variables with sociodemographic data and with the clinical presence of plaque and gingival inflammation. Five-hundred and fifty adult subjects from each city (Porto Alegre, Brazil; Tucumán, Argentina; Santiago, Chile) received full mouth examinations to determine visible plaque and gingival index. A structured questionnaire on demographics, habits, attitudes and knowledge of oral health was also administered. The data were analyzed according to dental visit frequency, toothbrushing frequency, interproximal tooth cleaning frequency, subjects' perception of gum bleeding, and proportion of subject sites with VP and bleeding sites. Analysis of the association among the variables was performed using either a chi-square test or Fischer's exact test. Toothbrushing twice a day or more was reported by 84.2% of the subjects, but only 17.7% reported daily interdental cleaning, and 60.2% reported visiting a dental clinic only in an emergency. Only 2.97% had no bleeding sites, whereas 33.7% had 50% or more bleeding sites. Regular interdental self-cleaning and a dental visit every 3-6 months was associated with less plaque and less gingival bleeding. More than 12 years of education was associated with healthier habits, less bleeding and plaque scores. In conclusion, the oral health behavior of South American adult subjects from these cities is below the international recommendations, especially in relation to interdental cleaning and regular dental visits.

Quarterly Performance/Technical Report of the National Marrow Donor Program

DTIC Science & Technology

2010-11-05

care. IIBA. Task 1: Period 8 Activity: Expand Network Co=unications Extended the Business to Business ( B2B ) Services to support the new alleles...exterior glass. • Site visit was conducted at the NMDP operated donor center in Philadelphia (August 12,2010) 0 At these site visits the Business ...Continuity Planner reviews the Business Continuity Action Guide with staff to better prepare each location for responding to incidents that interrupt

Telecare for diabetes, CHF or COPD: effect on quality of life, hospital use and costs. A randomised controlled trial and qualitative evaluation.

PubMed

Kenealy, Timothy W; Parsons, Matthew J G; Rouse, A Paul B; Doughty, Robert N; Sheridan, Nicolette F; Hindmarsh, Jennifer K Harré; Masson, Sarah C; Rea, Harry H

2015-01-01

To assess the effect of telecare on health related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals. Patients were randomly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station. Patients had congestive heart failure (Site A), chronic obstructive pulmonary disease (Site B), or any long-term condition, mostly diabetes (Site C). Site C contributed only intervention patients - they considered a usual care option to be unethical. The study took place in New Zealand between September 2010 and February 2012, and lasted 3 to 6 months for each patient. The primary outcome was health-related quality of life (SF36). Data on experiences were collected by individual and group interviews and by questionnaire. There were 171 patients (98 intervention, 73 control). Quality of life, self-efficacy and disease-specific measures did not change significantly, while anxiety and depression both decreased significantly with the intervention. Hospital admissions, days in hospital, emergency department visits, outpatient visits and costs did not differ significantly between the groups. Patients at all sites were universally positive. Many felt safer and more cared-for, and said that they and their family had learned more about managing their condition. Staff could all see potential benefits of telecare, and, after some initial technical problems, many staff felt that telecare enabled them to effectively monitor more patients. Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes. Telecare led to patients and families taking a more active role in self-management. It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data, especially feelings of safety and being cared-for. Australian New Zealand Clinical Trials Registry ACTRN12610000269033.

Beyond Web 2.0 … and Beyond the Semantic Web

NASA Astrophysics Data System (ADS)

Bénel, Aurélien; Zhou, Chao; Cahier, Jean-Pierre

Tim O'Reilly, the famous technology book publisher, changed the life of many of us when he coined the name "Web 2.0" (O' Reilly 2005). Our research topics suddenly became subjects for open discussion in various cultural formats such as radio and TV, while at the same time they became part of an inappropriate marketing discourse according to several scientific reviewers. Indeed Tim O'Reilly's initial thoughts were about economic consequence, since it was about the resurrection of the Web after the bursting of the dot-com bubble. Some opponents of the concept do not think the term should be used at all since it is underpinned by no technological revolution. In contrast, we think that there was a paradigm shift when several sites based on user-generated content became some of the most visited Web sites and massive adoption of that kind is worthy of researchers' attention.

The expert site visitor chairperson: supportive, effective, efficient.

PubMed

Wawrzynski, Mary; Davidhizar, Ruth

2004-01-01

In much of nursing academe the words "self-study" and "accreditation site visit" are enough to squeeze the coronary arteries of nurse administrators and faculty. Such words conjure up images of months of labor intensive work, anxiety and concerns that all might not go well and that the program's accreditation will be placed in jeopardy. Both the completion of a self-study, designed as a self-assessment of program strengths and weaknesses, and preparation for the on-site visit are an addition to the normal tasks of nurse administrators and thus often result in overtaxing resources allotted to maintenance of the program.

A Learning Collaborative Approach to Improve Primary Care STI Screening.

PubMed

McKee, M Diane; Alderman, Elizabeth; York, Deborah V; Blank, Arthur E; Briggs, Rahil D; Hoidal, Kelsey E S; Kus, Christopher; Lechuga, Claudia; Mann, Marie; Meissner, Paul; Patel, Nisha; Racine, Andrew D

2017-10-01

The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites). GCC screening of sexually active youth increased at BOPS and non-BOPS sites. Screening at non-health care maintenance visits improved more at BOPS than non-BOPS sites. Data from nonparticipating sites suggests that introduction of an adolescent EMR template or other factors improved screening rates regardless of BOPS participation; BOPS activities appear to promote additional improvement of screening during non-health maintenance visits.

Value of chiropractic services at an on-site health center.

PubMed

Krause, Curt A; Kaspin, Lisa; Gorman, Kathleen M; Miller, Ross M

2012-08-01

Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions. A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes. Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001). These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.

Using social media to quantify nature-based tourism and recreation

PubMed Central

Wood, Spencer A.; Guerry, Anne D.; Silver, Jessica M.; Lacayo, Martin

2013-01-01

Scientists have traditionally studied recreation in nature by conducting surveys at entrances to major attractions such as national parks. This method is expensive and provides limited spatial and temporal coverage. A new source of information is available from online social media websites such as flickr. Here, we test whether this source of “big data” can be used to approximate visitation rates. We use the locations of photographs in flickr to estimate visitation rates at 836 recreational sites around the world, and use information from the profiles of the photographers to derive travelers' origins. We compare these estimates to empirical data at each site and conclude that the crowd-sourced information can indeed serve as a reliable proxy for empirical visitation rates. This new approach offers opportunities to understand which elements of nature attract people to locations around the globe, and whether changes in ecosystems will alter visitation rates. PMID:24131963

Using social media to quantify nature-based tourism and recreation.

PubMed

Wood, Spencer A; Guerry, Anne D; Silver, Jessica M; Lacayo, Martin

2013-10-17

Scientists have traditionally studied recreation in nature by conducting surveys at entrances to major attractions such as national parks. This method is expensive and provides limited spatial and temporal coverage. A new source of information is available from online social media websites such as flickr. Here, we test whether this source of "big data" can be used to approximate visitation rates. We use the locations of photographs in flickr to estimate visitation rates at 836 recreational sites around the world, and use information from the profiles of the photographers to derive travelers' origins. We compare these estimates to empirical data at each site and conclude that the crowd-sourced information can indeed serve as a reliable proxy for empirical visitation rates. This new approach offers opportunities to understand which elements of nature attract people to locations around the globe, and whether changes in ecosystems will alter visitation rates.

Development and promotion of a national website to improve dissemination of information related to the prevention of mother-to-child HIV transmission (PMTCT) in Tanzania.

PubMed

Stephan, Gudila; Hoyt, Mary Jo; Storm, Deborah S; Shirima, Sylvia; Matiko, Charles; Matechi, Emmanuel

2015-10-22

Websites that address national public health issues provide an important mechanism to improve health education and services in resource limited countries. This article describes the development, promotion and initial evaluation of a national website to increase access to information and resources about prevention of mother-to-child transmission of HIV (PMTCT) among healthcare workers and PMTCT stakeholders in Tanzania. A participatory approach, involving the Tanzania Ministry of Health and Social Welfare (MOHSW) and key PMTCT stakeholders, was used to develop and manage the online PMTCT National Resource Center (NRC), http://pmtct.or.tz/ . The website was created with a content management system software system that does not require advanced computer skills and facilitates content updates and site management. The PMTCT NRC hosts related regularly updated PMTCT-related news, resources and publications. Website implementation, access and performance were evaluated over two years using Google Analytics data about visits, page views, downloads, bounce rates and location of visitors, supplemented by anecdotal feedback. Following its launch in July 2013, the PMTCT NRC website received a total of 28,400 visits, with 66,463 page views, over 2 years; 30 % of visits were from returning visitors. During year 1, visits increased by 80 % from the first to second 6 month period and then declined slightly (9-11 %) but remained stable in Year 2. Monthly visits spiked by about 70 % during October 2013 and January 2014 in response to the release and promotion of revised national PMTCT guidelines and training manuals. The majority of visitors came from primarily urban areas in Tanzania (50 %) and from other African countries (16 %). By year 2, over one-third of visitors used mobile devices to access the site. The successfully implemented PMTCT NRC website provides centralized, easily accessed information designed to address the needs of clinicians, educators and program partners in Tanzania. Ongoing involvement of the MOHSW and key stakeholders are essential ensure the website's growth, effectiveness and sustainability. Additional efforts are needed to expand use of the PMTCT NRC throughout the country. Future evaluations should examine the role of the website in supporting implementation of national PMTCT guidelines and services in Tanzania.

Korean guidelines for the diagnosis and management of dry eye: development and validation of clinical efficacy.

PubMed

Hyon, Joon Young; Kim, Hyo-Myung; Lee, Doh; Chung, Eui-Sang; Song, Jong-Suk; Choi, Chul Young; Lee, Jungbok

2014-06-01

To evaluate the clinical efficacy of newly developed guidelines for the diagnosis and management of dry eye. This retrospective, multi-center, non-randomized, observational study included a total of 1,612 patients with dry eye disease who initially visited the clinics from March 2010 to August 2010. Korean guidelines for the diagnosis and management of dry eye were newly developed from concise, expert-consensus recommendations. Severity levels at initial and final visits were determined using the guidelines in patients with 90 ± 7 days of follow-up visits (n = 526). Groups with different clinical outcomes were compared with respect to clinical parameters, treatment modalities, and guideline compliance. Main outcome measures were ocular and visual symptoms, ocular surface disease index, global assessment by patient and physician, tear film break-up time, Schirmer-1 test score, ocular surface staining score at initial and final visits, clinical outcome after three months of treatment, and guideline compliance. Severity level was reduced in 47.37% of patients treated as recommended by the guidelines. Younger age (odd ratio [OR], 0.984; p = 0.044), higher severity level at initial visit, compliance to treatment recommendation (OR, 1.832; p = 0.047), and use of topical cyclosporine (OR, 1.838; p = 0.011) were significantly associated with improved clinical outcomes. Korean guidelines for the diagnosis and management of dry eye can be used as a valid and effective tool for the treatment of dry eye disease.

Report of investigation on underground limestone mines in the Ohio region. [Jonathan Mine, Alpha Portland Cement Mine, and Lewisburg Mine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Byerly, D.W.

1976-06-01

The following is a report of investigation on the geologic setting of several underground limestone mines in Ohio other than the PPG mine at Barberton, Ohio. Due to the element of available time, the writer is only able to deliver a brief synopsis of the geology of three sites visited. These three sites and the Barberton, Ohio site are the only underground limestone mines in Ohio to the best of the writer's knowledge. The sites visited include: (1) the Jonathan Mine located near Zanesville, Ohio, and currently operated by the Columbia Cement Corporation; (2) the abandoned Alpha Portland Cement Minemore » located near Ironton, Ohio; and (3) the Lewisburg Mine located at Lewisburg, Ohio, and currently being utilized as an underground storage facility. Other remaining possibilities where limestone is being mined underground are located in middle Ordovician strata near Carntown and Maysville, Kentucky. These are drift mines into a thick sequence of carbonates. The writer predicts, however, that these mines would have some problems with water due to the preponderance of carbonate rocks and the proximity of the mines to the Ohio River. None of the sites visited nor the sites in Kentucky have conditions comparable to the deep mine at Barberton, Ohio.« less

Improving acute patient flow and resolving emergency department overcrowding in New Zealand hospitals--the major challenges and the promising initiatives.

PubMed

Ardagh, Michael W; Tonkin, Gary; Possenniskie, Clare

2011-10-14

To determine the most common challenges to improving acute patient flow and resolving emergency department (ED) overcrowding in New Zealand hospitals, and to share some of the promising initiatives that have been implemented in response to them. To facilitate progress towards achievement of the Shorter Stays in Emergency Departments Health Target (the Target), the authors visited every District Health Board (DHB) in New Zealand. These visits followed a standardised visit format and subsequent to each visit a report was produced that noted the observed challenges, initiatives and successes in relation to the DHB's pursuit of the Target. Using these reports, the significant challenges and the promising initiatives across all of the DHBs were collated. Access to hospital beds, access to diagnostic tests and inpatient team delays were the most common challenges, followed by increased demand for ED services, ED facility deficiencies, ED staff deficiencies, delay to discharge of inpatients, difficulty engaging hospital clinical staff in changes, difficulty accessing aged care beds, and problems at nights and weekends. Promising initiatives were noted in relation to each of these. To improve acute care, resolve ED overcrowding and achieve the Target we need a comprehensive, whole of system approach and some significant changes to the way we use our physical and human resources. To address common challenges we need to share our experiences and expertise.

Timing of Chemotherapy After MammoSite Radiation Therapy System Breast Brachytherapy: Analysis of the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haffty, Bruce G.; Vicini, Frank A.; Beitsch, Peter

2008-12-01

Purpose: To evaluate cosmetic outcome and radiation recall in the American Society of Breast Surgeons registry trial, as a function of the interval between accelerated partial breast irradiation (APBI) and initiation of chemotherapy (CTX). Methods and Materials: A total of 1440 patients at 97 institutions participated in this trial. After lumpectomy for early-stage breast cancer, patients received APBI (34 Gy in 10 fractions) with MammoSite RTS brachytherapy. A total of 148 patients received CTX within 90 days of APBI. Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good or fair/poor. Results: Chemotherapy was initiated at a meanmore » of 3.9 weeks after the final MammoSite procedure and was administered {<=}3 weeks after APBI in 54 patients (36%) and >3 weeks after APBI in 94 patients (64%). The early and delayed groups were well balanced with respect to multiple factors that may impact on cosmetic outcome. There was a superior cosmetic outcome in those receiving chemotherapy >3 weeks after APBI (excellent/good in 72.2% at {<=}3 weeks vs. excellent/good in 93.8% at >3 weeks; p = 0.01). Radiation recall in those receiving CTX at {<=}3 weeks was 9 of 50 (18%), compared with 6 of 81(7.4%) in those receiving chemotherapy at >3 weeks (p = 0.09). Conclusion: The majority of patients receiving CTX after APBI have excellent/good cosmetic outcomes, with a low rate of radiation recall. Chemotherapy initiated >3 weeks after the final MammoSite procedure seems to be associated with a better cosmetic outcome and lower rate of radiation recall. An excellent/good cosmetic outcome in patients receiving CTX after 3 weeks was similar to the cosmetic outcome of the overall patient population who did not receive CTX.« less

Lifestyle counseling in hypertension-related visits – analysis of video-taped general practice visits

PubMed Central

Milder, Ivon EJ; Blokstra, Anneke; de Groot, Judith; van Dulmen, Sandra; Bemelmans, Wanda JE

2008-01-01

Background The general practitioner (GP) can play an important role in promoting a healthy lifestyle, which is especially relevant in people with an elevated risk of cardiovascular diseases due to hypertension. Therefore, the aim of this study was to determine the frequency and content of lifestyle counseling about weight loss, nutrition, physical activity, and smoking by GPs in hypertension-related visits. A distinction was made between the assessment of lifestyle (gathering information or measuring weight or waist circumference) and giving lifestyle advice (giving a specific advice to change the patient's behavior or referring the patient to other sources of information or other health professionals). Methods For this study, we observed 212 video recordings of hypertension-related visits collected within the Second Dutch National Survey of General Practice in 2000/2001. Results The mean duration of visits was 9.8 minutes (range 2.5 to 30 minutes). In 40% of the visits lifestyle was discussed (n = 84), but in 81% of these visits this discussion lasted shorter than a quarter of the visit. An assessment of lifestyle was made in 77 visits (36%), most commonly regarding body weight and nutrition. In most cases the patient initiated the discussion about nutrition and physical activity, whereas the assessment of weight and smoking status was mostly initiated by the GP. In 35 visits (17%) the GP gave lifestyle advice, but in only one fifth of these visits the patient's motivation or perceived barriers for changing behavior were assessed. Supporting factors were not discussed at all. Conclusion In 40% of the hypertension-related visits lifestyle topics were discussed. However, both the frequency and quality of lifestyle advice can be improved. PMID:18854020

Tracking How Science Resources Result in Educator- and Community-Level Outcomes

NASA Astrophysics Data System (ADS)

Dusenbery, P.; Harold, J. B.; Fitzhugh, G.; LaConte, K.; Holland, A.

2017-12-01

Learners frequently need to access increasingly complex information to help them understand our changing world. More and more libraries are transforming themselves into places where learners not only access STEM information, but interact with professionals and undertake hands-on learning. Libraries are beginning to position themselves as part of learning ecosystems that contribute to a collective impact on the community. Traveling STEM exhibits are catalyzing these partnerships and engaging students, families, and adults in repeat visits through an accessible venue: their public library. This talk will explore impacts from two STAR Library Network's (STAR_Net) exhibitions (Discover Earth and Discover Tech) on partnerships, the circulation of STEM resources, and the engagement of learners. The STAR_Net project's summative evaluation utilized mixed methods to investigate project implementation and its outcomes. Methods included pre- and post-exhibit surveys administered to staff from each library that hosted the exhibits; interviews with staff from host libraries; patron surveys; exhibit-related circulation records; web metrics regarding the online STAR_Net community of practice; and site visits. The latter provides a more complete view of impacts on the community, including underserved audiences. NASA@ My Library is a new STAR_Net initiative, which provides STEM facilitation kits, training, and other resources to 75 libraries nationwide. Initial results will be presented that show high levels of engagement by librarians and strong response rate from patrons on surveys.

Physician activity during outpatient visits and subjective workload.

PubMed

Calvitti, Alan; Hochheiser, Harry; Ashfaq, Shazia; Bell, Kristin; Chen, Yunan; El Kareh, Robert; Gabuzda, Mark T; Liu, Lin; Mortensen, Sara; Pandey, Braj; Rick, Steven; Street, Richard L; Weibel, Nadir; Weir, Charlene; Agha, Zia

2017-05-01

We describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. We collected temporally-resolved activity data including audio, video, EHR activity, and eye-gaze along with post-visit assessments of workload. These data are then analyzed through a combination of manual content analysis and computational techniques to temporally align streams, providing a range of process measures of EHR usage, clinical workflow, and physician-patient communication. Data was collected from primary care and specialty clinics at the Veterans Administration San Diego Healthcare System and UCSD Health, who use Electronic Health Record (EHR) platforms, CPRS and Epic, respectively. Grouping visit activity by physician, site, specialty, and patient status enables rank-ordering activity factors by their correlation to physicians' subjective work-load as captured by NASA Task Load Index survey. We developed a coding scheme that enabled us to compare timing studies between CPRS and Epic and extract patient and visit complexity profiles. We identified similar patterns of EHR use and navigation at the 2 sites despite differences in functions, user interfaces and consequent coded representations. Both sites displayed similar proportions of EHR function use and navigation, and distribution of visit length, proportion of time physicians attended to EHRs (gaze), and subjective work-load as measured by the task load survey. We found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload. We discuss implications of our study for methodology, clinical workflow and EHR redesign. Copyright © 2017 Elsevier Inc. All rights reserved.

Periodontist-Dental Hygienist Collaboration in Periodontal Care for Chronic Periodontitis: An 11-year Case Report.

PubMed

Tomita, Sachiyo; Uekusa, Tomomi; Hosono, Meiko; Kigure, Takashi; Sugito, Hiroki; Saito, Atsushi

2016-01-01

We report a case of severe chronic periodontitis treated and longitudinally maintained by a periodontist and dental hygienists. The patient was a 45-year-old woman who presented with the chief complaint of gingival bleeding and tooth mobility. An initial examination revealed generalized gingival inflammation and subgingival calculus in the premolar and molar regions. Premature contact was observed in #14 and 45. Clinical examination revealed 42% of sites with a probing depth (PD) of ≥4 mm and 44% of sites with bleeding on probing. Radiographic examination revealed vertical bone resorption in #35, 36, and 45, and horizontal bone resorption in other regions. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, and removal of an ill-fitting prosthesis was performed. Following suppression of inflammation, occlusal adjustment of premature contact sites was performed. Open flap debridement was performed for teeth with a PD of ≥5 mm. After confirming the stability of the periodontal tissue, final prostheses were placed on #16, 35-37, and 46. Following re-evaluation, the patient was placed on supportive periodontal therapy. It has been 11 years since the patient's first visit, and the periodontal conditions have remained stable. Meticulous periodontal care maintained over a number of years by a periodontist and dental hygienist have yielded a clinically favorable outcome.

Impact of patient-centered medical home assignment on emergency room visits among uninsured patients in a county health system.

PubMed

Roby, Dylan H; Pourat, Nadereh; Pirritano, Matthew J; Vrungos, Shelley M; Dajee, Himmet; Castillo, Dan; Kominski, Gerald F

2010-08-01

The Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.

Impacts of visitors on soil and vegetation of the recreational area "Nacimiento del Río Mundo" (Castilla-La Mancha, Spain).

PubMed

Andrés-Abellán, Manuela; Del Alamo, Javier Benayas; Landete-Castillejos, Tomás; López-Serrano, Francisco R; García-Morote, Francisco A; Del Cerro-Barja, Antonio

2005-02-01

This study examines the effects of recreational use on the soil and vegetation at a site of ecological importance (Nacimiento del Río Mundo, Albacete, Spain). The most visited sites showed increased soil compaction of approximately 50%, bare ground increase to 61 +/- 10% and a decrease in richness (from 25 +/- 2 to 15 +/- 2 species), diversity (from 4.0 +/- 0.1 to 2.7 +/- 0.4) and stratification of plant species (from 80 +/- 11 to 21 +/- 4%). The most visited sites had 90% less plant species as compared to the least visited. Intense use was associated with the presence of nitrophilous plant and vegetal species with a morphology adapted to heavy trampling. The recreational areas showed a distribution pattern of impact radiating outwards from the most used and degraded point. At the most visited point, "Los Chorros" (the spring of the river), the impact radiated outwards for about 20 m. A pilot experiment examining the effects of one-year restriction to visitors for access to a formerly impacted area showed a plant cover increase by anthropic and not by native species of 57 percent units.

Eisenhower National Historic Site visitor transportation and access study

DOT National Transportation Integrated Search

2017-11-01

This study evaluates the current shuttle system and Eisenhower National Historic Site, which is currently the sole access to the site. Visitation at Eisenhower has been declining since the site opened, and the study looks at the impacts of this trend...

Clinical evaluation of acute phase nystagmus associated with cerebellar lesions.

PubMed

Ogawa, Y; Otsuka, K; Hagiwara, A; Inagaki, T; Shimizu, S; Nagai, N; Konomi, U; Itani, S; Kondo, T; Suzuki, M

2016-06-01

To determine the characteristics of acute phase nystagmus in patients with cerebellar lesions, and to identify a useful indicator for differentiating central lesions from peripheral lesions. Acute phase nystagmus and the appearance of neurological symptoms were retrospectively investigated in 11 patients with cerebellar stroke. At the initial visit, there were no patients with vertical nystagmus, direction-changing gaze evoked nystagmus or pure rotatory nystagmus. There were four cases with no nystagmus and seven cases with horizontal nystagmus at the initial visit. There were no neurological symptoms, except for vertigo and hearing loss, in any cases at the initial visit. The direction and type of nystagmus changed with time, and neurological symptoms other than vertigo appeared subsequently to admission. It is important to observe the changes in nystagmus and other neurological findings for the differential diagnosis of central lesions.

The Effectiveness of Course Web Sites in Higher Education: An Exploratory Study.

ERIC Educational Resources Information Center

Comunale, Christie L.; Sexton, Thomas R.; Voss, Diana J. Pedagano

2002-01-01

Describes an exploratory study of the educational effectiveness of course Web sites among undergraduate accounting students and graduate students in business statistics. Measured Web site visit frequency, usefulness of each site feature, and the impacts of Web sites on perceived learning and course performance. (Author/LRW)

On-site wildland activity choices among African Americans and White Americans in the rural south: implications for management

Treesearch

Cassandra Y. Johnson; J. Michael Bowker

1999-01-01

Johnson and Bowker compare wildland activity choices for a sample of rural African Americans and Whites who visited wildland settings in and around the Apalachicola National Forest. The authors also look at intra-racial (same race, different gender) variations for activity participation. This research extends previous research focused on the visit/not visit wildland...

Welcome Home and Early Start: An Assessment of Program Quality and Outcomes

ERIC Educational Resources Information Center

Daro, Deborah, Howard, Eboni; Tobin, Jennifer; Harden, Allen

2005-01-01

Chapin Hall Center for Children at the University of Chicago, in collaboration with Westat Associates, designed and implemented a comprehensive evaluation of the Early Childhood Initiative's (ECI) two home visitation programs: Welcome Home, a universal home visitation program that provides a single home visit to all first-time and teen parents,…

Stoma creation: does onset of ostomy care education delay hospital length of stay?

PubMed

Rashidi, Laila; Long, Kevin; Hawkins, Melinda; Menon, Raman; Bellevue, Oliver

2016-05-01

Balancing patient safety with hospital length of stay (LOS) and associated cost is critically important. Subjectively, we have observed that patients undergoing ostomy creation early in the week have a shorter LOS. We retrospectively reviewed LOS based on day of the week the operation was performed. We reviewed 180 patients undergoing minimally invasive surgery with planned ostomy. Group 1 underwent surgery on Monday to Wednesday (n = 77), Group 2 on Thursday (n = 49), and Group 3 on Friday (n = 54). The average LOS for Group 1, 2, and 3 was 6.2, 4.9, and 7.2 days, respectively. The average number of visits with ostomy nursing for Group 1, 2, and 3 was 2.7, 1.8, and 2.3, respectively. Day of initial ostomy nursing visit was significantly correlated between the delay to initial visit and LOS with Group 3 delayed most. Patients with the longest delay to initial nurse visit had the longest LOS, with Friday operations being most delayed. A contributing factor may be absence of ostomy teaching over the weekend. Copyright © 2016 Elsevier Inc. All rights reserved.

Utilization patterns in an asthma intervention.

PubMed

Portnoy, Jay M; Jennings, Donna

2006-07-01

The National Cooperative Inner-City Asthma Study (NCICAS) tested a model of asthma management in which a master's degree-prepared social worker functioned as an asthma counselor. The NCICAS resulted in decreased symptom days and a trend toward fewer emergency department (ED) visits and hospital admissions in the intervention group compared with the control group. To determine whether a real-world implementation would give similar results to the NCICAS. Children with moderate or severe persistent asthma were enrolled in a 1-year program, the Inner-City Asthma Intervention (ICAI) program, modeled on the NCICAS. Since the program initially was not designed to be research, data were collected retrospectively. ED and hospital visits were compared 1 year before and after the intervention at 2 of the intervention sites, Children's Mercy Hospital (CMH) and Baystate Medical Center, to determine whether there was a significant change. Data for 93 children from CMH and 77 from Baystate were evaluated. At CMH annual ED visits were 0.38 before, 0.42 during, and 0.41 after the intervention, whereas at Baystate ED visits were 0.09 before, 0.17 during, and 0.15 after the intervention. Mean hospitalizations at CMH increased from 0.06 before to 0.22 during and then decreased to 0.12 after (P > .05), whereas admissions at Baystate increased from 0.03 before to 0.05 during and 0.04 after the intervention. Asthma self-management interventions can lead to decreases in asthma utilization under controlled circumstances. Further prospective studies are needed to determinewhether the ICAI intervention is effective under real-world conditions.

Acid Mine Drainage and Metal Sulfate Minerals in the Shasta Mining District, California

NASA Astrophysics Data System (ADS)

Livingston, J. D.; Murphy, W. M.; Miller, R. M.; Ayars, E. J.

2005-12-01

Metal sulfate minerals were collected at four surface water drainage sites during September and October of 2004 in the Shasta Mining District, southern Klamath Mountains, Shasta County, California and analyzed by X-ray fluorescence, atomic absorption spectroscopy, and X-ray diffraction to determine elements present, quantities of Fe, Cu, and Zn, and mineralogy. The Shasta Mining District produced major quantities of Cu, Zn, and pyrite (S) with minor amounts of Au, Ag, and Fe from massive sulfide bodies (Kinkel et al., 1956). Three study sites are located on Iron Mountain and one study site is at Bully Hill. Although mining occurred during a period of just over 100 years, it is estimated that acid mine drainage (AMD) will continue from Iron Mountain for over 3,200 years (Nordstrom and Alpers, 1998). AMD at the study sites produces blooms of metal sulfates during California's Mediterranean climate summer. The minerals readily dissolve in the "first flush" of seasonal rain creating runoff water of low pH with high amounts of dissolved metals (Bayless and Olyphant, 1993; Jambor et al., 2000). Data were examined for mineralogical changes in time and space and for zoning of minerals on a scale of centimeters. Sulfate mineral samples are complex with some samples composed of over a dozen different minerals. Site 1 is located on Spring Creek downstream from the Iron Mountain superfund remediation site, so levels of Fe, Cu, and Zn in the sulfates at this site are lower than at the other sites. Two site 1 samples from the same location taken a month apart show Ca, Fe, Cu, Sr, Y, and Sn, and the first sample also has detectable Br. The metal sulfates identified from the first visit are celestine, cesanite, chessexite, hectorfloresite, and ungemachite, and the mineralogy of the second visit is bilinite, epsomite, millosevichite, and anhydrite. The Fe bearing sulfate mineral during the first visit is ungemachite, but bilinite was the Fe bearing mineral at the time of the second visit. Analyses indicate a dynamic evolution of sulfate minerals at individual locations over time, mineralogical and chemical differences among individual locations at a site, and mineralogical zonations in individual samples.

Internet use, browsing, and the urban poor: implications for cancer control.

PubMed

Viswanath, K; McCloud, Rachel; Minsky, Sara; Puleo, Elaine; Kontos, Emily; Bigman-Galimore, Cabral; Rudd, Rima; Emmons, Karen M

2013-12-01

Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Internet use increased among intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.

Internet Use, Browsing, and the Urban Poor: Implications for Cancer Control

PubMed Central

2013-01-01

Background Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. Methods The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Results Internet use increased among Intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals’ sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Conclusions Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information. PMID:24395992

E-consult implementation: lessons learned using consolidated framework for implementation research.

PubMed

Haverhals, Leah M; Sayre, George; Helfrich, Christian D; Battaglia, Catherine; Aron, David; Stevenson, Lauren D; Kirsh, Susan; Ho, Michael; Lowery, Julie

2015-12-01

In 2011, the Veterans Health Administration (VHA) implemented electronic consults (e-consults) as an alternative to in-person specialty visits to improve access and reduce travel for veterans. We conducted an evaluation to understand variation in the use of the new e-consult mechanism and the causes of variable implementation, guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative case studies of 3 high- and 5 low-implementation e-consult pilot sites. Participants included e-consult site leaders, primary care providers, specialists, and support staff identified using a modified snowball sample. We used a 3-step approach, with a structured survey of e-consult site leaders to identify key constructs, based on the CFIR. We then conducted open-ended interviews, focused on key constructs, with all participants. Finally, we produced structured, site-level ratings of CFIR constructs and compared them between high- and low-implementation sites. Site leaders identified 14 initial constructs. We conducted 37 interviews, from which 4 CFIR constructs distinguished high implementation e-consult sites: compatibility, networks and communications, training, and access to knowledge and information. For example, illustrating compatibility, a specialist at a high-implementation site reported that the site changed the order of consult options so that all specialties listed e-consults first to maintain consistency. High-implementation sites also exhibited greater agreement on constructs. By using the CFIR to analyze results, we facilitate future synthesis with other findings, and we better identify common patterns of implementation determinants common across settings.

Popularity of internet physician rating sites and their apparent influence on patients' choices of physicians.

PubMed

Burkle, Christopher M; Keegan, Mark T

2015-09-26

There has been a substantial increase in the number of on-line health care grading sites that offer patient feedback on physicians, staff and hospitals. Despite a growing interest among some consumers of medical services, most studies of Internet physician rating sites (IPRS) have restricted their analysis to sampling data from individual sites alone. Our objective was to explore the frequency with which patients visit and leave comments on IPRS, evaluate the nature of comments written and quantify the influence that positive comments, negative comments and physician medical malpractice history might have on patients' decisions to seek care from a particular physician. One-thousand consecutive patients visiting the Pre-Operative Evaluation (POE) Clinic at Mayo Clinic in Rochester Minnesota between June 2013 and October 2013 were surveyed using a written questionnaire. A total of 854 respondents completed the survey to some degree. A large majority (84%) stated that they had not previously visited an IPRS. Of those writing comments on an IPRS in the past, just over a third (36%) provided either unfavorable (9 ) or a combination of favorable and unfavorable (27%) reviews of physician interactions. Among all respondents, 28.1% strongly agreed that a positive physician review alone on an IPRS would cause them to seek care from that practitioner. Similarly, 27% indicated that a negative IPRS review would cause them to choose against seeking care from that physician. Fewer than a third indicated that knowledge of a malpractice suit alone would negatively impact their decision to seek care from a physician. Whether a respondent had visited an IPRS in the past had no impact on the answers provided. Few patients had visited IPRS, with a limited number reporting that information provided on these sites would play a significant role in their decision to seek care from a particular physician.

Proceedings of the scientific visit on crystalline rock repository development.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mariner, Paul E.; Hardin, Ernest L.; Miksova, Jitka

2013-02-01

A scientific visit on Crystalline Rock Repository Development was held in the Czech Republic on September 24-27, 2012. The visit was hosted by the Czech Radioactive Waste Repository Authority (RAWRA), co-hosted by Sandia National Laboratories (SNL), and supported by the International Atomic Energy Agency (IAEA). The purpose of the visit was to promote technical information exchange between participants from countries engaged in the investigation and exploration of crystalline rock for the eventual construction of nuclear waste repositories. The visit was designed especially for participants of countries that have recently commenced (or recommenced) national repository programmes in crystalline host rock formations.more » Discussion topics included repository programme development, site screening and selection, site characterization, disposal concepts in crystalline host rock, regulatory frameworks, and safety assessment methodology. Interest was surveyed in establishing a %E2%80%9Cclub,%E2%80%9D the mission of which would be to identify and address the various technical challenges that confront the disposal of radioactive waste in crystalline rock environments. The idea of a second scientific visit to be held one year later in another host country received popular support. The visit concluded with a trip to the countryside south of Prague where participants were treated to a tour of the laboratory and underground facilities of the Josef Regional Underground Research Centre.« less

D Modelling and Mapping for Virtual Exploration of Underwater Archaeology Assets

NASA Astrophysics Data System (ADS)

Liarokapis, F.; Kouřil, P.; Agrafiotis, P.; Demesticha, S.; Chmelík, J.; Skarlatos, D.

2017-02-01

This paper investigates immersive technologies to increase exploration time in an underwater archaeological site, both for the public, as well as, for researchers and scholars. Focus is on the Mazotos shipwreck site in Cyprus, which is located 44 meters underwater. The aim of this work is two-fold: (a) realistic modelling and mapping of the site and (b) an immersive virtual reality visit. For 3D modelling and mapping optical data were used. The underwater exploration is composed of a variety of sea elements including: plants, fish, stones, and artefacts, which are randomly positioned. Users can experience an immersive virtual underwater visit in Mazotos shipwreck site and get some information about the shipwreck and its contents for raising their archaeological knowledge and cultural awareness.

Visits to Registered Nurses

PubMed Central

Parker, Emese C.; Kong, Kevin; Watts, Leslie A.; Schwarz, Eleanor B.; Darney, Philip D.; Thiel de Bocanegra, Heike

2017-01-01

Background In 2013, California passed Assembly Bill (A.B.) 2348, approving registered nurses (RNs) to dispense patient self-administered hormonal contraceptives and administer injections of hormonal contraceptives. The Family Planning, Access, Care and Treatment (Family PACT) program, which came into effect in 1997 to expand low-income, uninsured California resident access to contraceptives at no cost, is one program in which qualified RNs can dispense and administer contraceptives. Aims The aims of this study were to (a) describe utilization of RN visits within California's Family PACT program and (b) evaluate the impact of RN visits on client birth control acquisition during the first 18 months after implementation of A.B. 2348 (January 1, 2013 to June 30, 2014). Methods A descriptive observational design using administrative databases was used. Family PACT claims were retrieved for RN visits and contraception. Paid claims for contraceptive dispensing and/or administration visits by physicians, nurse practitioners, certified nurse midwives, and physician assistants were compared before and after the implementation of A.B. 2348 at practice sites where RN visits were and were not utilized. Contraceptive methods and administration procedures were identified using Healthcare Common Procedure Coding System codes, National Drug Codes, and Common Procedural Terminology codes. Claims data for healthcare facilities were abstracted by site location based on a unique combination of National Provider Identifier (NPI), NPI Owner, and NPI location number. Results RN visits were found mainly in Northern California and the Central Valley (73%). Sixty-eight percent of RN visits resulted in same-day dispensing and/or administration of hormonal (and/or barrier) methods. Since benefit implementation, RN visits resulted in a 10% increase in access to birth control dispensing and/or administration visits. RN visits were also associated with future birth control acquisition and other healthcare utilization within the subsequent 30 days. Discussion RN visits, though underutilized across the state, have resulted in increased access to contraception in some communities, an effect that may continue to grow with time and can serve as a model for other states. PMID:28604507

Visits to Registered Nurses: An Opportunity to Increase Contraceptive Access in California.

PubMed

Parker, Emese C; Kong, Kevin; Watts, Leslie A; Schwarz, Eleanor B; Darney, Philip D; Thiel de Bocanegra, Heike

In 2013, California passed Assembly Bill (A.B.) 2348, approving registered nurses (RNs) to dispense patient self-administered hormonal contraceptives and administer injections of hormonal contraceptives. The Family Planning, Access, Care and Treatment (Family PACT) program, which came into effect in 1997 to expand low-income, uninsured California resident access to contraceptives at no cost, is one program in which qualified RNs can dispense and administer contraceptives. The aims of this study were to (a) describe utilization of RN visits within California's Family PACT program and (b) evaluate the impact of RN visits on client birth control acquisition during the first 18 months after implementation of A.B. 2348 (January 1, 2013 to June 30, 2014). A descriptive observational design using administrative databases was used. Family PACT claims were retrieved for RN visits and contraception. Paid claims for contraceptive dispensing and/or administration visits by physicians, nurse practitioners, certified nurse midwives, and physician assistants were compared before and after the implementation of A.B. 2348 at practice sites where RN visits were and were not utilized. Contraceptive methods and administration procedures were identified using Healthcare Common Procedure Coding System codes, National Drug Codes, and Common Procedural Terminology codes. Claims data for healthcare facilities were abstracted by site location based on a unique combination of National Provider Identifier (NPI), NPI Owner, and NPI location number. RN visits were found mainly in Northern California and the Central Valley (73%). Sixty-eight percent of RN visits resulted in same-day dispensing and/or administration of hormonal (and/or barrier) methods. Since benefit implementation, RN visits resulted in a 10% increase in access to birth control dispensing and/or administration visits. RN visits were also associated with future birth control acquisition and other healthcare utilization within the subsequent 30 days. RN visits, though underutilized across the state, have resulted in increased access to contraception in some communities, an effect that may continue to grow with time and can serve as a model for other states.

Bradbury

Science.gov Websites

Search Site submit About | Contacts | Directions Los Alamos National LaboratoryBradbury Science Museum Your Window into Los Alamos National Laboratory Bradbury Science Museum Menu About Contacts Directions Visit Visitor Information About the Museum Large Group Visits Around Los Alamos Contact Us

Risk factors of chronic periodontitis on healing response: a multilevel modelling analysis.

PubMed

Song, J; Zhao, H; Pan, C; Li, C; Liu, J; Pan, Y

2017-09-15

Chronic periodontitis is a multifactorial polygenetic disease with an increasing number of associated factors that have been identified over recent decades. Longitudinal epidemiologic studies have demonstrated that the risk factors were related to the progression of the disease. A traditional multivariate regression model was used to find risk factors associated with chronic periodontitis. However, the approach requirement of standard statistical procedures demands individual independence. Multilevel modelling (MLM) data analysis has widely been used in recent years, regarding thorough hierarchical structuring of the data, decomposing the error terms into different levels, and providing a new analytic method and framework for solving this problem. The purpose of our study is to investigate the relationship of clinical periodontal index and the risk factors in chronic periodontitis through MLM analysis and to identify high-risk individuals in the clinical setting. Fifty-four patients with moderate to severe periodontitis were included. They were treated by means of non-surgical periodontal therapy, and then made follow-up visits regularly at 3, 6, and 12 months after therapy. Each patient answered a questionnaire survey and underwent measurement of clinical periodontal parameters. Compared with baseline, probing depth (PD) and clinical attachment loss (CAL) improved significantly after non-surgical periodontal therapy with regular follow-up visits at 3, 6, and 12 months after therapy. The null model and variance component models with no independent variables included were initially obtained to investigate the variance of the PD and CAL reductions across all three levels, and they showed a statistically significant difference (P < 0.001), thus establishing that MLM data analysis was necessary. Site-level had effects on PD and CAL reduction; those variables could explain 77-78% of PD reduction and 70-80% of CAL reduction at 3, 6, and 12 months. Other levels only explain 20-30% of PD and CAL reductions. Site-level had the greatest effect on PD and CAL reduction. Non-surgical periodontal therapy with regular follow-up visits had a remarkable curative effect. All three levels had a substantial influence on the reduction of PD and CAL. Site-level had the largest effect on PD and CAL reductions.

A pharmacovigilance study of adults on highly active antiretroviral therapy, South Africa: 2007 - 2011.

PubMed

Dube, Nomathemba Michell; Summers, Robert; Tint, Khin-San; Mayayise, Guistee

2012-01-01

Of the 1.6 million South African people infected with human immunodeficiency virus (HIV), approximately 970,000 (55%) have been initiated on HAART. Despite these numbers, very little has been published about the safety profile of antiretroviral (ARV) medicines in the country. This study was performed at the Medunsa National Pharmacovigilance Centre and aimed to describe the demographic characteristics of patients enrolled in the pharmacovigilance surveillance study; highly active antiretroviral therapy (HAART) initiation regimen patterns; reasons for regimen changes; and adverse effects of ARV medicines. A cohort study of HIV-infected individuals aged 15 years or older who were on ARV medicines was conducted at four sentinel sites. After HAART initiation, with an average lapse of 17.8 months (range: 0 - 83.8 months), 2,815 patients were enrolled into the study. Results show that patients were observed for 1,606.2 person-years for pharmacy visits (collection of ARV medicines) and 817.1 person-years for clinical visits (consultation with the doctor). Females constituted 69.6% (1,958/2,815) of the study population. Almost all patients initiated HAART on first-line regimens (2,801/2,815). Some patients (6.7%, 190/2,815) dropped out of the study after HAART initiation. Reasons for regimen changes were not recorded for 2.5% (22/891) of the patients who changed regimens. The primary reason for regimen changes was drug-related toxicity (76.1%, 678/891), mostly evident in patients taking first-line regimens. Adverse effects experienced by patients were polyneuropathy (24.0%, 163/678); lipodystrophy (23.9%, 162/678); neuropathy (10.6%, 72/678); and suspected lactic acidosis (3.8%, 26/678). The majority of prescribers complied with the HAART guidelines and initiated most patients on first-line regimens. However, adverse effects are evident in patients taking first-line regimens. We recommend that the Department of Health should introduce less toxic first-line ARV regimens. Future efforts will aim to initiate patients on HAART and enrol them into the study simultaneously to determine early risk profiles of ARV medicines.

Integrating Behavioral Health in Primary Care Using Lean Workflow Analysis: A Case Study

PubMed Central

van Eeghen, Constance; Littenberg, Benjamin; Holman, Melissa D.; Kessler, Rodger

2016-01-01

Background Primary care offices are integrating behavioral health (BH) clinicians into their practices. Implementing such a change is complex, difficult, and time consuming. Lean workflow analysis may be an efficient, effective, and acceptable method for integration. Objective Observe BH integration into primary care and measure its impact. Design Prospective, mixed methods case study in a primary care practice. Measurements Change in treatment initiation (referrals generating BH visits within the system). Secondary measures: primary care visits resulting in BH referrals, referrals resulting in scheduled appointments, time from referral to scheduled appointment, and time from referral to first visit. Providers and staff were surveyed on the Lean method. Results Referrals increased from 23 to 37/1000 visits (P<.001). Referrals resulted in more scheduled (60% to 74%, P<.001) and arrived visits (44% to 53%, P=.025). Time from referral to first scheduled visit decreased (Hazard Ratio (HR) 1.60; 95% Confidence Interval (CI) 1.37, 1.88; P<0.001) as did time to first arrived visit (HR 1.36; 95% CI 1.14, 1.62; P=0.001). Surveys and comments were positive. Conclusions This pilot integration of BH showed significant improvements in treatment initiation and other measures. Strengths of Lean included workflow improvement, system perspective, and project success. Further evaluation is indicated. PMID:27170796

Mississippi lieutenant governor visits Stennis

NASA Image and Video Library

2009-10-01

Stennis Space Center Director Gene Goldman (left) stands with Mississippi Lt. Gov. Phil Bryant at the A-3 Test Stand construction site during an Oct. 1 visit by the state official. During his tour, Bryant was updated on construction of the first large test stand at Stennis since the 1960s. The A-3 stand will be used to conduct simulated high-altitude testing on the next generation of rocket engines that will take humans back to the moon and possibly beyond. In addition to touring Stennis facilities, Bryant visited the INFINITY Science Center construction site, where he was updated on work under way to construct a 72,000-square-foot facility that will showcase the science underpinning the missions of NASA and resident agencies at Stennis.

Envisioning Transformation in VA Mental Health Services Through Collaborative Site Visits.

PubMed

Kearney, Lisa K; Schaefer, Jeanne A; Dollar, Katherine M; Iwamasa, Gayle Y; Katz, Ira; Schmitz, Theresa; Schohn, Mary; Resnick, Sandra G

2018-04-16

This column reviews the unique contributions of multiple partners in establishing a standardized site visit process to promote quality improvement in mental health care at the Veterans Health Administration. Working as a team, leaders in policy and operations, staff of research centers, and regional- and facility-level mental health leaders developed a standardized protocol for evaluating mental health services at each site and using the data to help implement policy goals. The authors discuss the challenges experienced and lessons learned in this systemwide process and how this information can be part of a framework for improving mental health services on a national level.

Satellite communications systems and technology. Executive Summary

NASA Technical Reports Server (NTRS)

Edelson, Burton I.; Pelton, Joseph N.; Bostian, Charles W.; Brandon, William T.; Chan, Vincent W. S.; Hager, E. Paul; Helm, Neil R.; Jennings, Raymond D.; Kwan, Robert; Mahle, Christoph E.

1993-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of US experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members travelled to Europe, Japan, and Russia to gather information first-hand. They visited 17 sites in Europe, 20 sites in Japan, and four in Russia. These included major manufacturers, government organizations, service providers, and associated R&D facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of US industry. The report details the information collected and compares it to US activities.

Witnessing the first sign of retinitis pigmentosa onset in the allegedly normal eye of a case of unilateral RP: a 30-year follow-up.

PubMed

Gauvin, Mathieu; Chakor, Hadi; Koenekoop, Robert K; Little, John M; Lina, Jean-Marc; Lachapelle, Pierre

2016-06-01

A patient initially presented with constricted visual field, attenuated retinal vasculature, pigmentary clumping and reduced ERG in OS only, suggestive of unilateral retinitis pigmentosa (RP). This patient was subsequently seen on eight occasions (over three decades), and, with time, the initially normal eye (OD) gradually showed signs of RP-like degeneration. The purpose of this study was to evaluate which clinical modality (visual field, funduscopy or electroretinography) could have first predicted this fate. At each time points, data obtained from our patient were compared to normative data using Z tests. At initial visit, all tests were significantly (p < 0.05) altered in OS and normal in OD. Visual field and retinal vessel diameter in OD reduced gradually to reach statistical significance at the 5th visit and 6th visit (21 and 22 years after the first examination, respectively). In OD, the amplitude of the scotopic and photopic ERGs reduced gradually and was significantly smaller than normal at the 2nd visit (after 11 years) and 3rd visit (after 18 years), respectively. When the photopic ERG was analyzed using the discrete wavelet transform (DWT), we were able to detect a significant change at the 2nd visit (after 11 years) instead of the 3rd visit (18 years). Our study allowed us to witness the earliest manifestation of an RP disease process. The ERG was the first test to detect significant RP changes. A significantly earlier detection of ERG anomalies was obtained when the DWT was used, demonstrating its advantage for early detection of ERG changes.

Determining Virtual Environment "Fit": The Relationship between Navigation Style in a Virtual Field Trip, Student Self-Reported Desire to Visit the Field Trip Site in the Real World, and the Purposes of Science Education

ERIC Educational Resources Information Center

Tutwiler, M. Shane; Lin, Ming-Chao; Chang, Chun-Yen

2013-01-01

In this study, a follow-up analysis of the data reported in Lin et al. ("Learn Media Technol." doi: 10.1080/17439884.2011.629660 , 2011), we investigated the relationship between student use of a virtual field trip (VFT) system and the probability of students reporting wanting to visit the national park site upon which the VFT was modeled,…

Micro*scope: a new internet resources for microbiology teaching

NASA Astrophysics Data System (ADS)

Patterson, D. J.; Sogin, M. L.

Micro-organisms are major players in all natural ecosystems, have dominated the Earth's biosphere for most of its existence, and have determined the character of the habitable planet. Yet a lack of adequate educational resources hinders the appreciation of microbial diversity and ecology. micro*scope is a new internet initiative which aims to provide resources to students and teachers. The site has five major domains. Classification: A comprehensive hierarchical classification of all prokaryotes and protists to the level of genus. The classification is used to navigate to further information. UbIO sofware new software for the management of names and classification schemes, allowing all known names for the same organisms to be mapped against each other so maximize the recovery of information. Images: about 3500 images are available, with high quality versions available to be downloaded. Outward internet links, the web site prompts the user to explore more authoritative or specialist sites to find further information on any species or taxon being visited. Educational resources, we include simple to use Lucid guides to help students and scientists identify micro-organisms are available through the internet. Other resources are also being assembled. The site is still under development.

Crisis Nursery and Respite Care Programs: Site Visit Results of Staff and Family Interviews (Winter and Spring of 1991).

ERIC Educational Resources Information Center

Huntington, Gail S.; And Others

Visits were made to selected respite care and crisis nursery programs in order to describe the programs and services they offered to families of young children with special needs and to learn more about the families who used the services and the staff who provided them. The visits to 10 crisis nurseries and 24 respite care programs resulted in…

World Presidents Organization

NASA Technical Reports Server (NTRS)

2010-01-01

Members of the World Presidents' Organization enjoy a buffet luncheon during a Jan. 26 visit to NASA's John C. Stennis Space Center. WPO members from several states toured Stennis facilities during a daylong visit that included a river ride with Special Boat Team 22, the U.S. Navy's elite boat warriors group that trains at Stennis. Visiting president also had an opportunity to learn about the ongoing work of the nation's premier rocket engine testing site.

World Presidents Organization

NASA Image and Video Library

2010-01-26

Members of the World Presidents' Organization enjoy a buffet luncheon during a Jan. 26 visit to NASA's John C. Stennis Space Center. WPO members from several states toured Stennis facilities during a daylong visit that included a river ride with Special Boat Team 22, the U.S. Navy's elite boat warriors group that trains at Stennis. Visiting president also had an opportunity to learn about the ongoing work of the nation's premier rocket engine testing site.

Bradbury Science Museum

Science.gov Websites

Search Site submit About | Contacts | Directions Los Alamos National LaboratoryBradbury Science Museum Your Window into Los Alamos National Laboratory Bradbury Science Museum Menu About Contacts Directions Visit Visitor Information About the Museum Large Group Visits Around Los Alamos Contact Us

Initial home health outcomes under prospective payment.

PubMed

Schlenker, Robert E; Powell, Martha C; Goodrich, Glenn K

2005-02-01

To assess initial changes in home health patient outcomes under Medicare's home health Prospective Payment System (PPS), implemented by the Centers for Medicare and Medicaid Services (CMS) in October 2000. Pre-PPS and early PPS data were obtained from CMS Outcome and Assessment Information Set (OASIS) and Medicare claims files. Regression analysis was applied to national random samples (n=164,810) to estimate pre-PPS/PPS outcome and visit-per-episode changes. Outcome episodes were constructed from OASIS data and linked with Medicare claims data on visits. Outcome changes (risk adjusted) were mixed and generally modest. Favorable changes included higher improvement rates under PPS for functioning and dyspnea, higher community discharge rates, and lower hospitalization and emergent care rates. Most stabilization (nonworsening) outcome rates also increased. However, improvement rates were lower under PPS for wounds, incontinence, and cognitive and emotional/behavioral outcomes. Total visits per episode (case-mix adjusted) declined 16.6 percent although therapy visits increased by 8.4 percent. The outcome and visit results suggest improved system efficiency under PPS (fewer visits, similar outcomes). However, declines in several improvement rates merit ongoing monitoring, as do subsequent (posthome health) hospitalization and emergent care use. Since only the early PPS period was examined, longer-term analyses are needed.

Veterans in substance abuse treatment program self-initiate box gardening as a stress reducing therapeutic modality.

PubMed

Lehmann, Lauren P; Detweiler, Jonna G; Detweiler, Mark B

2018-02-01

To assess the experiences of a veteran initiated horticultural therapy garden during their 28-day inpatient Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). Retrospective study. Veterans Affairs Medical Center (VAMC), Salem, Virginia, USA INTERVENTIONS: Group interviews with veterans from the last SARRTP classes and individual interviews with VAMC greenhouse staff in summer of 2016. Time spent in garden, frequency of garden visits, types of passive and active garden activities, words describing the veterans' emotional reactions to utilizing the garden. In 3 summer months of 2016, 50 percent of the 56 veterans interviewed visited and interacted with the gardens during their free time. Frequency of visits generally varied from 3 times weekly to 1-2 times a day. Amount of time in the garden varied from 10min to 2h. The veterans engaged in active and/or passive gardening activities during their garden visits. The veterans reported feeling "calm", "serene", and "refreshed" during garden visitation and after leaving the garden. Although data was secured only at the end of the 2016 growing season, interviews of the inpatient veterans revealed that they used their own initiative and resources to continue the horticulture therapy program for 2 successive growing years after the original pilot project ended in 2014. These non-interventionist, therapeutic garden projects suggest the role of autonomy and patient initiative in recovery programs for veterans attending VAMC treatment programs and they also suggest the value of horticulture therapy as a meaningful evidence- based therapeutic modality for veterans. Published by Elsevier Ltd.

Non-steroidal Anti-inflammatory Drugs and Cancer Risk in Women: Results from the Women’s Health Initiative

PubMed Central

Brasky, Theodore M.; Liu, Jingmin; White, Emily; Peters, Ulrike; Potter, John D.; Walter, Roland B.; Baik, Christina S.; Lane, Dorothy S.; Manson, JoAnn E.; Vitolins, Mara Z.; Allison, Matthew A.; Tang, Jean Y.; Wactawski-Wende, Jean

2017-01-01

The use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risks of cancers at several sites in some studies; however, we recently reported no association between their use and total cancer risk in women in a prospective study. Here we examine the association between NSAIDs and total and site-specific cancer incidence in the large, prospective Women’s Health Initiative (WHI). 129,013 women were recruited to participate in the WHI at 40 US clinical centers from 1993 to 1998 and followed prospectively. After 9.7 years of follow-up, 12,998 incident, first primary, invasive cancers were diagnosed. NSAID use was systematically collected at study visits. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between NSAIDs use and total and site-specific cancer risk. Relative to non-use, consistent use (i.e., use at baseline and year 3 of follow-up) of any NSAID was not associated with total cancer risk (HR 1.00, 95% CI: 0.94–1.06). Results for individual NSAIDs were similar to the aggregate measure. In site-specific analyses, NSAIDs were associated with reduced risks of colorectal cancer, ovarian cancer, and melanoma. Our study confirms a chemopreventive benefit for colorectal cancer in women and gives preliminary evidence for a reduction of the risk of some rarer cancers. NSAIDs’ benefit on cancer risk was limited to specific sites and not evident when total cancer risk was examined. This information may be of importance when NSAIDs are considered as chemopreventive agents. PMID:24599876

Hydrologic investigations in the Araguaia-Tocantins River basin (Brazil)

USGS Publications Warehouse

Snell, Leonard J.

1979-01-01

The Araguaia-Tocantins River basin system of central and northern Brazil drains an area of about 770,000 square kilometers and has the potential for supporting large-scale developments. During a short visit to the headquarters of the Interstate Commission for the Araguaia-Tocantins Valley and to several stream-gaging stations in June 1964, the author reviewed the status of the streamflow and meteorological data-collection programs in relation to the streamflow and meteorological data-collection programs in relation to the pressing needs of development project studies. To provide data for areal and project-site studies and for main-stream sites, an initial network of 33 stream gaging stations was proposed, including the 7 stations then in operation. Suggestions were made in regard to operations, staffing and equipment. Organizational responsibilities for operations were found to be divided uncertainly. The Brazilian Meteorological Service had 15 synoptic stations in operation in and near the basin, some in need of reconditioning. Plans were at hand for the addition of 15 sites to the synoptic network and for limited data collection at 27 other sites. The author proposed collection of precipitation data at about 50 other locations to achieve a more representative areal distribution. Temperature, evaporation, and upper-air data sites were suggested to enhance the prospective hydrometeorological studies. (USGS)

Group visits for chronic illness management: implementation challenges and recommendations.

PubMed

Jones, Katherine R; Kaewluang, Napatsawan; Lekhak, Nirmala

2014-01-01

The group visit approach to improve chronic illness self-management appears promising in terms of selected outcomes, but little information is available about best ways to organize and implement group visits. This literature review of 84 articles identified group visit implementation challenges, including lack of a group visit billing code, inadequate administrative support and resources, difficult participant recruitment and retention, and logistical issues such as space and scheduling. Recommendations for future implementation initiatives were also abstracted from the literature. Patients and providers can benefit from well-planned and well-conducted group visits. These benefits include greater patient and provider satisfaction, reduced overall utilization, improved clinical outcomes, and greater provider efficiency and productivity.

Diplomacy Through Earth Sciences: An Overview of US Geological Survey Technical Assistance Regarding the Ongoing LUSI Mud Eruption, East Java, Indonesia

NASA Astrophysics Data System (ADS)

Casadevall, T. J.

2009-12-01

In June 2007, the US Department of State (DOS) requested assistance from the USGS to provide technical guidance and advice to the US Mission in Indonesia regarding the Lumpur Sidoarjo (LUSI) mud crisis. In May 2006, LUSI began as a mud eruption from a series of mud springs adjacent to an oil and gas exploration well being drilled near Surabaya, East Java, Indonesia. The production of mud and waters from the LUSI crater area has now continued for more than 3 years with no significant change in mud production rate (~110,000 cubic meters per day) nor in temperature of the mud (70-80 degrees C). Engineers suggest that mud production will continue at these rates for years to decades to come. Regardless of future activity at LUSI, the current mud accumulation of more than 100 million cubic meters poses a physical and environmental hazard which requires continuous monitoring and observation. The first response to the 2007 DOS request involved a site visit to Indonesia in September 2007. The result of that visit was to recommend to the Government of Indonesia (GOI) that they focus on long-term management of the mud rather than focus on the controversy as to the cause of the eruption or the debate about stopping the flow. Other recommendations from the initial 2007 technical visit included contracting for a US scientist to be co-located with engineers of the Sidoarjo Mud Management Board (BPLS) in Surabaya, East Java, to advise and consult on day-to-day developments at the site of the mud eruption. A second technical team visit by USGS scientists and an engineer from the US Army Corps of Engineers in October-November 2008 made additional recommendations on the long-term management of the mud and was followed in December by the start of a 6 month contract for the US mud adviser. From the start of activity in mid-2006 through late-2008, there was a clear sense of urgency at the US Mission in Indonesia to provide guidance and advice and included the personal intervention of the new US Ambassador. The USGS has completed the requests made in the June 2007 DOS cable, including an initial characterization of the mud and fluids; an analysis of land surface changes using the INSAR method; and an assessment of the seismic hazards in East Java. In the coming year, USGS will assist DOI agencies in the geophysical monitoring of the LUSI area and in the continued characterization of mud and fluids produced by the eruption.

The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study.

PubMed

Wade, Timothy J; Sams, Elizabeth A; Beach, Michael J; Collier, Sarah A; Dufour, Alfred P

2013-08-21

Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming. The overall incidence of self-reported earache was 1.6% in the 10-12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively. There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates.

What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

PubMed

Matthias, Marianne S; Fukui, Sadaaki; Salyers, Michelle P

2017-01-01

Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.

From biofuels to predicting the flu

Science.gov Websites

Search Site submit About | Contacts | Directions Los Alamos National LaboratoryBradbury Science Museum Your Window into Los Alamos National Laboratory Bradbury Science Museum Menu About Contacts Directions Visit Visitor Information About the Museum Large Group Visits Around Los Alamos Contact Us

Climate change and the Arctic

Science.gov Websites

Search Site submit About | Contacts | Directions Los Alamos National LaboratoryBradbury Science Museum Your Window into Los Alamos National Laboratory Bradbury Science Museum Menu About Contacts Directions Visit Visitor Information About the Museum Large Group Visits Around Los Alamos Contact Us

Rocky Mountain National Park dynamic message sign/highway advisory radio : operations plan.

DOT National Transportation Integrated Search

2011-07-01

Visitation to Rocky Mountain National Park (ROMO) has remained consistent over the last few : years, with approximately 3 million annual visitors (1). It is the most visited National Park site : in Colorado (2). The Town of Estes Park is the gateway ...

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study

PubMed Central

Nathan, Lisa M.; Shi, Quihu; Plewniak, Kari; Zhang, Charles; Nsabimana, Damien; Sklar, Marc; Mutimura, Eugene; Merkatz, Irwin R.; Einstein, Mark H.; Anastos, Kathryn

2015-01-01

To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB. PMID:25652061

Photovoltaics on Landfills in Puerto Rico

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salasovich, J.; Mosey, G.

The U.S. Environmental Protection Agency (EPA), in accordance with the RE-Powering America's Land initiative, selected the Commonwealth of Puerto Rico for a feasibility study of m0treAlables on several brownfield sites. The EPA defines a brownfield as 'a property, the expansion, redevelopment, or reuse of which may be complicated by the presence or potential presence of a hazardous substance, pollutant, or contaminant.' All of the brownfields in this study are landfill sites. Citizens of Puerto Rico, city planners, and site managers are interested in redevelopment uses for landfills in Puerto Rico, which are particularly well suited for solar photovoltaic (PV) installation.more » The purpose of this report is to assess the landfills with the highest potential for possible solar PV installation and estimate cost, performance, and site impacts of three different PV options: crystalline silicon (fixed-tilt), crystalline silicon (single-axis tracking), and thin film (fixed-tilt). Each option represents a standalone system that can be sized to use an entire available site area. In addition, the report outlines financing options that could assist in the implementation of a system. The feasibility of PV systems installed on landfills is highly impacted by the available area for an array, solar resource, operating status, landfill cap status, distance to transmission lines, and distance to major roads. All of the landfills in Puerto Rico were screened according to these criteria in order to determine the sites with the greatest potential. Eight landfills were chosen for site visits based on the screening criteria and location. Because of time constraints and the fact that Puerto Rico is a relatively large island, the eight landfills for this visit were all located in the eastern half of the island. The findings from this report can be applied to landfills in the western half of the island. The economics of a potential PV system on landfills in Puerto Rico depend greatly on the cost of electricity. Currently, PREPA has an average electric rate of $0.119/kWh. Based on past electric rate increases in Puerto Rico and other islands in the Caribbean, this rate could increase to $0.15/kWh or higher in a relatively short amount of time. In the coming years, increasing electrical rates and increased necessity for clean power will continue to improve the feasibility of implementing solar PV systems at these sites.« less

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic.

PubMed

Moon, Young Joon; Kim, Hong-Wook; Kim, Jin Bum; Kim, Hyung Joon; Chang, Young-Seop

2015-10-01

To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

Factor Analysis and Item Reduction of the Banff Patella Instability Instrument (BPII): Introduction of BPII 2.0.

PubMed

Lafave, Mark R; Hiemstra, Laurie; Kerslake, Sarah

2016-08-01

Clinical management of patellofemoral (PF) instability is a challenge, particularly considering the number of variables that should be taken into consideration for treatment. Quality of life is an important measure to consider with this patient population. To factor analyze and reduce the total number of items in the Banff Patella Instability Instrument (BPII). Subsequent to the factor analysis, the new, item-reduced BPII 2.0 was tested for validity, reliability, and responsiveness. Cohort study (diagnosis); Level of evidence, 2. Quality of life was measured for PF instability patients (N = 223) through use of the original BPII at their initial consultation. Data from the BPII scores were used in a principal components analysis (PCA) to factor analyze and reduce the total number of items in the original BPII, to create a revised BPII 2.0. The BPII 2.0 underwent content validation (Cronbach alpha, patient interviews, and grade-level checking), construct validation (analysis of variance comparing the initial visit and the 6-, 12-, and 24-month postoperative visits, eta-square), convergent validation (Pearson r correlation to the original BPII), responsiveness testing (eta-square, anchor-based distribution testing), and reliability testing (intraclass correlation coefficient [ICC]). The BPII was successfully reduced from 32 to 23 items with excellent Cronbach alpha values in the new BPII 2.0: initial visit = 0.91; 6-month postoperative visit = 0.96; 12-month postoperative visit = 0.97; and 24-month postoperative visit = 0.76. Grade-level reading for all items was assessed as below grade 12. The BPII 2.0 was able to discriminate between all time periods with significant differences between groups (P < .05). Eta-square was 0.40, demonstrating a medium to large effect size. The BPII significantly correlated with the BPII 2.0 (0.82, 0.90, 0.90, and 0.94 at the initial visit and 6-, 12-, and 24-month postoperative visits, respectively), providing evidence of convergent validity. A significant correlation was found between the 7-point scale and 24-month postoperative BPII 2.0 scores, a sign of anchor-based responsiveness. ICC (2,k) was 0.97, indicating strong reliability. The BPII 2.0 is valid, reliable, and responsive for assessment of patients with PF instability, both surgically and nonsurgically treated. © 2016 The Author(s).

A STUDY OF CURRICULUM CHANGES IN SELECTED TWO-YEAR COLLEGES INITIATED BY THE EVALUATION PROCESS USED BY THE MIDDLE STATES ASSOCIATION.

ERIC Educational Resources Information Center

BRASE, PETER CHARLES, JR.

DURING THE 1-YEAR PERIOD FOLLOWING ACCREDITATION COMMITTEE VISITS TO FOUR JUNIOR COLLEGES, THE AUTHOR VISITED THESE INSTITUTIONS AND STUDIED THEIR SELF-EVALUATION REPORTS AND THE VISITING COMMITTEE REPORTS, IN AN EFFORT TO DETERMINE THE EFFECTS OF THE ACCREDITATION PROCESS ON THE QUALITY OF INSTRUCTION. WHILE ACTIONS WERE TAKEN AS RESULTS OF BOTH…

Gestational Age at First Antenatal Care Visit in Malawi.

PubMed

Mkandawire, Paul

2015-11-01

This paper examines the gestational age at first antenatal care (ANC) visit and factors associated with timely initiation of ANC in Malawi in a context where maternal and child health services are generally provided for free. Lognormal survival models are applied to Demographic and Health Survey data from a nationally representative sample of women (n = 13,588) of child-bearing age. The findings of this study show that less than 30 % of pregnant women initiate ANC within the World Health Organization recommended gestational timeframe of 16 weeks or earlier. The hazard analysis shows a gradient in the initiation of ANC by maternal education level, with least educated mothers most likely to delay their first ANC visit. However, after adjusting for variables capturing intimate partner violence in the multivariate models, the effect of maternal education attenuated and lost statistical significance. Other significant predictors of gestational age at first ANC include media exposure, perceived distance from health facility, age, and birth order. The findings of the study link domestic violence directly with the gestational age at which mothers initiate ANC, suggesting that gender-based violence may operate through delayed initiation of ANC to undermine maternal and child health outcomes.

Self-guided field trips for students of environments

NASA Astrophysics Data System (ADS)

Moore, G.; Kerr, Roger; Hadgraft, Roger

2011-05-01

In many learning institutions around the world, there is a trend towards larger classes, more flexible learning pathways and reduced teaching resources. Experiential learning is often used in the form of site visits or field trips for students studying engineering, natural resource management, geography and similar disciplines. Providing opportunities for students to undertake field trips without the traditional support mechanism is one of the more challenging issues for subject designers. How can large cohorts of students gain practical exposure to various aspects of the natural or built environment? Although this is typically done using traditional site visits and fieldwork with a high staff/student ratio, the goal has been to use action research to design and develop resources to enable small groups (three or four) to make self-guided visits to sites close to campus. Multimedia resources to examine and interpret aspects of the site that relate to their on-campus learning guide the students. One critical issue in the success of these activities has been proper risk assessment and control procedures. The outcome of this research is a framework to provide a safe, active learning experience by way of self-guided field trips that is suitable for implementation with large classes.

Ecological modules and roles of species in heathland plant-insect flower visitor networks.

PubMed

Dupont, Yoko L; Olesen, Jens M

2009-03-01

1. Co-existing plants and flower-visiting animals often form complex interaction networks. A long-standing question in ecology and evolutionary biology is how to detect nonrandom subsets (compartments, blocks, modules) of strongly interacting species within such networks. Here we use a network analytical approach to (i) detect modularity in pollination networks, (ii) investigate species composition of modules, and (iii) assess the stability of modules across sites. 2. Interactions between entomophilous plants and their flower-visitors were recorded throughout the flowering season at three heathland sites in Denmark, separated by >or= 10 km. Among sites, plant communities were similar, but composition of flower-visiting insect faunas differed. Visitation frequencies of visitor species were recorded as a measure of insect abundance. 3. Qualitative (presence-absence) interaction networks were tested for modularity. Modules were identified, and species classified into topological roles (peripherals, connectors, or hubs) using 'functional cartography by simulated annealing', a method recently developed by Guimerà & Amaral (2005a). 4. All networks were significantly modular. Each module consisted of 1-6 plant species and 18-54 insect species. Interactions aggregated around one or two hub plant species, which were largely identical at the three study sites. 5. Insect species were categorized in taxonomic groups, mostly at the level of orders. When weighted by visitation frequency, each module was dominated by one or few insect groups. This pattern was consistent across sites. 6. Our study adds support to the conclusion that certain plant species and flower-visitor groups are nonrandomly and repeatedly associated. Within a network, these strongly interacting subgroups of species may exert reciprocal selection pressures on each other. Thus, modules may be candidates for the long-sought key units of co-evolution.

10 CFR 40.5 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

...: ATTN: Document Control Desk, Director, Office of Federal and State Materials and Environmental... electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e...

Bus rapid transit developments in China : perspectives from research, meetings, and site visits in April 2006.

DOT National Transportation Integrated Search

2006-07-01

This report briefly summarizes the information related to Bus Rapid Transit (BRT) developments in China collected through : independent research and a visit to China from April 17-26, 2006 as part of FTA Public Transportation Trade Mission. The purpo...

Risk factors for increased immune reconstitution in response to Mycobacterium tuberculosis antigens in tuberculosis HIV-infected, antiretroviral-naïve patients.

PubMed

da Silva, Tatiana Pereira; Giacoia-Gripp, Carmem Beatriz Wagner; Schmaltz, Carolina A; Sant'Anna, Flavia Marinho; Saad, Maria Helena; Matos, Juliana Arruda de; de Lima E Silva, Julio Castro Alves; Rolla, Valeria Cavalcanti; Morgado, Mariza Gonçalves

2017-09-06

Little is known regarding the restoration of the specific immune response after combined antiretroviral therapy (cART) and anti-tuberculosis (TB) therapy introduction among TB-HIV patients. In this study, we examined the immune response of TB-HIV patients to Mycobacterium tuberculosis (Mtb) antigens to evaluate the response dynamics to different antigens over time. Moreover, we also evaluated the influence of two different doses of efavirenz and the factors associated with immune reconstitution. This is a longitudinal study nested in a clinical trial, where cART was initiated during the baseline visit (D0), which occurred 30 ± 10 days after the introduction of anti-TB therapy. Follow-up visits were performed at 30, 60, 90 and 180 days after cART initiation. The production of IFN-γ upon in vitro stimulation with Mtb antigens purified protein derivative (PPD), ESAT-6 and 38 kDa/CFP-10 using ELISpot was examined at baseline and follow-up visits. Sixty-one patients, all ART-naïve, were selected and included in the immune reconstitution analysis; seven (11.5%) developed Immune Reconstitution Inflammatory Syndrome (IRIS). The Mtb specific immune response was higher for the PPD antigen followed by 38 kDa/CFP-10 and increased in the first 60 days after cART initiation. In multivariate analysis, the variables independently associated with increased IFN-γ production in response to PPD antigen were CD4 + T cell counts <200 cells/mm 3 at baseline, age, site of tuberculosis, 800 mg efavirenz dose and follow-up CD4 + T cell counts. Moreover, the factors associated with the production of IFN-γ in response to 38 kDa/CFP-10 were detectable HIV viral load (VL) and CD4 + T cell counts at follow-up visits of ≥200 cells/mm 3 . These findings highlight the differences in immune response according to the specificity of the Mtb antigen, which contributes to a better understanding of TB-HIV immunopathogenesis. IFN-γ production elicited by PPD and 38 kDa/CFP-10 antigens have a greater magnitude compared to ESAT-6 and are associated with different factors. The low response to ESAT-6, even during immune restoration, suggests that this antigen is not adequate to assess the immune response of immunosuppressed TB-HIV patients.

Comparative effectiveness of generic versus brand-name antiepileptic medications.

PubMed

Gagne, Joshua J; Kesselheim, Aaron S; Choudhry, Niteesh K; Polinski, Jennifer M; Hutchins, David; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H

2015-11-01

The objective of this study was to compare treatment persistence and rates of seizure-related events in patients who initiate antiepileptic drug (AED) therapy with a generic versus a brand-name product. We used linked electronic medical and pharmacy claims data to identify Medicare beneficiaries who initiated one of five AEDs (clonazepam, gabapentin, oxcarbazepine, phenytoin, zonisamide). We matched initiators of generic versus brand-name versions of these drugs using a propensity score that accounted for demographic, clinical, and health service utilization variables. We used a Cox proportional hazards model to compare rates of seizure-related emergency room (ER) visit or hospitalization (primary outcome) and ER visit for bone fracture or head injury (secondary outcome) between the matched generic and brand-name initiators. We also compared treatment persistence, measured as time to first 14-day treatment gap, between generic and brand-name initiators. We identified 19,760 AED initiators who met study eligibility criteria; 18,306 (93%) initiated a generic AED. In the matched cohort, we observed 47 seizure-related hospitalizations and ER visits among brand-name initiators and 31 events among generic initiators, corresponding to a hazard ratio of 0.53 (95% confidence interval, 0.30 to 0.96). Similar results were observed for the secondary clinical endpoint and across sensitivity analyses. Mean time to first treatment gap was 124.2 days (standard deviation [sd], 125.8) for brand-name initiators and 137.9 (sd, 148.6) for generic initiators. Patients who initiated generic AEDs had fewer adverse seizure-related clinical outcomes and longer continuous treatment periods before experiencing a gap than those who initiated brand-name versions. Copyright © 2015 Elsevier Inc. All rights reserved.

10 CFR 70.5 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to: ATTN: Document Control Desk, Director, Office of Nuclear Material Safety and Safeguards or... electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e...

An assessment of workplace programmes designed to control inhalation risks using respiratory protective equipment.

PubMed

Bell, Nikki; Vaughan, Nicholas P; Morris, Len; Griffin, Peter

2012-04-01

Few studies have assessed respiratory protective equipment (RPE) failures at the organizational level despite evidence to suggest that compliance with good practice may be low. The aim of this study was to develop an understanding of what current RPE programmes look like across industry and how this compares with good practice. Twenty cross-industry site visits were conducted with companies that had RPE programmes in place. Visits involved management interviews to explore current RPE systems and procedures and the decision making underpinning these. Observations of RPE operatives were included followed by short interviews to discuss the behaviours observed. Post-site assessments jointly undertaken by an RPE scientist and psychologist produced ratings for each site on six critical aspects of RPE programmes (knowledge/awareness, selection, use, training/information, supervision, and storage/cleaning/maintenance). Overall ratings for theoretical competence (i.e. management knowledge of RPE) and practical control (i.e. actual RPE practice on the shop floor) were also given. Qualitative analysis was performed on all interview data. The performance of RPE programmes varied across industry. Fewer than half the companies visited were considered to have an acceptable level of theoretical competence and practical control. Four distinct groups emerged from the 20 sites studied, ranging from Learners (low theoretical competence and practical control--four sites), Developers (acceptable theoretical competence and low practical control--five sites), and Fortuitous (low theoretical competence and acceptable practical control--two sites), to Proficient (acceptable theoretical competence and practical control--nine sites). None of the companies visited were achieving optimal control through the use of RPE. Widespread inadequacies were found with programme implementation, particularly training, supervision, and maintenance. Our taxonomy based on the four groups (Learners, Developers, Fortuitous, and Proficient) provided a useful expert-informed tool for explaining the variation in performance of RPE programmes across industry. Although further research and development are required, this taxonomy offers a useful starting point for the development of practical tools that may assist managers in making the much-needed improvements to all facets of programme implementation, particularly training, supervision, and maintenance.

Urban Telemedicine Enables Equity in Access to Acute Illness Care.

PubMed

Ronis, Sarah D; McConnochie, Kenneth M; Wang, Hongyue; Wood, Nancy E

2017-02-01

Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall. We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation. Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year. When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001). At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts. Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.

Contrasting past and current numbers of bears visiting Yellowstone cutthroat trout streams

USGS Publications Warehouse

Haroldson, Mark A.; Schwartz, Charles C.; Teisberg, Justin E.; Gunther, Kerry A.; Fortin, Jennifer K.; Robbins, Charles T.

2014-01-01

Spawning cutthroat trout (Oncorhynchus clarkii bouvieri) were historically abundant within tributary streams of Yellowstone Lake within Yellowstone National Park and were a highly digestible source of energy and protein for Yellowstone’s grizzly bears (Ursus arctos) and black bears (U. americanus). The cutthroat trout population has subsequently declined since the introduction of non-native lake trout (Salvelinus namaycush), and in response to effects of drought and whirling disease (Myxobolus cerebralis). The trout population, duration of spawning runs, and indices of bear use of spawning streams had declined in some regions of the lake by 1997–2000. We initiated a 3-year study in 2007 to assess whether numbers of spawning fish, black bears, and grizzly bears within and alongside stream corridors had changed since 1997– 2000. We estimated numbers of grizzly bears and black bears by first compiling encounter histories of individual bears visiting 48 hair-snag sites along 35 historically fished streams.We analyzed DNA encounter histories with Pradel-recruitment and Jolly-Seber (POPAN) capture-mark-recapture models. When compared to 1997–2000, the current number of spawning cutthroat trout per stream and the number of streams with cutthroat trout has decreased. We estimated that 48 (95% CI¼42–56) male and 23 (95% CI¼21–27) female grizzly bears visited the historically fished tributary streams during our study. In any 1- year, 46 to 59 independent grizzly bears (8–10% of estimated Greater Yellowstone Ecosystem population) visited these streams. When compared with estimates from the 1997 to 2000 study and adjusted for equal effort, the number of grizzly bears using the stream corridors decreased by 63%. Additionally, the number of black bears decreased between 64% and 84%. We also document an increased proportion of bears of both species visiting front-country (i.e., near human development) streams. With the recovery of cutthroat trout, we suggest bears that still reside within the Lake basin will readily use this high-quality food resource.

Characteristics of Food Industry Web Sites and "Advergames" Targeting Children

ERIC Educational Resources Information Center

Culp, Jennifer; Bell, Robert A.; Cassady, Diana

2010-01-01

Objective: To assess the content of food industry Web sites targeting children by describing strategies used to prolong their visits and foster brand loyalty; and to document health-promoting messages on these Web sites. Design: A content analysis was conducted of Web sites advertised on 2 children's networks, Cartoon Network and Nickelodeon. A…

Chilean Teachers Begin Exchange Program Visit in Magdalena

NASA Astrophysics Data System (ADS)

2007-01-01

Two teachers from the town of San Pedro de Atacama, in the northern desert of the South American nation of Chile, arrive in Magdalena, New Mexico, Sunday, January 28, for a two-week visit that is part of a Sister Cities program sponsored by Associated Universities, Inc. (AUI), the nonprofit research corporation that operates the National Radio Astronomy Observatory (NRAO). They will be accompanied by their town's mayor. Myriam Nancy Rivera Mercado, Head of the high school in San Pedro, Gabriela Fernanda Rodriguez Moraleda, a tourism teacher there, and San Pedro Mayor Sandra Berna Martinez will begin a visit that includes classroom observations in the Magdalena schools, a reception hosted by the Magdalena Village Council, and a Mayor's Breakfast with Magdalena Mayor Jim Wolfe. They also will meet local residents, tour the Bosque del Apache National Wildlife Refuge with a second-grade class, visit an area ranch, tour the Very Large Array (VLA) radio telescope, and see Socorro's Community Arts Party. "These teachers will learn much about New Mexico, the United States, and our educational system, and will take this new knowledge back to their students and their community," said NRAO Education Officer Robyn Harrison. The visit is part of a Sister Cities program initiated and funded by AUI, which operates the NRAO for the U.S. National Science Foundation. Radio astronomy is a common link between San Pedro de Atacama and Magdalena. San Pedro is near the site of the Atacama Large Millimeter/submillimeter Array (ALMA), an international telescope project now under construction with funding by major partners in North America, Europe, and Japan. Magdalena is near the site of NRAO's VLA radio telescope. In Magdalena, the Village Council and Mayor Wolfe formalized their participation in the Sister Cities program last September, and San Pedro ratified the program in December. In San Pedro, the ceremony ratifying the agreement was attended by U.S. Ambassador to Chile Craig K. Kelly. The Chilean teachers are visiting Magdalena while they are on their Southern Hemisphere summer vacation, and Magdalena's schools are in session. Two Magdalena teachers, Joleen Welborn and Sandra Montoya, will visit San Pedro in June, while they are on summer vacation and the Chilean schools will be in session. Dr. Eduardo Hardy, the AUI/NRAO representative in Chile, will accompany the Chilean teachers on their visit, which has been coordinated by Harrison. "ALMA is a groundbreaking example of the type of international cooperation that marks the future of astronomy. We are especially pleased to sponsor a program that brings together two communities that both enjoy proximity to world-class astronomical research facilities," said Dr. Fred K.Y. Lo, NRAO Director. "While separated by many miles, San Pedro de Atacama and Magdalena have much in common. Both are small communities in high desert environments, and both are next to telescopes where the world's astronomers will be making many exciting discoveries in the coming decades. Bringing these two communities together will advance education and international understanding," Harrison said. The National Radio Astronomy Observatory is a facility of the National Science Foundation, operated under cooperative agreement by Associated Universities, Inc.

Pre-Visit Prioritization for Complex Patients with Diabetes: Randomized Trial Design and Implementation within an Integrated Health Care System

PubMed Central

Grant, Richard W; Uratsu, Connie S; Hansen, Karen R; Altschuler, Andrea; Kim, Eileen; Fireman, Bruce; Adams, Alyce S; Schmittdiel, Julie A; Heisler, Michele

2016-01-01

Background/Aims Despite robust evidence to guide clinical care, most patients with diabetes do not meet all goals of risk factor control. Improved patient-provider communication during time-limited primary care visits may represent one strategy for improving diabetes care. Methods We designed a controlled, cluster-randomized, multi-site intervention (Pre-Visit Prioritization for Complex Patients with Diabetes) that enables patients with poorly controlled type 2 diabetes to identify their top priorities prior to a scheduled visit and sends these priorities to the primary care physician progress note in the electronic medical record. In this paper, we describe strategies to address challenges to implementing our health IT-based intervention study within a large health care system. Results This study is being conducted in 30 primary care practices within a large integrated care delivery system in Northern California. Over a 12-week period (3/1/2015 – 6/6/2015), 146 primary care physicians consented to enroll in the study (90.1%) and approved contact with 2496 of their patients (97.6%). Implementation challenges included: (1) Navigating research vs. quality improvement requirements; (2) Addressing informed consent considerations; and (3) Introducing a new clinical tool into a highly time-constrained workflow. Strategies for successfully initiating this study included engagement with institutional leaders, Institutional Review Board members, and clinical stakeholders at multiple stages both before and after notice of Federal funding; flexibility by the research team in study design; and strong support from institutional leadership for “self-learning health system” research. Conclusions By paying careful attention to identifying and collaborating with a wide range of key clinical stakeholders, we have shown that researchers embedded within a learning care system can successfully apply rigorous clinical trial methods to test new care innovations. PMID:26820612

Factors associated with use of pre-operative chemoradiation therapy for rectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium

PubMed Central

Charlton, Mary E.; Lin, Chi; Jiang, Dingfeng; Stitzenberg, Karyn B.; Halfdanarson, Thorvardur R.; Pendergast, Jane F.; Chrischilles, Elizabeth A.; Wallace, Robert B.

2012-01-01

Purpose Pre-operative (pre-op) chemoradiation therapy (CRT) improves local control and reduces toxicity more than post-operative (post-op) CRT for the treatment of stages II/III rectal cancer, but studies suggest many patients still receive post-op CRT. We examined patient beliefs, and clinical and provider characteristics associated with receipt of recommended therapy. Methods We identified stage II/III rectal cancer patients who had primary site resection and CRT among subjects in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort of newly diagnosed colorectal cancer patients from 2003 to 2005. Patient surveys and abstracted medical records were used to construct variables and determine sequence of CRT and surgery. Logistic regression was used to model the association between predictors and receipt of pre-op CRT. Results Of the 201 patients, 66% received pre-op and 34% received post-op CRT. Those visiting a medical oncologist and/or radiation oncologist prior to a surgeon had a 96% (95% CI, 92% to 100%) predicted probability of receiving pre-op CRT, compared to 48% (95% CI, 41% to 55%) for those visiting a surgeon first. Among those visiting a surgeon first, documentation of recommended staging procedures was associated with receiving pre-op CRT. Conclusion Sequence of provider visits and documentation of recommended staging procedures were important predictors of receiving pre-op CRT. Initial multidisciplinary evaluation led to better adherence to CRT guidelines. Further evaluation of provider characteristics, referral patterns and related health system processes should be undertaken to inform targeted interventions to reduce variation from recommended care. PMID:22992624

Pre-Visit Prioritization for complex patients with diabetes: Randomized trial design and implementation within an integrated health care system.

PubMed

Grant, Richard W; Uratsu, Connie S; Estacio, Karen R; Altschuler, Andrea; Kim, Eileen; Fireman, Bruce; Adams, Alyce S; Schmittdiel, Julie A; Heisler, Michele

2016-03-01

Despite robust evidence to guide clinical care, most patients with diabetes do not meet all goals of risk factor control. Improved patient-provider communication during time-limited primary care visits may represent one strategy for improving diabetes care. We designed a controlled, cluster-randomized, multi-site intervention (Pre-Visit Prioritization for Complex Patients with Diabetes) that enables patients with poorly controlled type 2 diabetes to identify their top priorities prior to a scheduled visit and sends these priorities to the primary care physician progress note in the electronic medical record. In this paper, we describe strategies to address challenges to implementing our health IT-based intervention study within a large health care system. This study is being conducted in 30 primary care practices within a large integrated care delivery system in Northern California. Over a 12-week period (3/1/2015-6/6/2015), 146 primary care physicians consented to enroll in the study (90.1%) and approved contact with 2496 of their patients (97.6%). Implementation challenges included: (1) navigating research vs. quality improvement requirements; (2) addressing informed consent considerations; and (3) introducing a new clinical tool into a highly time-constrained workflow. Strategies for successfully initiating this study included engagement with institutional leaders, Institutional Review Board members, and clinical stakeholders at multiple stages both before and after notice of Federal funding; flexibility by the research team in study design; and strong support from institutional leadership for "self-learning health system" research. By paying careful attention to identifying and collaborating with a wide range of key clinical stakeholders, we have shown that researchers embedded within a learning care system can successfully apply rigorous clinical trial methods to test new care innovations. Copyright © 2016 Elsevier Inc. All rights reserved.

Early Childhood Home Visiting.

PubMed

Duffee, James H; Mendelsohn, Alan L; Kuo, Alice A; Legano, Lori A; Earls, Marian F

2017-09-01

High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home. Copyright © 2017 by the American Academy of Pediatrics.

Congressman Clyburn Visit

ScienceCinema

Cody, Tom

2017-12-13

Congressman James Clyburn visits the new employees of the Savannah River Site. These new jobs the graduates have received are a result of the Recovery Act at work. Lisa Jackson of the Environmental Protection Agency speaks about how the ARRA is in line with President Obama's vision of a better economy and cleaner environment.

75 FR 20885 - National Park Week, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... childhood obesity, I encourage all Americans to visit our national parks and take part in outdoor activities... nearly 100 years, the American people have entrusted the National Park Service (NPS) to care for the... Underground Railroad, countless American stories are enshrined in these sites. By visiting them, we can...

Expedition 52 Red Square Visit

NASA Image and Video Library

2017-07-10

Expedition 52 flight engineers Paolo Nespoli of ESA, left, Sergey Ryazanskiy of Roscosmos, center, and Randy Bresnik of NASA visit Red Square to lay roses at the site where Russian space icons are interred as part of traditional pre-launch ceremonies, Monday, July 10, 2017 in Moscow. Photo Credit: (NASA/Bill Ingalls)

Expedition 50 Red Square Visit

NASA Image and Video Library

2016-10-26

Expedition 50 NASA astronaut Peggy Whitson, left, Russian cosmonaut Oleg Novitskiy of Roscosmos, center, and ESA astronaut Thomas Pesquet visit Red Square to lay roses at the site where Russian space icons are interred as part of traditional pre-launch ceremonies, Wednesday, Oct. 26, 2016, in Moscow. Photo Credit: (NASA/Bill Ingalls)

Expedition 52 Red Square Visit

NASA Image and Video Library

2017-07-10

Expedition 52 flight engineers Paolo Nespoli of ESA, left, Sergey Ryazanskiy of Roscosmos, center, and Randy Bresnik of NASA visit Red Square prepare to lay roses at the site where Russian space icons are interred as part of traditional pre-launch ceremonies, Monday, July 10, 2017 in Moscow. Photo Credit: (NASA/Bill Ingalls)

Trip experiences and tourists' motivation

Treesearch

Joseph S. Chen; Alan R. Graefe; Deborah L. Kerstetter

1998-01-01

Little evidence exists to support the proposition that travel experiences may affect tourists' motivations. This study found that there was a significant difference in travel motivation between tourists who had an experience visiting other routes similar to the route they currently visited and tourists who did not have this experience; "interest in the site...

Requirements analysis report for transport estimation, preconstruction, construction, decision support and electronic bidding systems

DOT National Transportation Integrated Search

2009-01-01

Info Tech conducted an on-site visit at the Connecticut Department of Transportation in Newington : from October 27-31, 2008. The purpose of the visit was to conduct an analysis of ConnDOTs : processes and to review the operations and business sys...

Wild bees visiting cucumber on midwestern U.S. organic farms benefit from near-farm semi-natural areas.

PubMed

Smith, A A; Bentley, M; Reynolds, H L

2013-02-01

Wild bees that provide pollination services to vegetable crops depend on forage resources, nesting sites, and overwintering sites in the agricultural landscape. The scale at which crop-visiting bees use resources in the landscape can vary regionally, and has not been characterized in the Midwestern United States. We investigated the effects of seminatural land cover on wild bee visitation frequency to cucumber (Cucumis sativus L.) and on wild bee species richness on 10 organic farms in Indiana. We estimated the spatial scale at which the effects of land cover were strongest, and also examined the effects of nonlandscape factors on wild bees. The visitation frequency of wild bees to cucumber was positively related to the proportion of seminatural land in the surrounding landscape, and this relationship was strongest within 250 m of the cucumber patch. The species richness of wild cucumber visitors was not affected by land cover at any spatial scale, nor by any of the nonlandscape factors we considered. Our results indicate that wild, crop visiting bees benefit from seminatural areas in the agricultural landscape, and benefit most strongly from seminatural areas within 250 m of the crop field. This suggests that setting aside natural areas in the near vicinity of vegetable fields may be an effective way to support wild, crop-visiting bees and secure their pollination services.

Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013

PubMed Central

De La Mata, Nicole L.; Ly, Penh Sun; Van Nguyen, Kinh; Merati, Tuti Parwati; Pham, Thuy Thanh; Lee, Man Po; Choi, Jun Yong; Ross, Jeremy; Law, Matthew G.; Ng, Oon Tek

2017-01-01

Introduction Over time there has been substantial improvement in antiretroviral treatment (ART) programmes, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. Methods Analysis included HIV-positive adults initiating ART in 2003-2013 at seven ART programmes in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results A total of 8,305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3%(2.9-6.1%) in 2003-05 to 8.1%(7.1-9.2%) in 2006-09, then decreased to 6.7%(5.9-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2%(4.5-8.2%) in 2003-05 to 3.3%(2.8-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared to 2006-09 (adjusted subhazard ratio=0.73, 0.69-0.99). Conclusions LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years while mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years. PMID:28129256

Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program, Mobile Asthma Care for Kids Network).

PubMed

Scott, Lyne; Li, Marilyn; Thobani, Salima; Nichols, Breck; Morphew, Tricia; Kwong, Kenny Yat-Choi

2016-08-01

To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.

Improving the Climate for Female Scientists at the National Center for Atmospheric Research

NASA Astrophysics Data System (ADS)

Killeen, T. L.

2003-12-01

In the summer of 2000, at the invitation of the former Director of the National Center for Atmospheric Research (NCAR), a committee of senior female scientists affiliated with the American Physical Society's Committee on the Status of Women in Physics visited NCAR and NCAR's parent organization, the University Corporation for Atmospheric Research (UCAR). The purpose of the site visit was to develop recommendations designed to improve the climate for women scientists at NCAR. This site visit and the subsequent written report and response from NCAR/UCAR management were instrumental in the establishment of a series of new programs and recruitment/mentoring activities that have had a significant impact at NCAR. The APS Committee's report included recommendations in the areas of: staff recruitment and demographic balance; communication and consistent implementation of policies; mentoring and career development programs; and "family friendliness". The constructive and helpful report of the visiting APS committee was openly shared with staff and led to a series of discussions, debates, actions, and programs at NCAR that continue to this day. This poster will describe the APS Committee's recommendations, the institutional process that occurred in response to this study, and the resulting actions and their impact at the national center. Specific progress since the site visit has included a doubling of the percentage participation by females in the ladder (tenure-equivalent) scientist track at NCAR to a level that now significantly exceeds the national average for tenured or tenure-track female faculty at Ph.D.-granting institutions in the geosciences.

Sustaining new parents in home visitation services: key participant and program factors.

PubMed

Daro, Deborah; McCurdy, Karen; Falconnier, Lydia; Stojanovic, Daniela

2003-10-01

As prevention efforts have adopted more intensive service models, concerns over initial enrollment and retention rates have become more salient. This study examines the participant, provider and program factors that contribute to a longer length of stay and greater number of home visits for new parents enrolling in one national home visitation program. Retrospective data were collected on a random sample of 816 participants served by one of 17 Healthy Families America (HFA) program sites around the country. Using case record reviews, research staff documented each participant's characteristics and service experiences. To capture relevant staff and program information, research staff collected basic descriptive information from published documents and interviews with program managers. All home visitors who had contact with sample families also completed a self-assessment instrument regarding personal and professional characteristics. Hierarchical linear modeling allowed us to examine the unique role of participant, provider and program characteristics while recognizing the lack of independence among these three sets of variables. The combined provider and program levels in the HLM model accounted for one-third of the variance in service duration and one-quarter of the variance in the number of home visits. Older participants, those unemployed, and those who enrolled in the program early in their pregnancy were more likely to remain in services longer and to complete a greater number of home visits. Compared to White participants, African Americans and Hispanics were significantly more likely to remain in services longer and, in the case of African Americans, to receive a greater number of home visits. Participants who were enrolled in school were more likely to remain in services longer. Age was the only consistent provider characteristic associated with positive results in both models, with younger home visitors performing better. Prior experience showed a significant relationship only in the service dosage model and African American workers demonstrated greater success than White home visitors did in retaining families in service. At the program level, programs with lower caseloads and greater success in matching their participants and providers on parenting status and race/ethnicity were significantly more likely to demonstrate stronger enrollment patterns.

What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

PubMed Central

Matthias, Marianne S.; Fukui, Sadaaki; Salyers, Michelle P.

2016-01-01

Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed. PMID:26427999

10 CFR 74.6 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to: ATTN: Document Control Desk, Director of Nuclear Material Safety and Safeguards, U.S. Nuclear... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to MSHD.Resource...

10 CFR 74.6 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S. Nuclear Regulatory Commission...

10 CFR 25.9 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S. Nuclear Regulatory Commission...

10 CFR 25.9 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S. Nuclear Regulatory Commission...

The effects of visitation on incarcerated juvenile offenders: how contact with the outside impacts adjustment on the inside.

PubMed

Monahan, Kathryn C; Goldweber, Asha; Cauffman, Elizabeth

2011-04-01

The present study investigates how visitation from parents impacts youths' mental health in the first two months of incarceration in a secure juvenile facility. A diverse sample of 276 male, newly incarcerated serious adolescent offenders (14-17 years) was interviewed over a 60-day period. Results indicate that youth who receive visits from parents report more rapid declines in depressive symptoms over time compared to youth who do not receive parental visits. Moreover, these effects are cumulative, such that the greater number of visits from parents, the greater the decrease in depressive symptoms. Importantly, the protective effect of receiving parental visits during incarceration exists regardless of the quality of the parent-adolescent relationship. Policy changes that facilitate visitation may be key for easing adjustment during the initial period of incarceration.

Recreational Use of the Countryside: No Evidence that High Nature Value Enhances a Key Ecosystem Service

PubMed Central

Hornigold, Karen; Lake, Iain; Dolman, Paul

2016-01-01

In Western Europe, recreational amenity is presented as an important cultural ecosystem service that, along with other values, helps justify policies to conserve biodiversity. However, whether recreational use by the public is enhanced at protected areas designated for nature conservation is unknown. This is the first study to model outdoor recreation at a national scale, examining habitat preferences with statutory designation (Site of Special Scientific Interest) as an indicator of nature conservation importance. Models were based on a massive, three year national household survey providing spatially-referenced recreational visits to the natural environment. Site characteristics including land cover were compared between these observed visit sites (n = 31,502) and randomly chosen control sites (n = 63,000). Recreationists preferred areas of coast, freshwater, broadleaved woodland and higher densities of footpaths and avoided arable, coniferous woodland and lowland heath. Although conservation designation offers similar or greater public access than undesignated areas of the same habitat, statutory designation decreased the probability of visitation to coastal and freshwater sites and gave no effect for broadleaved woodland. Thus general recreational use by the public did not represent an important ecosystem service of protected high-nature-value areas, so that intrinsic and existence values remain as the primary justifications for conservation of high nature value areas. Management of ‘green infrastructure’ sites of lower conservation value that offer desirable habitats and enhanced provision of footpaths, could mitigate recreational impacts on nearby valuable conservation areas. PMID:27828990

An exploration of visitor motivations: The search for silence

NASA Astrophysics Data System (ADS)

Marin, Lelaina D.

2011-12-01

This research aims to study the relationship between visitor motivations for experiencing solitude, sounds of nature, and quiet and a visitor's soundscape experience. This relationship will improve managers' ability to provide satisfying and diverse experiences for their visitors and "protect" something that is increasingly rare outside of national parks and other protected natural areas; natural sounds and quiet. Chapter 1 focuses on the effect motivation for a quiet setting can have on acceptability of natural or human-caused sound in Muir Woods National Monument. This study used a dose-response methodology where visitors listened to five audio recordings varying in the percentage of time that human-caused sound was louder than natural sound (percent time above). Visitors were then asked to rate the acceptability of each recording. Three sound-related motivations for visiting Muir Woods were examined: "enjoying peace and quiet", "hearing sounds of nature" and "experiencing solitude." Cluster analysis was used to identify discrete groups with similar motivational profiles (i.e., low, moderate and high motivation for quiet). Results indicated that as percent time above natural sound increased, visitor ratings of human-caused sound decreased. Tolerance for human-caused sound also decreased as motivation for quiet increased. Consensus regarding the acceptability of sound was greatest when the percent time above natural sound was lowest (i.e., quietest sounds). Chapter 2 describes a study of the ability of motivations to predict which of three locations a visitor would most likely choose for recreation. Particular focus was given to sound-related motivations. Data for this study were collected at three sites with varying visitation levels within two national parks; Sequoia National Park-backcountry (low visitation), Sequoia National Park-frontcountry (moderate visitation), and Muir Woods National Monument-frontcountry (high visitation). Survey respondents were asked to rate the importance of six items in their decision to visit the particular park; (a) scenic beauty; (b) experience solitude; (c) time with family and friends; (d) get exercise; (e) experience the sounds of nature; and (f) peace and quiet. Results showed that, of the three study sites, those visitors more motivated to spend time with family and friends and experience the sounds of nature were more likely to visit a frontcountry site, while those motivated for experiencing solitude and getting exercise were more likely to visit a backcountry site. The experience of peace and quiet was not a significant predictor of park location chosen, suggesting that respondents were similarly motivated for quiet across all three sites. Both chapters in this thesis reveal interesting results that may cause managers to consider soundscape management differently in frontcountry and backcountry areas of national parks. For example, these results imply setting acoustic standards, designating management zones, and using education programs to manage for and meet varying levels of motivation for experiencing natural sounds and quiet.

Health visiting assessment--unpacking critical attributes in health visitor needs assessment practice: a case study.

PubMed

Appleton, Jane V; Cowley, Sarah

2008-02-01

Assessment of family health need is a central feature of health visiting practice in which a range of skills, knowledge and judgements are used. These assessments are pivotal in uncovering need, safeguarding children and in determining levels of health intervention to be offered to children and their families by the health visiting service in the UK. The central focus of this paper is to outline the critical attributes of the basic principles that underpin health visiting assessment practice that emerged as part of a case study enquiry. A case study design informed by a constructivist methodology was used to examine health visitors' professional judgements and use of formal guidelines in identifying health needs and prioritising families requiring extra health visiting support. The main study was conducted in three community Trust case sites in England, UK, with pilot work being undertaken in a fourth site. Fifteen health visitors participated in the main study and data were collected during 56 observed home visits to families receiving extra health visiting support. Separate in-depth interviews were conducted with the health visitors, pre- and post-home contacts, while 53 client interviews also took place. The analysis suggests that there are certain fundamental elements associated with the majority of health visitor assessments and these have been termed assessment principles. These characteristics are integral to, and provide the basis upon which health visitors' assessments are conducted and professional judgement is formed. They reflect the basic principles of health visiting assessment practice, which exist despite the constraints and realities of the practice context and can be differentiated from the activity centred methods of assessment processes.

Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative

PubMed Central

McGinn, A. P.; Budrys, N.; Chlebowski, R.; Ho, G. Y.; Johnson, K. C.; Lane, D. S.; Li, W.; Neuhouser, M. L.; Saquib, J.; Shikany, J. M.; Song, Y.; Thomson, C.

2014-01-01

Multivitamin use is common in the United States. It is not known whether multivitamins with minerals supplements (MVM) used by women already diagnosed with invasive breast cancer would affect their breast cancer mortality risk. To determine prospectively the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer, a prospective cohort study was conducted of 7,728 women aged 50–79 at enrollment in the women's health initiative (WHI) in 40 clinical sites across the United States diagnosed with incident invasive breast cancer during WHI and followed for a mean of 7.1 years after breast cancer diagnosis. Use of MVM supplements was assessed at WHI baseline visit and at visit closest to breast cancer diagnosis, obtained from vitamin pill bottles brought to clinic visit. Outcome was breast cancer mortality. Hazard ratios and 95 % confidence intervals (CIs) for breast cancer mortality comparing MVM users to non-users were estimated using Cox proportional hazard regression models. Analyses using propensity to take MVM were done to adjust for potential differences in characteristics of MVM users versus non-users. At baseline, 37.8 % of women reported MVM use. After mean post-diagnosis follow-up of 7.1 ± 4.1 (SD) years, there were 518 (6.7 %) deaths from breast cancer. In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60–0.96). Postmenopausal women with invasive breast cancer using MVM had lower breast cancer mortality than non-users. The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation. PMID:24104882

Another Treatment Gap: Restarting Secondary Prevention Medications The Women’s Health Initiative

PubMed Central

Robinson, Jennifer G; Wallace, Robert; Safford, Monika M.; Pettinger, Mary; Cochrane, Barbara; Ko, Marcia G.; O’Sullivan, Mary Jo; Masaki, Kamal; Petrovich, Helen

2010-01-01

Background Women’s long-term patterns of evidence-based preventive medication utilization following a coronary heart disease (CHD) diagnosis have not been sufficiently studied. Methods Postmenopausal women 50–79 years were eligible for randomization in the Women’s Health Initiative’s (WHI) hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis (n=2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6 and 9. Results Utilization at the first WHI visit following a CHD diagnosis increased over time for statins (49% to 72%; p<0.0001), beta-blockers (49% to 62%; p=0.003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs ) [26 to 43%; p<0.0001]. Aspirin use remained stable at 76% (p=0.09). Once women reported using a statin, aspirin, or beta-blocker, 84–89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28% respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively. Conclusions Efforts to improve secondary prevention medication utilization should target both drug initiation and restarting drugs in patients who have discontinued them. PMID:20354566

Home Quick – Occupational Therapy Home Visits Using mHealth, to Facilitate Discharge from Acute Admission Back to the Community

PubMed Central

NIX, JACQUELINE; COMANS, TRACY

2017-01-01

This article reports upon an initiative to improve the timeliness of occupational therapy home visits for discharge planning by implementing technology solutions while maintaining patient safety. A community hospital in Queensland, Australia, hosted a process evaluation that examined which aspects of home visiting could be replaced or augmented by alternative technologies. Strategies were trialled, implemented and assessed using the number of home visits completed and the time from referral to completion as outcomes. A technology-enhanced solution called “Home Quick” was developed using technology to facilitate pre-discharge home visits. The implementation of Home Quick resulted in an increase in the number of home visits conducted prior to discharge (50% increase from 145 to 223) and significantly increased the number of patients seen earlier following referral (X2=69.3; p<0.001). The substitution of direct home visits with technology-enabled remote visits is suitable for a variety of home visiting scenarios traditionally performed by occupational therapists. PMID:28814994

Mobile mammography: An evaluation of organizational, process, and information systems challenges.

PubMed

Browder, Casey; Eberth, Jan M; Schooley, Benjamin; Porter, Nancy R

2015-03-01

The purpose of this case study was to evaluate the information systems, personnel, and processes involved in mobile mammography settings, and offer recommendations to improve efficiency and satisfaction among patients and staff. Data includes on-site observations, interviews, and an electronic medical record review of a hospital who offers both mobile and fixed facility mammography services to their community. The optimal expectations for the process of mobile mammography from multiple perspectives were defined as (1) patient receives mammogram the day of their visit, (2) patient has efficient intake process with little wait time, (3) follow-up is completed and timely, (4) site contact and van staff are satisfied with van visit and choose to schedule future visits, and (5) the MMU is able to assess its performance and set goals for improvement. Challenges that prevent the realization of those expectations include a low patient pre-registration rate, difficulty obtaining required physician orders, frequent information system downtime/Internet connectivity issues, ill-defined organizational communication/roles, insufficient site host/patient education, and disparate organizational and information systems. Our recommendations include employing a dedicated mobile mammography team for end-to-end oversight, mitigating for system connectivity issues, allowing for patient self-referrals, integrating scheduling and registration processes, and a focused approach to educating site hosts and respective patients about expectations for the day of the visit. The MMU is an important community resource; we recommend simple process improvements and information flow improvements to further enable the MMU׳s goals. Copyright © 2015 Elsevier Inc. All rights reserved.

Integrating multi-criteria decision analysis for a GIS-based hazardous waste landfill sitting in Kurdistan Province, western Iran

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharifi, Mozafar; Hadidi, Mosslem; Vessali, Elahe

2009-10-15

The evaluation of a hazardous waste disposal site is a complicated process because it requires data from diverse social and environmental fields. These data often involve processing of a significant amount of spatial information which can be used by GIS as an important tool for land use suitability analysis. This paper presents a multi-criteria decision analysis alongside with a geospatial analysis for the selection of hazardous waste landfill sites in Kurdistan Province, western Iran. The study employs a two-stage analysis to provide a spatial decision support system for hazardous waste management in a typically under developed region. The purpose ofmore » GIS was to perform an initial screening process to eliminate unsuitable land followed by utilization of a multi-criteria decision analysis (MCDA) to identify the most suitable sites using the information provided by the regional experts with reference to new chosen criteria. Using 21 exclusionary criteria, as input layers, masked maps were prepared. Creating various intermediate or analysis map layers a final overlay map was obtained representing areas for hazardous waste landfill sites. In order to evaluate different landfill sites produced by the overlaying a landfill suitability index system was developed representing cumulative effects of relative importance (weights) and suitability values of 14 non-exclusionary criteria including several criteria resulting from field observation. Using this suitability index 15 different sites were visited and based on the numerical evaluation provided by MCDA most suitable sites were determined.« less

Integrating multi-criteria decision analysis for a GIS-based hazardous waste landfill sitting in Kurdistan Province, western Iran.

PubMed

Sharifi, Mozafar; Hadidi, Mosslem; Vessali, Elahe; Mosstafakhani, Parasto; Taheri, Kamal; Shahoie, Saber; Khodamoradpour, Mehran

2009-10-01

The evaluation of a hazardous waste disposal site is a complicated process because it requires data from diverse social and environmental fields. These data often involve processing of a significant amount of spatial information which can be used by GIS as an important tool for land use suitability analysis. This paper presents a multi-criteria decision analysis alongside with a geospatial analysis for the selection of hazardous waste landfill sites in Kurdistan Province, western Iran. The study employs a two-stage analysis to provide a spatial decision support system for hazardous waste management in a typically under developed region. The purpose of GIS was to perform an initial screening process to eliminate unsuitable land followed by utilization of a multi-criteria decision analysis (MCDA) to identify the most suitable sites using the information provided by the regional experts with reference to new chosen criteria. Using 21 exclusionary criteria, as input layers, masked maps were prepared. Creating various intermediate or analysis map layers a final overlay map was obtained representing areas for hazardous waste landfill sites. In order to evaluate different landfill sites produced by the overlaying a landfill suitability index system was developed representing cumulative effects of relative importance (weights) and suitability values of 14 non-exclusionary criteria including several criteria resulting from field observation. Using this suitability index 15 different sites were visited and based on the numerical evaluation provided by MCDA most suitable sites were determined.

The effect of systematic clinical interventions with cigarette smokers on quit status and the rates of smoking-related primary care office visits.

PubMed

Land, Thomas G; Rigotti, Nancy A; Levy, Douglas E; Schilling, Thad; Warner, Donna; Li, Wenjun

2012-01-01

The United States Public Health Service (USPHS) Guideline for Treating Tobacco Use and Dependence includes ten key recommendations regarding the identification and the treatment of tobacco users seen in all health care settings. To our knowledge, the impact of system-wide brief interventions with cigarette smokers on smoking prevalence and health care utilization has not been examined using patient population-based data. Data on clinical interventions with cigarette smokers were examined for primary care office visits of 104,639 patients at 17 Harvard Vanguard Medical Associates (HVMA) sites. An operational definition of "systems change" was developed. It included thresholds for intervention frequency and sustainability. Twelve sites met the criteria. Five did not. Decreases in self-reported smoking prevalence were 40% greater at sites that achieved systems change (13.6% vs. 9.7%, p<.01). On average, the likelihood of quitting increased by 2.6% (p<0.05, 95% CI: 0.1%-4.6%) per occurrence of brief intervention. For patients with a recent history of current smoking whose home site experienced systems change, the likelihood of an office visit for smoking-related diagnoses decreased by 4.3% on an annualized basis after systems change occurred (p<0.05, 95% CI: 0.5%-8.1%). There was no change in the likelihood of an office visit for smoking-related diagnoses following systems change among non-smokers. The clinical practice data from HVMA suggest that a systems approach can lead to significant reductions in smoking prevalence and the rate of office visits for smoking-related diseases. Most comprehensive tobacco intervention strategies focus on the provider or the tobacco user, but these results argue that health systems should be included as an integral component of a comprehensive tobacco intervention strategy. The HVMA results also give us an indication of the potential health impacts when meaningful use core tobacco measures are widely adopted.

The Effect of Systematic Clinical Interventions with Cigarette Smokers on Quit Status and the Rates of Smoking-Related Primary Care Office Visits

PubMed Central

Land, Thomas G.; Rigotti, Nancy A.; Levy, Douglas E.; Schilling, Thad; Warner, Donna; Li, Wenjun

2012-01-01

Background The United States Public Health Service (USPHS) Guideline for Treating Tobacco Use and Dependence includes ten key recommendations regarding the identification and the treatment of tobacco users seen in all health care settings. To our knowledge, the impact of system-wide brief interventions with cigarette smokers on smoking prevalence and health care utilization has not been examined using patient population-based data. Methods and Findings Data on clinical interventions with cigarette smokers were examined for primary care office visits of 104,639 patients at 17 Harvard Vanguard Medical Associates (HVMA) sites. An operational definition of “systems change” was developed. It included thresholds for intervention frequency and sustainability. Twelve sites met the criteria. Five did not. Decreases in self-reported smoking prevalence were 40% greater at sites that achieved systems change (13.6% vs. 9.7%, p<.01). On average, the likelihood of quitting increased by 2.6% (p<0.05, 95% CI: 0.1%–4.6%) per occurrence of brief intervention. For patients with a recent history of current smoking whose home site experienced systems change, the likelihood of an office visit for smoking-related diagnoses decreased by 4.3% on an annualized basis after systems change occurred (p<0.05, 95% CI: 0.5%–8.1%). There was no change in the likelihood of an office visit for smoking-related diagnoses following systems change among non-smokers. Conclusions The clinical practice data from HVMA suggest that a systems approach can lead to significant reductions in smoking prevalence and the rate of office visits for smoking-related diseases. Most comprehensive tobacco intervention strategies focus on the provider or the tobacco user, but these results argue that health systems should be included as an integral component of a comprehensive tobacco intervention strategy. The HVMA results also give us an indication of the potential health impacts when meaningful use core tobacco measures are widely adopted. PMID:22911834

Adherence to Highly Active Antiretroviral Treatment in HIV-Infected Rwandan Women

PubMed Central

Musiime, Stephenson; Muhairwe, Fred; Rutagengwa, Alfred; Mutimura, Eugene; Anastos, Kathryn; Hoover, Donald R.; Qiuhu, Shi; Munyazesa, Elizaphane; Emile, Ivan; Uwineza, Annette; Cowan, Ethan

2011-01-01

Background Scale-up of highly active antiretroviral treatment therapy (HAART) programs in Rwanda has been highly successful but data on adherence is limited. We examined HAART adherence in a large cohort of HIV+ Rwandan women. Methods The Rwanda Women's Interassociation Study Assessment (RWISA) was a prospective cohort study that assessed effectiveness and toxicity of ART. We analyzed patient data 12±3 months after HAART initiation to determine adherence rates in HIV+ women who had initiated HAART. Results Of the 710 HIV+ women at baseline, 490 (87.2%) initiated HAART. Of these, 6 (1.2%) died within 12 months, 15 others (3.0%) discontinued the study and 80 others (19.0%) remained in RWISA but did not have a post-HAART initiation visit that fell within the 12±3 month time points leaving 389 subjects for analysis. Of these 389, 15 women stopped their medications without being advised to do so by their doctors. Of the remaining 374 persons who reported current HAART use 354 completed the adherence assessment. All women, 354/354, reported 100% adherence to HAART at the post-HAART visit. The high self-reported level of adherence is supported by changes in laboratory measures that are influenced by HAART. The median (interquartile range) CD4 cell count measured within 6 months prior to HAART initiation was 185 (128, 253) compared to 264 (182, 380) cells/mm3 at the post-HAART visit. Similarly, the median (interquartile range) MCV within 6 months prior to HAART initiation was 88 (83, 93) fL compared to 104 (98, 110) fL at the 12±3 month visit. Conclusion Self-reported adherence to antiretroviral treatment 12±3 months after initiating therapy was 100% in this cohort of HIV-infected Rwandan women. Future studies should explore country-specific factors that may be contributing to high levels of adherence to HAART in this population. PMID:22114706

Geothermal energy in Tibet

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lund, J.W.; McEuen, R.B.; Roberts, A.

1984-09-01

During the fall of 1983, a American delegation of 14 geothermal experts visited the People's Republic of China. The three-week trip included visits to Beijing (Peking), Chengdu, Lhasa, Yangbajing, and Kunming. By far the highlight of the trip was the journey to Tibet where the geothermal field and power station at Yangbajing were toured. Technical exchanges with Chinese and Tibetan geothermal scientists and engineers were made at Beijing, Lhasa, Yangbajing and Kunming. At Kunming in Yunnan Province, the geothermal field in the western part of the province was discussed, but not visited. This latter field is in the process ofmore » extensive investigation, but only minor direct-use development such as sulfur collection and wool washing is being undertaken. The drilling of wells and power plant construction is anticipated in the Rehai and Ridian fields in the near future. In general, Yunnan has one of the largest geothermal potentials in China with over 600 sites identified so far. The sites are widespread throughout the province, but the high temperature sites are located in the western part, a very mountainous area.« less

Early detection and treatment of sexually transmitted disease in pregnant adolescents of low socioeconomic status.

PubMed

Matson, S C; Pomeranz, A J; Kamps, K A

1993-10-01

This study evaluated the prevalence of sexually transmitted disease (STD) in adolescents presenting to a primary pediatric care clinic (PPCC) for the diagnosis of pregnancy and our ability to eradicate identified infections. We followed 168 pregnant adolescents of low socioeconomic status from their original pregnancy diagnosis until their first prenatal clinic visit. We collected screening cervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis by completing a pelvic examination on 91 patients at our PPCC. At the PPCC visit, 29% were positive for gonorrhea, chlamydia, or both. Screening tests for these infections were collected on all patients at the initial prenatal clinic visit. The risk for presenting to the prenatal clinic with a STD was significantly greater in patients not screened and treated for STD at the PPCC. Average delay from diagnosis to first prenatal clinic visit was 35.7 days. Thus, in this adolescent population, primary care providers are missing an important therapeutic opportunity by failing to identify and treat STD at initial diagnosis of pregnancy.

Does information available at admission for delivery improve prediction of vaginal birth after cesarean?

PubMed Central

Grobman, William A.; Lai, Yinglei; Landon, Mark B.; Spong, Catherine Y.; Leveno, Kenneth J.; Rouse, Dwight J.; Varner, Michael W.; Moawad, Atef H.; Simhan, Hyagriv N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; O'sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

2010-01-01

Objective To construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care. Study design Using multivariable modeling, we constructed a predictive model for VBAC that included patient factors known at the initial prenatal visit as well as those that only became evident as the pregancy progressed to the admission for delivery. Results 9616 women were analyzed. The regression equation for VBAC success included multiple factors that could not be known at the first prenatal visit. The area under the curve for this model was significantly greater (P < .001) than that of a model that included only factors available at the first prenatal visit. Conclusion A prediction model for VBAC success that incorporates factors that can be ascertained only as the pregnancy progresses adds to the predictive accuracy of a model that uses only factors available at a first prenatal visit. PMID:19813165

STS-133 crew visit

NASA Image and Video Library

2011-04-20

Stennis Space Center Deputy Director Rick Gilbrech (far right) welcomes members of the STS-133 shuttle mission crew during an April 20 visit. The mission was the final flight for the space shuttle Discovery, which now becomes the first of the three-orbiter fleet to be retired. During the visit to Stennis, Mission Commander Steven Lindsey ( l to r), Pilot Eric Boe and mission specialists Alvin Drew, Steven Bowen, Michael Barratt and Nicole Stott recapped their historic flight and thanked site employees for providing main engines that performed 'as advertised.'

The National Library of Kosovo "PJETER Bogdani" Rapid Condition Assessment and Documentation

NASA Astrophysics Data System (ADS)

Eppich, R.; Ramku, B.; Binakaj, N.

2017-08-01

The National Library of Kosovo "Pjetër Bogdani" is a symbol of Prishtina, Kosovo and the quest for knowledge. It is simultaneously an icon of modernity and symbol of the past. Unfortunately, it suffered through the Kosovo war and neglect in times of economic difficulty. It was also unfortunately featured in the British newspaper The Telegraph in their travel section: "One of the world's 30 ugliest buildings?" In late 2015 the Kosovo Architectural Foundation, a non-profit dedicated to spirit of creating and preserving unique architecture, became concerned with the reputation and condition of the Library and contacted the Kosovo Ministry of Culture, visited the site and initiated a project to raise awareness and document this modern masterpiece. The Getty Foundation and their Keeping it Modern grant program awarded funding for initial condition assessment, documentation, capacity building and investigations. This paper discusses the project to document and improve the image and awareness of this important structure and set priorities for its future.

Blue Ribbon Commission Tour of Hanford Site

ScienceCinema

Paul Saueressig

2017-12-09

The Blue Ribbon Commission on America's Nuclear Future toured the Department of Energy's Hanford Site on July 14, 2010. Commission members, invited guests, and members of the public visited facilities that store high-level, radioactive waste.

42 CFR 3.110 - Assessment of PSO compliance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... reviews of, or site visits to, PSOs, to assess or verify PSO compliance with the requirements of this subpart and for these purposes will be allowed to inspect the physical or virtual sites maintained or...

10 CFR 60.4 - Communications and records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... sent by mail addressed: ATTN: Document Control Desk: Director, Office of Nuclear Material Safety and... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

10 CFR 30.6 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... may be submitted to the Commission as follows: (1) By mail addressed: ATTN: Document Control Desk... visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to MSHD.Resource...

10 CFR 110.4 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... Detailed guidance on making electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office...

10 CFR 110.4 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... Detailed guidance on making electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office...

SEXUAL SELECTION THROUGH FEMALE CHOICE IN LAWES' PAROTIA, A LEK-MATING BIRD OF PARADISE.

PubMed

Pruett-Jones, S G; Pruett-Jones, M A

1990-05-01

We studied sexual selection in Lawes' Parotia, a lek-mating bird of paradise, during 1981-1983 in Papua New Guinea. There was a high variance in mating success among males, with fewer than half of the individuals mating in any one year. This variance was independent of male-male interactions and disruptions. A role of female choice in sexual selection was suggested by the patterns of female visitation to courts and statistical correlations across males between phenotypic traits and mating success. Females repeatedly visited most males in their home ranges and began visiting males up to six weeks before mating. In one or more years, six aspects of male behavior and one morphological variable were positively correlated with mating success, but the probability values were not significant using a simultaneous inference test. Calculation of combined probability values across all three years revealed that one aspect of male display behavior, the probability of display, positively and significantly influenced mating status. The probability of display was also significantly correlated with relative mating success among males. Females showed strong fidelity to mates, both within and between seasons. Display sites of male Lawes' Parotia are variably dispersed, but mating success did not differ for grouped and solitary males. These data confirm an important role of female choice in sexual selection in birds of paradise but also suggest that female choice may be unrelated to the process of lek-initiation in this species. © 1990 The Society for the Study of Evolution.

Case Studies of Selected Cooperative Adult Education Programs.

ERIC Educational Resources Information Center

Moore, Allen B., Ed.; And Others

Third in a series of five, the document presents case study reports of site visits to cooperative adult education programs. The five locations visited included programs between: (1) Wharton County Junior College and Johnson Testers, Inc. (Texas); (2) Louisiana State Department of Education and B. F. Trappey and Sons (Louisiana); (3) Grand Rapids…

JPRS Report: Proliferation Issues

DTIC Science & Technology

1993-03-08

Mo’allem Khani -ye, approximately 150 km north of Rafsanjani’s brother-in-law and among the leaders of the Tehran. This is a base-most of it underground...the manner national Atomic Energy Agency visited Iran, its mem- in which Saddam Husayn was defeated. bers asked to visit the site at Mo’allem Khani -ye

A Study of Operator and Mechnaic Training Needs in the Transit Industry. Volume II, Appendices. Final Report.

ERIC Educational Resources Information Center

Henderson, Harold L.; And Others

Surveys of 188 transit properties and on-site visits were conducted to determine the training needs of operators and mechanics in the urban mass transportation industry. The appendices include listings of respondents and sample copies of the survey questionnaires and visit reports. (NTIS)

SOLVENT-BASED TO WATERBASED ADHESIVE-COATED SUBSTRATE RETROFIT - VOLUME IV: FILM AND LABEL MANUFACTURING CASE STUDY: FLEXCON COMPANY, INC.

EPA Science Inventory

This volume discusses a visit to a site operated by FLEXcon Company, Inc., a pressure-sensitive adhesive coater, to collect information on the pollution prevention opportunities and barriers associated with waterbased adhesives. The purpose of the visit to FLEXcon was to gather i...

Defense.gov - Special Report: Travels with Lynn

Science.gov Websites

social media. Story Simulation Center Provides Taste of Combat MARINE CORPS BASE CAMP PENDELTON, Calif Force's battle simulation center at Marine Corps Base Camp Pendleton, Calif. Story 'Adaptable' U.S. Troops Visits Vandenberg Air Force Base and Los Angeles Lynn Visits Navy and Marine Bases About This Site DoD

"Response to Intervention" Sparks Interest, Questions

ERIC Educational Resources Information Center

Samuels, Christina A.

2008-01-01

As a demonstration site designated by Oregon as a prime example of "response to intervention" in action, the Tigard-Tualatin district has had to pare visiting groups down to no more than 25 people. During the last few visits, 50 people descended on the district just outside Portland at one time. As educators in Tigard-Tualatin and…

Business Administration and Management: Current Trends and Future Directions.

ERIC Educational Resources Information Center

Flewellen, William C., Jr.

Drawing from site visits to 39 public and private colleges in Massachusetts, this report presents an evaluation of college programs in business administration and management and recommendations for improvement. Section 1 provides an overview of the statewide study and its findings. After identifying the colleges visited and the members of the…

Racial/ethnic minority children's use of psychiatric emergency care in California's Public Mental Health System.

PubMed

Snowden, Lonnie R; Masland, Mary C; Libby, Anne M; Wallace, Neal; Fawley, Kya

2008-01-01

We examined rates and intensity of crisis services use by race/ethnicity for 351,174 children younger than 18 years who received specialty mental health care from California's 57 county public mental health systems between July 1998 and June 2001. We used fixed-effects regression for a controlled assessment of racial/ethnic disparities in children's use of hospital-based services for the most serious mental health crises (crisis stabilization services) and community-based services for other crises (crisis intervention services). African American children were more likely than were White children to use both kinds of crisis care and made more visits to hospital-based crisis stabilization services after initial use. Asian American/Pacific Islander and American Indian/Alaska Native children were more likely than were White children to use hospital-based crisis stabilization services but, along with Latino children, made fewer hospital-based crisis stabilization visits after an initial visit. African American children used both kinds of crisis services more than did White children, and Asian Americans/Pacific Islander and American Indians/Alaska Native children visited only when they experienced the most disruptive and troubling kind of crises, and made nonrecurring visits.

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization.

PubMed

Gordon, Aliza S; Adamson, Wallace C; DeVries, Andrea R

2017-02-17

Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions. A cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy. A total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, P<.001; UCC: 39.01%, P<.001; ED: 53.15%, P<.001; PCP: 37.40%, P<.001), and imaging rates for virtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, P<.001; ED: 43.06%, P<.001; PCP: 11.26%, P<.001). RHC, UCC, ED, and PCP were estimated to be $36, $153, $1735, and $162 more expensive than virtual visit episodes, respectively, including medical and pharmacy costs. Virtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care. ©Aliza S Gordon, Wallace C Adamson, Andrea R DeVries. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.02.2017.

Report on SARS backfit evaluation, Exxon Donor Solvent Plant, Baytown, Texas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meyer, A.F. Jr.

1980-07-02

This report provides information on observations, findings, and conclusions arising from a site visit to the Exxon Donor Solvent Plant, Baytown, Texas. That visit was to provide technical assistance and professional services to the DOE/ASFE/OPTA Project Officer regarding verification of his initial determination that this pilot plant is exempt from the SARS backfit requirement (DOE Order 5481.1). A secondary purpose was to obtain further information regarding the occupational safety and health plans and procedures at this new pilot plant facility. It is concluded that a well planned and implemented occupational safety and health program exists at the Exxon Donor Solventmore » Plant. Excellent manuals regarding general safety requirements and protection against carcinogens have been prepared and distributed. A Safe Operations Committee is in effect as is a Risk Management Committee. Adequate safety and industrial hygiene staff has been assigned and an excellent medical surveillance program has been established. Adequate compliance with environmental codes, standards, and regulations is being achieved. Although this plant is not subject to SARS because of the nature of the contract, adequate documentation exists in any case to exempt it from the SARS backfit requirement.« less

Flowers visited by hummingbirds in the open habitats of the southeastern Brazilian mountaintops: species composition and seasonality.

PubMed

Rodrigues, L C; Rodrigues, M

2014-08-01

The hummingbird-visited plant community located on the open-habitat mountaintop of the Espinhaço Range was studied for two years (from August 2007 to July 2009) in Serra do Cipó National Park, Southeastern Brazil (19° 15' S and 43° 31' W). The floral characteristics and flowering period of the hummingbird-visited plants was monthly recorded along trails located in three vegetation types: (1) typical campos rupestres (TCR), (2) open fields (OPF), and (3) capões de mata (CAM). Hummingbird visitation was observed in 51 plant species, 22 ornithophilous and 29 non-ornithophilous species. The TCR showed the greatest number of species visited (N = 38), followed by the OPF (N = 18) and CAM (N = 17). Six species of hummingbirds were recorded visiting flowers: Augastes scutatus, Campylopterus largipennis, Colibri serrirostris, Chlorostilbon lucidus, Eupetomena macroura and Phaethornis pretrei. This study demonstrates that the species richness and the number of ornithophilous species visited by the hummingbirds at the study site are more similar to hummingbird-plant communities of the Atlantic Forest than to those of the Cerrado communities and other Brazilian highland open-habitat communities. The plant families most visited by hummingbirds were Bromeliaceae and Asteraceae. Although the Asteraceae family is rarely used as a food resource for hummingbirds in other high and lowland communities, in the study site this family is used mainly by the endemic hummingbird Augastes scutatus. We found a large overlap of flowering throughout the year among the species visited by the hummingbirds. Thus, the nectar availability supports these resident hummingbirds. The present study also showed that the studied hummingbird-plant community is composed of many species endemic to the campos rupestres of the Espinhaço Range, some of which are considered to be in danger of extinction, thus constituting a unique and threatened community. Thus, understanding hummingbird-plant pollination dynamics becomes fundamental to the conservation of the campos rupestres.

The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study

PubMed Central

2013-01-01

Background Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. Methods Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming. Results The overall incidence of self-reported earache was 1.6% in the 10–12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively. Conclusions There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates. PMID:23962340

Factors affecting yearly and monthly visits to Taipei Zoo

NASA Astrophysics Data System (ADS)

Su, Ai-Tsen; Lin, Yann-Jou

2018-02-01

This study investigated factors affecting yearly and monthly numbers of visits to Taipei Zoo. Both linear and nonlinear regression models were used to estimate yearly visits. The results of both models showed that the "opening effect" and "animal star effect" had a significantly positive effect on yearly visits, while a SARS outbreak had a negative effect. The number of years had a significant influence on yearly visits. Results showed that the nonlinear model had better explanatory power and fitted the variations of visits better. Results of monthly model showed that monthly visits were significantly influenced by time fluctuations, weather conditions, and the animal star effect. Chinese New Year, summer vacation, numbers of holidays, and animal star exhibitions increased the number of monthly visits, while the number of days with temperatures at or below 15 °C, the number of days with temperatures at or above 30 °C, and the number of rainy days had significantly negative effects. Furthermore, the model of monthly visits showed that the animal star effect could last for over two quarters. The results of this study clarify the factors affecting visits to an outdoor recreation site and confirm the importance of meteorological factors to recreation use.

Weir Farm National Historic Site : alternative transportation feasibility study

DOT National Transportation Integrated Search

2012-07-31

This report provides an assessment of the feasibility of alternative transportation options to accommodate visitation at Weir Farm National Historic Site in Ridgefield, Connecticut. Weir Farm, the historic home of artist J. Alden Weir, faces numerous...

Report: Observed Conditions at Five Deleted Superfund Sites

EPA Pesticide Factsheets

Report #11-P-0433, August 3, 2011. Conditions at two of the five sites we visited in EPA Region 3, which had been remediated and deleted from the National Priorities List, may warrant additional attention from EPA.

10 CFR 15.3 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S...

10 CFR 15.3 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... electronic submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S...

Medical Records Flag for Suicide Risk: Predictors and Subsequent Use of Care Among Veterans With Substance Use Disorders.

PubMed

Berg, Joanna M; Malte, Carol A; Reger, Mark A; Hawkins, Eric J

2018-06-08

The U.S. Department of Veterans Affairs (VA) health care system established policies to include patient record flags (PRFs) for high suicide risk in the electronic medical record to alert providers and to increase health care contacts. This study identified predictors of new PRFs and described health care utilization before and after PRF initiation among VA patients with substance use disorders. The sample included patients ages ≥18 who received a substance use disorder diagnosis in 2012 (N=474,946). Demographic, clinical, and utilization predictors of PRFs were identified by multivariable logistic regression. Changes in short-term (three months) and longer-term (12 months) health care utilization before and after PRF initiation were compared by negative binomial regression. A total of 8,913 patients received PRFs. Demographic predictors of PRF initiation included being younger than 35, white, and homeless. Clinical predictors were cocaine, opioid, and sedative use disorders; posttraumatic stress, psychotic, bipolar, and depressive disorders; and diagnosis of a suicide attempt. Patients with PRFs averaged 1.33 (95% confidence interval [CI]=1.29-1.38) times more primary care visits, 2.29 (CI=2.24-2.34) times more mental health visits, 4.10 (CI=3.80-4.42) times more substance use visits, and fewer (incidence rate ratio=.55, CI=.53-.58) emergency department visits in the three months following compared with the three months before PRF initiation. Modest increases in mental health- and substance use--related days hospitalized were observed. Veterans received significantly more health care services after PRF initiation. Further research is warranted on the effects of PRFs on clinical outcomes, such as suicide behaviors.

Establishing a health information workforce: innovation for low- and middle-income countries.

PubMed

Ledikwe, Jenny H; Reason, Letitia L; Burnett, Sarah M; Busang, Lesego; Bodika, Stephane; Lebelonyane, Refeletswe; Ludick, Steven; Matshediso, Ellah; Mawandia, Shreshth; Mmelesi, Mpho; Sento, Baraedi; Semo, Bazghina-Werq

2013-07-18

To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative. Data were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment. An average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues' misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%). The development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.

Establishing a health information workforce: innovation for low- and middle-income countries

PubMed Central

2013-01-01

Background To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative. Methods Data were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment. Results An average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues’ misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%). Conclusions The development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system. PMID:23866794

Maintaining High Quality Data and Consistency Across a Diverse Flux Network: The Ameriflux QA/QC Technical Team

NASA Astrophysics Data System (ADS)

Chan, S.; Billesbach, D. P.; Hanson, C. V.; Biraud, S.

2014-12-01

The AmeriFlux quality assurance and quality control (QA/QC) technical team conducts short term (<2 weeks) intercomparisons using a portable eddy covariance system (PECS) to maintain high quality data observations and data consistency across the AmeriFlux network (http://ameriflux.lbl.gov/). Site intercomparisons identify discrepancies between the in situ and portable measurements and calculated fluxes. Findings are jointly discussed by the site staff and the QA/QC team to improve in the situ observations. Despite the relatively short duration of an individual site intercomparison, the accumulated record of all site visits (numbering over 100 since 2002) is a unique dataset. The ability to deploy redundant sensors provides a rare opportunity to identify, quantify, and understand uncertainties in eddy covariance and ancillary measurements. We present a few specific case studies from QA/QC site visits to highlight and share new and relevant findings related to eddy covariance instrumentation and operation.

Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database.

PubMed

Abraham, Manoj T; Rousso, Joseph J; Hu, Shirley; Brown, Ryan F; Moscatello, Augustine L; Finn, J Charles; Patel, Neha A; Kadakia, Sameep P; Wood-Smith, Donald

2017-07-01

The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.

'heartfailurematters.org', an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions.

PubMed

Wagenaar, Kim P; Rutten, Frans H; Klompstra, Leonie; Bhana, Yusuf; Sieverink, Floor; Ruschitzka, Frank; Seferovic, Petar M; Lainscak, Mitja; Piepoli, Massimo F; Broekhuizen, Berna D L; Strömberg, Anna; Jaarsma, Tiny; Hoes, Arno W; Dickstein, Kenneth

2017-11-01

In 2007, the Heart Failure Association of the European Society of Cardiology (ESC) launched the information website heartfailurematters.org (HFM site) with the aim of creating a practical tool through which to provide advice and guidelines for living with heart failure to patients, their carers, health care professionals and the general public worldwide. The website is managed by the ESC at the European Heart House and is currently available in nine languages. The aim of this study is to describe the background, objectives, use, lessons learned and future directions of the HFM site. Data on the number of visitor sessions on the site as measured by Google Analytics were used to explore use of the HFM site from 2010 to 2015. Worldwide, the annual number of sessions increased from 416 345 in 2010 to 1 636 368 in 2015. Most users (72-75%) found the site by using a search engine. Desktops and, more recently, smartphones were used to visit the website, accounting for 50% and 38%, respectively, of visits to the site in 2015. Although its use has increased, the HFM site has not yet reached its full potential: fewer than 2 million users have visited the website, whereas the number of people living with heart failure worldwide is estimated to be 23 million. Uptake and use could be further improved by a continuous process of qualitative assessment of users' preferences, and the provision of professional helpdesk facilities, comprehensive information technology, and promotional support. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Ocular morbidities of juvenile idiopathic arthritis-associated uveitis in adulthood: results from a tertiary center study.

PubMed

Oray, Merih; Khachatryan, Naira; Ebrahimiadib, Nazanin; Abu Samra, Khawla; Lee, Stacey; Foster, C Stephen

2016-09-01

To describe the clinical and visual outcomes of juvenile idiopathic arthritis (JIA)-associated uveitis in adults and to examine risk factors for ongoing inflammation in adulthood. Medical records were reviewed for patients with JIA-associated uveitis who were >16 years old at the final visit (the last visit prior to data collection). In total, 135 eyes of 77 patients (70 female, 7 male) were included. The mean age of patients at the final visit was 29.72 ± 11.27 years. The number of eyes with visual acuity of ≤20/50 and ≤20/200 at the final visit was 37 (28 %) and 20 (15 %), respectively; at least one ocular complication was present in 72 % of eyes. Band keratopathy was the most frequent complication (42 %), followed by cataract (25 %), posterior synechiae (22 %), maculopathy (22 %), ocular hypertension (13 %), and hypotony (5 %). At the final visit, patients who were >16 years of age at presentation to the Massachusetts Eye Research and Surgery Institution had more ocular complications and a greater degree of vision loss than patients who were ≤16 years of age. Ongoing inflammation at the final visit was noted in 40 patients (52 %). The presence of posterior synechiae, hypotony, cataract at presentation, and a history of cataract surgery prior to presentation were predictive of ongoing inflammation in adulthood in univariate analysis. The presence of hypotony and posterior synechiae at the initial visit were predictive factors in multivariate analysis. JIA-associated uveitis may be associated with ongoing inflammation, ocular complications, and severe visual impairment in adulthood. The presence of posterior synechiae and hypotony at the initial visit is predictive of ongoing inflammation.

Influence of Patients’ Requests for Directly Advertised Antidepressants: A Randomized Controlled Trial

PubMed Central

Kravitz, Richard L.; Epstein, Ronald; Feldman, Mitchell D.; Franz, Carol E.; Azari, Rahman; Wilkes, Michael S.; Hinton, Ladson; Franks, Peter

2011-01-01

Context Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that DTC advertising leads to over-prescribing, while proponents counter that it helps avert under-use of effective treatments, especially for conditions such as depression that are poorly recognized or stigmatized. Objective To ascertain the effects of patients’ DTC-related requests on physicians’ initial treatment decisions (prescribing, referral, and follow-up) in patients with depressive symptoms. Design Randomized trial using Standardized Patients (SPs). Six SP roles (experimental cells) were created by crossing two conditions (major depression or adjustment disorder) with three request types (brand-specific, general, or none). Setting Offices of primary care physicians in Sacramento, CA; San Francisco, CA; and Rochester, NY. Participants 152 family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%. Interventions SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder (approximately 50 visits per experimental cell). Main Outcome Measures Data on prescribing, mental health referral, and primary care follow-up were obtained from SP written reports, visit audio-recordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics. Results SP role fidelity was excellent, and the detection rate was 12%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific requests, general requests, and no requests, respectively (p<.0001). In adjustment disorder, antidepressant prescribing was 55%, 39%, and 10%, respectively (p<.0001). The results were confirmed in multivariate models. “Minimally acceptable initial care” (any combination of an antidepressant, mental health referral, or follow-up within two weeks) in the major depression role was offered to 98% of SPs making a general request, 90% of those making a brand-specific request, and 56% of those making no request (p<0.001). Conclusions Patients’ requests have a profound effect on physician prescribing in major depression and adjustment disorder. DTC advertising may have competing effects on quality, potentially both averting under-use and promoting over-use. PMID:15855433

76 FR 78264 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... HHAs and Supp. Regs. in 42 CFR 48.55, 484.205, 484.245, 484.250; Use: This data set is currently... program. Since 1999, the Medicare CoPs have mandated that HHAs use the OASIS data set when evaluating... visits; the data collected during site visits facilitates the verification of the accuracy and...

Estimating Recreation Visitation Response to Forest Management Alternatives in the Columbia River Basin

Treesearch

Donald B.K. English; Amy Horne

1996-01-01

To evaluate how forest management alternatives affect recreation visitation, managers need to know both the changes in demand for the sites being altered and the general changes in regional recreation trip production. This paper shows one way to obtain that information. Trip-generation models developed for the United States Forest Service's national assessments of...

10 CFR 4.5 - Communications and reports.

Code of Federal Regulations, 2012 CFR

2012-01-01

... submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S. Nuclear...

10 CFR 4.5 - Communications and reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

... submissions can be obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to [email protected]gov; or by writing the Office of Information Services, U.S. Nuclear...

Protecting the Lunar Heritage Sites from the Effects of Visiting Spacecraft

NASA Technical Reports Server (NTRS)

Metzger, Philip; Lane, John E.

2012-01-01

The Problem: Rocket exhaust blows soil and rocks over vast distances at velocities upwards of 1 to 3 km/s, and this will be highly abrasive and damaging if it impacts the valuable lunar heritage sites.

Rochester scientist discovers new comet with Dark Energy Camera (DECam) at

Science.gov Websites

Sites Group MASS-DIMM New Projects NOAO Future Instrumentation DECam SAM LSST MONSOON What is MONSOON AURA Sites Group Talks and Meetings Upcoming Colloquia Sky Conditions CTIO Site Conditions TASCA colleagues believe. David Cameron, a visiting scientist in Eric Mamajek's research group in the Department of

Testing the Effectiveness of Interactive Multimedia for Library-User Education

ERIC Educational Resources Information Center

Markey, Karen; Armstrong, Annie; De Groote, Sandy; Fosmire, Michael; Fuderer, Laura; Garrett, Kelly; Georgas, Helen; Sharp, Linda; Smith, Cheri; Spaly, Michael; Warner, Joni E.

2005-01-01

A test of the effectiveness of interactive multimedia Web sites demonstrates that library users' topic knowledge was significantly greater after visiting the sites than before. Library users want more such sites about library services, their majors, and campus life generally. Librarians describe the roles they want to play on multimedia production…

Perceived Value of Educational Hypermedia: An Exploratory Study

ERIC Educational Resources Information Center

Gao, Yuan; Wu, Xiaoyu

2010-01-01

This paper explores the idea of perceived value of educational hypermedia by extending prior research in advertising and information systems. It proposes that the value of a course support site comes from both its information content and users' experience when they visit the site. The cognitive antecedents of a site's perceived value include…

International use of an academic nephrology World Wide Web site: from medical information resource to business tool.

PubMed

Abbott, Kevin C; Oliver, David K; Boal, Thomas R; Gadiyak, Grigorii; Boocks, Carl; Yuan, Christina M; Welch, Paul G; Poropatich, Ronald K

2002-04-01

Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers.

Rationale and methodology of a collaborative learning project in congenital cardiac care

PubMed Central

Wolf, Michael J.; Lee, Eva K.; Nicolson, Susan C.; Pearson, Gail D.; Witte, Madolin K.; Huckaby, Jeryl; Gaies, Michael; Shekerdemian, Lara S.; Mahle, William T.

2018-01-01

Background Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another’s knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Rationale and development Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center’s practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Conclusion Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease. PMID:26995379

Rationale and methodology of a collaborative learning project in congenital cardiac care.

PubMed

Wolf, Michael J; Lee, Eva K; Nicolson, Susan C; Pearson, Gail D; Witte, Madolin K; Huckaby, Jeryl; Gaies, Michael; Shekerdemian, Lara S; Mahle, William T

2016-04-01

Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another's knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center's practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease. Copyright © 2016 Elsevier Inc. All rights reserved.

Study of biological communities subject to imperfect detection: Bias and precision of community N-mixture abundance models in small-sample situations

USGS Publications Warehouse

Yamaura, Yuichi; Kery, Marc; Royle, Andy

2016-01-01

Community N-mixture abundance models for replicated counts provide a powerful and novel framework for drawing inferences related to species abundance within communities subject to imperfect detection. To assess the performance of these models, and to compare them to related community occupancy models in situations with marginal information, we used simulation to examine the effects of mean abundance (λ¯: 0.1, 0.5, 1, 5), detection probability (p¯: 0.1, 0.2, 0.5), and number of sampling sites (n site : 10, 20, 40) and visits (n visit : 2, 3, 4) on the bias and precision of species-level parameters (mean abundance and covariate effect) and a community-level parameter (species richness). Bias and imprecision of estimates decreased when any of the four variables (λ¯, p¯, n site , n visit ) increased. Detection probability p¯ was most important for the estimates of mean abundance, while λ¯ was most influential for covariate effect and species richness estimates. For all parameters, increasing n site was more beneficial than increasing n visit . Minimal conditions for obtaining adequate performance of community abundance models were n site  ≥ 20, p¯ ≥ 0.2, and λ¯ ≥ 0.5. At lower abundance, the performance of community abundance and community occupancy models as species richness estimators were comparable. We then used additive partitioning analysis to reveal that raw species counts can overestimate β diversity both of species richness and the Shannon index, while community abundance models yielded better estimates. Community N-mixture abundance models thus have great potential for use with community ecology or conservation applications provided that replicated counts are available.

Detection of new HIV infections in a multicentre HIV antiretroviral pre-exposure prophylaxis trial.

PubMed

Fransen, Katrien; de Baetselier, Irith; Rammutla, Elizabeth; Ahmed, Khatija; Owino, Frederick; Agingu, Walter; Venter, Gustav; Deese, Jen; Van Damme, Lut; Crucitti, Tania

2017-08-01

Monthly specimens collected from FEM-PrEP-a Phase III trial [1] were investigated for the detection of acute HIV (AHI) infection. To evaluate the efficiency of the study-specific HIV algorithm in detecting AHI, and the performance of each of the serological and molecular tests used in diagnosing new infections, and their contribution to narrowing the window period. A total of 83 pre-seroconversion specimens from 61 seroconverters from the FEM-PrEP trial were further analyzed in a sub-study. During the trial, HIV seroconversion was diagnosed on site using a testing algorithm with simple/rapid tests (SRTs) and confirmed with a gold standard testing algorithm (see short communication: Fig. 1). The infection date was determined more accurately by the use of standard ELISAs and Nucleic Acid Amplification Tests (NAAT) in a look-back procedure. For this sub-study, the international central laboratory repeated the study algorithm using SRTs. A total of 83 pre-seroconversions specimens from 61 seroconverters were analyzed in a look-back procedure. RNA was detected in 35/61 seroconverters at the visit before the seroconversion visit as determined at the study sites. Four seroconversion dates were inaccurate at one study site as the international central laboratory detected the HIV infection one visit earlier using the same test algorithm. Using the gold standard, an additional seroconversion was detected at an earlier visit. The combined antigen/antibody and the single antigen test had a higher sensitivity compared to the SRTs in detecting acute infections. In the FEM-PrEP trial, the international central laboratory detected a small number of seroconversions one month earlier than the study sites using the same study algorithm. Standard tests are still the most sensitive tests in detecting pre-seroconversion or acute HIV infection, but they are costly, time consuming and not recommended for use on-site in a clinical trial. Copyright © 2017 Elsevier B.V. All rights reserved.

KSC-04pd0851

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy (center) and Principal Aaron Fernander (right) visit a classroom in Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. At left is Ralph Thomas, assistant administrator for Small and Disadvantaged Business Utilization at NASA. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

Using social networking sites (namely Facebook) in health visiting practice--an account of five years experience.

PubMed

Dion, Xena

2015-02-01

With new developments in electronic and social networking communication methods the way health visitors communicate with clients is rapidly changing. With good governance these technologies can be utilised to enhance the health visiting service and can be an effective way of accessing hard-to-reach families, saving time and resources. This paper presents five years' experience in the use of Facebook between the health visiting team and clients and explains the benefits and potential it offers to health visitors and other community practitioners.

Economic Impact of Treatment Duration and Persistence with Basal Insulin in Previously Insulin-Naive Users.

PubMed

Kalirai, Samaneh; Duan, Ran; Liu, Dongju; Reed, Beverly L

2017-03-01

Although insulin is a well-established therapy that is associated with improved clinical outcomes, adherence and persistence with insulin regimens are poor in patients with type 2 diabetes mellitus (T2DM). Diabetes-related health care costs and the impact of insulin persistence patterns on these health care costs have been previously studied; however, these aspects of insulin therapy have limited data beyond the first year of use and have not been characterized among patients previously naive to basal insulin. To (a) describe and compare medical- and pharmacy-related costs, health care resource utilization, and comorbidities and complications during the initial year and second (experienced) year of basal insulin therapy, and (b) describe and compare the impact of continuous versus interrupted basal insulin use during each year. This was a retrospective observational database analysis using claims from multiple U.S. commercial health plans (Truven Health MarketScan) in previously insulin-naive patients with T2DM who were initiated on basal insulin. Data collected included all-cause and diabetes-related medical and pharmacy costs, health care resource utilization (i.e., number and type of outpatient visits, hospitalization, emergency department [ED] visits), medication use, and preselected comorbidities and complications. This cost analysis described and compared health care costs and resource use between the initial and experienced years and further compared health care costs and resource use between continuers and interrupters within each of those years. A total of 23,645 patients were included in the analysis; 12,224 were classified as continuers and 11,421 were classified as interrupters. Among all patients, mean increases from the initial year to the experienced year were observed for all-cause medical costs ($12,690-$13,408; P = 0.048), all-cause pharmacy costs ($6,253-$6,559; P < 0.001), and all-cause health care costs ($18,943-$19,967; P = 0.006), after adjusting for inflation. All-cause pharmacy costs were significantly higher for continuers versus interrupters, but total diabetes-related medical care costs, all-cause ED costs, and all-cause medical costs were significantly lower, resulting in similar all-cause health care costs between continuers and interrupters in both the initial and experienced years. Among all patients, diabetes-related inpatient visits and outpatient primary care physician (PCP) visits, total medical inpatient visits, and total medical outpatient PCP visits were significantly higher in the initial year than in the experienced year; however, there were fewer diabetes-related ED visits in the initial year. Initiation of basal insulin appears to be associated with increased health care costs, and treatment persistence pattern (continuers vs. interrupters) is further correlated with health care expenditures. Although associated with decreased pharmacy costs, interruption of therapy increases medical costs, underscoring the importance of addressing persistence to therapy. This study was funded by Eli Lilly and Company and Boehringer Ingelheim. Eli Lilly reviewed and approved this manuscript for submission. All the authors are employees and minor shareholders of Eli Lilly and Company. Study concept and design were contributed by Kalirai, Duan, and Reed. Duan and Liu collected the data, and data interpretation was performed by Kalirai. The manuscript was written by all the authors and revised by Kalirai.

Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions.

PubMed

Fukui, Sadaaki; Matthias, Marianne S; Salyers, Michelle P

2015-01-01

Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.

Seafloor Uplift in Middle Valley, Juan de Fuca Ridge: New High-Resolution Pressure Data

NASA Astrophysics Data System (ADS)

Inderbitzen, K. E.; Becker, K.; Davis, E. E.

2011-12-01

Currently, in-situ seafloor and basement pressures are continuously monitored and recorded by an ODP subseafloor hydrogeological observatory (CORK) located in Middle Valley, Juan de Fuca Ridge. Hole 857D was drilled in 1991 in thickly sedimented crust to a depth of 936 mbsf and instrumented with an original CORK that was replaced in 1996. A large hydrothermal field (Dead Dog) lies roughly 1.7 km north of the hole, and two isolated chimneys and several diffuse flow sites are located ~800 meters northeast. The borehole and the vent fields have been visited periodically by submersible/ROV since 1999. Recent results from the CORK at 857D have shown apparent seafloor uplift, supported by depth records from the submersible Alvin. A constant rate of pressure change of ~6 kPa/yr, from its initiation in 2005 to the visit in 2010, has reduced mean seafloor pressure by ~28 kPa, equivalent to nearly 3 meters of head. This uplift rate is several times the typical pre-eruption inflation rates observed at Axial Seamount further south along the Juan de Fuca Ridge. Initially, the apparent uplift at 857D did not seem to have any effect on local high-temperature hydrothermal venting, however recent operations in Middle Valley revealed distinct changes at not only the hydrothermal field to the northeast, but also a shutdown of high-temperature venting to the north of 857D. We will present new data from Middle Valley, including the first year of data collected by a high-resolution pressure data logger deployed at 857D in June, 2010.

Pre‐moult patterns of habitat use and moult site selection by Brent Geese Branta bernicla nigricans: Individuals prospect for moult sites

USGS Publications Warehouse

Lewis, Tyler; Flint, Paul L.; Schmutz, Joel A.; Derksen, Dirk V.

2010-01-01

In environments where habitat quality varies, the mechanism by which individuals assess and select habitats has significant consequences on their spatial distribution and ability to respond to environmental change. Each year, thousands of Black Brent Geese Branta bernicla nigricans migrate to the Teshekpuk Lake Special Area (TLSA), Alaska, to undergo a flightless wing‐moult. Over the last three decades, moulting Brent Geese have changed their distribution within the TLSA, redistributing from inland, freshwater wetlands towards coastal, brackish wetlands. To understand better the mechanism by which Brent Geese select a moult site, as well as reasons behind the long‐term shift of moulting distributions, we examined movements and habitat use of birds marked with GPS‐transmitters during the pre‐moult period. Brent Geese did not generally migrate directly to their moulting site during the pre‐moult period, defined as the time from arrival at the moulting grounds to the onset of flightlessness. Rather, individuals used an average of 3.7 ± 0.6 (se) wetland complexes and travelled a minimum of 95.14 ± 15.84 km during the pre‐moult period. Moreover, 69% of Brent Geese visited their final moult site only to leave and visit other sites before returning for the flightless moult. Brent Geese spent significant time in both inland freshwater and coastal estuarine habitats during the pre‐moult, irrespective of the habitat in which they ultimately moulted. Whereas previous research suggested that Brent Geese choose moult sites based largely upon the experience of previous years, our observations suggest a mechanism of moult site selection whereby Brent Geese ‘prospect’ for moult sites, visiting multiple potential moult sites across varied habitat types, presumably gathering information from each site and correspondingly using this information to choose an appropriate moult site. By allowing individuals to adjust their distributions in response to habitat quality cues that may change annually, such as forage type and availability, prospecting may have influenced the long‐term shift in moulting distributions of Brent Geese in the TLSA.

Prevalence and predictors of chlamydia co-infection among patients infected with gonorrhoea at a sexual health clinic in Sydney.

PubMed

Templeton, David J; Manokaran, Niveditha; O'Connor, Catherine C

2012-09-01

Anogenital gonorrhoea (Neisseria gonorrhoeae) is commonly diagnosed at sexual health clinics by on-site microscopy. Whether to add anti-chlamydial therapy in such situations is unclear. The medical records of all patients diagnosed with gonorrhoea between May 2005 and April 2010 at RPA Sexual Health were reviewed. Of 165 patients diagnosed with anogenital gonorrhoea, 27 (16.4%, 95% confidence interval (CI) 11.1-22.9%) were co-infected with chlamydia (Chlamydia trachomatis). Compared with those only infected with anogenital gonorrhoea, there was no correlation of anogenital gonorrhoea-chlamydia co-infection with any demographic, behavioural or clinical variables examined. Anti-chlamydial therapy should be considered for all patients with gram stain diagnosed anogenital gonorrhoea at the initial clinic visit.

The AIP Career Pathways Project: Learning the Effective Practices of Physics Departments Preparing Graduates with the Bachelor's Degree for STEM Careers

NASA Astrophysics Data System (ADS)

Olsen, Thomas; Redmond, Kendra; Czujko, Roman

2012-10-01

Forty percent of students graduating with the bachelor's degree in physics seek employment immediately upon graduation. The AIP Career Pathways Project, funded by NSF, seeks to learn by site visits the effective practices of departments in preparing these students to successfully secure positions in STEM and to make these practices known by presentations, publications, and workshops. This talk will review AIP Statistical Resources data on the careers of physicists with the bachelor's degree, provide preliminary insights from the site visits, provide some advice for graduates seeking employment, and describe the upcoming workshops.

Information and communication technology

NASA Technical Reports Server (NTRS)

Edelson, Burton I.; Pelton, Joseph N.; Bostian, Charles W.; Brandon, William T.; Chan, Vincent W. S.; Hager, E. Paul; Helm, Neil R.; Jennings, Raymond D.; Kwan, Robert K.; Mahle, Christoph E.

1994-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of U.S. experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members traveled to Europe, Japan, and Russia to gather information firsthand. They visited 17 sites in Europe, 20 in Japan, and 4 in Russia. These included major manufacturers, government organizations, service providers, and associated research and development facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of U.S. industry. The report details the information collected and compares it to U.S. activities.

Pediatric refugees in Rhode Island: increases in BMI percentile, overweight, and obesity following resettlement.

PubMed

Heney, Jessica H; Dimock, Camia C; Friedman, Jennifer F; Lewis, Carol

2014-01-05

To evaluate BMI change among pediatric refugees resettling in Providence, RI. Retrospective chart review of pediatric refugees from the initial evaluation to year 3 post-resettlement at Hasbro Children's Hospital. Primary outcome of interest was within person change in BMI percentile at each time point. From 2007-2012, 181 children visited the clinic. Initial prevalence of overweight and obesity was 14.1% and 3.2% versus 22.8% and 12.6% at year 3. From visit 1 and years 1-3, there was a positive mean within person change in BMI percentile of 12.9% (95% CI 6.3-19.6%s), 16.6% (95% CI 11.2-21.9%), and 14.4% (95% CI 9.1-19.7%). The prevalence of overweight and obesity increased from 17.3% at initial intake to 35.4% at 3 years post-resettlement to surpass that of American children (31.7-31.8% for 2007-2012). Refugee children have additional risk factors for obesity; multidisciplinary interventions must be designed to address nutrition at each visit.

ECL-IAA and ECL-GADA Can Identify High-Risk Single Autoantibody-Positive Relatives in the TrialNet Pathway to Prevention Study.

PubMed

Steck, Andrea K; Fouts, Alexandra; Miao, Dongmei; Zhao, Zhiyuan; Dong, Fran; Sosenko, Jay; Gottlieb, Peter; Rewers, Marian J; Yu, Liping

2016-07-01

Relatives with single positive islet autoantibodies have a much lower risk of progression to diabetes than those with multiple autoantibodies. TrialNet subjects positive for single autoantibody to insulin (mIAA) (n = 50) or single autoantibody to glutamic acid decarboxylase (GADA) (n = 50) were analyzed using new electrochemiluminescence (ECL) assays (ECL-IAA and ECL-GADA, respectively) at their initial visit and longitudinally over time. Affinity assays were performed on a subset of single autoantibody-positive subjects at initial and most recent visits. After a mean follow-up of 5.3 years, 20 subjects developed type 1 diabetes. Among either single GADA or single mIAA subjects, those who were positive in the ECL assay showed higher affinity at the initial visit, and affinity results stayed consistent over time. No converting events from low to high or high to low affinity were seen over time. Confirmed positivity for ECL is associated with high affinity and can help staging of risk for type 1 diabetes in single autoantibody-positive subjects.

Role of depletion on the dynamics of a diffusing forager

NASA Astrophysics Data System (ADS)

Bénichou, O.; Chupeau, M.; Redner, S.

2016-09-01

We study the dynamics of a starving random walk in general spatial dimension d. This model represents an idealized description for the fate of an unaware forager whose motion is not affected by the presence or absence of resources. The forager depletes its environment by consuming resources and dies if it wanders too long without finding food. In the exactly solvable case of one dimension, we explicitly derive the average lifetime of the walk and the distribution for the number of distinct sites visited by the walk at the instant of starvation. We also give a heuristic derivation for the averages of these two quantities. We tackle the complex but ecologically relevant case of two dimensions by an approximation in which the depleted zone is assumed to always be circular and which grows incrementally each time the walk reaches the edge of this zone. Within this framework, we derive a lower bound for the scaling of the average lifetime and number of distinct sites visited at starvation. We also determine the asymptotic distribution of the number of distinct sites visited at starvation. Finally, we solve the case of high spatial dimensions within a mean-field approach.

Study of the impact on Salmonella of moving outdoor pigs to fresh land.

PubMed

Smith, R P; Andres, V; Dormer, L; Gosling, R; Oastler, C; Davies, R H

2017-07-01

Anecdotal evidence has suggested that outdoor-kept pigs show an improvement to health and productivity after being moved to a new site. This study explores whether Salmonella occurrence reduced and was sustained after moving to a new site. Nine farms were followed for a year in which four sampling visits were completed. The highest detection of Salmonella was from pooled faecal dropping from pigs, run-off/ pooled water, rodents and wild birds. Descriptive summaries showed that the prevalence of both all Salmonella and serovars of public health importance were lower at all visits after the move. Some variability was shown in results from individual farms, but a year after the move, six farms still maintained a lower prevalence. A risk factor model showed that the prevalence at visits 2 and 3 after the move was significantly lower than baseline, after accounting for a number of significant factors that were included in the model. These were sample type and seasonality (included as a priori), presence of coughing in the sampled group and Glasser's disease on the farm, and the use of tent or kennel accommodation. This finding provides important evidence that more frequent site moves may help reduce Salmonella prevalence in outdoor herds.

Use of an Orientation Clinic to Reduce Failed New Patient Appointments in Primary Care

PubMed Central

Jain, Sharad; Chou, Calvin L

2000-01-01

Patients who fail to attend initial appointments reduce clinic efficiency. To maximize attendance by newly referred outpatients, we introduced a mandatory group orientation clinic for all new patients and determined its effects on no-show rates. Orientation clinic also provided health care screening and opportunities for patient feedback. The new patient no-show rate for initial provider visits decreased significantly from 45% before institution of orientation clinic to 18% afterwards (P < .0001). The total no-show (patients who failed to attend orientation clinic or an initial provider visit) rate of the postintervention group was 51% (P = .28, compared with before the intervention). This intervention improved the efficiency and minimized the wasted time of our clinicians. PMID:11119184

Reducing Emergency Room Visits and In-Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data.

PubMed

Hewner, Sharon; Sullivan, Suzanne S; Yu, Guan

2018-06-01

Efforts to improve care transitions require coordination across the healthcare continuum and interventions that enhance communication between acute and community settings. To improve post-discharge utilization value using technology to identify high-risk individuals who might benefit from rapid nurse outreach to assess social and behavioral determinants of health with the goal of reducing inpatient and emergency department visits. The project employed a before and after comparison of the intervention site with similar primary care practice sites using population-level Medicaid claims data. The intervention targeted discharged persons with preexisting chronic disease and delivered a care transition alert to a nurse care coordinator for immediate telephonic outreach. The nurse assessed social determinants of health and incorporated problems into the EHR to share across settings. The project evaluated health outcomes and the value of nursing care on existing electronic claims data to compare utilization in the years before and during the intervention using negative binomial regression to account for rare events such as inpatient visits. Avoiding readmissions and emergency visits, and increasing timely outpatient visits improved the individual's experience of care and the work life of healthcare providers, while reducing per capita costs (Quadruple Aim). In the intervention practice, the nurse care coordinator demonstrated the value of nursing care by reducing inpatient (25%) and emergency (35%) visits, and increasing outpatient visits (27%). The estimated value of avoided encounters over the secular Medicaid trend was $664 per adult with chronic disease, generating $71,289 in revenue from additional outpatient visits. Using health information exchange to deliver appropriate and timely evidence-based clinical decision support in the form of care transition alerts and assessment of social determinants of health, in conjunction with data science methods, demonstrates the value of nursing care and resulted in achieving the Quadruple Aim. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Factors that attract and repel visitation to urban recreation sites: a framework for research

Treesearch

David Klenosky; Cherie LeBlanc; Christine Vogt; Herbert Schroeder

2008-01-01

The mix of natural features and manmade elements in urban and metropolitan areas presents unique challenges for resource managers and planners. While some elements of the urban landscape (e.g., forested areas, parks, water features, and museums) may attract or encourage visitation, others (e.g., industrial and commercial activity, odors, noises, crime, litter, and...

Leveraging Collection Structure in Information Retrieval with Applications to Search in Conversational Social Media

ERIC Educational Resources Information Center

Elsas, Jonathan L.

2011-01-01

Social media collections are becoming increasingly important in the everyday life of Internet users. Recent statistics show that sites hosting social media and community-generated content account for five of the top ten most visited websites in the United States [4] are visited regularly by a broad cross-section of Internet users [61, 67, 115] and…

Stennis' granddaughter visits Mississippi Facility

NASA Image and Video Library

2009-04-06

Jane Kenna of Atlanta, granddaughter of the late Sen. John C. Stennis, stands with her husband, John, near a bust of her grandfather displayed in StenniSphere, the visitor center at NASA's John C. Stennis Space Center. Kenna visited Stennis on April 6, her first trip to the rocket engine testing facility since the 1988 ceremony to rename the site in honor of Stennis.

World Presidents Organization

NASA Technical Reports Server (NTRS)

2010-01-01

Mississippi Gov. Haley Barbour speaks to members of the World Presidents' Organization during the group's visit to NASA's John C. Stennis Space Center on Jan. 26. WPO members from several states spent the day touring Stennis facilities and learning about the work of the nation's premier rocket engine testing site. Barbour visited with group members during a morning session in StenniSphere, the center's visitors center and museum.

Environmental Field Trips - Some Places to Visit in Maryland, Virginia and the District of Columbia.

ERIC Educational Resources Information Center

Meetre, Jeff

This publication lists 40 places in the metropolitan Washington, D.C. area that could be visited on an environmental field trip. The sites are placed into five categories: (1) Air Monitoring; (2) Ecology and Nature Study; (3) Solid Waste Management; (4) Wastewater Treatment; and (5) Water Supply. Each entry includes name, address, and phone number…

World Presidents Organization

NASA Image and Video Library

2010-01-26

Mississippi Gov. Haley Barbour speaks to members of the World Presidents' Organization during the group's visit to NASA's John C. Stennis Space Center on Jan. 26. WPO members from several states spent the day touring Stennis facilities and learning about the work of the nation's premier rocket engine testing site. Barbour visited with group members during a morning session in StenniSphere, the center's visitors center and museum.

Randomized Trial of a Statewide Home Visiting Program: Impact in Preventing Child Abuse and Neglect

ERIC Educational Resources Information Center

Duggan, Anne; McFarlane, Elizabeth; Fuddy, Loretta; Burrell, Lori; Higman, Susan M.; Windham, Amy; Sia, Calvin

2004-01-01

Objectives: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. Methods: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based…

2012 Take Our Children to Work Day

NASA Image and Video Library

2012-07-31

More than 250 children of employees at 15 Stennis Space Center resident agencies and organizations visited the facility July 31 to participate in annual Take Our Children to Work Day activities. Participants enjoyed various presentations and demonstrations on topics such as cryogenics and information security. They also had an opportunity to visit site facilities to learn about various work performed at the NASA center.

Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores.

PubMed

Christensen, Helen; Griffiths, Kathleen M; Korten, Ailsa

2002-01-01

Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face, via self-help books (bibliotherapy), and through computer administration. The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners. We have developed a free Internet-based cognitive behavior therapy intervention (MoodGYM, http://moodgym.anu.edu.au) designed to treat and prevent depression in young people, available to all Internet users, and targeted to those who may have no formal contact with professional help services. To document site usage, visitor characteristics, and changes in depression and anxiety symptoms among users of MoodGYM, a Web site delivering a cognitive-behavioral-based preventive intervention to the general public. All visitors to the MoodGYM site over about 6 months were investigated, including 2909 registrants of whom 1503 had completed at least one online assessment. Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately. The main outcome measures were (1) site-usage measures including number of sessions, hits and average time on the server, and number of page views; (2) visitor characteristics including age, gender, and initial Goldberg self-report anxiety and depression scores; and (3) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions. Over the first almost-6-month period of operation, the server recorded 817284 hits and 17646 separate sessions. Approximately 20% of sessions lasted more than 16 minutes. Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population-based surveys and those characterizing a sample of University students. For the Web-based population, both anxiety and depression scores decreased significantly as individuals progressed through the modules. CONCLUSIONS Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public. However, randomized controlled trials are required to establish the effectiveness of these interventions.

Reading, Learning and Enacting: Interpretation at Visitor Sites in the Wet Tropics Rainforest of Australia

ERIC Educational Resources Information Center

McNamara, Karen Elizabeth; Prideaux, Bruce

2010-01-01

The northern Wet Tropics rainforest of Australia was declared a world heritage site in 1988 and now supports an extensive tourism industry that attracts an estimated 2.5 million local and international visits annually. As part of the visitor experience, many sites include both environmental and cultural interpretation experiences, which range from…

Commentary: Online Reviews and Other Digital Marketing Strategies.

PubMed

Levin, Roger P

2017-02-01

As getting patient reviews posted on online sites appears problematic for periodontal practices, the author urges periodontists to encourage patients to review their practices online on Yelp and other sites. The more positive online reviews practices receive, the higher the rankings on review sites, which will translate into more website visits and, ultimately, more new patient appointments.

Web Analytics: A Picture of the Academic Library Web Site User

ERIC Educational Resources Information Center

Black, Elizabeth L.

2009-01-01

This article describes the usefulness of Web analytics for understanding the users of an academic library Web site. Using a case study, the analysis describes how Web analytics can answer questions about Web site user behavior, including when visitors come, the duration of the visit, how they get there, the technology they use, and the most…

Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

PubMed

Bush, Stephen H; Lao, Michael R; Simmons, Kathy L; Goode, Jeff H; Cunningham, Steve A; Calhoun, Byron C

2007-12-01

To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program. Observational study. Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed. Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged. Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.

A Retrospective Analysis of Corticosteroid Utilization Before Initiation of Biologic DMARDs Among Patients with Rheumatoid Arthritis in the United States.

PubMed

Spivey, Christina A; Griffith, Jenny; Kaplan, Cameron; Postlethwaite, Arnold; Ganguli, Arijit; Wang, Junling

2018-06-01

Understanding the effects of corticosteroid utilization prior to initiation of biologic disease-modifying antirheumatic drugs (DMARDs) can inform decision-makers on the appropriate use of these medications. This study examined treatment patterns and associated burden of corticosteroid utilization before initiation of biologic DMARDs among rheumatoid arthritis (RA) patients. A retrospective analysis was conducted of adult RA patients in the US MarketScan Database (2011-2015). The following patterns of corticosteroid utilization were analyzed: whether corticosteroids were used; duration of use (short/long duration defined as < or ≥ 3 months); and dosage (low as < 2.5, medium as 2.5 to < 7.5 and high as ≥ 7.5 mg/day). Effects of corticosteroid use on time to biologic DMARD initiation were examined using Cox proportional hazards models. Likelihood and number of adverse events were examined using logistic and negative binomial regression models. Generalized linear models were used to examine healthcare costs. Independent variables in all models included patient demographics and health characteristics. A total of 25,542 patients were included (40.84% used corticosteroids). Lower hazard of biologic DMARD initiation was associated with corticosteroid use (hazard ratio = 0.89, 95% confidence interval = 0.83-0.96), long duration and lower dose. Corticosteroid users compared to non-users had higher incidence rates of various adverse events including cardiovascular events (P < 0.05). Higher likelihood of adverse events was associated with corticosteroid use and long duration of use, as was increased number of adverse events. Corticosteroid users had a greater annualized mean number of physician visits, hospitalizations, and emergency department (ED) visits than non-users in adjusted analysis. Corticosteroid users compared to non-users had higher mean costs for total healthcare, physician visits, hospitalizations, and ED visits. Among patients with RA, corticosteroid utilization is associated with delayed initiation of biologic DMARDS and higher burden of adverse events and healthcare utilization/costs before the initiation of biologic DMARDs. AbbVie Inc.

Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components

PubMed Central

Burnett, Sarah M.; Mbonye, Martin K.; Naikoba, Sarah; Zawedde-Muyanja, Stella; Kinoti, Stephen N.; Ronald, Allan; Rubashembusya, Timothy; Willis, Kelly S.; Colebunders, Robert; Manabe, Yukari C.; Weaver, Marcia R.

2015-01-01

Background Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration required to improve facility performance. We sought to evaluate the effects of an infectious disease training program followed by either immediate or delayed on-site support (OSS), an educational outreach approach, on nine facility performance indicators for emergency triage, assessment, and treatment; malaria; and pneumonia. We also compared the effects of nine monthly OSS visits to extended OSS, with three additional visits over six months. Methods This study was conducted at 36 health facilities in Uganda, covering 1,275,960 outpatient visits over 23 months. From April 2010 to December 2010, 36 sites received infectious disease training; 18 randomly selected sites in arm A received nine monthly OSS visits (immediate OSS) and 18 sites in arm B did not. From March 2011 to September 2011, arm A sites received three additional visits every two months (extended OSS), while the arm B sites received eight monthly OSS visits (delayed OSS). We compared the combined effect of training and delayed OSS to training followed by immediate OSS to determine the effect of delaying OSS implementation by nine months. We also compared facility performance in arm A during the extended OSS to immediate OSS to examine the effect of additional, less frequent OSS. Results Delayed OSS, when combined with training, was associated with significant pre/post improvements in four indicators: outpatients triaged (44% vs. 87%, aRR = 1.54, 99% CI = 1.11, 2.15); emergency and priority patients admitted, detained, or referred (16% vs. 31%, aRR = 1.74, 99% CI = 1.10, 2.75); patients with a negative malaria test result prescribed an antimalarial (53% vs. 34%, aRR = 0.67, 99% CI = 0.55, 0.82); and pneumonia suspects assessed for pneumonia (6% vs. 27%, aRR = 2.97, 99% CI = 1.44, 6.17). Differences between the delayed OSS and immediate OSS arms were not statistically significant for any of the nine indicators (all adjusted relative RR (aRRR) between 0.76–1.44, all p>0.06). Extended OSS was associated with significant improvement in two indicators (outpatients triaged: aRR = 1.09, 99% CI = 1.01; emergency and priority patients admitted, detained, or referred: aRR = 1.22, 99% CI = 1.01, 1.38) and decline in one (pneumonia suspects assessed for pneumonia: aRR: 0.93; 99% CI = 0.88, 0.98). Conclusions Educational outreach held up to nine months after training had similar effects on facility performance as educational outreach started within one month post-training. Six months of bi-monthly educational outreach maintained facility performance gains, but incremental improvements were heterogeneous. PMID:26352257

Bringing home sustainability and climate change research and developments via on-line virtual reality

NASA Astrophysics Data System (ADS)

Granshaw, F. D.

2016-12-01

One of the key challenges of sustainability and climate education is one of accessibility. For example many of the sites where significant climate research is taking place in National Parks are largely inaccessible to the average park visitor. Likewise, taking students to visit exemplary efforts in environmentally sustainable design or habitat restoration projects may be logistically difficult or impossible for the average class. Yet despite these difficulties, finding ways to give students, park visitors, and the general public a chance to explore these areas is critical to their developing sustainability and climate literacy. To address this issue, the author has been working with National Park staff and community groups to develop desktop virtual reality environments that showcase glacier-climate research sites, developments designed with environmental sustainability in mind, and urban watersheds being rehabilitated by volunteer groups and public agencies. These environments provide the user with a chance to take a virtual walk through a site of interest, access data collected at the site, and even listen to researchers and site stewards talk about key activities taking place there. Though they are used as proxies for actual visits via independent on-line exploration, media for public talks, or the framework for student lab exercises, they these virtual environments have also been used to encourage and guide actual sites visits. A focus of this talk will be a recently launched project involving the construction of a library showcasing environmental sustainability projects in the Portland Metropolitan area. In addition to being a resource for local sustainability educators, the library will be a contribution to international sustainability education efforts as it is being developed under the umbrella of a UN affiliate (Greater Portland Sustainability Education Network).

Factors contributing to initial weight loss among adolescents with polycystic ovary syndrome.

PubMed

Geier, L M; Bekx, M T; Connor, E L

2012-12-01

To evaluate the impact of a multidisciplinary clinic on weight management among adolescents with PCOS. 140 adolescent females were evaluated in a multidisciplinary PCOS clinic from March 2005 to December 2008. The team included a pediatric endocrinologist, health psychologist, dietitian, and pediatric gynecologist. 110 were diagnosed with PCOS based on the Rotterdam Criteria. Height, weight, BMI, number of subspecialists seen, use of metformin, and compliance with return visits were obtained from medical records. American Family Children's Hospital in Madison, Wisconsin. 110 adolescent females with polycystic ovary syndrome. Consultation with a dietitian and health psychologist. Change in weight. The average age at first visit was 15.9 years. The average BMI was 34.7 kg/m(2) (range 18.1-55.5). Seventy-six percent had an initial BMI above the 95(th) percentile. Interactions with providers at the initial visit included a pediatric endocrinologist (100%), health psychologist (60.9%), dietitian (75.5%) and gynecologist (70.9%). Seventy one percent returned for a follow-up visit, (average time of 4.5 months between visits) with 57% achieving weight loss (average 3.5 kg) and an additional 12.6% demonstrating no significant weight gain (< 1.5 kg). Thus, 69.6% demonstrated weight loss/stabilization. In this multidisciplinary clinic for adolescents with PCOS, nearly 70% of patients succeeded in short-term weight stabilization, with 57% demonstrating weight loss. Interactions with the health psychologist and dietitian appeared to play a key role in successful weight control, supporting the importance of psychology and nutrition expertise in the management of this disorder. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Smoking cessation and its predictors: results from a community-based pharmacy tobacco cessation program in New Mexico.

PubMed

Khan, Nasreen; Anderson, Joe R; Du, Juan; Tinker, Dale; Bachyrycz, Amy M; Namdar, Rocsanna

2012-09-01

The New Mexico Pharmaceutical Care Foundation received funding through the Tobacco Use Prevention and Control Program (TUPAC) to provide support for pharmacist-delivered tobacco cessation services. The goal of the program was to increase the availability of tobacco cessation services to residents of New Mexico. Program outcomes are presented, using data from the first 2 fiscal years. To assess tobacco quit rates among smokers who participated in the community pharmacist-based program and identify the predictors of quitting at the end of a 6-month program. Pharmacists, who had received Rx for Change training, provided tobacco cessation services. Patients were scheduled for an initial visit and then were seen at regularly scheduled follow-up visits at 1 month, 3 months, and 6 months from the initial visit. Data collected at the initial visit included demographics, smoking history, and readiness for quitting. Smoking status was collected at each of the follow-up visits. Data were analyzed using SAS (SAS Institute) and STATA (StataCorp LP) statistical software. Tobacco quit rates were calculated at 1, 3, and 6 months. Multivariate regression analysis was performed to assess predictors of quitting. Standard errors were adjusted for repeated observation. Data were available for 346 participants. The average quit rate at the end of 6 months was 25%. Significant predictors of quitting were high confidence levels in quitting at baseline, individuals who had first cigarettes at least 30 minutes after waking up, first cessation attempt, and nonwhite patients. A smoking cessation program delivered through trained community pharmacists with prescriptive authority is an effective approach to reducing smoking. Further research should be conducted to compare the effectiveness of pharmacists with that of other providers of tobacco cessation services.

The influence of gender on respiratory outcomes in children with bronchopulmonary dysplasia during the first 3 years of life.

PubMed

Collaco, Joseph M; Aherrera, Angela D; McGrath-Morrow, Sharon A

2017-02-01

Since premature males are more likely to be diagnosed with bronchopulmonary dysplasia we hypothesized that differences in respiratory outcomes after initial hospital discharge and during the first 3 years of life would exist between females and males diagnosed with BPD. Subjects with the diagnosis of BPD were recruited from the Johns Hopkins Bronchopulmonary Dysplasia Clinic between 2008 and 2014. Clinical features were assessed through chart review (n = 482). Respiratory morbidities were assessed by caregiver questionnaires at clinic visits (n = 429), including emergency department visits, hospital admissions, systemic steroid use, and antibiotic use for respiratory reasons since the last BPD clinic visit or after initial hospital discharge if assessed at the first visit. Male infants weighed significantly more at birth, had higher birth weight percentiles and were more likely to be non-white compared to female infants. The frequency of ever acute care use was 36.9% for emergency department visits, 27.4% for hospital admissions, 36.9% for systemic steroid use, and 40.5% for antibiotic use for a respiratory illness. No differences in respiratory morbidities were found between males and females. Females however, tended to be weaned from supplemental oxygen over 3 months later than males. Compared to females with BPD, males were more likely to weigh more, have higher birth weight percentiles and be non-white. After initial hospital discharge, there were no difference in respiratory morbidities between males and females with BPD. Female infants however were more likely to be weaned from supplemental oxygen at a later age than male infants. Pediatr Pulmonol. 2017;52:217-224. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Quality and accuracy of sexual health information web sites visited by young people.

PubMed

Buhi, Eric R; Daley, Ellen M; Oberne, Alison; Smith, Sarah A; Schneider, Tali; Fuhrmann, Hollie J

2010-08-01

We assessed online sexual health information quality and accuracy and the utility of web site quality indicators. In reviewing 177 sexual health web sites, we found below average quality but few inaccuracies. Web sites with the most technically complex information and/or controversial topics contained the most inaccuracies. We found no association between inaccurate information and web site quality. (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Expanding the Operational Use of Total Lightning Ahead of GOES-R

NASA Technical Reports Server (NTRS)

Stano, Geoffrey T.; Wood, Lance; Garner, Tim; Nunez, Roland; Kann, Deirdre; Reynolds, James; Rydell, Nezette; Cox, Rob; Bobb, William R.

2015-01-01

NASA's Short-term Prediction Research and Transition Center (SPoRT) has been transitioning real-time total lightning observations from ground-based lightning mapping arrays since 2003. This initial effort was with the local Weather Forecast Offices (WFO) that could use the North Alabama Lightning Mapping Array (NALMA). These early collaborations established a strong interest in the use of total lightning for WFO operations. In particular the focus started with warning decision support, but has since expanded to include impact-based decision support and lightning safety. SPoRT has used its experience to establish connections with new lightning mapping arrays as they become available. The GOES-R / JPSS Visiting Scientist Program has enabled SPoRT to conduct visits to new partners and expand the number of operational users with access to total lightning observations. In early 2014, SPoRT conducted the most recent visiting scientist trips to meet with forecast offices that will used the Colorado, Houston, and Langmuir Lab (New Mexico) lightning mapping arrays. In addition, SPoRT met with the corresponding Center Weather Service Units (CWSUs) to expand collaborations with the aviation community. These visits were an opportunity to learn about the forecast needs of each office visited as well as to provide on-site training for the use of total lightning, setting the stage for a real-time assessment during May-July 2014. With five lightning mapping arrays covering multiple geographic locations, the 2014 assessment has demonstrated numerous uses of total lightning in varying situations. Several highlights include a much broader use of total lightning for impact-based decision support ranging from airport weather warnings, supporting fire crews, and protecting large outdoor events. The inclusion of the CWSUs has broadened the operational scope of total lightning, demonstrating how these data can support air traffic management, particularly in the Terminal Radar Approach Control Facilities (TRACON) region around an airport. These collaborations continue to demonstrate, from the operational perspective, the utility of total lightning and the importance of continued training and preparation in advance of the Geostationary Lightning Mapper.

Changes in Nutrition Policies and Dietary Intake in Child Care Homes Participating in Healthy Eating and Active Living Initiative.

PubMed

Woodward-Lopez, Gail; Kao, Janice; Kuo, Elena S; James, Paula; Lenhart, Kitty; Becker, Christina; Boyle, Kathryn; Williamson, Dana; Rauzon, Suzanne

2018-05-01

From 2012 to 2014, a total of 17 family child care homes participated in a multisector, community-wide initiative to prevent obesity. Strategies included staff workshops, materials, site visits, and technical assistance regarding development and implementation of nutrition policies. The purpose of the evaluation was to examine the impact of the initiative on family child care home nutrition-related policies and practices and child dietary intake. Pre- and post-intervention without control group. Measures taken at baseline and follow-up included structured observations and questionnaires regarding nutrition policies, practices, and environments; documentation of lunch foods served on 5 days; and lunch plate waste observations on 2 days. Paired t-tests were used to determine the significance of change over time. Seventeen family child care homes in a low-income diverse community in Northern California; children aged 2-5 years who attended the family child care homes. Change in nutrition-related policies and practices, lunch foods served and consumed. Data was collected at 17 sites for an average of 5.2 children aged 2-5 years per site per day at baseline and 4.6 at follow-up for a total of 333 plate waste observations. There were significant increases in staff training, parental involvement, and several of the targeted nutrition-related practices; prevalence of most other practices either improved or was maintained over time. There were significant increases in the number of sites meeting Child and Adult Care Food Program meal guidelines, variety of fruit and frequency of vegetables offered, and reductions in frequency of juice and high-fat processed meats offered. Adequate portions of all food groups were consumed at both time points with no significant change over time. A simple, policy-focused intervention by a child care resource and referral agency was successful at reinforcing and improving upon nutrition-related practices at family child care homes. Children consumed adequate, but not excessive, portions of the balanced meals served to them, suggesting there is no reason to offer unhealthy options. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

76 FR 80377 - Notice of Submission of Proposed Information Collection to OMB Additional On-Site Data Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... with PHA staff and reviews of client files and administrative data collected by the PHA. The results of... reviews of client files and administrative data collected by the PHA. The results of the site visits will...

78 FR 76629 - The National Children's Study, Vanguard (Pilot) Study; Submission for OMB Review; 30-Day Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-18

..., revisions to existing Study visits, and the initiation of methodological substudies. The NCS Vanguard Study... design of the Main Study of the National Children's Study. Background: The National Children's Study is a... questionnaire containing key variables and designed to collect core data at every study visit contact from the...

Memoir of Tanzania: Learning about Early Childhood Projects in Developing Countries

ERIC Educational Resources Information Center

Penn, Helen

2017-01-01

This article considers the contribution of memoir as a method for understanding complex early childhood issues. It recounts the author's first visit to Tanzania, a low-income country with a chequered history of independence from colonial rule. The article uses memories from that initial visit to reflect on the changing interpretations of colonial…

Visiting Astronomers Travel Guide | CTIO

Science.gov Websites

please advise Ximena Herreros at the time that you initiate travel plans, if your stay in Chile will , well in advance of their travel time, regarding current visa requirements for Chile. back to top Visiting Astronomers Travel Guide Director's Discretionary (DD) Time CTIO 2016 Ephemeris ToO Policy CTIO

Potential for gulls to transport bacteria from human waste sites to beaches.

PubMed

Alm, Elizabeth W; Daniels-Witt, Quri R; Learman, Deric R; Ryu, Hodon; Jordan, Dustin W; Gehring, Thomas M; Santo Domingo, Jorge

2018-02-15

Contamination of recreational beaches due to fecal waste from gulls complicates beach monitoring and may pose a risk to public health. Gulls that feed at human waste sites may ingest human fecal microorganisms associated with that waste. If these gulls also visit beaches, they may serve as vectors, transporting fecal microorganisms to the beach where they may subsequently contaminate sand and water. In this study, samples collected from landfills, treated wastewater storage lagoons, and public beaches demonstrated a spatial and temporal overlap of markers for gull and human-associated microorganisms. In addition, markers for gull, fecal indicator bacteria, and the human-associated marker, HF183, were detected in gull feces and cloacae samples. Further, HF183 was detected in cloacae samples from gulls that were documented by radio-telemetry traveling between human waste sites and public beaches. This study highlights the potential for gulls that visit human waste sites to disperse human-associated microorganisms in the beach landscape. Copyright © 2017 Elsevier B.V. All rights reserved.

From bioactive substances to research on breast-feeding promotion.

PubMed

Morrow, A L; Guerrero, M L

2001-01-01

Despite known health benefits, exclusive breast-feeding for at least 4 months is uncommon in many countries. In Mexico, most mothers initiate breast-feeding but few breast-feed exclusively. The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico. An ethnographic assessment conducted in 1994 that identified key maternal beliefs, practices, and needs was used to guide educational strategies. Lay counselors were recruited from the same community and trained by La Leche League. From March 1995 through September 1996, pregnant women were identified by community census and invited to participate. Women were enrolled into a randomized, controlled study of 3 groups: no intervention (control), 3 visits, and 6 visits during pregnancy and early postpartum. Data collection was performed by a social worker apart from the counselors. Exclusive breast-feeding was defined by WHO criteria. The study enrolled 130 women; 52 were in the 3-visit group, 44 in the 6-visit group, and 34 in the control group. Study groups did not differ in the maternal characteristics or initiation of breast-feeding (96%). At 3 months postpartum, exclusive breast-feeding was practiced by only 12% of controls vs. 52% in the 3-visit group and 67% in the 6-visit group (P < 0.001, log rank test). In the first 3 months, significantly (P = 0.037) fewer intervention than control infants had an episode of diarrhea (11% vs. 26%, respectively). Intervention effectiveness was independent of maternal factors or birth hospital. This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well-designed maternal support including early intervention and repeated contact.

New Delivery Model for Rising-Risk Patients: The Forgotten Lot?

PubMed

Cheung, Lauren; Norden, Justin; Harrington, Robert A; Desai, Sumbul A

2017-08-01

Shared-risk models encourage providers to engage young patients early. Telemedicine may be well suited for younger, healthier patients although it is unclear how best to incorporate telemedicine into routine clinical care. We test the assumptions surrounding the use of telemedicine, younger and rising-risk patients, and primary care in ClickWell Care (CWC), a care model developed at our institution for our own accountable care organization. CWC's team of physicians and wellness coaches work together to provide comprehensive primary care through in-person, phone, and video visits. This study examines usage of the clinic over its initial year in operation. 1,464 unique patients conducted a total of 3,907 visits. 2,294 (58.7%) visits were completed virtually (1,382 [35.4%] by phone and 912 [23.3%] by video). Patients were more inclined to see the physician in-person for a new visit (1,065 visits [70.5%] vs. 362 [24%] phone and 83 [6%] video) and more likely to see the physician virtually for a return visit (606 [43.2%] phone and 249 [17.7%] video vs. 548 [39.1%] in-person), a statistically significant difference (X 2  = 306.7, p < 0.00001). This new care model successfully engaged a younger population of patients. However, our data suggest young patients may not be inclined to establish care with a primary care physician virtually and, in fact, choose an initial in-person touch point, although many are willing to conduct return visits virtually. This new model of care could have a large impact on how care is delivered to low- and rising-risk patients.

Toxic anterior segment syndrome: Update on the most common causes.

PubMed

Bodnar, Zachary; Clouser, Sue; Mamalis, Nick

2012-11-01

To determine how the most common risk factors for toxic anterior segment syndrome (TASS) have evolved over the past decade. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Cross-sectional study. This was a retrospective analysis of surveys from centers reporting cases of TASS from June 1, 2007, through March 1, 2012, and information from visits to afflicted sites between October 1, 2005, and December 31, 2011. Results from June 1, 2009, to March 1, 2012, were compared with those collected before June 1, 2009. The data from 130 questionnaires and 71 site visits were analyzed. The reporting centers performed approximately 69 000 surgeries and reported 1454 cases of TASS. Several trends were noted when comparing the most recent data with previously reported results. There was a 26% reduction in sites reporting inadequate handpiece flushing volumes and a 27% increase in sites using a deionized/distilled final rinse. At sites visited, there was a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents. However, there was a 21% increase in handling of intraocular lenses or instrument tips with gloved hands, a 47% increase in poor instrument maintenance, and a 34% increase in ultrasound bath use without adequate routine cleaning. Education may have improved some instrument-cleaning and perioperative practices that increase the risk for TASS; however, other practices may be headed in an unfavorable direction. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Floral Visitors of Three Asteraceae Species in a Xeric Environment in Central Mexico.

PubMed

Figueroa-Castro, Dulce María; González-Tochihuitl, Guadalupe; Rivas-Arancibia, Sombra Patricia; Castaño-Meneses, Gabriela

2016-12-01

We describe the spatial variation in the structure and composition of the communities of insects visiting the inflorescences of Flaveria ramosissima Klatt, Florestina pedata (Cav.) Cass., and Parthenium bipinnatifidum (Ort.) Rollins (Asteraceae) in a xeric environment in Central Mexico. Inflorescences of the three Asteraceae were visited by a total of 96 species of Hymenoptera, Diptera, Lepidoptera, Coleoptera, and Hemiptera. Total species richness of floral visitors to the three Asteraceae and total abundance of insects of Fl. pedata and P. bipinnatifidum did not differ between low and high vegetation cover sites. Total abundance of insects visiting the inflorescences of F. ramosissima and abundance of Hymenoptera in all three Asteraceae were higher at the low vegetation coverage (LVC) site than at the high vegetation coverage (HVC) one. Diversity of insects of Fl. pedata and P. bipinnatifidum was higher at the HVC site. However, in F. ramosissima diversity was higher at the LVC site. The communities of insects of each Asteraceae were dissimilar between sites. These differences can be attributed to variation in the abundance of Lepidophora (Diptera: Bombyliidae), Miridae (Hemiptera), Melyridae (Coleoptera), Tiphiidae (Hymenoptera), Myrmecocystus mexicanus Wesmael, and Dorymyrmex grandulus (Forel) (Hymenoptera: Formicidae). The first three insect groups were sensitive to LVC, high temperature, and low humidity, whereas the last three tolerated those same environmental conditions. Changes in temperature, humidity, and resources associated with vegetation coverage seem to differentially affect each species of floral visitors of the three Asteraceae species studied. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study.

PubMed

Mussi-Pinhata, Marisa M; Freimanis, Laura; Yamamoto, Aparecida Y; Korelitz, James; Pinto, Jorge A; Cruz, Maria L S; Losso, Marcelo H; Read, Jennifer S

2007-03-01

The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1-exposed but uninfected infants. The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow-up data through the 6-month study visit. Definitive and presumed infections were recorded at study visits (birth, 6-12 weeks, and 6 months). Of 462 HIV-1-uninfected infants with 11,644 child-weeks of observation, 283 experienced > or = 1 infection. These 283 infants experienced 522 infections (1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child-weeks of observation. Overall, the most common infections were skin or mucous membrane infections (1.9 cases per 100 child-weeks) and respiratory tract infections (1.7 cases per 100 child-weeks). Thirty-six percent of infants had > 1 respiratory tract infection (1.8 cases per 100 child-weeks). Incidence rates of upper and lower respiratory tract infections were similar (0.89 cases per 100 child-weeks and 0.9 cases per 100 child-weeks, respectively). Cutaneous and/or oral candidiasis occurred in 48 neonates (10.3%) and 92 older infants (19.3%). Early neonatal sepsis was diagnosed in 12 infants (26.0 cases per 1000 infants). Overall, 81 of 462 (17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently (40.7%). The occurrence of > or = 1 neonatal infection was associated with more-advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4+ cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections. Close monitoring of HIV-1-exposed infants, especially those who are anemic at birth or whose mothers have more-advanced HIV-1 disease or who smoked during pregnancy, remains important.

Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi

PubMed Central

Pell, Christopher; Meñaca, Arantza; Were, Florence; Afrah, Nana A.; Chatio, Samuel; Manda-Taylor, Lucinda; Hamel, Mary J.; Hodgson, Abraham; Tagbor, Harry; Kalilani, Linda; Ouma, Peter; Pool, Robert

2013-01-01

Background Antenatal care (ANC) is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi) with varying levels of ANC attendance. Methods Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. Results Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care – checking the foetus’ position or monitoring its progress – motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women’s timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures – in spite of policies of free ANC – combined with ideas about the compulsory nature of follow-up appointments. Conclusion In these socially and culturally diverse sites, the findings suggest that ‘supply’ side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation. PMID:23335973

Institutional transformation: An analysis of change initiatives at NSF ADVANCE institutions

NASA Astrophysics Data System (ADS)

Plummer, Ellen W.

The purpose of this study was to examine how institutional culture promoted or impeded the implementation of round one and two NSF ADVANCE initiatives designed to improve academic climates for women in science and engineering. This study was conducted in two phases. In phase one, 35 participants from 18 institutions were interviewed to answer three research questions. Participants identified a policy, process, or program designed to improve academic cultures for women in science and engineering fields. Participants also identified strategies that promoted the implementation of these efforts, and discussed factors that impeded these efforts. In phase two, site visits were conducted at two institutions to answer a fourth research question. How did institutional culture shape the design and implementation of faculty search processes? Policies, processes, and programs were implemented by participants at the institutional, departmental, and individual levels and included family friendly and dual career policies at the institutional level, improved departmental faculty search and climate improvement processes, and mentoring programs and training for department heads at the individual level. Communication and leadership strategies were key to the successful implementation of policies, processes, and programs designed to achieve institutional transformation. Communication strategies involved shaping change messages to reach varied audiences often with the argument that change efforts would improve the climate for everyone not just women faculty members. Administrative and faculty leaders from multiple levels proved important to change efforts. Institutional Transformation Institutional culture shaped initiatives to improve faculty search processes. Faculty leaders in both settings used data to persuade faculty members of the need for change. At one site, data that included national availability information was critical to advancing the change agenda. At the other site, social science data that illustrated gender bias was persuasive. Faculty members who were effective as change agents were those who were credible with their peers in that setting.

Longitudinal supportive periodontal therapy for severe chronic periodontitis with furcation involvement: a 12-year follow-up report.

PubMed

Komiya-Ito, Akiyo; Tomita, Sachiyo; Kinumatsu, Takashi; Fujimoto, Yoshihiro; Tsunoda, Masatake; Saito, Atsushi

2013-01-01

We report a case involving a 12-year follow-up after treatment for chronic periodontitis with furcation involvement. A 54-year-old woman presented with the chief complaint of hypersensitivity. Clinical examination at the first visit revealed 15% of sites with a probing depth ≥4 mm and 35% of sites with bleeding on probing. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. For #44, regenerative periodontal therapy using enamel matrix derivative (Emdogain(®)) was selected. For #16, which exhibited a 2- to 3-wall vertical bony defect and class III (mesio-distal) furcation involvement, bone graft was scheduled. Other sites with residual periodontal pockets were treated by open flap debridement. For #37, with a gutter-shaped root, odontoplasty was performed. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). During 12 years of SPT, the periodontal condition remained uneventful in most of the teeth. However, bone resorption was observed in the distal aspect of #37, making the prognosis poor. This indicates the need to continuously monitor risk factors, including inflammation and traumatic occlusion, during SPT. Although some problems still remain, severe periodontitis with furcation involvement was successfully maintained longitudinally with an adequate level of patient compliance and careful SPT.

Impact of an alcohol misuse intervention for health care workers --2: Employee assistance programme utilization, on-the-job injuries, job loss and health services utilization.

PubMed

Lapham, Sandra C; McMillan, Garnett; Gregory, Cindy

2003-01-01

We evaluated the effects of an enhanced substance misuse (SM) prevention/early intervention programme on referrals to an employee assistance programme, health care utilization rates, on-the-job injury rates and job termination rates among health care professionals employed in a managed care organization. The intervention was implemented at one site, with the remaining sites serving as the comparison group. Existing data from hospital databases were used to compare events occurring in the periods before and after initiation of the intervention. To account for baseline differences in age, gender and job class, logistic regression models produced adjusted means for events per employee month-at-risk. We found that employee assistance referrals and non-SM-related in-patient hospitalizations increased significantly post-intervention, while rates of total out-patient SM-related visits decreased at both the intervention and comparison sites post-intervention. There was a small, statistically significant decrease in the monthly rate (OR = 0.92) of non-SM out-patient utilization at the intervention site, once the intervention was in place. No differences potentially attributable to the intervention were detected in job turnover or injury rates. We conclude that, while the intervention did not appear to affect health care utilization for SM-related problems, it was associated with increased referrals for employee assistance.

KSC-04pd0837

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy (right) talks to Aaron Fernander, principal of Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

KSC-04pd0839

NASA Image and Video Library

2004-04-13

KENNEDY SPACE CENTER, FLA. - Center Director Jim Kennedy talks to students and faculty at Ralph Bunche Middle School, a NASA Explorer School, in Atlanta, Ga. Kennedy is visiting NES sites to share America’s new vision for space exploration with the next generation of explorers. He was accompanied by astronaut Rick Linnehan on the visit. The purpose of the school visit is to talk with students about our destiny as explorers, NASA’s stepping stone approach to exploring Earth, the Moon, Mars and beyond, how space impacts our lives, and how people and machines rely on each other in space.

Neonatal care in a Japanese NICU: notes based on a site visit.

PubMed

Chirinian, Nevart; Uji, Atsuko; Isayama, Tetsuya; Shah, Vibhuti

2012-01-01

This article presents an overview of a neonatal intensive care unit along with resuscitative care and management of the 22 to 23 weeks gestational age infant is as it was noted during a visit to the NICU of a large academic center in Japan. Non-English speaking neonatology communities may be at a disadvantage of having their research and practices well known in the English speaking ones. Thus, visits such as this are beneficial in exchanging ideas and practices that may ultimately be mutually beneficial in reducing mortality and morbidity in a specific category of neonates.

Travel-related infections in children.

PubMed

Fox, Thomas G; Manaloor, John J; Christenson, John C

2013-04-01

Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

Revised FINAL–REPORT NO. 2: INDEPENDENT CONFIRMATORY SURVEY SUMMARY AND RESULTS FOR THE ENRICO FERMI ATOMIC POWER PLANT, UNIT 1, NEWPORT, MICHIGAN (DOCKET NO. 50 16; RFTA 10-004) 2018-SR-02-1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Erika Bailey

2011-10-27

The Enrico Fermi Atomic Power Plant, Unit 1 (Fermi 1) was a fast breeder reactor design that was cooled by sodium and operated at essentially atmospheric pressure. On May 10, 1963, the Atomic Energy Commission (AEC) granted an operating license, DPR-9, to the Power Reactor Development Company (PRDC), a consortium specifically formed to own and operate a nuclear reactor at the Fermi 1 site. The reactor was designed for a maximum capability of 430 megawatts (MW); however, the maximum reactor power with the first core loading (Core A) was 200 MW. The primary system was filled with sodium in Decembermore » 1960 and criticality was achieved in August 1963. The reactor was tested at low power during the first couple years of operation. Power ascension testing above 1 MW commenced in December 1965 immediately following the receipt of a high-power operating license. In October 1966 during power ascension, zirconium plates at the bottom of the reactor vessel became loose and blocked sodium coolant flow to some fuel subassemblies. Two subassemblies started to melt and the reactor was manually shut down. No abnormal releases to the environment occurred. Forty-two months later after the cause had been determined, cleanup completed, and the fuel replaced, Fermi 1 was restarted. However, in November 1972, PRDC made the decision to decommission Fermi 1 as the core was approaching its burn-up limit. The fuel and blanket subassemblies were shipped off-site in 1973. Following that, the secondary sodium system was drained and sent off-site. The radioactive primary sodium was stored on-site in storage tanks and 55 gallon (gal) drums until it was shipped off-site in 1984. The initial decommissioning of Fermi 1 was completed in 1975. Effective January 23, 1976, DPR-9 was transferred to the Detroit Edison Company (DTE) as a 'possession only' license (DTE 2010a). This report details the confirmatory activities performed during the second Oak Ridge Institute for Science and Education (ORISE) site visit to Fermi 1 in November 2010. The survey was strategically planned during a Unit 2 (Fermi 2) outage to take advantage of decreased radiation levels that were observed and attributed to Fermi 2 from the operating unit during the first site visit. However, during the second visit there were elevated radiation levels observed and attributed to the partially dismantled Fermi 1 reactor vessel and a waste storage box located on the 3rd floor of the Fermi 1 Turbine Building. Confirmatory surveys (unshielded) performed directly in the line of sight of these areas were affected. The objective of the confirmatory survey was to verify that the final radiological conditions were accurately and adequately described in Final Status Survey (FSS) documentation, relative to the established release criteria. This objective was achieved by performing document reviews, as well as independent measurements and sampling. Specifically, documentation of the planning, implementation, and results of the FSS were evaluated; side-by-side FSS measurement and source comparisons were performed; site areas were evaluated relative to appropriate FSS classification; and areas were assessed for residual, undocumented contamination.« less

Development and Assessment of Student Social/Civic Responsibility and Ethical Reasoning. TLTC Paper No. 5. CRLT Occasional Paper No. 36

ERIC Educational Resources Information Center

Hallman, Samantha K.

2016-01-01

University of Michigan (U-M) students visit community-based organizations in Detroit on a weekly basis to work on projects aimed at improving the well being of children and their families, such as tutoring youth in after school programs. Their site visits are supplemented by relevant readings, class discussions and written reflections on topics…

Traveling Exhibitions as Sites for Informal Learning: Assessing Different Strategies with Field Trips to Traveling Exhibitions at Non-Museum Sites

ERIC Educational Resources Information Center

Harker, Richard J. W.; Badger, James

2015-01-01

This study investigated the use of different pedagogical techniques to create an intellectually engaging experience for middle school students who visited a traveling exhibition from the United States Holocaust Memorial Museum at a non-museum host site: the University of North Georgia Dahlonega's Library and Technology Center. The findings of this…

Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015.

PubMed

Bemis, Kelley; Frias, Mabel; Patel, Megan Toth; Christiansen, Demian

Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance. We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016. Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year. Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

Changes in Healthcare Utilization After Etanercept Initiation in Patients with Rheumatoid Arthritis: A Retrospective Claims Analysis.

PubMed

Accortt, Neil A; Schenfeld, Jennifer; Chang, Eunice; Papoyan, Elya; Broder, Michael S

2017-09-01

Effective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization. We evaluated healthcare utilization before and after initiation of the tumor necrosis factor inhibitor etanercept in patients with moderate to severe RA. This retrospective cohort study used data from the MarketScan ® claims database. Data from adult patients with RA newly exposed to etanercept between January 1, 2010 and December 31, 2013 were analyzed. Patients had at least one inpatient or outpatient claim for RA and at least one claim for etanercept (first claim was index date). Etanercept compliance was determined on the basis of proportion of days covered (PDC). Primary outcome was change in overall and RA-related healthcare utilization in the year before and year after etanercept initiation. McNemar's test and paired t test, respectively, were used to determine statistical significance for dichotomous and continuous variables. Data from 6737 patients were analyzed; mean age was 49.8 years and 77.3% were female. Overall outpatient services, office visits, outpatient hospital services, laboratory visits, and emergency department visits were significantly lower in the post-index period compared to pre-index. RA-related pharmacotherapy use (oral corticosteroids, opioid analgesics, nonsteroidal anti-inflammatory drugs, and nonbiologic disease-modifying antirheumatic drugs) was significantly lower in the post-index period compared to pre-index. Rates of RA-related total joint arthroplasty, joint reconstructions, and soft tissue procedures were similar in pre-index and post-index periods. High etanercept compliance (PDC ≥80%) was associated with significantly lower rates of RA-related outpatient services, office visits, diagnostic imaging studies, and joint reconstructions compared with noncompliance. Overall healthcare utilization decreased after etanercept initiation. Patients who were most compliant with etanercept had significantly lower utilization than less compliant patients. Amgen, Inc.

Scaling up kangaroo mother care in South Africa: 'on-site' versus 'off-site' educational facilitation

PubMed Central

Bergh, Anne-Marie; van Rooyen, Elise; Pattinson, Robert C

2008-01-01

Background Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. Methods Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care and participated in the trial. The hospitals were paired with respect to their geographical location and annual number of births. One hospital in each pair was randomly allocated to receive either 'on-site' facilitation (Group A) or 'off-site' facilitation (Group B). Hospitals in Group A received two on-site visits, whereas delegates from hospitals in Group B attended one off-site, 'hands-on' workshop at a training hospital. All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0–30. Successful implementation was regarded as demonstrating evidence of practice (score >10) during the site visit. Results There was no significant difference between the scores of Groups A and B (p = 0.633). Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice. The median score for Group A was 16.52 (range 00.00–23.79) and that for Group B 14.76 (range 07.50–23.29). Conclusion A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, did not influence the ability of a hospital to implement KMC. The choice of outreach strategy should be guided by local circumstances, cost and the availability of skilled facilitators. PMID:18651961

The visiting specialist model of rural health care delivery: a survey in Massachusetts.

PubMed

Drew, Jacob; Cashman, Suzanne B; Savageau, Judith A; Stenger, Joseph

2006-01-01

Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =-0.573, P = .032); study hospitals ranged in bed size from 15 to 129. The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability.

Rehospitalizations and outpatient contacts of mothers and neonates after hospital discharge after vaginal delivery.

PubMed

Meikle, S F; Lyons, E; Hulac, P; Orleans, M

1998-07-01

Our purpose was to determine whether length of hospital stay after vaginal delivery as determined by the discharging physician is associated with rehospitalizations or increased outpatient contacts by mothers and neonates and to assess the impact of home health care visits. An inception cohort study of all rehospitalizations and outpatient contacts of mothers and neonates after vaginal delivery at St. Joseph Hospital, Denver, Colorado, was done from January 1, 1994, to September 30, 1995. All Kaiser Permanente mother-neonate pairs in which the delivery was vaginal (excluding those with multiple gestations or birth weight < 2500 g) were included. Length of initial hospital stay was divided into three time periods: < or = 24 hours, 25 to 48 hours, and > 48 hours. The Colorado Kaiser Permanente Perinatal Database was used to identify perinatal and demographic factors that might have increased health care use. Additional information was sought in administrative databases, bill records, and inpatient charts. Mothers were followed up for 6 weeks and neonates for 28 days after delivery. Home care visits were provided to more than half the mothers and neonates by means of a standardized protocol. The main outcome measures were rehospitalizations and outpatient visits for mothers and neonate, controlling for home care visits. A total of 4323 mother-neonate pairs were identified. For the mothers, a longer initial hospital stay (> 48 hours) was significantly associated with both readmission (P < .01) and increased outpatient care use (P = .01) in the 6-week postpartum period. Thirty-five mothers (.81%) were rehospitalized by 6 weeks. Maternal factors associated with increased outpatient contacts were preeclampsia, preterm delivery, and instrument delivery. Sixty-seven neonates (1.55%) were readmitted to the hospital. Home care visits reduced the need for both readmissions and outpatient visits. For mothers in this cohort a longer initial hospital stay was significantly associated with hospital readmission and increased outpatient care in the postpartum period. Further analysis revealed that mothers with recognized potential and observed problems were rarely discharged in < or = 24 hours. We did not find statistically significant problems among neonates that were related to the length of their initial hospital stay. Those neonates receiving home care were less likely to require hospital readmission and less likely to seek outpatient care. It is unlikely that a single discharge policy will be appropriate for all mothers and neonates.

A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers.

PubMed

Simpson, Grant G; Hahn, Hallie R; Powel, Alex A; Leverence, Robert R; Morris, Linda A; Thompson, Lara G; Zumberg, Marc S; Borde, Deepa J; Tyndall, Joseph A; Shuster, Jonathan J; Yealy, Donald M; Allen, Brandon R

2017-04-01

A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily. We evaluated the effects of a single-site interventional study targeted at a population of adult sickle-cell disease super-utilizers using a pre- and post-implementation design. The pre-intervention period was 06/01/13 to 12/31/13 (seven months) and the post-intervention period was 01/01/14 to 02/28/15 (14 months). Our approach included patient-specific best practice advisories (BPA); an ED management protocol; and formation of a "medical home" for these patients. For 10 subjects targeted initially we developed and implemented coordinated care plans; after deployment, we observed a tendency toward reduction in ED and inpatient utilization across all measured indices. Between the annualized pre- and post-implementation periods we found the following: ED visits decreased by 16.5 visits/pt-yr (95% confidence interval [CI] [-1.32-34.2]); ED length of state (LOS) decreased by 115.3 hours/pt-yr (95% CI [-82.9-313.5]); in-patient admissions decreased by 4.20 admissions/pt-yr (95% CI [-1.73-10.1]); in-patient LOS decreased by 35.8 hours/pt-yr (95% CI [-74.9-146.7]); and visits where the patient left before treatment were reduced by an annualized total of 13.7 visits. We observed no patient mortality in our 10 subjects, and no patient required admission to the intensive care unit 72 hours following discharge. This effort suggests that a targeted approach is both feasible and potentially effective, laying a foundation for broader study.

A quantitative measure of diabetes risk in community practice impacts clinical decisions: the PREVAIL initiative.

PubMed

Shah, B R; Cox, M; Inzucchi, S E; Foody, J M; Zimmer, L O; Jorge, C B; Ratner, R E; Barringer, T A; McGuire, D K; Peterson, E D

2014-04-01

While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care. Thirty sites who used the PreDx(®) (Tethys BioScience, Emeryville, CA) abstracted clinical information from baseline clinic visits prior to a PreDx test and from the most recent visit at time of abstraction. All visits occurred between May 2008-April 2011 (median follow-up 198 days, IQR 124-334). The primary analysis was the influence of the PreDx test (5-year diabetes prediction) on subsequent care; descriptive statistics were used to summarize baseline and follow-up variables. Overall 913 patients with 2 abstracted visits were included. Relative to baseline, median SBP decreased 1.5 mmHg (p = 0.039), DBP decreased 2 mmHg (p < 0.001), LDL-C decreased 4 mg/dL (p = 0.009), and HDL-C increased 2 mg/dL (p < 0.001) at follow-up. Behavioral or lifestyle counseling was not significantly different from baseline to follow-up (71.2% vs. 68.1% (p = 0.077), but BMI was lower by 0.2 kg/m(2) at follow up (p = 0.013). At follow-up, more patients were prescribed metformin (13.7% vs. 9.7%, p < 0.001). A higher PreDx score was significantly associated with metformin prescription (p = 0.0003), lifestyle counseling (p = 0.0099), and a lower BMI at follow-up (p = 0.007). The use of a prognostic test in patients perceived to be high risk for diabetes was associated with a modest but significant increase in the prescription of metformin and lifestyle interventions and a reduction in BMI. Copyright © 2013 Elsevier B.V. All rights reserved.

Early return visits by primary care patients: a retail nurse practitioner clinic versus standard medical office care.

PubMed

Rohrer, James E; Angstman, Kurt B; Garrison, Gregory

2012-08-01

The purpose of this study was to compare return visits made by patients within 2 weeks after using retail nurse practitioner clinics to return visits made by similar patients after using standard medical office clinics. Retail medicine clinics have become widely available. However, their impact on return visit rates compared to standard medical office visits for similar patients has not been extensively studied. Electronic medical records of adult primary care patients seen in a large group practice in Minnesota in 2009 were analyzed for this study. Patients who were treated for sinusitis were selected. Two groups of patients were studied: those who used one of 2 retail walk-in clinics staffed by nurse practitioners and a comparison group who used one of 4 regular office clinics. The dependent variable was a return office visit to any site within 2 weeks. Multiple logistic regression analysis was used to adjust for case-mix differences between groups. Unadjusted odds of return visits were lower for retail clinic patients than for standard office care patients. After adjustment for case mix, patients with more outpatient visits in the previous 6 months had higher odds of return visits within 2 weeks (2-6 prior visits: odds ratio [OR]=1.99, P=0.00; 6 or more prior visits: OR=6.80, P=0.00). The odds of a return visit within 2 weeks were not different by clinic type after adjusting for propensity to use services (OR=1.17, P=0.28). After adjusting for case mix differences, return visit rates did not differ by clinic type.

10 CFR 171.9 - Communications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... LICENSES, INCLUDING HOLDERS OF CERTIFICATES OF COMPLIANCE, REGISTRATIONS, AND QUALITY ASSURANCE PROGRAM... example, via Electronic Information Exchange, or CD-ROM. Electronic submissions must be made in a manner... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

General Healthcare Maintenance of IBD

MedlinePlus

... is helpful to determine medication-associated abnormalities and benefits. Colonoscopies: These are key in the management of ... Want to Talk? Talk to a Specialist by phone at (888) MY-GUT-PAIN by email at info@crohnscolitisfoundation.org , or ... Visit our mobile site Full Site CCF Facebook Follow The CCF ...

10 CFR 171.9 - Communications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... LICENSES, INCLUDING HOLDERS OF CERTIFICATES OF COMPLIANCE, REGISTRATIONS, AND QUALITY ASSURANCE PROGRAM... example, via Electronic Information Exchange, or CD-ROM. Electronic submissions must be made in a manner... obtained by visiting the NRC's Web site at http://www.nrc.gov/site-help/e-submittals.html; by e-mail to...

POTENTIAL FOR GULLS TO TRANSPORT BACTERIA FROM HUMAN WASTE SITES

EPA Science Inventory

This study was designed as a first step in assessing whether gulls visiting human waste sites can acquire human microorganisms and distribute them across the coastal landscape. Beaches, landfills, and a lagoon of treated wastewater located in a coastal Lake Michigan county were t...

James Ferguson remembered

NASA Astrophysics Data System (ADS)

Davenhall, Clive

2012-03-01

The year 2010 marked the three hundredth anniversary of the birth of the astronomer, author and lecturer James Ferguson (1710-1776). Subsequently I visited the site of the churchyard where Ferguson is buried. He is mentioned in a plaque on the site and I thought that the details might be of interest.

Nearest greedy for solving the waste collection vehicle routing problem: A case study

NASA Astrophysics Data System (ADS)

Mat, Nur Azriati; Benjamin, Aida Mauziah; Abdul-Rahman, Syariza; Wibowo, Antoni

2017-11-01

This paper presents a real case study pertaining to an issue related to waste collection in the northern part of Malaysia by using a constructive heuristic algorithm known as the Nearest Greedy (NG) technique. This technique has been widely used to devise initial solutions for issues concerning vehicle routing. Basically, the waste collection cycle involves the following steps: i) each vehicle starts from a depot, ii) visits a number of customers to collect waste, iii) unloads waste at the disposal site, and lastly, iv) returns to the depot. Moreover, the sample data set used in this paper consisted of six areas, where each area involved up to 103 customers. In this paper, the NG technique was employed to construct an initial route for each area. The solution proposed from the technique was compared with the present vehicle routes implemented by a waste collection company within the city. The comparison results portrayed that NG offered better vehicle routes with a 11.07% reduction of the total distance traveled, in comparison to the present vehicle routes.

Three visits to eternity: Freud, Wiesel, and Patient X.

PubMed

Weiss, S S

1986-01-01

Freud's experience on the Acropolis is reviewed and reappraised. Also, the experience of Elie Wiesel at the Wall in Jerusalem and Patient X's reaction visiting an Egyptian temple are examined. Carl Jung's wish to go to Rome and his inability to do so are noted. The aim of the paper is to offer deeper understanding about intense reactions many sensitive and creative people experience over travel to special places. These places are treated as idealized and ambivalently loved transference objects. Normal anticipatory pleasure prior to the trip is impaired and reality pleasure at the site cannot be enjoyed. When these spots are reached, ego regression is initiated by the intolerably intense narcissistic pleasure mobilized by the gratification of fantasies that were felt to be unrealizable. The fantasies can be conscious or unconscious and from oedipal as well as preoedipal and postoedipal developmental levels; however, they always involve the fulfillment of overwhelmingly powerful wishes. The deep ego regression, archaic fantasies, and the complex defenses mobilized are frightening since there may also be concern about ego dissolution or irreversible transformation. One highly adaptive solution which helps master these conflictual and developmental experiences is creative ego activity. While maintaining integrity for the individual ego and enhancing the self, creative work and accomplishment also enrich and advance the cultural process.

Population ecology of breeding Pacific common eiders on the Yukon-Kuskokwim Delta, Alaska

USGS Publications Warehouse

Wilson, Heather M.; Flint, Paul L.; Powell, Abby N.; Grand, J. Barry; Moral, Christine L.

2012-01-01

Populations of Pacific common eiders (Somateria mollissima v-nigrum) on the Yukon-Kuskokwim Delta (YKD) in western Alaska declined by 50–90% from 1957 to 1992 and then stabilized at reduced numbers from the early 1990s to the present. We investigated the underlying processes affecting their population dynamics by collection and analysis of demographic data from Pacific common eiders at 3 sites on the YKD (1991–2004) for 29 site-years. We examined variation in components of reproduction, tested hypotheses about the influence of specific ecological factors on life-history variables, and investigated their relative contributions to local population dynamics. Reproductive output was low and variable, both within and among individuals, whereas apparent survival of adult females was high and relatively invariant (0.89 ± 0.005). All reproductive parameters varied across study sites and years. Clutch initiation dates ranged from 4 May to 28 June, with peak (modal) initiation occurring on 26 May. Females at an island study site consistently initiated clutches 3–5 days earlier in each year than those on 2 mainland sites. Population variance in nest initiation date was negatively related to the peak, suggesting increased synchrony in years of delayed initiation. On average, total clutch size (laid) ranged from 4.8 to 6.6 eggs, and declined with date of nest initiation. After accounting for partial predation and non-viability of eggs, average clutch size at hatch ranged from 2.0 to 5.8 eggs. Within seasons, daily survival probability (DSP) of nests was lowest during egg-laying and late-initiation dates. Estimated nest survival varied considerably across sites and years (mean = 0.55, range: 0.06–0.92), but process variance in nest survival was relatively low (0.02, CI: 0.01–0.05), indicating that most variance was likely attributed to sampling error. We found evidence that observer effects may have reduced overall nest survival by 0.0–0.36 across site-years. Study sites with lower sample sizes and more frequent visitations appeared to experience greater observer effects. In general, Pacific common eiders exhibited high spatio-temporal variance in reproductive components. Larger clutch sizes and high nest survival at early initiation dates suggested directional selection favoring early nesting. However, stochastic environmental effects may have precluded response to this apparent selection pressure. Our results suggest that females breeding early in the season have the greatest reproductive value, as these birds lay the largest clutches and have the highest probability of successfully hatching. We developed stochastic, stage-based, matrix population models that incorporated observed spatio-temporal (process) variance and co-variation in vital rates, and projected the stable stage distribution () and population growth rate (λ). We used perturbation analyses to examine the relative influence of changes in vital rates on λ and variance decomposition to assess the proportion of variation in λ explained by process variation in each vital rate. In addition to matrix-based λ, we estimated λ using capture–recapture approaches, and log-linear regression. We found the stable age distribution for Pacific common eiders was weighted heavily towards experienced adult females (≥4 yr of age), and all calculations of λ indicated that the YKD population was stable to slightly increasing (λmatrix = 1.02, CI: 1.00–1.04); λreverse-capture–recapture = 1.05, CI: 0.99–1.11; λlog-linear = 1.04, CI: 0.98–1.10). Perturbation analyses suggested the population would respond most dramatically to changes in adult female survival (relative influence of adult survival was 1.5 times that of fecundity), whereas retrospective variation in λ was primarily explained by fecundity parameters (60%), particularly duckling survival (42%). Among components of fecundity, sensitivities were highest for duckling survival, suggesti

Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice.

PubMed

Ma, Joseph D; Tran, Victor; Chan, Carissa; Mitchell, William M; Atayee, Rabia S

2016-12-01

We have previously reported the development of an outpatient palliative care practice under pharmacist-physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients. This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice. This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed. Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients (n = 80) were mostly women (n = 44), had localized disease (n = 42), a gastrointestinal cancer type (n = 21), and were on a long-acting (n = 61) and short-acting (n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits. A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits. © The Author(s) 2015.

Effectiveness of home visiting programs on child outcomes: a systematic review

PubMed Central

2013-01-01

Background The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. Results Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families. Conclusions Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues. PMID:23302300

[To evaluate the quality of life and peristomal skin ostomy patient with the new device Sensura].

PubMed

Crespo Fontán, Beatriz; Caparrós Sanz, María Rosario; Lainez Pardos, Pilar Lourdes; Davín Durban, Inmaculada

2010-10-01

In 2006, Coloplast launched in several European countries a new device for ostomy care called Sensura. This clinical research report includes only the results of the subpopulation included in Spain as a part of an international study involving many countries such as Denmark, United States, Canada, Australia, Poland, Netherlands, France, Slovakia, Germany, UK, Italy, Iceland, Japan, Czech Republic, Portugal, South Korea and Argentina. OBJECTIVES AND STUDY VARIABLES: The main purpose of the study is to evaluate the experience with Sensura, under normal conditions of use, with special attention to skin condition and quality of life. The main objective of the study is to evaluate the quality of life, through Quality of Life Questionnaire called "Stoma QoL". A secondary objective, is to study the correlation between quality of life and the peristomal skin condition. Other Secondary objectives include the evaluation of the patient's current device at the time of entering the study and by the other hand, the device Sensura and safety evaluation throughout the study. The study was designed as an open label non-comparative, multi-national Post Market study. The study period for each patient is 6 to 8 weeks +/- 4 days, which includes an initial visit and a final visit. The study population included people who carry a colostomy or ileostomy. Regarding Spain, a total of 10 sites participated and included a total of 131 patients. This report only presents results for nine sites and a total of 123 patients. The reason is that the last participating site began the study with a considerable delay The remaining subjects included in this site together with the other centers in Spain and the other participating countries will be included in the final international report, that will present the overall results. MEASUREMENT TOOLS. Stoma-QoL (Quality of Life Questionnaire for people with an ostomy). OST (Ostomy Skin Tool) instrument for the assessment of peristomal skin. As for the quality of life, at baseline we found a mean of 59 out of 100 (SD = 8.8), while the final study visit, mean score was 59.6 out of 100 (SD = 9.3), although the final results on this variable will be presented in the global report, since it has not reached sufficient population in Spain for the analysis of this variable. The study revealed a significant improvement in the peristomal skin condition at the end of the study, measured by the tool OST (Ostomy Skin Tool). Regarding the evaluation of the SenSura device, there was a significant improvement related to the appearance of leakage of effluent, as well as other items evaluated in relation with the device.

Mineral licks: motivational factors for visitation and accompanying disease risk at communal use sites of elk and deer.

PubMed

Lavelle, Michael J; Phillips, Gregory E; Fischer, Justin W; Burke, Patrick W; Seward, Nathan W; Stahl, Randal S; Nichols, Tracy A; Wunder, Bruce A; VerCauteren, Kurt C

2014-12-01

Free-ranging cervids acquire most of their essential minerals through forage consumption, though occasionally seek other sources to account for seasonal mineral deficiencies. Mineral sources occur as natural geological deposits (i.e., licks) or as anthropogenic mineral supplements. In both scenarios, these sources commonly serve as focal sites for visitation. We monitored 11 licks in Rocky Mountain National Park, north-central Colorado, using trail cameras to quantify daily visitation indices (DVI) and soil consumption indices (SCI) for Rocky Mountain elk (Cervus elaphus) and mule deer (Odocoileus hemionus) during summer 2006 and documented elk, mule deer, and moose (Alces alces) visiting licks. Additionally, soil samples were collected, and mineral concentrations were compared to discern levels that explain rates of visitation. Relationships between response variables; DVI and SCI, and explanatory variables; elevation class, moisture class, period of study, and concentrations of minerals were examined. We found that DVI and SCI were greatest at two wet, low-elevation licks exhibiting relatively high concentrations of manganese and sodium. Because cervids are known to seek Na from soils, we suggest our observed association of Mn with DVI and SCI was a likely consequence of deer and elk seeking supplemental dietary Na. Additionally, highly utilized licks such as these provide an area of concentrated cervid occupation and interaction, thus increasing risk for environmental transmission of infectious pathogens such as chronic wasting disease, which has been shown to be shed in the saliva, urine, and feces of infected cervids.

Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative.

PubMed

Wassertheil-Smoller, S; McGinn, A P; Budrys, N; Chlebowski, R; Ho, G Y; Johnson, K C; Lane, D S; Li, W; Neuhouser, M L; Saquib, J; Shikany, J M; Song, Y; Thomson, C

2013-10-01

Multivitamin use is common in the United States. It is not known whether multivitamins with minerals supplements (MVM) used by women already diagnosed with invasive breast cancer would affect their breast cancer mortality risk. To determine prospectively the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer, a prospective cohort study was conducted of 7,728 women aged 50-79 at enrollment in the women's health initiative (WHI) in 40 clinical sites across the United States diagnosed with incident invasive breast cancer during WHI and followed for a mean of 7.1 years after breast cancer diagnosis. Use of MVM supplements was assessed at WHI baseline visit and at visit closest to breast cancer diagnosis, obtained from vitamin pill bottles brought to clinic visit. Outcome was breast cancer mortality. Hazard ratios and 95 % confidence intervals (CIs) for breast cancer mortality comparing MVM users to non-users were estimated using Cox proportional hazard regression models. Analyses using propensity to take MVM were done to adjust for potential differences in characteristics of MVM users versus non-users. At baseline, 37.8 % of women reported MVM use. After mean post-diagnosis follow-up of 7.1 ± 4.1 (SD) years, there were 518 (6.7 %) deaths from breast cancer. In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60-0.96). Postmenopausal women with invasive breast cancer using MVM had lower breast cancer mortality than non-users. The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation.

KSC-2014-2615

NASA Image and Video Library

2014-05-20

CAPE CANAVERAL, Fla. -- A crawler-transporter rolls toward Launch Pad 39A at NASA's Kennedy Space Center in Florida. Operations are underway to move Mobile Launcher Platform-2, or MLP-2, from the pad to a nearby park site in Launch Complex 39. The historic launch pad was the site from which numerous Apollo and space shuttle missions began and is beginning a new mission as a commercial launch site. NASA signed a property agreement with Space Exploration Technologies Corp., or SpaceX, of Hawthorne, California, on April 14 for use and occupancy of the seaside complex along Florida's central east coast. It will serve as a platform for SpaceX to support their commercial launch activities. For more information on Launch Pad 39A, visit http://www.nasa.gov/centers/kennedy/pdf/167416main_LC39-08.pdf. For learn more about the crawler-transporter, visit http://www.nasa.gov/centers/kennedy/pdf/167402main_crawlertransporters07.pdf. Photo credit: NASA/Kim Shiflett

KSC-2014-2622

NASA Image and Video Library

2014-05-20

CAPE CANAVERAL, Fla. -- A crawler-transporter carries Mobile Launcher Platform-2, or MLP-2, away from Launch Pad 39A at NASA's Kennedy Space Center in Florida. The MLP is being moved to a nearby park site in Launch Complex 39. The historic launch pad was the site from which numerous Apollo and space shuttle missions began and is beginning a new mission as a commercial launch site. NASA signed a property agreement with Space Exploration Technologies Corp., or SpaceX, of Hawthorne, California, on April 14 for use and occupancy of the seaside complex along Florida's central east coast. It will serve as a platform for SpaceX to support their commercial launch activities. For more information on Launch Pad 39A, visit http://www.nasa.gov/centers/kennedy/pdf/167416main_LC39-08.pdf. For learn more about the crawler-transporter, visit http://www.nasa.gov/centers/kennedy/pdf/167402main_crawlertransporters07.pdf. Photo credit: NASA/Kim Shiflett

Training the trainers: beyond providing a well-received course.

PubMed

Blitz, Julia; Edwards, Jill; Mash, Bob; Mowle, Steve

2016-09-01

The Royal College of General Practitioners in partnership with the South African Academy of Family Physicians obtained funding to run a series of 'Training the Trainers' courses for trainers of family medicine registrars, with a view to strengthening clinical supervision of postgraduate registrars. The authors wanted to establish whether it was worthwhile for the course to be provided on an ongoing basis after the funded project was completed. Development of a pilot tool for evaluation visits after a faculty development course. The authors developed a pre-visit pack and conducted five site visits to registrar trainers who had been on the course between 12 and 24 months earlier. Before the series of visits and after each visit we debriefed and modified our approach. Optimising the use of the pre-visit pack will require greater orientation of the trainer. Administrative support for the visits will be vital. The visits were experienced very positively. However, in a context in which these visits are not the norm, the trainers need support and encouragement to participate in an activity which made them feel quite vulnerable. The tool enabled course participants to show evidence of their behaviour change, enabled their colleagues to report on the impact on their own teaching practices, and enabled registrars to voice their opinions of their trainer's supervision skills. A post-course formative evaluation visit has the potential to catalyse the impact of the training course. It will be necessary to train the family physicians who conduct these visits.

Pollution Prevention through Peer Education: A Community Health Worker and Small and Home-Based Business Initiative on the Arizona-Sonora Border

PubMed Central

Moreno Ramírez, Denise; Ramírez-Andreotta, Mónica D.; Vea, Lourdes; Estrella-Sánchez, Rocío; Wolf, Ann Marie A.; Kilungo, Aminata; Spitz, Anna H.; Betterton, Eric A.

2015-01-01

Government-led pollution prevention programs tend to focus on large businesses due to their potential to pollute larger quantities, therefore leaving a gap in programs targeting small and home-based businesses. In light of this gap, we set out to determine if a voluntary, peer education approach led by female, Hispanic community health workers (promotoras) can influence small and home-based businesses to implement pollution prevention strategies on-site. This paper describes a partnership between promotoras from a non-profit organization and researchers from a university working together to reach these businesses in a predominately Hispanic area of Tucson, Arizona. From 2008 to 2011, the promotora-led pollution prevention program reached a total of 640 small and home-based businesses. Program activities include technical trainings for promotoras and businesses, generation of culturally and language appropriate educational materials, and face-to-face peer education via multiple on-site visits. To determine the overall effectiveness of the program, surveys were used to measure best practices implemented on-site, perceptions towards pollution prevention, and overall satisfaction with the industry-specific trainings. This paper demonstrates that promotoras can promote the implementation of pollution prevention best practices by Hispanic small and home-based businesses considered “hard-to-reach” by government-led programs. PMID:26371028

Pollution Prevention through Peer Education: A Community Health Worker and Small and Home-Based Business Initiative on the Arizona-Sonora Border.

PubMed

Ramírez, Denise Moreno; Ramírez-Andreotta, Mónica D; Vea, Lourdes; Estrella-Sánchez, Rocío; Wolf, Ann Marie A; Kilungo, Aminata; Spitz, Anna H; Betterton, Eric A

2015-09-09

Government-led pollution prevention programs tend to focus on large businesses due to their potential to pollute larger quantities, therefore leaving a gap in programs targeting small and home-based businesses. In light of this gap, we set out to determine if a voluntary, peer education approach led by female, Hispanic community health workers (promotoras) can influence small and home-based businesses to implement pollution prevention strategies on-site. This paper describes a partnership between promotoras from a non-profit organization and researchers from a university working together to reach these businesses in a predominately Hispanic area of Tucson, Arizona. From 2008 to 2011, the promotora-led pollution prevention program reached a total of 640 small and home-based businesses. Program activities include technical trainings for promotoras and businesses, generation of culturally and language appropriate educational materials, and face-to-face peer education via multiple on-site visits. To determine the overall effectiveness of the program, surveys were used to measure best practices implemented on-site, perceptions towards pollution prevention, and overall satisfaction with the industry-specific trainings. This paper demonstrates that promotoras can promote the implementation of pollution prevention best practices by Hispanic small and home-based businesses considered "hard-to-reach" by government-led programs.

Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees.

PubMed

Pahel, Bhavna T; Rozier, R Gary; Stearns, Sally C; Quiñonez, Rocio B

2011-03-01

To estimate the effectiveness of a medical office-based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries. We used longitudinal claims and enrollment data for all children aged 72 months or younger enrolled in North Carolina Medicaid from 2000 through 2006. Regression analyses compared subgroups of children who received up to 6 IMB visits at ages 6 to 35 months with children who received no IMB visits. Analyses were adjusted for child and area characteristics. Children enrolled in North Carolina Medicaid with ≥ 4 IMB visits experienced, on average, a 17% reduction in dental-caries-related treatments up to 6 years of age compared with children with no IMB visits. When we simulated data for initial IMB visits at 12 and 15 months of age, there was a cumulative 49% reduction in caries-related treatments at 17 months of age. The cumulative effectiveness declined because of an increase in treatments from 24 to 36 months, an increase in referrals for dental caries occurred with increasing time since fluoride application, and emergence of teeth not initially treated with fluoride. North Carolina's IMB program was effective in reducing caries-related treatments for children with ≥ 4 IMB visits. Multiple applications of fluoride at the time of primary tooth emergence seem to be most beneficial. Referrals to dentists for treatment of existing disease detected by physicians during IMB implementation limited the cumulative reductions in caries-related treatments, but also contributed to improved oral health.

Inviting Children's Authors and Illustrators: A How-To-Do-It Manual for School and Public Librarians. Number 49.

ERIC Educational Resources Information Center

East, Kathy

This document is a step-by-step guide for librarians who wish to host children's authors and illustrators at school and public libraries. Topics include reasons for having an author/illustrator visit; preliminary planning and making proposals; making initial contacts; the program plan, including types of events, examples of successful visits and…

Journey Through the Universe: Tenth Anniversary in 2014!

NASA Astrophysics Data System (ADS)

Harvey, J.

2014-07-01

Hawaii will celebrate its tenth anniversary of the flagship Journey through the Universe program that began in 2004. The Gemini-led initiative has engaged hundreds of astronomers and astronomy educators that have visited over 2,700 classrooms, visiting over 60,000 students over the course of the last nine years. The scientists have brought excitement and inspiration about the life-long possibilities available in science, technology and mathematics to our students. The Journey program nurtures our students' innate curiosity, offers workshops for hundreds of teachers in Science, Technology, Engineering, and Math (STEM) education, and provides an opportunity for our community members to visit the classrooms alongside our astronomers. This ten-day annual event also includes Family Science Events that are enjoyed by thousands. For the 2013 program, our governor, Neil Abercrombie, inquired about the program and its enormous impact on Hawaii's students. Governor Abercrombie actively participated by visiting classrooms at different schools and attending our chamber of commerce appreciation event. This paper will share how the Journey program came to be and what is anticipated for the tenth anniversary. Journey through the Universe is a model outreach initiative that could be duplicated in other locations.

Governance for clinical decision support: case studies and recommended practices from leading institutions

PubMed Central

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support. PMID:21252052

Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015.

PubMed

Muhammad, Wazir; Ullah, Asad; Mahmood, Khalid; Matiullah

2016-01-01

The purpose of this study was to ensure accuracy in radiation dose delivery, external dosimetry quality audit has an equal importance with routine dosimetry performed at clinics. To do so, dosimetry quality audit was organized by the Secondary Standard Dosimetry Laboratory (SSDL) of Pakistan Institute of Nuclear Science and Technology (PINSTECH) at the national level to investigate and minimize uncertainties involved in the measurement of absorbed dose, and to improve the accuracy of dose measurement at different radiotherapy hospitals. A total of 181 dosimetry quality audits (i.e., 102 of Co-60 and 79 of linear accelerators) for teletherapy units installed at 22 different sites were performed from 1989 to 2015. The percent deviation between users’ calculated/stated dose and evaluated dose (in the result of on-site dosimetry visits) were calculated and the results were analyzed with respect to the limits of ± 2.5% (ICRU "optimal model") ± 3.0% (IAEA on-site dosimetry visits limit) and ± 5.0% (ICRU minimal or "lowest acceptable" model). The results showed that out of 181 total on-site dosimetry visits, 20.44%, 16.02%, and 4.42% were out of acceptable limits of ± 2.5% ± 3.0%, and ± 5.0%, respectively. The importance of a proper ongoing quality assurance program, recommendations of the followed protocols, and properly calibrated thermometers, pressure gauges, and humidity meters at radiotherapy hospitals are essential in maintaining consistency and uniformity of absorbed dose measurements for precision in dose delivery.

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines

PubMed Central

Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-01-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks (Rhincodon typus) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6–43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May–November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions. PMID:28989750

Feeding the world's largest fish: highly variable whale shark residency patterns at a provisioning site in the Philippines.

PubMed

Thomson, Jordan A; Araujo, Gonzalo; Labaja, Jessica; McCoy, Emer; Murray, Ryan; Ponzo, Alessandro

2017-09-01

Provisioning wildlife for tourism is a controversial yet widespread practice. We analysed the residency patterns of juvenile whale sharks ( Rhincodon typus ) in Oslob, Philippines, where provisioning has facilitated a large shark-watching operation since 2011. We identified 208 individual sharks over three years, with an average of 18.6 (s.d. = 7.8, range = 6-43) individuals sighted per week. Weekly shark abundance varied seasonally and peak-season abundance (approx. May-November) increased across years. Whale sharks displayed diverse individual site visitation patterns ranging from a single visit to sporadic visits, seasonal residency and year-round residency. Nine individuals became year-round residents, which represents a clear response to provisioning. The timing of the seasonal peak at Oslob did not align with known non-provisioned seasonal aggregations elsewhere in the Philippines, which could suggest that seasonal residents at Oslob exploit this food source when prey availability at alternative sites is low. Since prolonged residency equates to less time foraging naturally, provisioning could influence foraging success, alter distributions and lead to dependency in later life stages. Such impacts must be carefully weighed against the benefits of provisioning (i.e. tourism revenue in a remote community) to facilitate informed management decisions.

Where is the UK's pollinator biodiversity? The importance of urban areas for flower-visiting insects.

PubMed

Baldock, Katherine C R; Goddard, Mark A; Hicks, Damien M; Kunin, William E; Mitschunas, Nadine; Osgathorpe, Lynne M; Potts, Simon G; Robertson, Kirsty M; Scott, Anna V; Stone, Graham N; Vaughan, Ian P; Memmott, Jane

2015-03-22

Insect pollinators provide a crucial ecosystem service, but are under threat. Urban areas could be important for pollinators, though their value relative to other habitats is poorly known. We compared pollinator communities using quantified flower-visitation networks in 36 sites (each 1 km(2)) in three landscapes: urban, farmland and nature reserves. Overall, flower-visitor abundance and species richness did not differ significantly between the three landscape types. Bee abundance did not differ between landscapes, but bee species richness was higher in urban areas than farmland. Hoverfly abundance was higher in farmland and nature reserves than urban sites, but species richness did not differ significantly. While urban pollinator assemblages were more homogeneous across space than those in farmland or nature reserves, there was no significant difference in the numbers of rarer species between the three landscapes. Network-level specialization was higher in farmland than urban sites. Relative to other habitats, urban visitors foraged from a greater number of plant species (higher generality) but also visited a lower proportion of available plant species (higher specialization), both possibly driven by higher urban plant richness. Urban areas are growing, and improving their value for pollinators should be part of any national strategy to conserve and restore pollinators.

Hominid visitation of the Moravian Karst during the Middle-Upper Paleolithic transition: New results from Pod Hradem Cave (Czech Republic).

PubMed

Nejman, L; Wood, R; Wright, D; Lisá, L; Nerudová, Z; Neruda, P; Přichystal, A; Svoboda, J

2017-07-01

In 1956-1958, excavations of Pod Hradem Cave in Moravia (eastern Czech Republic) revealed evidence for human activity during the Middle-Upper Paleolithic transition. This spanned 25,050-44,800 cal BP and contained artefacts attributed to the Aurignacian and Szeletian cultures, including those made from porcelanite (rarely used at Moravian Paleolithic sites). Coarse grained excavation techniques and major inversions in radiocarbon dates meant that site chronology could not be established adequately. This paper documents re-excavation of Pod Hradem in 2011-2012. A comprehensive AMS dating program using ultrafiltration and ABOx-SC pre-treatments provides new insights into human occupation at Pod Hradem Cave. Fine-grained excavation reveals sedimentary units spanning approximately 20,000 years of the Early Upper Paleolithic and late Middle Paleolithic periods, thus making it the first archaeological cave site in the Czech Republic with such a sedimentary and archaeological record. Recent excavation confirms infrequent human visitation, including during the Early Aurignacian by people who brought with them portable art objects that have no parallel in the Czech Republic. Raw material diversity of lithics suggests long-distance imports and ephemeral visits by highly mobile populations throughout the EUP period. Copyright © 2017 Elsevier Ltd. All rights reserved.

Where is the UK's pollinator biodiversity? The importance of urban areas for flower-visiting insects

PubMed Central

Baldock, Katherine C. R.; Goddard, Mark A.; Hicks, Damien M.; Kunin, William E.; Mitschunas, Nadine; Osgathorpe, Lynne M.; Potts, Simon G.; Robertson, Kirsty M.; Scott, Anna V.; Stone, Graham N.; Vaughan, Ian P.; Memmott, Jane

2015-01-01

Insect pollinators provide a crucial ecosystem service, but are under threat. Urban areas could be important for pollinators, though their value relative to other habitats is poorly known. We compared pollinator communities using quantified flower-visitation networks in 36 sites (each 1 km2) in three landscapes: urban, farmland and nature reserves. Overall, flower-visitor abundance and species richness did not differ significantly between the three landscape types. Bee abundance did not differ between landscapes, but bee species richness was higher in urban areas than farmland. Hoverfly abundance was higher in farmland and nature reserves than urban sites, but species richness did not differ significantly. While urban pollinator assemblages were more homogeneous across space than those in farmland or nature reserves, there was no significant difference in the numbers of rarer species between the three landscapes. Network-level specialization was higher in farmland than urban sites. Relative to other habitats, urban visitors foraged from a greater number of plant species (higher generality) but also visited a lower proportion of available plant species (higher specialization), both possibly driven by higher urban plant richness. Urban areas are growing, and improving their value for pollinators should be part of any national strategy to conserve and restore pollinators. PMID:25673686